April 30, 2018


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New article by Dr Malcolm Doupe, Dr Jeff Poss, and Dr Peter Norton
How well does the minimum data set measure healthcare use? a validation study.
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M. B. Doupe, J. Poss, P. G. Norton, et al.
BMC Health Serv Res 2018 Apr 11;18(1):279-018-3089-7
To improve care, planners require accurate information about nursing home (NH) residents and their healthcare use. We evaluated how accurately measures of resident user status and healthcare use were captured in the Minimum Data Set (MDS) versus administrative data. METHODS: This retrospective observational cohort study was conducted on all NH residents (N = 8832) from Winnipeg, Manitoba, Canada, between April 1, 2011 and March 31, 2013. Six study measures exist. NH user status (newly admitted NH residents, those who transferred from one NH to another, and those who died) was measured using both MDS and administrative data. Rates of in-patient hospitalizations, emergency department (ED) visits without subsequent hospitalization, and physician examinations were also measured in each data source. We calculated the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and overall agreement (kappa, kappa) of each measure as captured by MDS using administrative data as the reference source. Also for each measure, logistic regression tested if the level of disagreement between data systems was associated with resident age and sex plus NH owner-operator status. RESULTS: MDS accurately identified newly admitted residents (kappa = 0.97), those who transferred between NHs (kappa = 0.90), and those who died (kappa = 0.95). Measures of healthcare use were captured less accurately by MDS, with high levels of both under-reporting and false positives (e.g., for in-patient hospitalizations sensitivity = 0.58, PPV = 0.45), and moderate overall agreement levels (e.g., kappa = 0.39 for ED visits). Disagreement was sometimes greater for younger males, and for residents living in for-profit NHs. CONCLUSIONS: MDS can be used as a stand-alone tool to accurately capture basic measures of NH use (admission, transfer, and death), and by proxy NH length of stay. As compared to administrative data, MDS does not accurately capture NH resident healthcare use. Research investigating these and other healthcare transitions by NH residents requires a combination of the MDS and administrative data systems.

New study on bias in Canadian funding
Assessment of potential bias in research grant peer review in Canada
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R. Tamblyn, N. Girard, C. J. Qian and J. Hanley.
CMAJ 2018 Apr 23;190(16):E489-E499
Peer review is used to determine what research is funded and published, yet little is known about its effectiveness, and it is suspected that there may be biases. We investigated the variability of peer review and factors influencing ratings of grant applications. METHODS: We evaluated all grant applications submitted to the Canadian Institutes of Health Research between 2012 and 2014. The contribution of application, principal applicant and reviewer characteristics to overall application score was assessed after adjusting for the applicant’s scientific productivity. RESULTS: Among 11 624 applications, 66.2% of principal applicants were male and 64.1% were in a basic science domain. We found a significant nonlinear association between scientific productivity and final application score that differed by applicant gender and scientific domain, with higher scores associated with past funding success and h-index and lower scores associated with female applicants and those in the applied sciences. Significantly lower application scores were also associated with applicants who were older, evaluated by female reviewers only (v. male reviewers only, -0.05 points, 95% confidence interval [CI] -0.08 to -0.02) or reviewers in scientific domains different from the applicant’s (-0.07 points, 95% CI -0.11 to -0.03). Significantly higher application scores were also associated with reviewer agreement in application score (0.23 points, 95% CI 0.20 to 0.26), the existence of reviewer conflicts (0.09 points, 95% CI 0.07 to 0.11), larger budget requests (0.01 points per $100 000, 95% CI 0.007 to 0.02), and resubmissions (0.15 points, 95% CI 0.14 to 0.17). In addition, reviewers with high expertise were more likely than those with less expertise to provide higher scores to applicants with higher past success rates (0.18 points, 95% CI 0.08 to 0.28). INTERPRETATION: There is evidence of bias in peer review of operating grants that is of sufficient magnitude to change application scores from fundable to nonfundable. This should be addressed by training and policy changes in research funding.

Calls for Abstracts

1st Implementation Science Annual Research Conference

19 July London, UK
DEADLINE: 14 May
The aim of this conference is to showcase the latest research in the field of implementation science applied to health care. It is an opportunity for applied-health researchers and policy makers to come together and share how best to implement evidence-based practice and clinical research within health services and systems.

7th International Conference on Evidence-Based Healthcare

1-3 November Dubai, UAE
DEADLINE: 30 June
Conference organizers are accepting abstract submissions for poster, oral, and workshop presentations. Submissions should fall under the following themes:
Teaching
Evidence synthesis
Shared decision making
Implementation
Measurement

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Publications

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

KT

What can we learn from interventions that aim to increase policy-makers’ capacity to use research? A realist scoping review
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A. Haynes, S. J. Rowbotham, S. Redman, S. Brennan, A. Williamson and G. Moore.
Health Res Policy Syst 2018 Apr 10;16(1):31-018-0277-1
Health policy-making can benefit from more effective use of research. In many policy settings there is scope to increase capacity for using research individually and organisationally, but little is known about what strategies work best in which circumstances. This review addresses the question: What causal mechanisms can best explain the observed outcomes of interventions that aim to increase policy-makers’ capacity to use research in their work? METHODS: Articles were identified from three available reviews and two databases (PAIS and WoS; 1999-2016). Using a realist approach, articles were reviewed for information about contexts, outcomes (including process effects) and possible causal mechanisms. Strategy + Context + Mechanism = Outcomes (SCMO) configurations were developed, drawing on theory and findings from other studies to develop tentative hypotheses that might be applicable across a range of intervention sites. RESULTS: We found 22 studies that spanned 18 countries. There were two dominant design strategies (needs-based tailoring and multi-component design) and 18 intervention strategies targeting four domains of capacity, namely access to research, skills improvement, systems improvement and interaction. Many potential mechanisms were identified as well as some enduring contextual characteristics that all interventions should consider. The evidence was variable, but the SCMO analysis suggested that tailored interactive workshops supported by goal-focused mentoring, and genuine collaboration, seem particularly promising. Systems supports and platforms for cross-sector collaboration are likely to play crucial roles. Gaps in the literature are discussed. CONCLUSION: This exploratory review tentatively posits causal mechanisms that might explain how intervention strategies work in different contexts to build capacity for using research in policy-making.

 

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Health Care Administration and Organization

Determinants of staff commitment to hip protectors in long-term care: A cross-sectional survey.
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A. M. B. Korall, T. M. Loughin, F. Feldman, et al.
Int J Nurs Stud 2018 Mar 17;82:139-148
If worn, certain models of hip protectors are highly effective at preventing hip fractures from falls in residents of long-term care, but modest acceptance and adherence have limited the effectiveness of hip protectors. Residents of long-term care are more likely to accept the initial offer of hip protectors and to adhere to recommendations concerning the use of hip protectors when staff are committed to supporting the application of hip protectors. Yet, we know very little about the nature of and factors associated with staff commitment to hip protectors in long-term care. OBJECTIVE: To identify factors associated with staff commitment to hip protectors in long-term care. DESIGN: A cross-sectional survey. SETTING: Thirteen long-term care homes (total beds=1816) from a single regional health district in British Columbia, Canada. PARTICIPANTS: A convenience sample of 535 paid staff who worked most of their time (>50% of work hours) at a participating long-term care home, for at least one month, and for at least 8h per week. We excluded six (1.1%) respondents who were unaware of hip protectors. Of the remaining 529 respondents, 90% were female and 55% were health care assistants. METHODS: Respondents completed the Commitment to Hip Protectors Index to indicate their commitment to hip protectors. We used Bayesian Model Averaging logistic regression to model staff commitment as a function of personal variables, experiences with hip protectors, intraorganizational communication and influence, and organizational context. RESULTS: Staff commitment was negatively related to organizational tenure >20years (posterior probability=97%; logistic regression coefficient=-0.28; 95% confidence interval=-0.48, -0.08), and awareness of a padded hip fracture (100%; -0.57; -0.69, -0.44). Staff commitment was positively related to the existence of a champion of hip protectors within the home (100%; 0.24; 0.17, 0.31), perceived quality of intraorganizational communication (100%; 0.04; 0.02, 0.05), extent of mutual respect between residents and staff and perceived contribution to quality of life of the residents they serve (100%; 0.10; 0.05, 0.15), and frequency of transformational leadership practices by respondents’ primary supervisors (100%; 0.01; 0.01, 0.02). CONCLUSIONS: We provide novel insight into the factors governing staff commitment to hip protectors in long-term care. Targeting of these factors could improve acceptance and adherence with hip protectors, thereby contributing to enhanced effectiveness of hip protectors to prevent hip fractures in long-term care.

Electronic Medication Administration Records in Long-Term Care Facilities: A Scoping Review.
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A. E. C. Fuller, L. M. Guirguis, C. A. Sadowski and M. J. Makowsky.
J Am Geriatr Soc 2018 Apr 23
To map the extent, range, and nature of research on the effectiveness, level of use, and perceptions about electronic medication administration records (eMARs) in long-term care facilities (LTCFs) and identify gaps in current knowledge and priority areas for future research. DESIGN: Scoping review of quantitative and qualitative literature. SETTING: Literature review. PARTICIPANTS: Original research relating to eMAR in LTCF was eligible for inclusion. MEASUREMENTS: We systematically searched MEDLINE, CINAHL, Scopus, ProQuest, and the Cochrane Library and performed general and advanced searches of Google to identify grey literature. Two authors independently screened for eligibility of studies. Independent reviewers extracted data regarding country of origin, design, study methods, outcomes studied, and main results in duplicate. RESULTS: We identified 694 articles, of which 34 met inclusion criteria. Studies were published between 2006 and 2016 and were mostly from the United States (n=25). Twenty studies (59%) used quantitative methods, including surveys and analysis of eMAR data; 7 (21%) used qualitative methods, including interviews, focus groups, document review, and observation; and 7 (21%) used mixed methods. Three major research areas were explored: medication and medication administration error rates (n=11), eMAR benefits and challenges (n=19), and eMAR prevalence and uptake (n=15). Evidence linking eMAR use and reductions in medication errors is weak because of suboptimal study design and reporting. The majority of studies were descriptive and documented inconsistent benefits and challenges and low levels of eMAR implementation. CONCLUSION: Further investigation is required to rigorously evaluate the effect of standalone eMAR systems on medication administration errors and patient safety, the extent of eMAR implementation, pharmacists’ perceptions, and cost effectiveness of eMAR systems in LTCF.

Resident-to-Resident Mistreatment: Evaluation of a Staff Training Program in the Reduction of Falls and Injuries.
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J. A. Teresi, M. Ramirez, T. Fulmer, et al.
J Gerontol Nurs 2018 Apr 19:1-9
Resident-to-resident elder mistreatment (R-REM) occurs frequently in long-term services and support settings. The purpose of the current study was to evaluate the effect of a R-REM training program for nursing and other frontline staff on resident falls and injuries in a cluster randomized trial of units within four nursing homes. Interview and observational data from a sample of 1,201 residents (n = 600 and n = 601 in the usual care and intervention groups, respectively) and staff were collected at baseline and 6 and 12 months. A generalized linear model was used to model the falls/injuries outcome. The net reduction in falls and injuries was 5%, translating to 10 saved events per year in an averagesized facility. Although the result did not reach statistical significance due to low power, the findings of fall prevention associated with implementing the intervention in long-term care facilities is clinically important.

Differences Between Skilled Nursing Facilities in Risk of Subsequent Long-Term Care Placement.
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J. S. Goodwin, S. Li, A. Middleton, K. Ottenbacher and Y. F. Kuo.
J Am Geriatr Soc 2018 Apr 14
To determine how the risk of subsequent long-term care (LTC) placement varies between skilled nursing facilities (SNFs) and the SNF characteristics associated with this risk. DESIGN: Population-based national cohort study with participants nested in SNFs and hospitals in a cross-classified multilevel model. SETTING: SNFs (N=6,680). PARTICIPANTS: Fee-for-service Medicare beneficiaries (N=552,414) discharged from a hospital to a SNF in 2013. MEASUREMENTS: Participant characteristics from Medicare data and the Minimum Data Set. SNF characteristics from Medicare and Nursing Home Compare. Outcome was a stay of 90 days or longer in a LTC nursing home within 6 months of SNF admission. RESULTS: Within 6 months of SNF admission, 10.4% of participants resided in LTC. After adjustments for participant characteristics, the SNF where a participant received care explained 7.9% of the variance in risk of LTC, whereas the prior hospital explained 1.0%. Individuals in SNFs with excellent quality ratings had 22% lower odds of transitioning to LTC than those in SNFs with poor ratings (odds ratio=0.78, 95% confidence interval=0.74-0.84). Variation between SNFs and associations with quality markers were greater in sensitivity analyses limited to individuals least likely to require LTC. Results were essentially the same in a number of other sensitivity analyses designed to reduce potential confounding. CONCLUSION: Risk of subsequent LTC placement, an important and negatively viewed outcome for older adults, varies substantially between SNFs. Individuals in higher-quality SNFs are at lower risk.

The development and use of the assessment of dementia awareness and person-centred care training tool in long-term care.
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A. W. Griffiths, C. A. Surr, B. Creese, L. Garrod and L. Chenoweth.
Dementia (London) 2018 Jan 1:1471301218768165
Policy and practice guidelines recommend person-centred care to support people to live well with dementia in long-term care. Therefore, staff working in long-term care settings need to be trained in dementia awareness and person-centred care. However, the access to, content of and reach of training across long-term care settings can be varied. Data on current and ongoing access to person-centred care training can form an important component of data gathered on usual care in research studies, in particular clinical trials within long-term care. However, no suitable assessment tools are available to measure dementia awareness and person-centred care training availability, content and reach. This paper describes the development of a training audit tool to meet this need for a usual care measure of dementia awareness and person-centred care training. The ‘Assessment of Dementia Awareness and Person-centred care Training’ tool was based on a review of published person-centred care literature and consultation with dementia and aged care experts. The Assessment of Dementia Awareness and Person-centred care Training tool was piloted in 13 long-term care facilities the UK and Australia, before being used to assess the content of dementia and person-centred care awareness training in 50 UK settings in a randomized controlled trial as part of usual care recording. Following pilot testing, modifications to the Assessment of Dementia Awareness and Person-centred care Training tool’s wording were made to enhance item clarity. When implemented in the randomized controlled trial, pre-baseline training assessment data showed that the Assessment of Dementia Awareness and Person-centred care Training tool was able to differentiate between the training in different long-term care settings and identify settings where further dementia awareness training was required. The Assessment of Dementia Awareness and Person-centred care Training tool was then used as a method of recording data on dementia awareness and person-centred care training as part of ongoing usual care data collection. The Assessment of Dementia Awareness and Person-centred care Training tool is suitable for use by researchers to establish the availability, content and reach of dementia and person-centred care awareness training to staff within research studies.

Using an Interactive Video Simulator to Improve Certified Nursing Assistants’ Dressing Assistance and Nursing Home Residents’ Dressing Performance: A Pilot Study.
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P. F. Tsai, S. Kitch, C. Beck, et al.
Comput Inform Nurs 2018 Apr;36(4):183-192
This pilot study examined the initial effects and estimated effect size of a computer-based simulation education program on certified nursing assistants’ level of assistance when dressing nursing home residents with dementia and on residents’ dressing performance. Nine dyads, assigned to either the experimental or control group, completed the study. Both groups received a traditional 1-hour education module delivered by a research assistant. The experimental group was then instructed to undertake an additional 2-hour intervention using a video simulator that enabled nursing assistants to practice level of assistance skills. The appropriateness of dressing assistance from nursing assistants and residents’ dressing performance was measured before and 6 weeks after the intervention. The results showed that the two groups did not significantly differ in either appropriate levels of dressing assistance (P = .42) or residents’ dressing performance (P = .38). A lack of effort by some assistants to properly assist residents and low statistical power may explain the lack of significance. The effect sizes of the experimental intervention on appropriate levels of dressing assistance and resident dressing performance were 0.69 and 0.89, respectively. Incorporating a strategy to improve motivation should be considered in future studies.

A Systems Approach to Identify Factors Influencing Adverse Drug Events in Nursing Homes
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A. A. Al-Jumaili and W. R. Doucette.
J Am Geriatr Soc 2018 Apr 24
The objectives of the study were to identify the incidence rate and characteristics of adverse drug events (ADEs) in nursing homes (NHs) using the ADE trigger tool and to evaluate the relationships between resident and facility work system factors and incidence of ADEs using the System Engineering Initiative for Patient Safety (SEIPS) model. The study used 2 observational quantitative methods, retrospective resident chart extraction, and surveys. The participating staff included Directors of nursing, registered nurses, certified nurse assistants (CNAs). Data were collected from fall 2016 to spring 2017 from 11 NHs in 9 cities in Iowa. Binary logistic regression with generalized estimated equations was used to measure the association between ADE incidence and resident and facility characteristics. We extracted data from 755 medical charts and conducted 33 staff surveys. There were 6.13 ADEs per 100 residents per month. More than half were fall-related (51.1%), and half of those were due to hypotension. Regression analysis revealed significant associations between ADEs and opioid analgesics, psychotropic medications, warfarin, skilled care, consultant pharmacist accessibility, nurse-physician collaboration, CNA vital sign assessment skills, number of physician visits, nurse workload, and use of electronic health records. Five resident characteristics (skilled care, dementia, use of opioids, warfarin, psychotropics) and variables from 5 domains of the facility work system (organization, task, environment, person, technology) had significant associations with ADE incidence. The SEIPS model successfully identified work system factors influencing ADEs in NHs.

Exploring experience and perspectives of foreign-born direct care workers in dementia care: Accounts of Korean American personal care aides caring for older Korean Americans with dementia symptoms.
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S. E. Lee, B. L. Casado and M. Hong.
Dementia (London) 2018 May;17(4):423-438
This focus group study explored experience of Korean American personal care aides caring for older Korean Americans with dementia symptoms. Personal care aides described dementia caregiving as challenging, demanding and stressful, yet they cared for their clients with love and affection, particularly with jeong (i.e., a Korean cultural concept of love, affection, sympathy, and bondage). They learned about dementia mostly through their caregiving experience and expressed their need and strong desire to learn more about dementia. They felt for family struggle and observed family conflict and filial obligation. They advocated the value of personal care aides’ involvement in dementia care. This study revealed a pressing need for dementia training for personal care aides and called for an outreach effort to recruit and train direct care workers with potential of providing culturally competent care for traditionally underserved ethnic minorities.

The Funding of Long-Term Care in Canada: What Do We Know, What Should We Know?
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M. Grignon and B. G. Spencer.
Can J Aging 2018 Jun;37(2):110-120
Long-term care is a growing component of health care spending but how much is spent or who bears the cost is uncertain, and the measures vary depending on the source used. We drew on regularly published series and ad hoc publications to compile preferred estimates of the share of long-term care spending in total health care spending, the private share of long-term care spending, and the share of residential care within long-term care. For each series, we compared estimates obtainable from published sources (CIHI [Canadian Institute for Health Information] and OECD [Organization for Economic Cooperation and Development]) with our preferred estimates. We conclude that using published series without adjustment would lead to spurious conclusions on the level and evolution of spending on long-term care in Canada as well as on the distribution of costs between private and public funders and between residential and home care.

Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia.
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E. M. Pijl-Zieber, O. Awosoga, S. Spenceley, B. Hagen, B. Hall and J. Lapins.
Dementia (London) 2018 Apr;17(3):315-336
Moral distress is increasingly being recognized as a concern for health care professionals. The purpose of this study was to explore the nature and prevalence of moral distress among nursing staff who care for people living with dementia. Methods This study was focused on nursing staff caring for people with dementia in long-term care and assisted living sites. The Moral Distress in Dementia Care Survey instrument was distributed to 23 sites and nursing staff rated the frequency and severity of situations that were identified as potentially causing moral distress. Results Moral distress is prevalent in the nursing staff who provide dementia care. Nursing staff reported experiencing moral distress at least daily or weekly. Both frequency and severity of moral distress increased with proximity to (amount of time spent at) the bedside. Moral distress had negative psychological and physiological effects on nursing staff, and affected intention to quit.

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Health Care Innovation and Quality Assurance

Reducing Depressive Symptoms in Nursing Home Residents: Evaluation of the Pennsylvania Depression Collaborative Quality Improvement Program
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S. D. Crespy, K. Van Haitsma, M. Kleban and C. J. Hann.
J Healthc Qual 2016 Nov/Dec;38(6):e76-e88
Depression reduces quality of life for nursing home (NH) residents and places them at greater risk for disability, medical morbidity, and mortality. However, accumulating evidence suggests that interventions for early detection and treatment can mitigate symptoms of clinical and subclinical levels of depression. The Promoting Positive Well-Being (PPW) program is a quality improvement (QI) intervention that features tools and strategies to assist NHs in early identification, assessment, treatment, and monitoring of residents with depressive symptoms. The PPW was evaluated in 40 NHs through an 8-month QI collaborative that provided participants with tools, webinar training, and technical support. Results showed a significant group by time interaction effect with facility quality rating as a covariate; the active group (n = 18 NHs) outperformed the waitlist control group (n = 19 NHs). In all, there was a 58% relative reduction in the percentage of residents with self-reported moderate-to-severe depressive symptoms. Most NHs reported that they were satisfied with the collaborative (97%) and would recommend it to others (86%); only 15% reported significant challenges. The rate of webinar attendance and data submission compliance was 92%. Results suggest that PPW is a promising approach that should be further evaluated in larger NH initiatives and other settings.

Framework for Research on Implementation of Process Redesigns.
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M. Ashok, D. Hung, L. Rojas-Smith, M. T. Halpern and M. Harrison.
Qual Manag Health Care 2018 Jan/Mar;27(1):17-23
Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these factors in process redesign (PR) and for assessing PR outcomes. METHODS: Using literature scans and expert comment on draft frameworks based on the Consolidated Framework for Implementation Research, a team of researchers developed the PR framework for the Agency for Healthcare Research and Quality. As a case study, an independent team of researchers in a large care system subsequently applied the PR framework to implementation of Lean-based primary care redesigns. RESULTS: The PR framework adds 2 domains to the Consolidated Framework for Implementation Research, focused on relevant measures of implementation and outcomes, as well as some new constructs to the Consolidated Framework for Implementation Research. Using the PR framework to guide a study of primary care PR, researchers found that the health care reform environment encouraged staff recognition of need for redesign, but physicians worried about key redesign issues, including colocation with care team partners and the competencies of the individuals assigned to manage new workflows. Team member acceptance of the redesign was also influenced by other features of the implementation process and contextual features, including the decision style of the local clinic. CONCLUSIONS: The PR framework helped guide the qualitative study and aided researchers in informing their leadership about critical issues affecting PR implementation.

Using quality assessment tools to critically appraise ageing research: a guide for clinicians.
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J. K. Harrison, J. Reid, T. J. Quinn and S. D. Shenkin.
Age Ageing 2017 May 1;46(3):359-365
Evidence based medicine tells us that we should not accept published research at face value. Even research from established teams published in the highest impact journals can have methodological flaws, biases and limited generalisability. The critical appraisal of research studies can seem daunting, but tools are available to make the process easier for the non-specialist. Understanding the language and process of quality assessment is essential when considering or conducting research, and is also valuable for all clinicians who use published research to inform their clinical practice.We present a review written specifically for the practising geriatrician. This considers how quality is defined in relation to the methodological conduct and reporting of research. Having established why quality assessment is important, we present and critique tools which are available to standardise quality assessment. We consider five study designs: RCTs, non-randomised studies, observational studies, systematic reviews and diagnostic test accuracy studies. Quality assessment for each of these study designs is illustrated with an example of published cognitive research. The practical applications of the tools are highlighted, with guidance on their strengths and limitations. We signpost educational resources and offer specific advice for use of these tools.We hope that all geriatricians become comfortable with critical appraisal of published research and that use of the tools described in this review – along with awareness of their strengths and limitations – become a part of teaching, journal clubs and practice.

What Consumers Say About Nursing Homes in Online Reviews
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Caitlyn Kellogg, Yujun Zhu, Valeria Cardenas, et al.
Gerontologist 2018 04/20:gny025-gny025
Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care.Research Design and MethodsWe analyzed nursing home (NH) Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned.ResultsWe evaluated 264 reviews, identifying 24 codes, grouped under five categories: quality of staff care and staffing; physical facility and setting; resident safety and security; clinical care quality; and financial issues. More than half (53.41%) of Yelp reviewers posted comments related to staff attitude and caring and nearly a third (29.2%) posted comments related to staff responsiveness. Yelp reviewers also often posted about NHs’ physical environment. Infrequently mentioned were the quality of health care provided and concerns about resident safety and security.Discussion and ImplicationsOur results are consistent with those from related studies. Yelp reviewers focus on NH aspects that are not evaluated in most other NH rating systems. The federal Nursing Home Compare website, for instance, does not report measures of staff attitudes or the NH’s physical setting. Rather, it reports measures of staffing levels and clinical processes and outcomes. We recommend that NH consumers consult both types of rating systems because they provide complementary information.

 

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Research Practice and Methodology

Turning the Co-Production Corner: Methodological Reflections from an Action Research Project to Promote LGBT Inclusion in Care Homes for Older People.
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P. Willis, K. Almack, T. Hafford-Letchfield, P. Simpson, B. Billings and N. Mall.
Int J Environ Res Public Health 2018 Apr 7;15(4):10.3390/ijerph15040695
Background: Older lesbian, gay, bisexual and trans (LGBT) residents are often invisible in long-term care settings. This article presents findings from a community-based action research project, which attempted to address this invisibility through co-produced research with LGBT community members. Particular Question: What conditions enable co-produced research to emerge in long-term residential care settings for older people? Aims of Project: To analyse outcomes and challenges of action-oriented, co-produced research in the given context. In particular, we explore how co-production as a collaborative approach to action-orientated research can emerge during the research/fieldwork process; and reflect critically on the ethics and effectiveness of this approach in advancing inclusion in context. METHODS: The project was implemented across six residential care homes in England. Reflections are based on qualitative evaluation data gathered pre- and post-project, which includes 37 interviews with care home staff, managers and community advisors (two of whom are co-authors). Results and Conclusions: We discuss how the co-production turn emerged during research and evaluate how the politics of this approach helped advance inclusion-itself crucial to well-being. We argue for the value of co-produced research in instigating organizational change in older people’s care environments and of non-didactic storytelling in LGBT awareness-raising amongst staff.

Meta-Analysis of Complex Interventions
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E. E. Tanner-Smith and S. Grant.
Annu Rev Public Health 2018 Apr 1;39:135-151
Meta-analysis is a prominent method for estimating the effects of public health interventions, yet these interventions are often complex in ways that pose challenges to using conventional meta-analytic methods. This article discusses meta-analytic techniques that can be used in research syntheses on the effects of complex public health interventions. We first introduce the use of complexity frameworks to conceptualize public health interventions. We then present a menu of meta-analytic procedures for addressing various sources of complexity when answering questions about the effects of public health interventions in research syntheses. We conclude with a review of important practices and key resources for conducting meta-analyses on complex interventions, as well as future directions for research synthesis more generally. Overall, we argue that it is possible to conduct meaningful quantitative syntheses of research on the effects of public health interventions, though these meta-analyses may require the use of advanced techniques to properly consider and attend to issues of complexity.

Role of patient and public involvement in implementation research: a consensus study
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K. Gray-Burrows, T. Willis, R. Foy, et al.
BMJ Qual Saf 2018 Apr 17
Patient and public involvement (PPI) is often an essential requirement for research funding. Distinctions can be drawn between clinical research, which generally focuses on patients, and implementation research, which generally focuses on health professional behaviour. There is uncertainty about the role of PPI in this latter field. We explored and defined the roles of PPI in implementation research to inform relevant good practice guidance. METHODS: We used a structured consensus process using a convenience sample panel of nine experienced PPI and two researcher members. We drew on available literature to identify 21 PPI research roles. The panel rated their agreement with roles independently online in relation to both implementation and clinical research. Disagreements were discussed at a face-to-face meeting prior to a second online rating of all roles. Median scores were calculated and a final meeting held to review findings and consider recommendations. RESULTS: Ten panellists completed the consensus process. For clinical research, there was strong support and consensus for the role of PPI throughout most of the research process. For implementation research, there were eight roles with consensus and strong support, seven roles with consensus but weaker support and six roles with no consensus. There were more disagreements relating to PPI roles in implementation research compared with clinical research. PPI was rated as contributing less to the design and management of implementation research than for clinical research. CONCLUSIONS: The roles of PPI need to be tailored according to the nature of research to ensure authentic and appropriate involvement. We provide a framework to guide the planning, conduct and reporting of PPI in implementation research, and encourage further research to evaluate its use.

Variation in Research Designs Used to Test the Effectiveness of Dissemination and Implementation Strategies: A Review
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S. Mazzucca, R. G. Tabak, M. Pilar, et al.
Front Public Health 2018 Feb 19;6:32
The need for optimal study designs in dissemination and implementation (D&I) research is increasingly recognized. Despite the wide range of study designs available for D&I research, we lack understanding of the types of designs and methodologies that are routinely used in the field. This review assesses the designs and methodologies in recently proposed D&I studies and provides resources to guide design decisions. Methods: We reviewed 404 study protocols published in the journal Implementation Science from 2/2006 to 9/2017. Eligible studies tested the efficacy or effectiveness of D&I strategies (i.e., not effectiveness of the underlying clinical or public health intervention); had a comparison by group and/or time; and used >/=1 quantitative measure. Several design elements were extracted: design category (e.g., randomized); design type [e.g., cluster randomized controlled trial (RCT)]; data type (e.g., quantitative); D&I theoretical framework; levels of treatment assignment, intervention, and measurement; and country in which the research was conducted. Each protocol was double-coded, and discrepancies were resolved through discussion. Results: Of the 404 protocols reviewed, 212 (52%) studies tested one or more implementation strategy across 208 manuscripts, therefore meeting inclusion criteria. Of the included studies, 77% utilized randomized designs, primarily cluster RCTs. The use of alternative designs (e.g., stepped wedge) increased over time. Fewer studies were quasi-experimental (17%) or observational (6%). Many study design categories (e.g., controlled pre-post, matched pair cluster design) were represented by only one or two studies. Most articles proposed quantitative and qualitative methods (61%), with the remaining 39% proposing only quantitative. Half of protocols (52%) reported using a theoretical framework to guide the study. The four most frequently reported frameworks were Consolidated Framework for Implementing Research and RE-AIM (n = 16 each), followed by Promoting Action on Research Implementation in Health Services and Theoretical Domains Framework (n = 12 each). Conclusion: While several novel designs for D&I research have been proposed (e.g., stepped wedge, adaptive designs), the majority of the studies in our sample employed RCT designs. Alternative study designs are increasing in use but may be underutilized for a variety of reasons, including preference of funders or lack of awareness of these designs. Promisingly, the prevalent use of quantitative and qualitative methods together reflects methodological innovation in newer D&I research.

Knowledge dissemination in clinical trials: Exploring influences of institutional support and type of innovation on selective reporting
Non UofA Access

Rossella Salandra.
Research Policy 2018 04/17
This paper contributes to the ongoing debate on the reliability of published research. In particular, this study focuses on the selective reporting of research findings in clinical trials, defined as the publication of only part of the findings originally recorded during a research study, on the basis of the results. Selective reporting can lead to concerns ranging from publishing flawed scientific knowledge, to skewing medical evidence, to wasting time and resources invested in the conduct of research. Drawing upon a unique hand-collected dataset, this study investigates the contextual factors associated with selective reporting. Using ‘risk of bias’ ratings assessed based on expert judgment and presented in systematic reviews of clinical literature, this study explores whether selective reporting is associated with: (1) the source of institutional support; and, (2) the type of innovation evaluated. The results indicate that the odds of selective reporting are higher for industry-funded studies than for publicly-funded studies; however, this effect is restricted to studies where at least one author is industry-affiliated. In addition, the results suggest that selective reporting is more likely in projects exploring radical innovation, compared to those investigating incremental innovation.

Implementing a Data Management Platform for Longitudinal Health Research
Non UofA Access

J. P. Weiss, U. Hubner, J. Rauch, et al.
Stud Health Technol Inform 2017;243:85-89
Health IT adoption research is rooted in Rogers’ Diffusion of Innovation theory, which is based on longitudinal analyses. However, many studies in this field use cross-sectional designs. The aim of this study therefore was to design and implement a system to (i) consolidate survey data sets originating from different years (ii) integrate additional secondary data and (iii) query and statistically analyse these longitudinal data. Our system design comprises a 5-tier-architecture that embraces tiers for data capture, data representation, logics, presentation and integration. In order to historicize data properly and to separate data storage from data analytics a data vault schema was implemented. This approach allows the flexible integration of heterogeneous data sets and the selection of comparable items. Data analysis is prepared by compiling data in data marts and performed by R and related tools. IT Report Healthcare data from 2011, 2013 and 2017 could be loaded, analysed and combined with secondary longitudinal data.

Authorship grids: Practical tools to facilitate collaboration and ethical publication
Non UofA Access

J. C. Phillippi, F. E. Likis and E. L. Tilden.
Res Nurs Health 2018 Apr;41(2):195-208
Publication of new findings and approaches in peer-reviewed journals is fundamental to advancing science. As interprofessional, team-based scientific publication becomes more common, authors need tools to guide collaboration and ethical authorship. We present three forms of authorship grids that are based on national and international author recommendations, including guidelines from the International Committee of Medical Journal Editors, the Committee on Publication Ethics, National Institutes of Health data sharing policies, common reporting guidelines, and Good Clinical Practice standards from the International Conference on Harmonization. The author grids are tailored to quantitative research, qualitative research, and literature synthesis. These customizable grids can be used while planning and executing projects to define each author’s role, responsibilities, and contributions as well as to guide conversations among authors and help avoid misconduct and disputes. The grids also can be submitted to journal editors and published to provide public attribution of author contributions.

Review of methodologies of cohort studies of older people
Non UofA Access

A. Kingston and C. Jagger.
Age Ageing 2018 Mar 1;47(2):215-219
This paper describes a cohort study in terms of its design, the research questions answered by cohort studies, common analytic techniques and the strengths and limitations of this type of study. We also describe the main cohort studies of older populations, many of which are available for secondary data analysis.

Are randomised controlled trials positivist? Reviewing the social science and philosophy literature to assess positivist tendencies of trials of social interventions in public health and health services.
Non UofA Access

C. Bonell, G. Moore, E. Warren and L. Moore.
Trials 2018 Apr 19;19(1):238-018-2589-4
We have previously proposed that trials of social interventions can be done within a “realist” research paradigm. Critics have countered that such trials are irredeemably positivist and asked us to explain our philosophical position. METHODS: We set out to explore what is meant by positivism and whether trials adhere to its tenets (of necessity or in practice) via a narrative literature review of social science and philosophical discussions of positivism, and of the trials literature and three case studies of trials. RESULTS: The philosophical literature described positivism as asserting: (1) the epistemic primacy of sensory information; (2) the requirement that theoretical terms equate with empirical terms; (3) the aim of developing universal laws; and (4) the unity of method between natural and social sciences. Regarding (1), it seems that rather than embodying the epistemic primacy of sensory data, randomised controlled trials (RCTs) of social interventions in health embrace an anti-positivist approach aiming to test hypotheses derived deductively from prior theory. Considering (2), while some RCTs of social interventions appear to limit theorisation to concepts with empirical analogues, others examine interventions underpinned by theories engaging with mechanisms and contextual contingencies not all of which can be measured. Regarding (3), while some trialists and reviewers in the health field do limit their role to estimating statistical trends as a mechanistic form of generalisation, this is not an inevitable feature of RCT-based research. Trials of social interventions can instead aim to generalise at the level of theory which specifies how mechanisms are contingent on context. In terms of (4), while RCTs are used to examine biomedical as well as social interventions in health, RCTs of social interventions are often distinctive in using qualitative analyses of data on participant accounts to examine questions of meaning and agency not pursued in the natural sciences. CONCLUSION: We conclude that the most appropriate paradigm for RCTs of social interventions is realism not positivism.

A Conceptual Framework for Critical Appraisal in Systematic Mixed Studies Reviews
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Quan Nha Hong and Pierre Pluye.
Journal of Mixed Methods Research 2018 04/21; 2018/04:1558689818770058
The past decade has been rich with methodological advancements in systematic reviews, several of which were inspired by the literature on mixed methods research. Systematic mixed studies reviews?that is, reviews combining qualitative and quantitative evidence?are increasingly popular as they can provide a better understanding of complex phenomena and interventions. However, they raise new challenges, especially regarding how to perform critical appraisal of the included studies that vary regarding the methodologies used. To address this challenge, conceptually clarifying critical appraisal is necessary. To this end, this article provides a framework for critical appraisal in systematic mixed studies reviews. This framework is an essential first step toward providing clear guidance on how to perform critical appraisal.

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Aging

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.
Non UofA Access

A. Tynan, L. Deeth, D. McKenzie, et al.
Aust J Rural Health 2018 Apr 16
Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. DESIGN: A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. SETTING: One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. KEY MEASURES FOR IMPROVEMENT: Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. STRATEGIES FOR CHANGE: The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. EFFECTS OF CHANGE: Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. LESSONS LEARNT: Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities.

State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health.
Non UofA Access

T. W. Farrell, M. K. Luptak, K. P. Supiano, J. T. Pacala and R. De Lisser.
J Am Geriatr Soc 2018 Apr;66 Suppl 1:S40-S47
Interprofessional education (IPE) is essential to develop the healthcare workforce of the future. Geriatrics healthcare professionals have long championed innovations in IPE and patient care, but there is increased urgency to address challenges in aging, dementia, and geriatric mental health in America. In 2010, the Partnership for Health in Aging multidisciplinary competencies and a related position statement in the Journal of the American Geriatrics Society addressed interdisciplinary team (IDT) training in geriatrics. The position statement reported that training in higher education, academic, and continuing education settings has not been sufficiently responsive to workforce needs. In recent years, health professions educators and health systems leaders have increasingly recognized that IPE should be integrally linked with, and performed within, emerging models of team-based, value-driven health care. In this way, IPE will align with learning healthcare systems’ pursuit of the Quadruple Aim: improving patient experience, provider experience, and the health of populations, and reducing per capita health care costs. Backed by decades of developing effective team care models and the skill set needed to care for older adults with complex needs, geriatrics healthcare providers from multiple disciplines are uniquely positioned to lead learning healthcare systems in a new effort to develop, implement, and sustain IPE and practice models congruent with these Aims. We provide recommendations for health professions educators, healthcare systems leaders, and policymakers to realize the potential of IPE and interprofessional collaborative practice (IPCP) to improve the health of all Americans in aging, dementia, and mental health.

Long-term Care Status in Centenarians and Younger Cohorts of Oldest Old in the Last 6 Years of Life: Trajectories and Potential Mechanisms.
Non UofA Access

P. Gellert, S. Eggert, C. Zwillich, S. Horter, A. Kuhlmey and D. Drager.
J Am Med Dir Assoc 2018 Apr 13
A large proportion of the oldest old and centenarians live in long-term care facilities. Although there may be distinct care patterns in centenarians compared with other cohorts of oldest old, the exact development concerning prevalence, length of stay, and factors that are associated with long-term care status in the last years before death is unknown. DESIGN: Longitudinal analyses of health insurance data across 6 years before death. SETTING AND PARTICIPANTS: In all, 1398 institutionalized and noninstitutionalized oldest old [deceased at 80-89 (octogenarians), 90-99 (nonagenarians), or over 100 years of age (centenarians)] from Germany were included. Long-term care status and transition from home care into long-term care over 6 years (34,740 person-quarters). MEASUREMENTS: Dementia, musculoskeletal diseases, multimorbidity, hospital admission, gender, and age at death were derived from administrative data and analyzed using binary generalized estimating equations. RESULTS: Although the initial level of long-term care (6 years before death) was higher among centenarians (65.1% vs 53.6% in nonagenarians; 36.2% in octogenarians), the rate of increase was stronger in the younger cohorts. Distinguishing between long-term care escapers, delayers, and survivors, the proportion of those who escaped, delayed, or survived the entire 6 years of observation in long-term care was 33.4%/40.4%/26.2% in centenarians, 45.0%/45.1%/9.9% in nonagenarians, and 62.7%/33.7%/3.6% in octogenarians. Age, hospital admissions, and dementia were positively associated with being in long-term care, whereas musculoskeletal disorders were negatively associated with long-term care. The association with dementia was significantly weaker in centenarians. CONCLUSIONS: For centenarians, although they are more often in long-term care, the transition rate to long-term care progressed more slowly than the rates of the younger comparison cohorts of oldest old. The high proportion of long stays of centenarians in long-term care facilities require different concepts of long-term care.

Process Evaluation of an Intervention for the Management of Neuropsychiatric Symptoms in Young-Onset Dementia.
Non UofA Access

B. Appelhof, C. Bakker, J. C. L. van Duinen-van den IJssel, et al.
J Am Med Dir Assoc 2018 Apr 10
A process evaluation was performed for an intervention aimed at improvement of the management of neuropsychiatric symptoms in young-onset dementia. Data about sample quality and intervention quality was evaluated to better understand internal and external validity. In addition, data about the implementation strategy and factors affecting implementation were evaluated to improve further implementation of the intervention. DESIGN: A model proposed by Leontjevas and colleagues consisting of first-order (validity) and second-order (implementation) data was used. SETTING AND PARTICIPANTS: Care units delivering specialized treatment and support for residents with young-onset dementia. MEASURES: A description of the recruitment, randomization procedure, and intervention reach was carried out to determine sample quality. To determine intervention quality, data on satisfaction, relevance, feasibility, and fidelity were collected through a questionnaire and reports logged on the server of the web-based intervention. A description of the implementation strategy was provided. Barriers and facilitators for implementation were collected by a questionnaire and analyzed by deductive content analysis. RESULTS: Care units varied in size and were recruited from different geographical regions in the Netherlands. The informed consent rate of the residents was 87.7%. The majority of the nursing home staff were satisfied with the intervention. However, parts of the intervention were perceived as less relevant for their own organization. The feasibility of the intervention was considered low. The fidelity differed between care units. The implementation strategy did not overcome all barriers. Factors affecting implementation covered 3 themes: organizational aspects, culture of the organization, and aspects of the intervention. CONCLUSIONS: In general, our results showed sufficient internal and external validity, warranting further effect analyses. Adaptations to specific steps of the care program should be considered to increase feasibility and sustainability. In addition, integration of the care program into the electronic health records is expected to further improve implementation.

Physical, mental and cognitive disabilities in relation to utilization of dental care services by nursing home residents.
Non UofA Access

F. M. Almomani and W. Bani-Issa.
Spec Care Dentist 2017 May;37(3):126-133
The main purpose of this study was to investigate factors affecting dental care utilization among nursing home residents in Jordan. METHODS: A total of 221 subjects with a mean age of 62.4 years (121 males and 100 females) taken from among nursing home residents across Jordan were recruited and composed a convenience sample for this study. The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Assessment Battery for gait and balance (TAB), Disability of Arm, Shoulder, and Hand test (DASH) were administered and oral health status was assessed for all subjects and examined as expected correlates of dental care utilization among nursing home residents. RESULTS: The response rate was about 88%. One-third of residents suffered from total edentulism and most of the remaining dentate residents exhibited periodontal disease (90%). Of the dentate sample, 90% of residents had bleeding upon probing, 85% were diagnosed with tooth mobility, 88% had presence of dental calculus, and 30% were diagnosed with root caries. Of the denture wearers, 59.1 % reported having soreness with their dentures and 32% of denture wearers reported having poor quality dentures. MMSE score, suffering from tooth sensitivity and having diabetes mellitus were identified to be indicators for utilization of dental care services among the study population. CONCLUSION: Regular oral care, assessments, and rehabilitation services are considered to be limited for nursing home residents in Jordan. Based upon these findings, future interventions should address oral health among nursing home residents in Jordan.

End-of-Life Care in Nursing Homes: A Qualitative Interpretive Meta-Synthesis
Non UofA Access

C. L. Wallace, G. Adorno and D. B. Stewart.
J Palliat Med 2018 Apr;21(4):503-512
BACKGROUND: Due to large number of deaths occurring in nursing home (NH) settings, along with reports of pain and suffering, there is great need for improvements in the provision of end-of-life (EOL) care in NHs. OBJECTIVE: The aim of this study was to develop a comprehensive understanding of the experience of dying in NHs through the perspective of residents, family, and facility staff. DESIGN: This study uses a qualitative interpretive meta-synthesis to provide a holistic view of EOL care in NHs across multiple qualitative studies. SETTING/SUBJECTS: Researchers synthesized the findings of 13 qualitative articles, including the diverse perspective of 91 dying residents, 419 NH staff, and 156 family members/caregivers across at least 44 NHs. METHODS: A qualitative meta-synthesis employs the following steps: identification of studies, theme extraction, translation, and synthesis of findings. RESULTS: Thematic analysis is organized using a conceptual model demonstrating the links between environmental and personal factors impacting EOL care in NHs. CONCLUSIONS: Findings provide support for the importance of a relational community and culture change within NHs for positive EOL experiences, in addition to providing a model to guide future research priorities.

Using observational facial descriptors to infer pain in persons with and without dementia
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S. Lautenbacher, A. L. Walz and M. Kunz.
BMC Geriatr 2018 Apr 11;18(1):88-018-0773-8
For patients with advanced dementia, pain diagnosis and assessment requires observations of pain-indicative behavior by others. One type of behavior that has been shown to be a promising candidate is the facial response to pain. To further test how pain-indicative facial responses are, we investigated the predictive power of observational facial descriptors to (i) predict the self-report of pain and (ii) to differentiate between non-painful and painful conditions. In addition, the expertise of the observers (nurses vs. healthy controls) and the cognitive status of the observed (dementia vs. cognitively healthy) were considered. METHODS: Overall 62 participants (32 nurses and 30 control subjects) watched 40 video-clips, showing facial expressions of older individuals with and without dementia during non-painful and painful pressure stimulation. After each clip, participants were asked to rate the videos using commonly used facial descriptors of pain and also to provide global pain estimate ratings of how much pain the observed individual might have experienced. RESULTS: Out of the 12 facial descriptors used, only 7 were able to differentiate between non-painful and painful conditions. Moreover, participants were better in predicting the pain self-report of the observed individuals when using facial descriptors than when using global pain estimates. Especially, the anatomically-orienting descriptors (e.g. opened mouth, narrowing eyes) showed greatest predictive power. Results were not affected by pain-expertise of the observers (nurses vs. control subjects) or diagnostic status of the observed (patients with dementia vs. cognitively unimpaired subjects). CONCLUSIONS: The fine-grained and specific observation of facial responses to acute pain appeared to provide valid indication of pain that is not compromised when patients with dementia are observed. The regular professional training does not put nurses at advantage to detect pain via facial responses.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.
Non UofA Access

A. R. Villarosa, S. Clark, A. C. Villarosa, et al.
Gerodontology 2018 Apr 23
OBJECTIVE: This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. BACKGROUND: Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. MATERIALS AND METHODS: This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. RESULTS: The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. CONCLUSION: This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services.

Does Cognitive Impairment and Agitation in Dementia Influence Intervention Effectiveness? Findings From a Cluster-RCT With the Therapeutic Robot, PARO.
Non UofA Access

C. Jones, W. Moyle, J. Murfield, et al.
J Am Med Dir Assoc 2018 Apr 13
To explore whether severity of cognitive impairment and agitation of older people with dementia predict outcomes in engagement, mood states, and agitation after a 10-week intervention with the robotic seal, PARO. DESIGN: Data from the PARO intervention-arm of a cluster-randomized controlled trial was used, which involved individual, nonfacilitated, 15-minute sessions with PARO 3 afternoons per week for 10 weeks. SAMPLE AND PARTICIPANTS: One hundred thirty-eight residents-aged >/=60 years, with dementia-from 9 long-term care facilities. MEASURES: A series of stepwise multiple linear regressions were conducted. Dependent variables were participants’ levels of engagement, mood states, and agitation at week 10 [assessed by video observation and Cohen Mansfield Agitation Inventory-Short Form (CMAI-SF)]. Predictor variables were baseline levels of cognitive impairment [assessed by Rowland Universal Dementia Assessment Scale (RUDAS)] and agitation (CMAI-SF). RESULTS: Five models were produced. The strongest finding was that participants with more severe agitation at baseline had higher levels of agitation at week 10 (R(2) = .82, P < .001). Predictors of positive response were less significant. Low levels of agitation at baseline predicted greater positive behavioral engagement with PARO (R(2) = .054, P = .009) and fewer observed instances of agitation (R(2) = .033, P = .045) at week 10, whereas greater visual engagement was predicted by both lower levels of agitation and cognitive impairment (R(2) = .082, P = .006). Less severe cognitive impairment predicted greater pleasure at week 10 (R(2) = .067, P = .004). CONCLUSIONS/IMPLICATIONS: Participants with severe agitation had poor response to PARO. Lower levels of agitation and higher cognitive functioning were associated with better responses. In clinical practice, we recommend PARO should be restricted to people with low-moderate severity of agitation. Further research is needed to determine the optimal participant characteristics for response to PARO.

Certified nursing assistants’ understanding of nursing home residents’ pain
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E. Halifax, C. Miaskowski and M. Wallhagen.
J Gerontol Nurs 2018 Apr 1;44(4):29-36
Pain is a significant problem for nursing home residents, yet its assessment is complex. Certified nursing assistants (CNAs) spend significant time with residents, but their role in understanding residents’ pain is largely unexplored. The current qualitative grounded theory study analyzed interviews with 16 CNAs who described their experiences caring for residents in pain. Findings revealed how CNAs understood, recognized, interpreted, and responded to residents’ pain. CNAs were found to differentiate between pain that they considered normal (everyday pain) and new pain judged significant enough to report to licensed nurses. CNAs exhibited a holistic understanding of pain, knowledge of strategies to identify and interpret pain, and actions to independently mitigate and report pain. Although additional confirmatory data are needed, the differentiation made between everyday and reportable pain may have important clinical implications suggesting that CNAs should always report to a licensed nurse when they perceive or suspect that residents have pain.

New relationships and intimacy in long-term care: The views of relatives of residents with dementia and care home staff.
Non UofA Access

E. Wiskerke and J. Manthorpe.
Dementia (London) 2018 May;17(4):405-422
There is limited research on what family members and frontline care home staff consider to be the best responses to the sexual expression of a person with dementia, whilst at the same time respecting relatives’ feelings, managing their possible distress and conflict. Methods This exploratory study investigated the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia, whilst still married to another person. It reports the themes that emerged in qualitative interviews with eight relatives of people with dementia and with 12 frontline care home staff working in two English care homes. Interviews took place in 2015 using a hypothetical vignette that unfolded in four stages. Thematic analysis was used to analyse the data. Findings The views of care home staff and relatives had similarities in general terms regarding the problems arising around expressions of sexuality in care homes: indicting that a light-hearted or non-physical connection between residents is deemed acceptable, but the moment it becomes a sexual relationship then decision making becomes more complicated. Staff were inclined to turn to managers for advice and to consider separating residents. They expressed familiarity with distracting residents from situations that were of concern. Relatives were considerate of the difficulties and dilemmas faced by care home staff. Conclusion The use of a vignette facilitated discussion of a potentially sensitive topic. Areas for further research are identified.

The Factors Associated With Anxiety Symptom Severity in Older Adults Living in Nursing Homes and Other Residential Aged Care Facilities
Non UofA Access

A. S. Creighton, T. E. Davison and D. W. Kissane.
J Aging Health 2018 Apr 1:898264318767781
This study aimed to identify the biopsychosocial factors associated with anxiety among a residential aged care sample. METHOD: A total of 178 residents ( M age = 85.4 years, SD = 7.4 years) with mild cognitive impairment or normal cognition participated. Participants completed the Geriatric Anxiety Inventory (GAI) and a set of measures assessing cognition, depression, self-perceived health, mastery, attachment, perceived social support, social engagement, functional status, the experience of a fall, and other negative life events. RESULTS: Unique correlates of GAI scores were depression, a preoccupied attachment style, lower mastery, cognitive impairment, and lower self-perceived health. DISCUSSION: Most correlates that were uniquely associated with anxiety had little to do with the current environment. More variance was accounted for by stable and lifelong factors. This provides new insights into the characteristics of anxiety within aged care populations, and although preliminary, provides possible targets to prevent and treat anxiety within this setting.

HQCA: Long-Term Care Family Experience Survey Report

HQCA April 2018
The HQCA conducts surveys with family members of residents in long-term care facilities across Alberta, which is an integral part of our mandate to measure, monitor, and report to Albertans about their experience and satisfaction with the quality of health services they receive. The information we collect and analyze is shared with each long term care facility, Alberta Health Services and the government to help inform future improvements. From May to September, 2017 the HQCA conducted its fourth long term care family experience survey in collaboration with Alberta Health and Alberta Health Services.

CIHR Best Brains Exchange Report: Innovative approaches and pathways used to integrate home and community care with primary health care for elderly persons in rural Canada

CIHR, Health Canada 2017
On November 28, 2017, the Canadian Institutes of Health Research, in collaboration with Health Canada, brought together key experts and stakeholders in a Best Brains Exchange (BBE) format. The purpose of this BBE was to identify what works, and why, when it comes to integrating home and community care with primary health care for older persons in rural areas.

Assisted Living Denmark – A Dementia Friendly Society White Paper

Healthcare Denmark, 2018
Denmark holds a leading position in providing high quality treatment and care within the field of dementia. Our position is based on a strong ambition to maintain dignity, safety and quality of life for people with dementia and their families. This position is further reinforced by the Danish national dementia strategy, the National Action Plan on Dementia 2025, where a number of initiatives are launched to strengthen Denmark as a dementia friendly society. This white paper demonstrates a number of unique Danish initiatives and solutions to many of the challenges in relation to dementia.

 

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Events

Non UofA

Patient-Oriented Research Summer Institute

14-16 May Calgary AB
The Summer Institute 2018 is where researchers, patients, clinicians, students, policymakers and more, gather to share insights, connect with colleagues and promote patient-oriented research. This three-day event is packed with sessions highlighting many areas of patient-oriented research

Online

Identifying barriers and enablers, and determinants, in theory

Wednesday 2 May 10:00 MT
Presenters: Dr. Justin Presseau and Dr. Andrea Patey
Focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation. This webinary draws upon French’s (2014) model and highlight the importance of not jumping directly to solutions before further understanding the problem. This webinar will focus on the role of theoretical models and frameworks for informing the identification of barriers and enablers, focusing on providing an overview of key models used in Implementation Science, approaches for selecting a framework, and focus particularly on introducing the Theoretical Domains Framework as a means for barrier/enabler assessment (with examples). Participants wishing to consider and discuss the use of contemporary theory and frameworks for informing a rigorous assessment of barriers and enablers that can aid in the development of implementation patient safety initiatives, with a particular focus on behaviour change approaches, will find this session especially useful.

Knowledge Translation beyond Publications

Thursday 24 May 09:00-10:00
Presenter: Kate Hogan
Publications look great on a CV but rarely get into the hands of the people whose lives you’re trying to improve. Patient-oriented research is about real patient impacts but patients often don’t read academic journals or attend conferences. We should make the effort to move knowledge translation beyond publications, bringing in into the communities where patients can find and even enjoy it. In this webinar, we’ll discuss a number of accessible and creative strategies for sharing results with the public.

Identifying barriers and enablers, and determinants, in practice

Wednesday 30 May 10:00
Presenters: Dr. Justin Presseau and Dr. Andrea Patey
Using the Theoretical Domains Framework and practical examples, participants will consider qualitative and quantitative approaches for barrier/enabler identification, as well as advice on how to get the most out of such approaches. Adaptable tools for designing interview guides and questionnaires will be described, which participants can leverage for their own initiatives. This webinar will suit participants wanting to further consider how approaches from webinar 4 can be directly applied to planning their own patient safety initiatives.

KT Canada Webinar Writing and Defending Your Thesis

Monday 14 May 08:00-09:00 MT
Presenter: Dr. Jennifer Tomasone
Dr. Tomasone is an Assistant Professor in the School of Kinesiology and Health Studies at Queen’s University. Stemming from her formal training in exercise behaviour change and knowledge translation, her research aims to close the gap between what is known about promoting physical activity and health behaviours, and how this knowledge is applied in practical settings. She is a co-author of the Cancer Care Ontario “Exercise for People with Cancer” guideline and patient guide, and her current research is focusing on guideline implementation across Ontario. Dr. Tomasone is also the Faculty Advisor for the Exercise is Medicine Canada at Queen’s University campus group, and a Co-Director of Kingston Revved Up, an adapted exercise program for persons with physical and developmental disabilities.
These webinars are broadcast via Webex. To register, please contact Meghan Storey (StoreyM@smh.ca)

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News

LPZ – improving quality and safety in care homes (UK)

Secondary & Primary Qualitative Content Analysis: Distinguishing Between the Two Methods

Canada remains strong in research output and impact, capacity for R&D and innovation at risk: New expert panel report

Do These 4 Things When You’re Scaling Up Improvement

Quality Improvement Lessons Without the Jargon

Arts-based co-design: a valuable approach to implementing clinical guidelines? (UK)

Following a couple from diagnosis to the final stages of Alzheimer’s

Launch of the SPOR Evidence Alliance

Income, education tied to physical function in old age

The Clinical Trial Is Open. The Elderly Need Not Apply.

Ten-day hospital stay is enough to make pensioners age 10 years, new NHS medical chief warns (UK)

Women’s work across every aspect of healthcare is largely invisible

Patients seeking more involvement at medical meetings
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Opportunities

Propose/Edit Special Issue of SAGE Open Nursing

SAGE Open Nursing (SON) is seeking qualified researchers to propose and guest edit Special Collections. Proposals for Special Collections can be focused around a topic of your choosing, provided it falls within the scope of the journal and is an area of high current interest.

Associate Editor Journal of Pediatric Nursing

The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) publishes evidencebased practice, quality improvement, theory, and research papers on a variety of topics from US and international authors. JPN is the official journal of the Society of Pediatric Nurses and the Pediatric Endocrinology Nursing Society. Cecily L. Betz, PhD, RN, FAAN, is the Editor in Chief.

Editor in Chief Journal of Nurses in Professional Development

DEADLINE: 26 June
Lippincott Williams & Wilkins is seeking an Editor-in-Chief for Journal for Nurses in Professional Development. With a distinguished 35-year history, Journal for Nurses in Professional Development (JNPD) is the premier source of information for nursing professional development and patient educators in all healthcare settings. JNPD is the Official Journal of the Association for Nursing Professional Development (ANPD).

Editor-in-Chief Quality Management in Healthcare

DEADLINE:29 May
Lippincott Williams & Wilkins is seeking an Editor-in-Chief for Quality Management in Health Care. With a distinguished 27-year history of continuous publication, Quality Management in Health Care (QMHC) is an essential peer-reviewed journal on the theoretical, technical, and strategic elements of health care quality management. The Journal is included in many important bibliographic databases like PubMed, Medline, Scopus, and Web of Science.

Post-Doctoral Fellowship At The University Of Kansas School Of Medicine

Kansas City, KS
The Department of Health Policy & Management within the School of Medicine at The University of Kansas Medical Center (KUMC) is seeking applications for a post-doctoral research scientist. The postdoctoral candidate should have a Ph.D. in the social sciences with a strong background in implementation science and will be expected to assist with manuscript development, qualitative analysis and some quantitative analysis. Solid health services research or behavioral science training, strong qualitative analysis software skills, and excellent written and oral communication skills are required.

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