June 11, 2018

Aspects of the research and practice paradigm known as the diffusion of innovations are applicable to the complex context of health care, for both explanatory and interventionist purposes. This article answers the question, “What is diffusion?” by identifying the parameters of diffusion processes: what they are, how they operate, and why worthy innovations in health care do not spread more rapidly. We clarify how the diffusion of innovations is related to processes of dissemination and implementation, sustainability, improvement activity, and scale-up, and we suggest the diffusion principles that can be readily used in the design of interventions.

Long-term care (LTC) physical and psychosocial mealtime environments have been inconsistently assessed due to the lack of a standardized measure. The purpose of this study was to examine the construct validity of a new standardized observational measure, the Mealtime Scan (MTS), using the Making Most of Mealtimes data collected on 639 residents in 82 dining rooms in 32 LTC homes. The MTS includes physical, social, and person-centered care summary scales scored from 1 to 8. Mean ratings on these summary scales were moderate for physical (5.6 SD 0.9), social (5.0 SD 0.9), and person-centered care (PCC; 5.5 SD 0.8). Regression analyses determined which items within the MTS were associated with these summary scales: physical – music (B = 0.27, p = 0.04), number of staff passing food (B = -0.11, p = 0.03), number of residents (B = -0.03, p = 0.01); social – social sound (B = 0.31 p < 0.0001), number of residents requiring eating assistance (B = 0.11, p = 0.02); PCC – lighting (B = 0.01 p = 0.04), and total excess noise (B = 0.05, p < 0.0001). The Mealtime Relational Care Checklist (M-RCC) was associated positively with ratings on all three summary scales. Correlations revealed that the MTS summary scales were associated with other constructs: Dining Environment Audit Protocol functionality scale, resident and dining room level M-RCC, Mini Nutritional Assessment- Short Form, and resident Cognitive Performance Scale. These results demonstrate that the MTS summary scales exhibit construct validity, as the ratings were associated with expected observed mealtime characteristics and correlated with dining room and resident level constructs in anticipated directions.

Residents living in long term care (LTC) who consume a pureed diet tend to have inadequate intake; understanding factors associated with poor intake in this group of residents is not well established. This study examined the adequacy of nutrient intake among LTC residents consuming a pureed diet and the factors associated with this intake (n = 67). Data was collected as part of a cross-sectional study conducted in 32 LTC homes. Weighed food intake was measured on three non-consecutive days and analyzed using Food Processor software. Intake of nutrients were adjusted for intra-individual variability and compared to the Estimated Average Requirement or Adequate Intake for women only. Consumers of a pureed diet had low micronutrient intakes. Multivariate analysis found that the average number of staff assisting with a meal was associated with energy and protein intake. Overcoming eating challenges, careful menu planning and nutrient-dense options for pureed diets in LTC are recommended.

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Through the Betty Havens Prize for Knowledge Translation in Aging, the CIHR-Institute of Aging will recognize individual(s), team(s) or organization(s) that have advanced the translation of research in aging at a local or regional level.

Registered voluntary sector organizations with a knowledge translation mandate are eligible to apply for funding. Eligible organizations include health charities, non-governmental health policy regulators, foundations, and community-based organizations. The award can only be received once by an individual, team or organization.

It is widely accepted that research can lead to improved health outcomes. However, translating research into meaningful impacts in peoples’ lives requires actions that stretch well beyond those traditionally associated with knowledge creation. The research reported in this manuscript provides an international review of health research funders’ efforts to encourage this process of research uptake, application and scaling, often referred to as knowledge translation. METHODS: We conducted web-site review, document review and key informant interviews to investigate knowledge translation at 26 research funding agencies. The sample comprises the regions of Australia, Europe and North America, and a diverse range of funder types, including biomedical, clinical, multi-health domain, philanthropic, public and private organisations. The data builds on a 2008 study by the authors with the same international sample, which permitted longitudinal trend analysis. RESULTS: Knowledge translation is an objective of growing significance for funders across each region studied. However, there is no clear international consensus or standard on how funders might support knowledge translation. We found that approaches and mechanisms vary across region and funder type. Strategically tailored funding opportunities (grants) are the most prevalent modality of support. The most common funder-driven strategy for knowledge translation within these grants is the linking of researchers to research users. Funders could not to provide empirical evidence to support the majority of the knowledge translation activities they encourage or undertake. CONCLUSIONS: Knowledge translation at a research funder relies on context. Accordingly, we suggest that the diversity of approaches uncovered in our research is fitting. We argue that evaluation of funding agency efforts to promote and/or support knowledge translation should be prioritised and actioned. It is paradoxical that funders’ efforts to get evidence into practice are not themselves evidence based.

Increasing interest in implementation science has generated a demand for education and training opportunities for researchers and practitioners in the field. However, few implementation science courses have been described or evaluated in the scientific literature. The aim of the present study was to provide a short- and long-term evaluation of the implementation training at Linkoping University, Sweden. METHODS: Two data collections were carried out. In connection with the final seminar, a course evaluation form, including six items on satisfaction and suggestions for improvement, was distributed to the course participants, a total of 101 students from 2011 to 2015 (data collection 1), response rate 72%. A questionnaire including six items was distributed by e-mail to the same students in autumn 2016 (data collection 2), response rate 63%. Data from the two data collections were presented descriptively and analysed using the Kirkpatrick model consisting of four levels: reaction, learning, behaviour and results. RESULTS: The students were very positive immediately after course participation, rating high on overall perception of the course and the contents (reaction). The students also rated high on achievement of the course objectives and considered their knowledge in implementation science to be very good and to a high degree due to course participation (learning). Knowledge gained from the course was viewed to be useful (behaviour) and was applied to a considerable extent in research projects and work apart from research activities (results). CONCLUSIONS: The evaluation of the doctoral-level implementation science course provided by Linkoping University showed favourable results, both in the short and long term. The adapted version of the Kirkpatrick model was useful because it provided a structure for evaluation of the short- and long-term learning outcomes.

To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. BACKGROUND: We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. DEVELOPING THE FRAMEWORK: Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. FINDINGS: All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. DISCUSSION: This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.

Normalization Process Theory (NPT) identifies, characterises and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT’s contribution to understanding the dynamics of these processes.

In recent years there has been a rapid proliferation of standards of evidence and other frameworks which aim to tell us what is and isn’t working. Following in-depth consultation with the organisations who use them, Ruth Puttick has mapped and compared the 18 Standards of Evidence currently in use across UK social policy.

This grounded theory study examined how the certified nursing assistant (CNA) understands and responds to bullying in the workplace. Constant comparative analysis was used to analyze data from in-depth telephone interviews with CNAs ( N = 22) who experienced bullying while employed in a nursing home. The result of the analysis is a multistep model describing CNA perceptions of how, over time, they recognized and responded to the “toxic” work environment. The strategies used in responding to the “toxic” environment affected their care provision and were attributed to the development of several resident and worker safety outcomes. The data suggest that the etiology of abuse and neglect in nursing homes may be better explained by institutional cultures rather than individual traits of CNAs. Findings highlight the relationship between worker and patient safety, and suggest worker safety outcomes may be an indicator of quality in nursing homes.

The current study describes aged care workers’ interpretation of the concept of person-centred care; and identifies the barriers that exist to impede its practice, and the facilitators that encourage person-centred care practice. Data were collected from interviews with aged care workers from two residential aged care facilities providing both high and low care for residents with and without physical and psychological issues based in Australia. Data were analysed to identify and explore categories of meaning for barriers and facilitators. Analysis is grounded in Brooker’s VIPS framework for person-centred dementia care which is utilised as a comparative tool for analysing participants’ understanding of person-centred care. Findings revealed that aged care workers have a reasonable but incomplete understanding of person-centred care. Insufficient time and residents’ dementia behaviours acted as barriers to care workers’ provision of person-centred care. Teamwork was found to facilitate person-centred care by increasing instrumental and relationship resources.

Optimising quality of life and reducing hospitalisation for people living in residential aged care facilities (RACF) are important health policy goals. METHODS: A cluster controlled clinical trial of nurse practitioner care in RACF. Six facilities were included: three randomly allocated to intervention where nurse practitioners working with general practitioners and using a best practice guide were responsible for care, and three control. Participants were followed up for a minimum of 12 months unless dead or transferred to another facility. RESULTS: We enrolled two hundred patients (101 intervention and 99 control) with a mean (SD) follow up of 604 (276) days. There were 98 ED visits by intervention participants, resulting in 56 hospitalisations, compared with 121 ED visits and 70 hospitalisations for controls (risk reduction=8%, 95% CI=-1% -17%, p=0.10). For the pre-specified secondary outcomes of transfers within the first 12 months of enrolment, the number of residents making at least one visit (46 in each study arm) and rate of ED attendance (0.66 visits per intervention resident versus 0.70 visits per control resident) was not affected by the intervention. After adjusting for dependency and comorbidity, the intervention group had non-significantly lower transfers (OR 0.7, 95% CI 0.3-1.5, p=0.34). There was a reduction in the rate of decline in the quality of life of intervention compared to control residents. CONCLUSIONS: Nurse practitioner care coordination resulted in no statistically significant change in rates of ED transfer or health care utilisation, but better maintained resident quality of life.

Long-term care networks may soon buckle under the weight of overwhelming demand. We present two dynamic, large-scale mixed-integer programs for long-term care network design that execute jointly strategic and tactical facility location, modular capacity acquisition, and patient-assignment decisions. The first model is an adaptive network-design model whose focus is more strategic in nature, whereas the second model focuses exclusively on the expansion of an existing long-term care network and incorporates additional tactical decisions such as patient backlogs. Working directly with the president of the Order of Quebec Nurses-the provincial organization representing over 75,000 nurses-we incorporate facets such as assignment permanence, as well as develop and measure patient-centric quality-of-life proxies such as geographic mis-assignment and un-assigned patients, the latter of which is quantified via parametric optimization. Various network-design and patient-assignment policies are explored. We conclude that the use of home care as an alternative to long-term care facilities is cost prohibitive under specific conditions. Employing a bisection algorithm, we identify the implicit cost placed on keeping medically stable elderly patients in a hospital ward, concluding no cost savings are generated from such a policy. The model is analyzed and validated using empirical data from the long-term care network in Montreal, Canada.

To determine the views of care home (CH) staff in relation to experiencing and managing behaviour that challenges (BtC) in dementia and their experiences of training. METHOD: Cross-sectional survey using a self-report questionnaire, distributed to staff employed in a 20% sample of all registered dementia-specialist CHs in England, either by postal or direct distribution. RESULTS: Questionnaires were returned from 352 care staff (25%), representing 5% of all dementia-specialist CHs, half were CH without nursing. Respondents estimated caring for 14,585 residents, 9,361 with dementia and 5,258 with BtC. 30.2% of residents with dementia were estimated as being prescribed a medicine to control BtC. BtC reported as experienced by most respondents were: shouting (96.6%), verbal aggression (96.3%) and physical aggression (95.7%), with physical aggression viewed as most difficult to manage. Top behaviours experienced every shift were: wandering (77.8%), perseveration (68.2%) and restlessness (68.2%). Approaches such as assessing residents, knowing them and treating them as individuals, identifying triggers, having time for them and using an appropriate style of communication, were viewed as key to managing BtC, rather than guideline-specific interventions such as massage, aromatherapy and animal-assisted therapy. Only 38% agreed/strongly agreed medicines were useful to control BtC, which was related to the extent to which they were prescribed. Training was available, but variable in quality with on-line training being least useful and on-the job training most desirable. CONCLUSION: BtC are commonly and frequently experienced by care staff, who consider individual approaches, having time and good communication are key to successful management.

With increased responsibility for follow-up of patients in long-term care, the importance of accurate observations are reinforced. Here, health care professionals experience with the use of structured observations guides are studied. The results are based on five focus group interviews. The health care professionals states that the tools gives them confidence in their care delivery, it’s structures their actions and enhance communication. However, the implementing require competence, training and focus over time.

The protective, custodial, task-oriented care provided in residential aged care facilitates decreases health and wellbeing of residents. The aim of the study was to conduct a feasibility study of LifeFul – a 12 month reablement program in residential aged care. METHODS: LifeFul was developed based on systematic reviews of reablement and staff behaviour change in residential aged care, and in consultation with aged care providers, consumers and clinicians. LifeFul includes: engaging and supporting facility leaders to facilitate organisational change, procedural changes including dedicated rostering, assigning each resident a ‘focus’ carer and focusing on the psychosocial care of residents part of handovers and staff training. The study was conducted in three Australian residential aged care facilities. A pre-post mixed methods design was used to evaluate recruitment and retention, fidelity and adherence, acceptability, enablers and barriers and suitability of outcome measures for the program. RESULTS: Eighty of 146 residents agreed to participate at baseline and 69 of these were followed up at 12 months. One hundred and four of 157 staff participated at baseline and 85 of 123 who were still working at the facilities participated at 12 months. Staff perceived the program to be acceptable, barriers included having insufficient time, having insufficient staff, negative attitudes, misunderstanding new procedures, and lack of sufficient leadership support. Quantitative data were promising in regards to residents’ depression symptoms, functioning and social care related quality of life. CONCLUSION: It is feasible to deliver and evaluate LifeFul. The program could be improved through increased leadership training and support, and by focusing efforts on residents having a ‘best week’ rather than on completing a document each handover. TRIAL REGISTRATION: Registered prospectively on 22nd January 2016 on ANZCTR369802 .

Clinical dashboards that display targets compared to performance metrics are increasingly used by healthcare organizations in their quality improvement efforts. However, few studies have evaluated the extent to which healthcare professionals can readily understand and interpret these data. This study explored associations between measures of graph literacy and numeracy in home care nurses from two agencies (N=195) with comprehension of quality targets presented in a graphical dashboard format. Data were collected using an online survey. Results from linear regression models indicated that nurses’ levels of graph literacy and numeracy were positively associated with comprehension of quality targets. Nurses with low levels of both graph literacy and numeracy tended to have the lowest target comprehension scores compared to those who had high levels of both graph literacy and numeracy. Nurses with low graph literacy and high numeracy also had significantly lower scores for comprehension of quality targets compared to those with high graph literacy and numeracy. These findings suggest that developers of clinical dashboards that incorporate quality target information need to evaluate users’ ability to understand the information displayed in graphs and tables before they release the product for general use in healthcare settings.

The 2011 Productivity Commission report, Caring for Older Australians, observed that as the number of older Australians rises and the demand for aged care services increases, there will be a commensurate increase in demand for a well-trained aged care workforce. One of the significant issues impacting upon the ability of the aged services sector to respond to a growing number of older adults is to attract and retain sufficient numbers of staff. A number of factors are acknowledged to contribute to a failure of the aged care sector to attract and retain workers including: poor sector reputation, poor working conditions, including high client-staff ratios, a lack of career paths and professional development opportunities and low rates of remuneration. Poor perceptions about working in the aged care sector (e.g. that aged care nursing is less glamorous than nursing in the acute care sector) appear to develop early, with many nursing students indicating that they do not view aged care as an attractive career choice. Undergraduate nursing students have often found clinical placements in aged care unsatisfactory and unsettling, dissuading them from considering aged care as an employment option on graduation. In the following we describe one way we have attempted to address this issue by training undergraduate health sciences students (occupational therapy, nursing) to deliver a physical activity program to residents of an aged care facility using a novel telerehabilitation technology that enables remote prescription and monitoring of exercise programs. The main purpose of this quality assurance trial was to explore the feasibility and safety of supervised use of a novel telerehabilitation exercise system with older adults living in residential aged care. Four residents were recruited into the study and all displayed limitations in mobility, balance, strength and endurance. None had any had previous experience with computer games or interactive technologies. Resident diagnoses included multiple chronic health conditions and mild cognitive impairment. Over the six-week period, only one session was declined by a resident, providing an overall adherence rate of 98.5%. According to the resident’s scores of perceived level of enjoyment, at the end of the first week the program was rated as always enjoyable by 75% of the residents. At the conclusion of the program, 100% responded as always enjoying the exercises and activities. Active sitting and standing time for residents across the program increased markedly. A novel finding from our study is that senior undergraduate students are capable of designing and delivering telerehabilitation programs to residents in aged care facilities. Whilst attention has been given to telesimulation in undergraduate preparation (where learners are off site and connected to simulated laboratory), our trial opens opportunities for a further paradigm shift towards teleplacement.

Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size. PURPOSE: The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality. METHODS: A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance. FINDINGS: The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance. DISCUSSION: The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed. PRACTICE IMPLICATIONS: The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.

Nursing home (NH) quality improvement (QI) is challenging. The critical role of NH leaders in successful QI is well established; however, current options for assessing the QI capabilities of leaders such as the licensed NH administrator are limited. PURPOSE: This article presents the development and preliminary validation of an instrument to measure NH administrator self-efficacy in QI. METHODOLOGY/APPROACH: We used a mixed-methods cross-sectional design to develop and test the measure. For item generation, 39 NH leaders participated in qualitative interviews. Item reduction and content validity were established with a sample of eight subject matter experts. A random sample of 211 administrators from NHs with the lowest and highest Centers for Medicare and Medicaid Services Five-Star Quality ratings completed the measure. We conducted exploratory and confirmatory factor analyses and tested the measure for internal reliability and convergent, discriminant, and known group validity. FINDINGS: The final measure included five subscales and 32 items. Confirmatory factor analysis reaffirmed the factorial structure with good fit indices. The new measure’s subscales correlated with valid measures of self-efficacy and locus of control, supporting the measure’s convergent and discriminant validity. Significant differences in most of the subscales were found between the objective (Centers for Medicare and Medicaid Services Five-Star Quality rating) and subjective (Self-Rated Facility QI Index) quality outcomes, supporting the measure’s known group validity. PRACTICE IMPLICATIONS: The instrument has usefulness to both NH organizations and individual NH administrators as a diagnostic tool to identify administrators with higher/lower chances of successfully implementing QI. Organizations and individuals can use this diagnostic to identify the administrator’s professional development needs for QI, in general, and specific to the instrument’s five subscales, informing directions for in-house training, mentoring, and outside professional development. Attending to NH administrators’ QI professional development needs prior to implementing QI holds promise to enhance the chances for successful implementation of QI, which is urgently needed in many NHs.

Extant literature suggested that positive organizational climate leads to higher levels of organizational commitment, which is an important concept in terms of employee attitudes, likewise, the concept of perceived organizational performance, which can be assumed as a mirror of the actual performance. For healthcare settings, these are important matters to consider due to the fact that the service is delivered thoroughly by healthcare workers to the patients. Therefore, attitudes and perceptions of the employees can influence how they deliver the service. The aim of this study was to evaluate healthcare employees’ perceptions of organizational climate and test the hypothesized impact of organizational climate on organizational commitment and perceived organizational performance. METHODS: The study adopted a quantitative approach, by collecting data from the healthcare workers currently employed in public hospitals in North Cyprus, utilizing a self-administered questionnaire. Collected data was analyzed with the help of Statistical Package for Social Sciences, and ANOVA and Linear Regression analyses were used to test the hypothesis. RESULTS: Results revealed that organizational climate is highly correlated with organizational commitment and perceived organizational performance. Simple linear regression outcomes indicated that organizational climate is significant in predicting organizational commitment and perceived organizational performance. CONCLUSIONS: There was a positive and linear relationship between organizational climate with organizational commitment and perceived organizational performance. Results from the regression analysis suggested that organizational climate has an impact on predicting organizational commitment and perceived organizational performance of the employees in public hospitals of North Cyprus. Organizational climate was found to be statistically significant in determining the organizational commitment of the employees. The results of the study provided some critical issues regarding the relationship of three concepts in the study. According to the findings, if the organizational climate scores of the employees are high, organizational commitment scores of the employees are high at the same time. In other words, if the employees in public hospitals of North Cyprus perceive the organizational climate in a positive way, they will have higher levels of organizational commitment. Findings suggested that organizational climate is an important factor in healthcare settings in terms of employee commitment and how employees perceive organizational performance, which would lead to significant results about the provision of service in healthcare organizations.

This paper provides a unique perspective on knowledge ecosystems by studying their organization. Grounded in empirical evidence, we propose that knowledge ecosystems consist of users and producers of knowledge that are organized around a joint knowledge search. A distinction is drawn between knowledge ecosystems searching for a knowledge domain and those searching within an identified knowledge domain, respectively characterized as prefigurative and partial forms of organizing. In a knowledge ecosystem organized in prefigurative form (to identify a knowledge domain), actors whose participation is affiliated, self-resourced, and unobliged probe that domain to identify and establish shared knowledge as a basis for collective actorhood, with no formal rules or coordination mechanisms. In a knowledge ecosystem organized in partial form (where a knowledge domain has already been identified), actors search and reveal problem- and solution-related knowledge, participating though formal membership and access to resources, and their contributions are monitored. The present study contributes to the literature by 1) specifying the distinct types of joint search performed by knowledge ecosystems; 2) considering how the nature of joint search affects how knowledge ecosystems are organized; and 3) distinguishing two forms of organizing knowledge ecosystems, with a focus on participation and coordination.

Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers’ experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services. METHODS: Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis. RESULTS: Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or ‘student researchers’ were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner’s and researcher’s contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management. CONCLUSIONS: Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research.

The fields of implementation and improvement sciences have experienced rapid growth in recent years. However, research that seeks to inform health care change may have difficulty translating core components of implementation and improvement sciences within the traditional paradigms used to evaluate efficacy and effectiveness research. A review of implementation and improvement sciences grant proposals within an academic medical center using a traditional National Institutes of Health framework highlighted the need for tools that could assist investigators and reviewers in describing and evaluating proposed implementation and improvement sciences research. METHODS: We operationalized existing recommendations for writing implementation science proposals as the ImplemeNtation and Improvement Science Proposals Evaluation CriTeria (INSPECT) scoring system. The resulting system was applied to pilot grants submitted to a call for implementation and improvement science proposals at an academic medical center. We evaluated the reliability of the INSPECT system using Krippendorff’s alpha coefficients and explored the utility of the INSPECT system to characterize common deficiencies in implementation research proposals. RESULTS: We scored 30 research proposals using the INSPECT system. Proposals received a median cumulative score of 7 out of a possible score of 30. Across individual elements of INSPECT, proposals scored highest for criteria rating evidence of a care or quality gap. Proposals generally performed poorly on all other criteria. Most proposals received scores of 0 for criteria identifying an evidence-based practice or treatment (50%), conceptual model and theoretical justification (70%), setting’s readiness to adopt new services/treatment/programs (54%), implementation strategy/process (67%), and measurement and analysis (70%). Inter-coder reliability testing showed excellent reliability (Krippendorff’s alpha coefficient 0.88) for the application of the scoring system overall and demonstrated reliability scores ranging from 0.77 to 0.99 for individual elements. CONCLUSIONS: The INSPECT scoring system presents a new scoring criteria with a high degree of inter-rater reliability and utility for evaluating the quality of implementation and improvement sciences grant proposals.

The concept of knowledge co-production is used in health services research to describe partnerships (which can involve researchers, practitioners, managers, commissioners or service users) with the purpose of creating, sharing and negotiating different knowledge types used to make improvements in health services. Several knowledge co-production models have been proposed to date, some involving intermediary roles. This paper explores one such model, researchers-in-residence (also known as ’embedded researchers’).In this model, researchers work inside healthcare organisations, operating as staff members while also maintaining an affiliation with academic institutions. As part of the local team, researchers negotiate the meaning and use of research-based knowledge to co-produce knowledge, which is sensitive to the local context. Even though this model is spreading and appears to have potential for using co-produced knowledge to make changes in practice, a number of challenges with its use are emerging. These include challenges experienced by the researchers in embedding themselves within the practice environment, preserving a clear focus within their host organisations and maintaining academic professional identity.In this paper, we provide an exploration of these challenges by examining three independent case studies implemented in the UK, each of which attempted to co-produce relevant research projects to improve the quality of care. We explore how these played out in practice and the strategies used by the researchers-in-residence to address them. In describing and analysing these strategies, we hope that participatory approaches to knowledge co-production can be used more effectively in the future.

People with dementia may benefit from the effect of physical activity on behavioural and psychological symptoms of dementia. Qualitative synthesis of the importance of physical activity might complement and help clarify quantitative findings on this topic. The purpose of this systematic mixed studies review was to evaluate findings from both quantitative and qualitative methods about the effect and importance of physical activity on behavioural and psychological symptoms of dementia in people with dementia. Methods The systematic literature search was conducted in EMBASE, CINAHL, PubMed, PEDro and PsycINFO. Inclusion criteria were: people with a light to moderate degree of dementia, interventions including physical activity and outcomes focusing on behavioural and psychological symptoms of dementia or quality of life. To assess the methodological quality of the studies, the AMSTAR and GRADE checklists were applied for the quantitative studies and the CASP qualitative checklist for the qualitative studies. Results A small reduction in depression level and improved mood were seen in some quantitative studies of multi-component physical activity interventions, including walking. Due to high heterogeneity in the quantitative studies, a single summary of the effect of physical activity on behavioural and psychological symptoms of dementia should be interpreted with some caution. Across the qualitative studies, the common themes about the importance of physical activity were its ‘socially rewarding’ nature, the ‘benefits of walking outdoors’ and its contribution to ‘maintaining self-hood’. Conclusion For people with dementia, there was a small, quantitative effect of multi-component physical activity including walking, on depression level and mood. People with dementia reported the importance of walking outdoors, experiencing the social rewards of physical activity in groups, as well as physical activity were a means toward maintaining self-hood.

Frail nursing home residents face multiple health challenges as a result of their frail status. The aim of this study was to examine the effects of HT on the psychosocial well-being of frail and prefrail nursing home residents. DESIGN: Randomized controlled trial. SETTING: Nursing homes. PARTICIPANTS: One hundred eleven participants were randomly allocated into the intervention [horticultural therapy (HT)] and control (social activities) conditions. INTERVENTION: HT group participants attended a weekly 60-minute session for 8 consecutive weeks. Control group activities were social in nature, without any horticulture components. MEASUREMENTS: The outcome measures include happiness, depressive symptoms, self-efficacy, well-being, social network, and social engagement. The time points of measurement were at baseline (T0), immediately postintervention (T1), and 12 weeks postintervention (T2). A modified intention-to-treat approach was adopted. A multivariate general estimating equation was used to analyze the data. RESULTS: Forty-six and 50 participants received at least 1 session of the intervention and control condition protocol, respectively. A significant interaction effect between group and time was observed only on the happiness scale (beta = 1.457, P = .036), but not on other outcome variables. In a follow-up cluster analysis of those who received HT, a greater effect on subjective happiness (mean difference = 6.23, P < .001) was observed for participants who were happier at baseline. CONCLUSION: HT was found to be effective in promoting subjective happiness for frail and prefrail nursing home residents. Its favorable effect suggests that HT should be used to promote the psychosocial well-being of those who are frail.

To identify and synthesise qualitative research from 2001 investigating older people’s (65+ years) experiences of dying in nursing and care homes. METHODS AND OUTCOMES: Eight electronic databases (AMED, ASSIA, CINAHL Plus, Embase, HMIC, Medline, PsychINFO and Scopus) from 2001 to July 2017 were searched. Studies were included if they were qualitative, primary research and described the experiences of dying in nursing or care homes from the perspectives of the older people themselves, their families or staff. Study quality assessment was undertaken to systematically assess methodological quality, but no studies were excluded as a result. RESULTS: 1305 articles were identified. Nine met the inclusion criteria. North American studies dominated. Most used a mixture of observations and interviews. All the included studies highlighted the physical discomfort of dying, with many older people experiencing potentially avoidable symptoms if care were to be improved. Negative psychosocial experiences such as loneliness and depression were also often described in addition to limited support with spiritual needs. CONCLUSIONS: More qualitative research giving a holistic understanding of older people’s experiences of dying in residential care homes is needed. Undertaking research on this topic is challenging and requires great sensitivity, but the dearth of qualitative research from the perspectives of those most closely involved in older people’s deaths hampers service improvement.

Immigrant older adults are increasingly moving into long term residential care (LTRC) homes; however, most were designed and continue to be run in accordance with Anglocentric norms and values. Participation and interest in Family Councils-through which they might collectively voice concerns-was low within our purposive sample of nine Chinese-origin residents living in LTRC homes and 11 family carers. Our study, conducted in two LTRC homes in British Columbia, Canada between January and March 2016, further explored participants’ perceptions of quality of care by staff and quality of life of residents. Our findings negate participants’ rationale that they do not attend because they have no issues to raise. Solutions must recognize that carers’ time is precious and care-work is gendered; language incongruity and failure to address it marginalizes residents and their family members. A culturally informed reticence to speak out is reinforced when attempts to do so are silenced.

This study aimed to identify risk factors in medication management in Australian residential aged care (RAC) homes. Only 18 out of 3,607 RAC homes failed aged care accreditation standard in medication management between 7th March 2011 and 25th March 2015. Text data mining methods were used to analyse the reasons for failure. This led to the identification of 21 risk indicators for an RAC home to fail in medication management. These indicators were further grouped into ten themes. They are overall medication management, medication assessment, ordering, dispensing, storage, stock and disposal, administration, incident report, monitoring, staff and resident satisfaction. The top three risk factors are: “ineffective monitoring process” (18 homes), “noncompliance with professional standards and guidelines” (15 homes), and “resident dissatisfaction with overall medication management” (10 homes).

The management of pain in long-term care (LTC) residents with dementia is complex. A prospective exploratory study was conducted to describe the course of pain and pain management strategies following a guideline-based pain assessment procedure in LTC residents with pain and dementia. MEASURES: Pain observations with the Mobilization Observation Behaviour Intensity Dementia (MOBID-2) Pain Scale, a review of the electronic patient file and pharmacy files and physical examination of LTC residents with pain and dementia. INTERVENTION: Communication of the assessment results to the attending physician including guideline-based treatment recommendations. OUTCOMES: After three months, complete follow-up data were obtained for 64 residents. Pain intensity was significantly reduced (P < 0.001). The proportion of residents with persistent pain was 58% and the total number of analgesic prescriptions did not change significantly. CONCLUSIONS: There is room for improvement regarding pain management in LTC residents with pain and dementia, and performance feedback seems a promising strategy to explore further.

Multisensory environments (MSEs) for people with dementia have been available over 20 years but are used in an ad hoc manner using an eclectic range of equipment. Care homes have endeavored to utilize this approach but have struggled to find a design and approach that works for this setting. AIMS: Study aims were to appraise the evolving concept of MSEs from a user perspective, to study the aesthetic and functional qualities, to identify barriers to staff engagement with a sensory environment approach, and to identify design criteria to improve the potential of MSE for people with dementia. METHODS: Data were collected from 16 care homes with experience of MSE using ethnographic methods, incorporating semi-structured interviews, and observations of MSE design. Analysis was undertaken using descriptive statistics and thematic analysis. RESULTS: Observations revealed equipment that predominantly stimulated vision and touch. Thematic analysis of the semi-structured interviews revealed six themes: not knowing what to do in the room, good for people in the later stages of the disease, reduces anxiety, it’s a good activity, design and setting up of the space, and including relatives and care staff. CONCLUSION: Few MSEs in care homes are designed to meet needs of people with dementia, and staff receive little training in how to facilitate sessions. As such, MSEs are often underused despite perceived benefits. Results of this study have been used to identify the design principles that have been reviewed by relevant stakeholders.

To describe the relationship between nursing facility resident risk conditions and signs and symptoms at time of acute transfer and diagnosis of conditions associated with potentially avoidable acute transfers (pneumonia, urinary tract infection, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or asthma, dehydration, pressure sores). DESIGN: As part of a demonstration project to reduce potentially avoidable hospital transfers, Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project clinical staff collected data on residents who transferred to the emergency department (ED) or hospital. Cross-tabulations were used to identify associations between risk conditions or symptoms and hospital diagnoses or death. Mixed-effects logistic regression models were used to describe the significance of risk conditions, signs, or symptoms as predictors of potentially avoidable hospital diagnoses or death. SETTING: Indiana nursing facilities (N=19). PARTICIPANTS: Long-stay nursing facility residents (N=1,174), who experienced 1,931 acute transfers from November 2014 to July 2016. MEASUREMENTS: Participant symptoms, transfers, risk factors, and hospital diagnoses. RESULTS: We found that 44% of acute transfers were associated with 1 of 6 potentially avoidable diagnoses. Symptoms before transfer did not discriminate well among hospital diagnoses. Symptoms mapped into multiple diagnoses and most hospital diagnoses had multiple associated symptoms. For example, more than two-thirds of acute transfers of residents with a history of CHF and COPD were for reasons other than exacerbations of those two conditions. CONCLUSION: Although it is widely recognized that many transfers of nursing facility residents are potentially avoidable, determining “avoidability” at time of transfer is complex. Symptoms and risk conditions were only weakly predictive of hospital diagnoses.

To revise the Minimum Data Set (MDS) Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scale, an MDS 2.0-based measure widely used to predict mortality in institutional settings, in response to the release of MDS 3.0. DESIGN: Development of a predictive scale using observational data from the MDS and Medicare Master Beneficiary Summary File. SETTING: All Centers for Medicare and Medicaid Services (CMS)-certified nursing homes in the United States. PARTICIPANTS: Development cohort of 1.3 million Medicare beneficiaries newly admitted to a CMS-certified nursing home during 2012. Primary validation cohort of 1.2 million Medicare recipients who were newly admitted to a CMS-certified nursing home during 2013. MEASUREMENTS: Items from the MDS 3.0 assessments identified as likely to predict mortality. Death information was obtained from the Medicare Master Beneficiary Summary File. RESULTS: MDS-CHESS 3.0 scores ranges from 0 (most stable) to 5 (least stable). Ninety-two percent of the primary validation sample with a CHESS scale score of 5 and 15% with a CHESS scale of 0 died within 1 year. The risk of dying was 1.63 times as great (95% CI=1.628-1.638) for each unit increase in CHESS scale score. The MDS-CHESS 3.0 is also strongly related to hospitalization within 30 days and successful discharge to the community. The scale predicted death in long-stay residents at 30 days (C=0.759, 95% confidence interval (CI)=0.756-0.761), 60 days (C=0.716, 95% CI=0.714-0.718) and 1 year (C=0.655, 95% CI=0.654-0.657). CONCLUSION: The MDS-CHESS 3.0 predicts mortality in newly admitted and long-stay nursing home populations. The additional relationship to hospitalizations and successful discharges to community increases the utility of this scale as a potential risk adjustment tool.

To test the association between polypharmacy and 1-year change in physical and cognitive function among nursing home (NH) residents. DESIGN: Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. SETTING: NH in Europe (n = 50) and Israel (n = 7). PARTICIPANTS: 3234 NH older residents. MEASUREMENTS: Participants were assessed through the interRAI long-term care facility instrument. Polypharmacy was defined as the concurrent use of 5 to 9 drugs and excessive polypharmacy as the use of >/=10 drugs. Cognitive function was assessed through the Cognitive Performance Scale (CPS). Functional status was evaluated through the Activities of Daily Living (ADL) Hierarchy scale. The change in CPS and ADL score, based on repeated assessments, was the outcome, and their association with polypharmacy was modeled via linear mixed models. The interaction between polypharmacy and time was reported [beta and 95% confidence intervals (95% CIs)]. RESULTS: A total of 1630 (50%) residents presented with polypharmacy and 781 (24%) excessive polypharmacy. After adjusting for potential confounders, residents on polypharmacy (beta 0.10, 95% CI 0.01-0.20) and those on excessive polypharmacy (beta 0.13, 95% CI 0.01-0.24) had a significantly higher decline in CPS score compared to those using .05) significant change according to polypharmacy status was shown for ADL score. CONCLUSIONS: Polypharmacy is highly prevalent among older NH residents and, over 1 year, it is associated with worsening cognitive function but not functional decline.

This report from Alzheimers Society is based on qualitative research from five listening events with people affected by dementia, social care professionals and dementia lead nurses in Winchester, Newcastle, Birmingham, Cardiff and Belfast. In total, evidence and testimony was gathered from over 70 people to get an in-depth understanding of the challenges they face day-in and day-out to get the care they need.

This conference is for practitioners, care providers, scientists, clinicians, policy makers and experts in the field of frailty. Together we will present and discuss, the latest knowledge, evidence, approaches and policies that are transforming care and seeding the next generation of breakthrough innovations.

The theme of the 2018 Online Knowledge Translation (KT) Conference is “Engaging Ways to Engage Stakeholders,” and presenters will emphasize the importance of incorporating stakeholder participation into project planning and implementation. Stakeholder engagement throughout research and development processes generally aims to increase topic and product relevance; improve procedures, subject recruitment in particular; and inform how findings are interpreted, embedded in dissemination and technology products and applied in practice and policy (Bowen et al., 2017; Cottrell et al., 2014). As conference presenters will discuss, a systematic outreach to stakeholders is essential to achieving these targeted, measurable, and sustained impacts to research and development activities

The ability to store, provide access, and reuse publicly funded research data has become critical to scientific innovation, and key to successful grant proposals. This one-hour webinar will introduce you to research data management concepts and tri-agency standards, as well as the Portage Network which is dedicated to the shared stewardship of research data in Canada and promotion of national research data services and infrastructure.

In Cochrane, qualitative evidence syntheses must be linked with a named intervention effect review and are undertaken to explore specific phenomena of interest, such as: complexity, heterogeneity; variation in outcomes; implementation, feasibility, acceptability etc.

Digital health uses modern information and communication technologies, such as mobile phones or tablets, for health services. These tools can also be used at the same time for KT and dissemination. This presentation explores principles and practice of technology-enabled KT: opportunities, challenges and interesting paths for exploration.

This podcasts feature people with dementia and their care/life partners sharing experiences that may enable their peer listeners to understand and gain insight and strengthen their adaptive skills. Care providers understand this lived experience more fully and the public becomes more aware of what it means to live well with dementia.

UBC is searching for a seasoned knowledge mobilization leader to become the Associate Director, Knowledge Exchange. Motivated by the opportunity to support the University’s commitment to increase the societal impact of our research, this leadership role will lead and champion the development of the UBC Knowledge Exchange unit by working with a network which includes administrative units, faculty members, staff and students and key external stakeholders.