January 21, 2019

Professor Jo Rycroft-Malone will take up the post of Dean on 1 July 2019.

This panel of 6 experts was assembled at the request of Public Health Agency of Canada. Canada’s aging population and the increasing prevalence of Alzheimer’s disease and other dementias pose a significant challenge for Canadian families and their caregivers, and more broadly, for the health care system. Recognizing the importance of developing and implementing an effective strategy to address this challenge, the Minister of Health of Canada, through the Public Health Agency of Canada, asked the Canadian Academy of Health Sciences (CAHS) to provide an evidence-informed and authoritative assessment on the state of knowledge to help advance federal priorities under the National Strategy for Alzheimer’s Disease and Other Dementias Act. To address the charge, the CAHS assembled a multidisciplinary, multi-sectoral panel of six experts with a range of expertise, experience, and demonstrated leadership in this domain.

Overviews of reviews (overviews) compile information from multiple systematic reviews (SRs) to provide a single synthesis of relevant evidence for decision-making. Overviews may identify multiple SRs that examine the same intervention for the same condition and include some, but not all, of the same primary studies. There is currently limited guidance on whether and how to include these overlapping SRs in overviews. Our objectives were to assess how different inclusion decisions in overviews of healthcare interventions affect their comprehensiveness and results, and document challenges encountered when making different inclusion decisions in overviews. METHODS: We used five inclusion decisions to conduct overviews across seven topic areas, resulting in 35 overviews. The inclusion decisions were (1) include all Cochrane and non-Cochrane SRs, (2) include only Cochrane SRs, or consider all Cochrane and non-Cochrane SRs but include only non-overlapping SRs, and in the case of overlapping SRs, select (3) the Cochrane SR, (4) the most recent SR (by publication or search date), or (5) the highest quality SR (assessed using AMSTAR). For each topic area and inclusion scenario, we documented the amount of outcome data lost and changed and the challenges involved. RESULTS: When conducting overviews, including only Cochrane SRs, instead of all SRs, often led to loss/change of outcome data (median 31% of outcomes lost/changed; range 0-100%). Considering all Cochrane and non-Cochrane SRs but including only non-overlapping SRs and selecting the Cochrane SR for groups of overlapping SRs (instead of the most recent or highest quality SRs) allowed the most outcome data to be recaptured (median 42% of lost/changed outcome recaptured; range 28-86%). Across all inclusion scenarios, challenges were encountered when extracting data from overlapping SRs. CONCLUSIONS: Overlapping SRs present a methodological challenge for overview authors. This study demonstrates that different inclusion decisions affect the comprehensiveness and results of overviews in different ways, depending in part on whether Cochrane SRs examine all intervention comparisons relevant to the overview. Study results were used to develop an evidence-based decision tool that provides practical guidance for overview authors.

Clinician research competencies influence research use for evidence-based practice (EBP). We aimed to develop, refine, and psychometrically assess the Research Competencies Assessment Instrument for Nurses (RCAIN) to measure registered nurse research competencies (i.e., knowledge, skills, attitudes) focused on EBP-related domains: research process, knowledge synthesis, and knowledge translation activities. METHODS: The preliminary psychometrics (face, content, construct/criterion validity) were evaluated based on 63 completed surveys. RESULTS: The Cronbach’s alpha coefficients were .871, .813, and .946 for each domain, respectively; interitem correlations ranged from .472 to .833 (explained variance: 68.5%). Three components/factors revealed: comprehension of and skills required in research process and application of knowledge and skills. The revised RCAIN consists of 19 five-point Likert-type questions. CONCLUSIONS: The RCAIN assesses modifiable characteristics and explains variance in practice, health system, and patient outcomes. Further assessments are underway.

We’re working together to explore, evaluate and share the Impact & Opportunities of patient-oriented research. Join us for:
-an outstanding line-up of engaging speakers
-workshops on patient-oriented research topics
-networking opportunities with colleagues
-capacity building opportunities for patient-oriented research

The Health System Impact (HSI) Fellowship (for doctoral trainees and post-doctoral fellows) provides highly-qualified doctoral trainees and post-doctoral fellows studying health services and policy research (HSPR), or related fields, a unique opportunity to apply their research and analytic talents to critical challenges in health care that are being addressed by health system and related organizations (e.g., public, private for-profit, not-for-profit, and Indigenous health organizations that are not universities) outside of the traditional scholarly setting, and to also develop professional experience, new skills, and networks.

This unique, interactive training program will run from May 26 to 31, 2019 and will be held at the Estérel Resort in the Laurentian Mountains, 100 km from Montreal. Graduate students and post-doctoral fellows working in, or interested in learning about, research related to the area of Geroscience are encouraged to apply.

Trainees will have the opportunity to participate in advanced training that crosses disciplines and brings together trainees, researchers, and members of the public and private sector from Canada and abroad. The program will feature internationally renowned guest speakers, and networking opportunities will be offered throughout the week.

A system of dementia-specific case conferences (WELCOME-IdA) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia. A process evaluation of the context, the recruitment and target populations reached (residents and nursing staff) and the delivery of the intervention and implementation strategy was carried out to explore the lack of effectiveness of WELCOME-IdA on the residents’ prevalence of BPSD. METHODS: This study was part of a larger process evaluation using a mixed-methods design. Standardised questionnaires, semi-structured interviews, attendance lists, standardised protocols and written self-reports were used to collect the data. The quantitative data were analysed by calculating descriptive statistics. The qualitative interviews were analysed using deductive content analysis and the self-reports were analysed using a documentary analysis. RESULTS: None of the NHs had prior experience with dementia-specific case conferences on a specific concept related to BPSD. The number of residents for whom a dementia-specific case conference was held was lower than expected. The number of nursing staff reached was high, although as defined in the study protocol, core nursing teams continuously participating in all components of the intervention were not established throughout the study. An analysis of the delivery of the intervention showed a reduction in the frequency of dementia-specific case conferences and deviations in the process structure and role structure of WELCOME-IdA. The strategy used to facilitate the implementation of WELCOME-IdA was mostly followed. An analysis of the recruitment of residents indicated that the variation in which residents were included in the study sample was high and that the intended sample size required to achieve a power >80% was not reached. CONCLUSION: An analysis of the process evaluation data indicated that there were inaccuracies in the implementation of WELCOME-IdA and there were methodological limitations within the design of the effectiveness trial, both of which could explain the lack of effectiveness of WELCOME-IdA. To optimise the process structure of WELCOME-IdA, an assessment of BPSD and a pre-selection of possible domains for the behavioural analysis could be conducted prior to a dementia-specific case conference. TRIAL REGISTRATION: ISRCTN20203855 . Registered on 10 July 2013.

Evidence-based practice (EBP) is both a goal and an approach that requires a combination of clinical experience with the most credible recent research evidence when making decisions in healthcare practice. The approach has been widely embraced; however, an evidence-to-practice gap still exists. AIM: To assess barriers to EBP among nurses in low- and middle-income countries. METHODS: This review conforms to the PRISMA statement. Databases PubMed, Scopus, EMBASE, and Web of Science/Knowledge were searched using a combination of keywords that included “barriers,” “evidence-based practice,” and “nurses.” The references of the selected articles were also hand-searched to obtain additional relevant articles. Studies published in peer-reviewed journals in English between 2000 and 2018 were included in the review. RESULTS: Sixteen articles were included in the analysis, with a total number of 8,409 participants. Both qualitative and quantitative studies were included in the review. Three main themes emerged from eight categories found. The three main themes were institutional-related barriers, interdisciplinary barriers, and nurse-related barriers. The theme of institutional-related barriers emerged from four categories, which included scant resources, limited access to information, inadequate staffing, and lack of institutional support. The theme of interdisciplinary barriers emerged from subcategories that included lack of communication between academic and clinical practice environments, inconsistency between education and practice in the nursing discipline, lack of teamwork, and the public’s negative image about the nursing profession. Finally, the theme of nurse-related barriers emerged from categories including perceived limitations in the scope of nurses’ practice, time, knowledge of EBP, and individual-related barriers. LINKING EVIDENCE TO ACTION: These findings may guide the design of future interventions aimed at fostering EBP. Implementing EBP in practice should be systematic and requires institutional will and interdisciplinary and individual commitment. It should be a collective goal and a win-win situation for nurses, clinicians, and healthcare organizations.

The public health sector is moving toward adopting evidence-informed decision making into practice, but effort is still required to effectively develop capacity and promote contextual factors that advance and sustain it. This paper describes the impact of an organization-wide knowledge translation intervention delivered by knowledge brokers on evidence-informed decision making knowledge, skills and behaviour. METHODS: A case study design was implemented with the intervention and data collection tailored to the unique needs of each case (health department). A knowledge broker provided training workshops and mentored small groups through a seven step process of evidence-informed decision making. The intervention was delivered over 22 months; data related to evidence-informed decision making knowledge, skills and behaviour were collected at baseline and follow-up. Mixed effects regression models were developed to assess the impact of involvement in the intervention on the evidence-informed decision making outcomes. RESULTS: Data from a total of 606 health department staff were collected during baseline: 207 (33%) staff from Case A, 304 (28%) from Case B, and 95 (47%) from Case C. There were a total of 804 participants at follow-up: 258 (42%) from Case A, 391 from Case B (37%), and 155 (50%) from Case C. Statistically significant increases in knowledge and skills were observed overall, and in all three health departments. An increase in evidence-informed decision making behaviour was observed among those intensively involved in the intervention from all cases (statistically significant in Case A). The organizational characteristics of strategic priority, leadership, readiness, and choice of staff emerged as important factors in the change process. CONCLUSIONS: Knowledge brokering is a promising organizational knowledge translation intervention to support evidence-informed decision making. The intervention appeared to have the greatest impact on those who became actively engaged with the knowledge broker in the intervention. Active participation in face-to-face training activities with a knowledge broker, focused specifically on evidence-informed decision making skill development, led to the greatest impact on associated behaviours, knowledge, and skills. Several organizational factors emerged as integral to success of the knowledge translation intervention.

The quality and cost of care in nursing homes depend critically on the number and types of nurses. Recent research suggests that the nursing supply adjusts to macroeconomic conditions. However, prior work has failed to consider the effect of macroeconomic conditions on demand for nurses through the effect on revenues. We test how county-level unemployment rates affect direct-care staffing rates in nursing homes using California data. We exploit the wide variation in the unemployment rates across counties and over time in 2005-2012. We also test whether there are heterogeneous effects of unemployment rates by facility size, staffing level, and profit status. We find that as unemployment rates increase, staffing by registered nurses (RNs) decreases but staffing by licensed practical nurses (LPNs) increases. The increase in LPNs is larger in large nursing homes, nursing homes with higher staffing levels, and in for-profit nursing homes. We also find that as unemployment rates increase, nursing home revenue decreases. While the effect of macroeconomic conditions on nursing supply may be important for cost and quality of care, the mechanism is not simple, direct, or homogeneous for all types of nurses and nursing homes.

Thousands of individuals with communication disorders live in long-term residential care. Nursing staff are often their primary communication partners. The positive effects of social interaction and person-centred care have been recognised but there remains a paucity of research on the content and quality of communicative interaction between long-term care staff and residents with aphasia. This mixed method study investigates the discourse in interaction between nursing staff and residents with aphasia. Methods: A routine care activity was explored in 26 video-recordings featuring four enrolled nurses and four elderly persons with severe aphasia. Factors such as goals and roles in the activity were mapped out and a qualitative discourse analysis was performed. Based on the findings a coding scheme was constructed and the amount of time spent in different interactional foci of discourse was explored. Results: From the qualitative findings three broad, but distinct, foci in the nurse-initiated interaction could be distinguished: (1) a focus on getting the task done with minimum interaction; (2) topics related to the task, but not necessary to get the task done; and (3) personal topics related to themes beyond the caring task. The analysis of distribution of time revealed that although most of the interaction was focused on the main care activity, between 3 and 17% of the time was spent in either task-related or non task-related interaction. The distribution varied between dyads and could not be related to the residents’ severity of aphasia nor the activity as such. Conclusions: An endeavour to interact socially with the residents with aphasia influences the nurses’ foci of interaction. Contextual and personal factors of the residents and nurses need to be considered in clinical work as well as research on how communication may be supported to facilitate social interaction and person-centredness in long-term care of people with aphasia.

As medicine advances, health needs change and society develops, the NHS has to continually move forward so that in 10 years time we have a service fit for the future. The NHS Long Term Plan is drawn up by frontline staff, patients groups, and national experts to be ambitious but realistic.

Previous literature has reported that loneliness is the strongest predictor of frailty, which is also closely associated with activity engagement. Yet, to date, the path from loneliness to frailty has not been investigated. In this study, we evaluated whether activity engagement mediates the relationship between loneliness and frailty among older adults living in nursing homes. DESIGN: We employed the use of a cross-sectional descriptive survey. SETTING AND PARTICIPANTS: Residents (N = 370; aged >/=60 years; 220 female, 150 male) were from 33 nursing homes in China. MEASURES: Information was collected regarding loneliness, activity engagement, frailty, sociodemographic characteristics, nursing home characteristics, self-rated health, insomnia, and depression. The mediation analyses, comprising regression and bootstrap analyses, were performed to test both direct and indirect effects of loneliness on frailty (ie, the mediating role of activity engagement). RESULTS: The prevalence of frailty was 29.2% among Chinese older adults living in nursing homes. Activity engagement mediated the association between loneliness and frailty [95% confidence interval (CI) = 0.011, 0.070]; however, loneliness was not significantly related to frailty when covarying for activity engagement (95% CI = 0.028, 0.190). CONCLUSION AND IMPLICATIONS: Results suggest that it is not loneliness in general that affects frailty but actively engaging in activities. Therefore, preventing frailty by employing interventions that promote older adults’ activity engagement may improve nursing home residents’ quality of life. The main implication is that activity engagement should be an effective indicator for care planning and quality evaluation in nursing homes.

Depression and self-esteem affects the health and quality of life of older adults who live in nursing homes. This study tested the effectiveness of art therapy activities on reducing the depression and improving the self-esteem of elderly living in long-term care institutes. This was a quasi-experimental study. A purposive sampling strategy was used to select 55 subjects who were aged 65 and above with intact mental functions and depression tendencies and currently residing in nursing homes in Kaohsiung, Taiwan. 29 subjects who participated in a selection of 12 artistic activities were assigned to the experimental group and 26 subjects who adhered to their ordinary activities were allocated to the control group. Structured questionnaires of the artistic group were used for data collection. The art therapy programs showed promising effects in improving the depression and self-esteem of older adults living in nursing homes. Art therapy activities benefit the mental health of older adults. Incorporating artistic activities into social work care may help develop long-term care into a more diverse, unique, and innovative direction.

People with dementia (PwD) frequently use emergency care services. To mitigate the disproportionately high rate of emergency care use by PwD, an understanding of contributing factors driving reliance on emergency care services and identification of feasible alternatives are needed. This study aimed to identify clinician, caregiver, and service providers’ views and experiences of unmet needs leading to emergency care use among community-dwelling PwD and alternative ways of addressing these needs. DESIGN: Qualitative, employing semistructured interviews with clinicians, informal caregivers, and aging service providers. SETTING: Wisconsin, United States. PARTICIPANTS: Informal caregivers of PwD (n = 4), emergency medicine physicians (n = 4), primary care physicians (n = 5), geriatric healthcare providers (n = 5), aging service providers (n = 6), and community paramedics (n = 3). MEASUREMENTS: Demographic characteristics of participants and data from semistructured interviews. FINDINGS: Four major themes were identified from interviews: (1) system fragmentation influences emergency care use by PwD, (2) informational, decision-making, and social support needs influence emergency care use by PwD, (3) emergency departments (EDs) are not designed to optimally address PwD and caregiver needs, and (4) options to prevent and address emergency care needs of PwD. CONCLUSION: Participants identified numerous system and individual-level unmet needs and offered many recommendations to prevent or improve ED use by PwD. These novel findings, aggregating the perspectives of multiple dementia-care stakeholder groups, serve as the first step to developing interventions that prevent the need for emergency care or deliver tailored emergency care services to this vulnerable population through new approaches. J Am Geriatr Soc 00:1-8, 2019.

The attitudes of care staff toward the sexuality of residents with dementia they care for is assumed to influence the residents’ expression of their sexuality in the way they want. This paper examines the effect of organizational factors, person-centered care, and the culture of the organization on the attitudes of care staff toward the sexuality of residents with dementia in residential care facilities (RCF) . METHODS: Care staff in different functions at six RCF organizations (N = 187) participated. Using a survey, we gathered information on demographics and care-staff careers, attitudes toward resident sexuality, the culture of the organization, person-centered care, and knowledge of resident sexuality. Ordinary least square (OLS) hierarchical analyses were performed to analyze results. RESULTS: Care staff attitudes were found to be positively affected by person-centered care, and marginally positively affected by a supportive culture in the organization, Moreover, knowledge of resident sexuality positively affected care staff ‘attitudes toward resident sexuality, and the presence of policy regarding resident sexuality affected them negatively . CONCLUSIONS: Despite different study limitations, these results give a first insight in a broad perspective on care staff attitudes toward resident sexuality. In addition to improving knowledge of the care staff, enhancing person-centered care and a supportive culture in the organization will improve care-staff attitudes toward resident sexuality.

Identifying the objective and subjective aspects of the quality of life (QoL) of institutionalized cognitively impaired older adults (CIOAs) is a challenge. However, it can reveal which aspects of their care require improvement. Aim: The aim of this study was to identify the core aspects of the QoL of CIOAs living in a nursing home (NH) by involving informal and professional caregivers (PCs). Methods: Our sequential, mixed methods study exploring the QoL of CIOAs was based on Lodgson et al’s (2002) quantitative quality of life-Alzheimer’s disease (QoL-AD) questionnaire. Subsequently, a qualitative phase study analyzed perceptions and impressions of QoL using interviews of CIOAs and their most significant informal caregivers (SICs) and PCs. Results: Fifteen CIOAs, 12 SICs, and 2 PCs were recruited. Two-thirds of the older adults were females, overall average age was 86 years (SD=6.1), and all had a severe clinical dementia rating (CDR=3). A high level of comorbidity (measured using the Cumulative Illness Rating Scale for Geriatrics) was significantly associated with a lower QoL-AD score (P=0.046). Higher numbers of visits by SICs or family members had a positive effect on QoL-AD scores (P=0.036). No significant differences were found in overall QoL-AD scores as rated by CIOAs, SICs, and PCs (P=0.080). Combining quantitative and qualitative data analyses revealed four significant themes influencing the QoL of CIOAs: 1) human dignity and acceptance; 2) development and existence; 3) functionality and health; and 4) recognizability and safety. Conclusion: Sequentially using mixed methods proved an appropriate way to examine the QoL of severe CIOAs living in an NH, and these results were compared with the perceptions of informal and PCs. The factors optimizing overall health were visits by SICs and family members, and the major aspect that increases the QoL was freedom of movement inside and outside the NH.

Objective: to investigate the impact of the availability and supply of social care on healthcare utilisation (HCU) by older adults in high income countries. Design: systematic review and meta-analysis. Data sources: medline, EMBASE, Scopus, Health Management Information Consortium, Cochrane Database of Systematic Reviews, NIHR Health Technology Assessment, NHS Economic Evaluation Database, Database of Abstracts of Reviews of Effectiveness, SCIE Online and ASSIA. Searches were carried out October 2016 (updated April 2017 and May 2018). (PROSPERO CRD42016050772). Study selection: observational studies from high income countries, published after 2000 examining the relationship between the availability of social care (support at home or in care homes with or without nursing) and healthcare utilisation by adults >60 years. Studies were quality assessed. Results: twelve studies were included from 11,757 citations; ten were eligible for meta-analysis. Most studies (7/12) were from the UK. All reported analysis of administrative data. Seven studies were rated good in quality, one fair and four poor. Higher social care expenditure and greater availability of nursing and residential care were associated with fewer hospital readmissions, fewer delayed discharges, reduced length of stay and expenditure on secondary healthcare services. The overall direction of evidence was consistent, but effect sizes could not be confidently quantified. Little evidence examined the influence of home-based social care, and no data was found on primary care use. Conclusions: adequate availability of social care has the potential to reduce demand on secondary health services. At a time of financial stringencies, this is an important message for policy-makers.

There is an increased interest in using theoretical approaches in implementation and dissemination research to guide data collection and to better understand why and how implementation outcomes came about. A considerable number of frameworks and models for dissemination and implementation has been developed making it difficult for the researcher to identify and choose the best fit for their projects objectives. In this workshop we will shine light on differences between models, frameworks, and theories as well as on different aims and uses of frameworks.
We will explore: 1) why a theoretical foundation is crucial for designing and evaluating an implementation project; 2) different types, aims and uses, of models, frameworks, and theories; 3) considerations for the appropriate selection and application of a framework in the context of participants’ specific projects. We will discuss examples for each type and share experiences from our work to provoke discussion. Participants will be encouraged to reflect on their own projects in light of the presented frameworks and share ideas around their applicability in small groups.

As an individual you may strive for integration of mindfulness and resiliency into your life. These same skills may be utilized in the work environment to assist with coping and thriving in a person-centred care setting with its inherent stress from demands and responsibilities. So how do you and your team members integrate these skills into the 24/7 world of continuing care teams who may include some or all of: the person in care, their family, care team members, physicians, consultants and managers?

This presentation will provide strategies to assist in practicing being present in work situations when providing support to your team colleagues. Strategies will include reflection on your own unique experiences and the intersection of generational and cultural/organizational differences.

This arts-based presentation presents research findings through paintings and artistic works that healthcare professionals created when they were asked “What it is like to care for persons living with dementia who are receiving end-of-life care?” Through focus groups and creative expressions, we explored healthcare professionals’ experiences of caring for persons living with dementia at the end-of-life and the values, beliefs and assumptions that support and/or act as a barrier to providing quality care. This research is intended to provoke and contribute to local and national end-of-life conversations with the intention of enhancing end-of-life care for persons and families living with dementia.

Realist methodology assists us in developing our skill for recognizing the observable and hidden forces that produce outcomes in complex interventions. This workshop is over 2 days with an optional 3rd day for consultations. Participants will explore the advantages and challenges of using this methodology for evaluating complex interventions – to move past the question of ‘was it successful?’ to better understand how, for whom, and under what circumstances interventions produce their particular outcomes. This workshop is suitable for those new to the methodology or who are contemplating how it could be used, as well as those who are currently working on realist projects.

This course is designed for health professionals interested in building their knowledge and skills to implement change using best practices in KT.
In Practicing Knowledge Translation (PKT), participants learn how to:
-Develop an Evidence-informed, Theory-Driven program (ETP)
-Map barriers and facilitators to change using theories and frameworks
-Systematically select and operationalize implementation strategies
-Plan for implementation, evaluation and sustainability

The word “infographic” may have become an umbrella term for describing poster products that visually show some amount of quantifiable data. However, infographics and info-posters are very different visual knowledge products. How do we distinguish the two?

The GEM program is carefully curated and updated each year to align with the needs of high school girls as they prepare for the next phase of their lives. Through one-on-one mentorship, experiential workshops, enrichment opportunities, scholarships and internships, GEM aims to provide a program in which high school girls are given the skills, tools and resources to succeed, long after they have left the program.
Every year, GEM individually matches high school girls with mentors (girls and professional women) for a 9-month program running concurrently with the academic year. GEM mentors are carefully chosen for their professional success, their ability to connect and their commitment to improving the lives of GEM mentees. Participants are matched with mentors on the basis of their career aspirations, interests and personality. Mentors support GEMgirls as they navigate key issues in their lives, such as goal setting, time-management, confidence building, stress management, and knowledge sharing for interviews, university applications, and more.

We are inviting parties to tender proposals for the following research study:
Understanding the attractiveness of and attrition in clinical academic careers for doctors and dentists across the UK – a qualitative and systematic review focusing on gender inequalities.

The Research Fellow or Senior Research Fellow will develop capacity for research based upon realist evaluation methods and conducts health related research individually or as part of a team to achieve the objectives of the Centre for Health and Clinical Research as well as the Research and Evaluation team of Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (CCG), including identifying sources of funding and contributing to the process of securing funds. Collaborative working with the Research and Evidence Team at the CCG will be expected, to provide methodological support for evaluation of service initiatives.