March 10, 2019

Calls for Abstracts
Grants & Awards
Events & Training Opportunities


New TREC article
If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes-Part II.
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M. N. Yoon, L. L. Lu, C. Ickert, C. A. Estabrooks and M. Hoben.
Gerodontology 2020 Mar 1
To evaluate the response process validity of the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items and the organisational processes for assessing nursing home (NH) residents’ oral/dental status. BACKGROUND: Although care aides provide most direct care to NH residents, including oral care, they are not directly involved in structured care planning activities, including RAI assessments. This most likely affects the accuracy of RAI assessments, as well quality of care. However, we neither know how well regulated and unregulated care staff understand the RAI oral/dental items, nor what processes are used in completing oral/dental assessments. METHODS: We conducted nine focus groups with 44 care aides, nurses, allied health providers, clinical specialists and managers. We discussed randomly selected RAI oral/dental assessments with focus group participants, including participants’ understanding of the items and why the options were selected. Participants also explained the communication and process for completing the RAI. RESULTS: Participants’ perceptions of the oral/dental items aligned fairly well with the item definitions. However, responses primarily focused on severe oral/dental problems with obvious physical characteristics (eg black teeth denoting caries). For non-visual oral problems, such as pain, staff relied on resident verbalisation. No formal mechanisms were described for care aides to update nurses on residents’ oral health needs. CONCLUSIONS: Performance problems of RAI oral/dental items are largely rooted in poor communication between care aides and nurses and not integrating care aides in assessment processes. We need policies that address these problems in order to improve NH residents’ poor oral health.

New article by Anne Marie Hutchinson and Anita Kothari
Reporting health research translation and impact in the curriculum vitae: a survey

L. Boland, L. Brosseau, S. Caspar, et al.
Implementation Science Communications 2020 03/03;1(1):20
Increasingly, health researchers must demonstrate the impact and real-life applications of their research. We investigated how health researchers with expertise in knowledge translation report research translation activities and impact on their curriculum vitae (CV).

New article by Whitney Berta
Conceptualising the initiation of researcher and research user partnerships: a meta-narrative review.
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M. M. Zych, W. B. Berta and A. R. Gagliardi.
Health Res Policy Syst 2020 Feb 18;18(1):24-020-0536-9
Integrated knowledge translation refers to researcher and research user partnerships to co-generate and implement knowledge. This type of partnership may be critical to success in increasing knowledge use and impact, but the conceptualisation of its initiation has not been fully developed. Initiating this type of partnership has proven to be challenging but crucial to its success. The purpose of this study was to conduct a meta-narrative review of partnership initiation concepts, processes, enablers, barriers and outcomes in the disciplines of healthcare and social sciences where examples of researcher and research user partnerships were found. METHODS: Seven research traditions were identified. Three were in the discipline of social sciences (including psychology, education and business) and five were in the discipline of healthcare (including medicine, nursing, public health, health services research). Searches were conducted in MEDLINE, EMBASE, CINAHL, ABI Inform, ERIC, PsychInfo and the Cochrane Library on June 9, 2017. Fifty titles and abstracts were screened in triplicate; data were extracted from three records in duplicate. Narratives comprised of study characteristics and conceptual and empirical findings across traditions were tabulated, summarised and compared. RESULTS: A total of 7779 unique results were identified and 17 reviews published from 1998 to 2017 were eligible. All reviews identified a partnership initiation phase referred to as ‘early’ or ‘developmental’, or more vaguely as ‘fuzzy’, across six traditions – integrated knowledge translation, action research, stakeholder engagement, knowledge transfer, team initiation and shared mental models. The partnership initiation processes, enablers, barriers and outcomes were common to multiple narratives and summarised in a Partnership Initiation Conceptual Framework. Our review revealed limited use or generation of theory in most included reviews, and little empirical evidence testing the links between partnership initiation processes, enablers or barriers, and outcomes for the purpose of describing successful researcher and research user partnership initiation. CONCLUSIONS: Narratives across multiple research traditions revealed similar integrated knowledge translation initiation processes, enablers, barriers and outcomes, which were captured in a conceptual framework that can be employed by researchers and research users to study and launch partnerships. While partnership initiation was recognised, it remains vaguely conceptualised despite lengthy research in several fields of study. Ongoing research of partnership initiation is needed to identify or generate relevant theory, and to empirically establish outcomes and the determinants of those outcomes.

Calls for Abstracts

Canadian Knowledge Mobilization Forum

8-9 June, Halifax, NS
DEADLINE: 15 March
By continuing to assemble practitioners, researchers, students, administrators, thought leaders, and others engaged in the art and science of knowledge mobilization, we can create: better practice; better policy and supports; more effective monitoring and evaluation systems; enhanced training processes; improved employment and job classification policies; more efficient implementation procedures; and further innovation, all with an ultimate goal of greater value for society. The Forum is organized as an opportunity to share what you know and to push the current boundaries of what we do as KMb professionals. This event provides access to some of the best minds and most creative practitioners in the field.


6-8 July, Toronto, ON
DEADLINE: 12 March
We are accepting Abstracts for Workshops Orals & Posters on
Using Real-World Data to Improve Practice
Patient Involvement and Collaboration in Producing Research Evidence
Teaching, Developing and Leading in Evidence-Based Medicine
Translating Knowledge for Better-Quality Health Services


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Grants & Awards

CIHR Operating Grant : Active and Assisted Living Program

The AAL Calls for proposals provide a targeted funding mechanism for the development as well as the integration of ICT-based solutions (both products and services) into the social fabric of a particular region and/or health and care environment. This AAL Call responds not only to the challenges and opportunities of ageing well, but also provides another support angle to the health and care system, particularly at local and regional level. The smart solutions for healthy ageing funded under the AAL Programme should be designed to address the respective wishes/aspirations and needs identified by end-users as well as being both transnational and collaborative with a cost-sharing approach between private and public funding.


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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Culture and Change
Research Practice and Methodology


From novice to expert: a qualitative study of implementation facilitation skills

Mona J. Ritchie, Louise E. Parker and JoAnn E. Kirchner.
Implementation Science Communications 2020 02/25;1(1):25
It is widely reported that facilitation can aid implementation of evidence-based practices. Although scholars agree that facilitators need a diverse range of skills, only a few retrospective studies have identified some of these. During the test of a facilitation strategy within the context of a VA initiative to implement evidence-based care delivery models, we documented the skills an expert external facilitator transferred to two initially novice internal regional facilitators. Ours is the first study to explore facilitation skills as they are being applied and transferred.

Evidence-Based Practice Change Champion Program Improves Quality Care.
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L. Cullen, K. Hanrahan, M. Farrington, et al.
J Nurs Adm 2020 Mar;50(3):128-134
Nurses need training and mentoring to lead evidence-based practice (EBP) improvements. An array of roles have been reported to have a positive impact on EBP adoption. A training program was created to assist point-of-care nurses and nurse leader partners in operationalizing the EBP Change Champion role to address priority quality indicators. The program, a case exemplar, and lessons learned are described with implications for leaders responsible for promoting EBP to improve quality care.


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Health Care Administration and Organization

Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers.
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A. Backman, P. Ahnlund, K. Sjogren, H. Lovheim, K. S. McGilton and D. Edvardsson.
J Clin Nurs 2020 Jan;29(1-2):172-183
To explore how managers describe leading towards person-centred care in Swedish nursing homes. BACKGROUND: Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers’ own descriptions of leading their staff towards providing person-centred care is lacking. DESIGN: Descriptive interview study. COREQ guidelines have been applied. METHODS: The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis. RESULTS: Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures. CONCLUSIONS: The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to inspire nursing home leaders’ practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.

Factors Associated with Perception of the Quality of Physicians’ End-of-life Communication in Long-Term Care Facilities: PACE Cross-Sectional Study.
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I. Baranska, V. Kijowska, Y. Engels, et al.
J Am Med Dir Assoc 2020 Mar;21(3):439.e1-439.e8
To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). DESIGN: A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher’s visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. SETTINGS AND PARTICIPANTS: A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). METHODS: The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. RESULTS: The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident’s life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident’s life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = -0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. CONCLUSION: The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident’s life, and relatives’ emotional burden. IMPLICATIONS: LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives, and emotional support to relatives to improve their satisfaction with EOL communication.

Changes in Long-Term Care Markets: Assisted Living Supply and the Prevalence of Low-Care Residents in Nursing Homes.
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P. Y. Cornell, W. Zhang and K. S. Thomas.
J Am Med Dir Assoc 2020 Feb 26
To assess the effect of changes in assisted living (AL) capacity within a market on prevalence of residents with low care needs in nursing homes. DESIGN: Retrospective, longitudinal analysis of nursing home markets. SETTING AND PARTICIPANTS: Twelve thousand two hundred fifity-one nursing homes in operation during 2007 and 2014. MEASUREMENTS: We analyzed the percentage of residents in a nursing home who qualified as low-care. For each nursing home, we constructed a market consisting of AL communities, Medicare beneficiaries, and competing nursing homes within a 15-mile radius. We estimated the effect of change in AL beds on prevalence of low-care residents using multivariate linear models with year and nursing home fixed effects. RESULTS: The supply of AL beds increased by an average 258 beds per nursing home market (standard deviation = 591) during the study period. The prevalence of low-care residents decreased from an average of 13.0% (median 10.5%) to 12.2% (median 9.5%). In adjusted models, a 100-bed increase in AL supply was associated with a decrease in low-care residents of 0.041 percentage points (P = .026), controlling for changes in market and nursing home characteristics, county demographics, and year and nursing home fixed effects. In markets with a high percentage of its Medicare beneficiaries (>/=14%) dual eligible for Medicaid, the effect of AL is stronger, with a 0.066-percentage point decrease per 100 AL beds (P = .026) vs a 0.016-percentage point decrease in low-duals markets (P = .48). CONCLUSIONS AND IMPLICATIONS: Our analysis suggests that some of the growth in AL capacity serves as a substitute for nursing homes for patients with low care needs. Furthermore, the effects are concentrated in markets with an above-average proportion of beneficiaries with dual Medicaid eligibility.

Correlates of Administrator Tenure in US Residential Care Communities.
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S. Dys, O. Tunalilar and P. C. Carder.
J Am Med Dir Assoc 2020 Mar;21(3):351-354.e4
To determine community- and individual-level correlates of administrator tenure in US residential care communities (RCCs). DESIGN: Secondary data analysis of the 2010 National Survey of Residential Care Facilities designed by the National Center for Health Statistics. Analysis was conducted using Tobit regression. SETTING AND PARTICIPANTS: A nationally representative sample of RCCs in the United States (n = 2302). MEASURES: The outcome measure for this study is RCC administrator tenure. Residential care community characteristics include chain ownership, size, occupancy rate, profit status, years of operation, if the building was purposely constructed as an RCC, Medicaid census, presence of a dementia care unit, and whether administrative staff provided care. Administrator characteristics included age, gender, race/ethnicity, and level of education. RESULTS: Over a quarter of administrators in this sample remained employed with the same RCC for 10 or more years (28%). Chain membership, community size, and presence of a dementia care unit are associated with shorter administrator tenure (P < .001). Communities with greater than 80% occupancy, administrator’s age 40+, and Hispanic race/ethnicity were associated with longer administrator tenure (P < .001). CONCLUSIONS/IMPLICATIONS: Various community and administrator characteristics are associated with shorter or longer tenure within the same community. More setting-specific research is needed to identify how RCC administrators influence care quality and what different lengths of tenure indicate in the context of RCC operations.

Systematic Use of Song and Music in Dementia Care: Health Care Providers’ Experiences.
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E. M. R. Ekra and B. Dale.
J Multidiscip Healthc 2020 Feb 11;13:143-151
Using song and music in a systematic way in residential dementia care may have several positive impacts on the patients, as well as the care providers. The aim of this study was to explore how health care providers experienced taking responsibility for conducting a song and music program in dementia care in nursing homes. Methods: An explorative, qualitative study design was used. Focus groups were formed by 17 health care providers from 3 different nursing homes. These providers had experience implementing and using the “Gjenklang” (“reverberation”) song and music program especially developed for people with dementia. Focus group interviews were transcribed verbatim, and systematic text condensation was used for analysing the data. Results: Three categories with associated subcategories emerged from the analysis process. The categories were 1) the music program increased the staff’s consciousness and awareness; 2) the music program evoked the patients’ emotions and reactions; and 3) maintaining enthusiasm over time. Conclusion: The general opinion among the participants was that using the song and music program in a systematic and planned way had many benefits and positive impacts on the patients, as well as the staff. However, it was challenging to make it a part of the daily routine. Thus, it is important that the leaders of the units take responsibility to ensure continuity and maintain engagement among the staff over time.

Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper.
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K. A. Froggatt, D. C. Moore, L. Van den Block, J. Ling, S. A. Payne and PACE consortium collaborative authors on behalf of the European Association for Palliative Care.
J Am Med Dir Assoc 2020 Feb 27
The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of palliative care interventions in LTCFs. The PACE study mapped palliative care in LTCFs in Europe, evaluated quality of end-of-life care and quality of dying in a cross-sectional study of deceased residents of LTCFs in 6 countries, and undertook a cluster-randomized control trial that evaluated the impact of the PACE Steps to Success intervention in 7 countries. Working with the European Association for Palliative Care, a white paper was written that outlined recommendations for the implementation of interventions to improve palliative and end-of-life care for all older adults with serious illness, regardless of diagnosis, living in LTCFs. The goal of the article is to present these key domains and recommendations. DESIGN: Transparent expert consultation. SETTING: International experts in LTCFs. PARTICIPANTS: Eighteen (of 20 invited) international experts from 15 countries participated in a 1-day face-to-face Transparent Expert Consultation (TEC) workshop in Bern, Switzerland, and 21 (of 28 invited) completed a follow-up online survey. METHODS: The TEC study used (1) a face-to-face workshop to discuss a scoping review and initial recommendations and (2) an online survey. RESULTS: Thirty recommendations about implementing palliative care for older people in LTCFs were refined during the TEC workshop and, of these, 20 were selected following the survey. These 20 recommendations cover domains at micro (within organizations), meso (across organizations), and macro (at national or regional) levels addressed in 3 phases: establishing conditions for action, embedding in everyday practice, and sustaining ongoing change. CONCLUSIONS AND IMPLICATIONS: We developed a framework of 20 recommendations to guide implementation of improvements in palliative care in LTCFs.

Specialist healthcare services for UK care home residents: a latent class analysis.
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C. Hargreaves, S. Tucker, J. Hughes, R. Hays and D. Challis.
Prim Health Care Res Dev 2019 Sep 16;20:e132
To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence. BACKGROUND: Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this. METHOD: A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics. FINDINGS: Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff (‘predominantly direct care’). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training (‘direct and indirect care’). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff (‘predominantly indirect care’). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3. CONCLUSIONS: LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.

Measuring the quality of care in nursing home residents with early-onset neurodegenerative diseases: a scoping review.
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J. C. F. Heffels, I. H. J. Everink, M. Oosterloo, R. A. C. Roos and J. M. G. A. Schols.
BMC Palliat Care 2020 Feb 27;19(1):25-020-0528-0
Nursing home residents with early-onset neurodegenerative diseases are often younger in comparison with other residents, and need different, often more complex care. Accordingly, the measurements currently used for measuring quality of care in nursing homes may not be suitable for use in this target group. Little is known about the experiences of these residents and of their (in) formal caregivers regarding the quality of care they receive. Therefore, the aim of this scoping review is to explore which instruments are available for measuring the quality of care for nursing home residents with early-onset neurodegenerative diseases (excluding dementia), from the perspective of the resident and of (in) formal caregivers. METHODS: A literature search was performed in the databases Pubmed, Embase, Web of Science and Cinahl. The search strategy consisted of four main concepts: neurodegenerative diseases, quality of care, nursing homes and perspectives of residents, (in) formal caregivers. Studies were included if they used instruments and/or strategies to measure quality of care, focused on nursing home residents with early-onset neurodegenerative diseases and the perspective of either the resident or (in) formal caregiver. RESULTS: From a total of 809 identified articles, 87 full text articles were screened for eligibility. Five studies were included, only one of which described an instrument. The other four used topic lists and/or themes to measure quality of care. In total, 60 items related to quality of care could be derived. From these 60 items, eight overarching domains were found, with a subdivision into items derived, respectively, from the residents’, informal and formal caregivers’ perspective: ’emotional support’, ‘physical support’, ‘social support’, ‘care’, ‘care content’, ‘expertise’, ‘communication’ and ‘organization of care’. CONCLUSIONS: Currently, there are no methods for assessing the quality of care specifically focused on nursing home residents with early-onset neurodegenerative diseases. Therefore, the items retrieved in this review give an overview of important topics for measuring the quality of care for this target group, from the perspective of the resident, and of the informal and formal caregivers. These items might be used to develop a tailored instrument for assessing the quality of care for nursing home residents with early-onset neurodegenerative diseases.

Duration of Care Trajectories in Persons With Dementia Differs According to Demographic and Clinical Characteristics.
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O. Janssen, S. J. B. Vos, R. Handels, et al.
J Am Med Dir Assoc 2020 Feb 26
To estimate (1) the duration of no formal care, home care, and institutional care after dementia diagnosis, and (2) the effect of age, sex, living situation, dementia medication, migration background, and income on this dementia care duration. DESIGN: Longitudinal retrospective study using routinely recorded general practice electronic health records linked with population-based healthcare and mortality data. SETTING AND PARTICIPANTS: In total, 11,012 community-dwelling persons who received an incident dementia diagnosis and were listed in a Dutch general practitioner database from 448 general practices in the Netherlands. METHODS: Using multistate modeling analyses, we estimated the mean duration of care types (no/home/institutional care) for different ages based on simulations of transition rates and examined the influence of demographic and clinical factors on these durations. RESULTS: From dementia diagnosis onward in 85-year-old men, the mean duration without formal care was 0.7 years, of home care 1.7, and institutional care 1.1 years. In 85-year-old women, the duration without formal care was 0.8 years, of home care 2.3, and institutional care 2.3 years. Total care duration was 3.5 years in 85-year-old men and 5.4 years in 85-year-old women. In men, the duration of home care was longer compared with no formal care and institutional care. The duration of no formal care was longer in persons not living alone, without prescribed dementia medication, with a nonWestern migration background, or with a higher income. The duration of home or institutional care was longer in women, persons without polypharmacy, in those living alone, or those with a Western background. CONCLUSIONS AND IMPLICATIONS: Our findings help to increase understanding of long-term dementia care trajectories and show that demographic and clinical factors determine the duration of care types. Our results can contribute to the organization of healthcare resource planning and monitoring of the effects of healthcare policy and interventions.

Increasing Complexity of New Nursing Home Residents in Ontario, Canada: A Serial Cross-Sectional Study.
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R. Ng, N. Lane, P. Tanuseputro, et al.
J Am Geriatr Soc 2020 Mar 2
The main objective of the study was to investigate annual changes in the sociodemographic characteristics, morbidity, and functional status of new nursing home residents in Ontario, Canada, between 2000 and 2015. A secondary objective was to develop and assess the quality of an algorithm for ascertaining admissions into publicly funded nursing homes in Ontario using a combination of health administrative data sources that indirectly identifies the residential status of new nursing home residents. DESIGN: Population-based serial cross-sectional study with an accompanying quality assessment study of algorithms. SETTING: Publicly funded nursing care homes in Ontario, Canada. PARTICIPANTS: The reference standard for the assessment of algorithm performance was 21 544 newly admitted nursing home residents identified from the Resident Assessment Instrument-Minimum Data Set in 2012. The selected algorithm was then used to identify serial cross-sectional cohorts of newly admitted residents between 2000 and 2015 that ranged in size between 14 651 and 23 630 residents. MEASUREMENTS: Sociodemographic characteristics, morbidity, and functional status of new residents were determined upon admission to examine patterns in the cohorts’ profiles. RESULTS: The proportion of residents aged 85 years and older increased from 45.1% to 53.8% over 16 years. The proportions of individuals with seven or more chronic conditions (from 14.1% to 22.1%) and with nine or more prescription medications (from 44.9% to 64.2%) have also increased in parallel over time. Hypertension, osteoarthritis, and dementia were the most prevalent conditions captured, with the proportion of incoming residents with dementia increasing from 42.3% to 54.1% between 2000 and 2015. Newly admitted residents were more likely to have extensive physical and cognitive impairments upon admission. CONCLUSION: Admission trends show that new residents were older and had greater multimorbidity and limitations in physical functioning over time.

Oral health in residential aged care: Perceptions of nurses and management staff.
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T. Patterson Norrie, A. R. Villarosa, A. C. Kong, et al.
Nurs Open 2019 Nov 13;7(2):536-546
This study aimed to explore the perceptions of residential aged care nursing and management staff regarding oral care, to develop strategies to improve the oral health of aged care residents. Design: A qualitative approach was used. Methods: Two focus groups were conducted with nursing and management staff at two residential aged care facilities and transcripts were thematically analysed. Results: All staff had an awareness of the importance of oral health; however, they highlighted the significant challenges in the current system that affect implementation of oral health training and practice guidelines in the residential aged care facility. High staff turnover, time constraints, difficulties in accessing dental services and working together with residents, their families and external staff were barriers to providing oral health care. Staff highlighted the need for formalized clinical guidelines and processes and efficient dental referral pathways to create a more cohesive system of care.

Nursing Home Social Services and Post-Acute Care: Does More Qualified Staff Improve Behavioral Symptoms and Reduce Antipsychotic Drug Use?
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A. R. Roberts, A. C. Smith and J. R. Bowblis.
J Am Med Dir Assoc 2020 Mar;21(3):388-394
An increasing number of post-acute care patients are admitted to skilled nursing facilities (SNFs) with behavioral symptoms such as wandering and rejecting care, which can interfere with care and place a patient at risk of social isolation or injury. This study examines whether increasing the qualifications of social service staff through using a greater proportion of qualified social workers (QSWs) instead of paraprofessionals improves patients’ behavioral symptoms and reduces the use of antipsychotic medications. DESIGN: Secondary data analysis of national data drawn from the Minimum Data Set, Medicare Beneficiary Summary File, and Certification and Survey Provider Enhanced Reporting surveys. SETTING AND PARTICIPANTS: Newly admitted, Medicare fee-for-service patients aged >/=65 years who received post-acute care after a hospitalization from 2011-2015 (1,201,096 patient admissions in 5383 unique SNFs). METHODS: A regression discontinuity approach is used to identify how changes in the qualifications of social service staffing affect changes in patient outcomes, through exploiting a federal regulation that requires 1 full-time QSW for SNFs with at least 121 beds. RESULTS: SNFs with a greater proportion of QSWs improved behavioral symptoms that affected residents or others and reduced the use of antipsychotic medications. Marginally significant improvements were also found in patients’ rejecting care, wandering, and having any behavioral symptoms. There was no statistically significant change in delusions. CONCLUSIONS AND IMPLICATIONS: Although the focus of most research and effects on improving patient outcomes in SNFs has focused on nursing staff, our results underscore the importance of staffing in social services. Specifically, social service staff with higher qualifications are integral to improving care through reducing patients’ behavioral symptoms and avoiding the use of antipsychotic medications. It may be time for SNFs to revisit efforts to improve staffing in social services.

Systematic Dementia Screening by Multidisciplinary Team Meetings in Nursing Homes for Reducing Emergency Department Transfers: The IDEM Cluster Randomized Clinical Trial.
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Y. Rolland, N. Tavassoli, P. de Souto Barreto, et al.
JAMA Netw Open 2020 Feb 5;3(2):e200049
Dementia is often underdiagnosed in nursing homes (NHs). This potentially results in inappropriate care, and high rates of emergency department (ED) transfers in particular. Objective: To assess whether systematic dementia screening of NH residents combined with multidisciplinary team meetings resulted in a lower rate of ED transfer at 12 months compared with usual care. Design, Setting, and Participants: Multicenter, cluster randomized trial with NHs as the unit of randomization. The IDEM (Impact of Systematic Tracking of Dementia Cases on the Rate of Hospitalization in Emergency Care Units) trial took place at 64 public and private NHs in France. Recruitment started on May 1, 2010, and was completed on March 31, 2012. Residents who were aged 60 years or older, had no diagnosed or documented dementia, were not bedridden, had lived in the NH for at least 1 month at inclusion, and had a life expectancy greater than 12 months were included. The residents were followed up for 18 months. The main study analyses were completed on October 14, 2016. Intervention: Two parallel groups were compared: an intervention group consisting of NHs that set up 2 multidisciplinary team meetings to identify residents with dementia and to discuss an appropriate care plan, and a control group consisting of NHs that continued their usual practice. During the inclusion period of 23 months, all residents of participating NHs who met eligibility criteria were included in the study. Main Outcomes and Measures: The primary end point (ED transfer) was analyzed at 12 months, but the residents included were followed up for 18 months. Results: A total of 64 NHs participated in the study and enrolled 1428 residents (mean [SD] age, 84.7 [8.1] years; 1019 [71.3%] female): 599 in the intervention group (32 NHs) and 829 in the control group (32 NHs). The final study visit was completed by 1042 residents (73.0%). The main reason for early discontinuation was death (318 residents [22.7%]). The intervention did not reduce the risk of ED transfers during the 12-month follow-up: the proportion of residents transferred at least once to an ED during the 12-month follow-up was 16.2% in the intervention group vs 12.8% in the control group (odds ratio, 1.32; 95% CI, 0.83-2.09; P = .24). Conclusions and Relevance: This study failed to demonstrate that systematic screening for dementia in NHs resulted in fewer ED transfers. The findings do not support implementation of multidisciplinary team meetings for systematic dementia screening of all NH residents, beyond the national recommendations for dementia diagnosis, to reduce ED transfers. Trial Registration: Identifier: NCT01569997.

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities.
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E. Tennant, S. Fletcher, S. Kakar, et al.
Aust N Z J Public Health 2020 Feb;44(1):65-72
To explore factors associated with adverse outcomes during influenza outbreaks in residential aged care facilities. METHODS: A retrospective cohort study of all outbreaks reported to three Sydney metropolitan Public Health Units during 2017. RESULTS: A total of 123 outbreaks affected 1,787 residents and 543 staff. Early notification to a Public Health Unit was associated with shorter outbreak duration (p/=95% was associated with shorter outbreak duration in univariate testing but not on an adjusted model. CONCLUSIONS: Early public health notification is associated with improved outbreak parameters; sick staff may pose a risk to residents, yet vaccination rates are low. Resident vaccination may also be valuable. Implications for public health: Measures that facilitate early PHU involvement in influenza outbreaks should be implemented, such as compulsory reporting requirements and processes that permit easier notification through technology. Actions that enhance staff and resident vaccination coverage should also be undertaken.

The Post-Acute Delayed Discharge Risk Scale: Derivation and Validation With Ontario Alternate Level of Care Patients in Ontario Complex Continuing Care Hospitals.
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L. A. Turcotte, I. Daniel and J. P. Hirdes.
J Am Med Dir Assoc 2020 Feb 20
To describe and validate the Post-acute Delayed Discharge Risk Scale (PADDRS), which classifies patients by risk of delayed discharge on admission to post-acute care settings using information collected with the interRAI Minimum Data Set (MDS) 2.0 assessment. DESIGN: Retrospective cohort study of individuals admitted to Ontario Complex Continuing Care (CCC) hospitals. Person-level linkage between interRAI MDS 2.0 assessments and Cancer Care Ontario Wait Time Information System records was performed. SETTING AND PARTICIPANTS: Sample of 30,657 patients who received care in an Ontario CCC hospital and were assessed with the interRAI MDS 2.0 assessment between January 1, 2010, and March 31, 2013. MEASURES: Alternate Level of Care (ALC) designation of 30 or more days was used as the marker of delayed discharge. Scale validation was performed through computation of class-level effect sizes and receiver operating characteristic curves for each of Ontario’s geographic health regions. Additionally, Clinical Assessment Protocol (CAP) decision-support tool trigger rates by PADDRS risk level were computed for problem areas that are clinically relevant with the delayed discharge outcome. RESULTS: Overall, 9.4% of the sample experienced the delayed discharge outcome. The PADDRS algorithm achieved an overall area under the curve (AUC) statistic of 0.74, which indicates good discriminatory ability for predicting delayed discharge. PADDRS is generalizable across geographic regions, with AUC statistics ranging between 0.61 and 0.81 across each of Ontario’s 14 Local Health Integration Networks. PADDRS demonstrated strong concurrent validity, as the percentage of patients triggering CAPs increased with the risk of delayed discharge. CONCLUSIONS AND IMPLICATIONS: PADDRS combines numerous important clinical factors associated with delayed discharge from a post-acute hospital into a cohesive decision-support tool for use by discharge planners. In addition to early identification of patients who are most likely to experience delayed discharge, PADDRS has applications in risk-adjusted quality measurement of discharge planning efficiency.

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Health Care Innovation and Quality Assurance

Effectiveness of confidential reports to physicians on their prescribing of antipsychotic medications in nursing homes

Noah M. Ivers, Monica Taljaard, Vasily Giannakeas, et al.
Implementation Science Communications 2020 02/25;1(1):30
Antipsychotic medication use in nursing homes is associated with potential for harms. In Ontario, Canada, an agency of the provincial government offers nursing home physicians quarterly audit and feedback on their antipsychotic prescribing. We compared the characteristics of physicians who did and did not engage with the intervention, and assessed early changes in prescribing.

Costs and economic evaluations of Quality Improvement Collaboratives in healthcare: a systematic review.
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L. de la Perrelle, G. Radisic, M. Cations, B. Kaambwa, G. Barbery and K. Laver.
BMC Health Serv Res 2020 Mar 2;20(1):155-020-4981-5
In increasingly constrained healthcare budgets worldwide, efforts to improve quality and reduce costs are vital. Quality Improvement Collaboratives (QICs) are often used in healthcare settings to implement proven clinical interventions within local and national programs. The cost of this method of implementation, however, is cited as a barrier to use. This systematic review aims to identify and describe studies reporting on costs and cost-effectiveness of QICs when used to implement clinical guidelines in healthcare. METHODS: Multiple databases (CINAHL, MEDLINE, PsycINFO, EMBASE, EconLit and ProQuest) were searched for economic evaluations or cost studies of QICs in healthcare. Studies were included if they reported on economic evaluations or costs of QICs. Two authors independently reviewed citations and full text papers. Key characteristics of eligible studies were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Evers CHEC-List was used for full economic evaluations. Cost-effectiveness findings were interpreted through the Johanna Briggs Institute ‘three by three dominance matrix tool’ to guide conclusions. Currencies were converted to United States dollars for 2018 using OECD and World Bank databases. RESULTS: Few studies reported on costs or economic evaluations of QICs despite their use in healthcare. Eight studies across multiple healthcare settings in acute and long-term care, community addiction treatment and chronic disease management were included. Five were considered good quality and favoured the establishment of QICs as cost-effective implementation methods. The cost savings to the healthcare setting identified in these studies outweighed the cost of the collaborative itself. CONCLUSIONS: Potential cost savings to the health care system in both acute and chronic conditions may be possible by applying QICs at scale. However, variations in effectiveness, costs and elements of the method within studies, indicated that caution is needed. Consistent identification of costs and description of the elements applied in QICs would better inform decisions for their use and may reduce perceived barriers. Lack of studies with negative findings may have been due to publication bias. Future research should include economic evaluations with societal perspectives of costs and savings and the cost-effectiveness of elements of QICs. TRIAL REGISTRATION: PROSPERO registration number: CRD42018107417.

Clinician-Directed Performance Improvement: Moving Beyond Externally Mandated Metrics.
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L. Goitein.
Health Aff (Millwood) 2020 Feb;39(2):264-272
Pay-for-performance and public reporting programs have successfully focused hospitals’ attention on quality. But they have also had unintended consequences, including encouraging a narrowing of focus to mandated metrics, and their effectiveness in improving outcomes remains uncertain. Moreover, they have not successfully engaged clinicians. To offset these deficiencies, a community hospital in Santa Fe, New Mexico, developed a clinician-led quality improvement program that was parallel to its traditional quality program. Called Clinician-Directed Performance Improvement (CDPI), the program is designed to give clinicians the protected time, support, and training to select and conduct performance improvement projects. Since its implementation in September 2015, CDPI has been associated with large improvements in quality and physician engagement and has generated net savings. This article discusses the program, its results, and policy implications.

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care.
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J. P. Hirdes, C. van Everdingen, J. Ferris, et al.
Front Psychiatry 2020 Jan 17;10:926
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.

Process evaluation of the response of nursing homes to the implementation of the dementia-specific case conference concept WELCOME-IdA: A qualitative study.
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D. Holle, S. Teupen, R. Graf, et al.
BMC Nurs 2020 Feb 17;19:14-020-0403-6. eCollection 2020
The implementation of clearly structured dementia-specific case conferences could be an important tool to enable nursing staff to properly analyse and manage challenging behaviour in nursing home residents with dementia. A process evaluation of the responses of nursing homes to the implementation of WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) was carried out to gain insight into which key elements of the intervention were adopted by the nursing homes and which elements were adapted. Methods: This study was part of a larger process evaluation using a qualitative design. Thirty-four semi-structured telephone interviews and 15 focus group interviews were conducted in four nursing homes. The interviews were analysed using deductive content analysis, although inductive categories have been developed. Results: Nursing home staff adopted the roles of moderator, case reporter, keeper of the minutes and reflection partner in WELCOME-IdA, but the selection of the staff members who filled these roles differed across nursing homes. The recommended group size of 5-8 participants per case conference was sometimes adopted. The key element of having core nursing teams who participated continuously in all case conferences was not adopted at all. Instead, there was a high level of rotation among staff members. The pre-defined process structure of WELCOME-IdA was adapted in such a way that the assessment of the residents’ behaviour and the selection of the relevant domain for the behaviour analysis were conducted in advance of the case conference. The evaluation of the interventions was also organized differently. Conclusion: The scope of the response implies that WELCOME-IdA requires further adaptation to the requirements of nursing processes in nursing homes. The results provide important information on the selection of role keepers and offer insights into a) how knowledge of the structured training was circulated and transformed into self-organized case conferences and b) how knowledge was circulated throughout the entire processing of one case. Thus, these results can be used to optimize intervention and implementation. Overall, the intervention should allow more possibilities for tailored adaptation than it currently does.

MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention.
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I. D. Maidment, G. Barton, N. Campbell, et al.
BMC Health Serv Res 2020 Mar 2;20(1):157-020-5014-0
People living with dementia in care homes frequently exhibit “behaviour that challenges”. Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs. METHODS: People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour. Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated. RESULTS: Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (>/=88% at each of the time points where data was collected). CONCLUSIONS: It is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures. TRIAL REGISTRATION: ISRCTN58330068. Retrospectively registered, 15 October 2017.

Understanding in the Australian aged care sector of reablement interventions for people living with dementia: a qualitative content analysis.
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C. M. C. O’Connor, M. Gresham, R. G. Poulos, et al.
BMC Health Serv Res 2020 Feb 24;20(1):140-020-4977-1
Reablement has potential for enhancing function and independence in people with dementia. In order to enhance the use of evidence-based reablement in this population, this study sought to understand the current practices and needs of the sector around these interventions. METHODS: A purposive sample of 22 Australian aged and community-care providers participated in a semi-structured interview. Qualitative content analysis was applied to the data, with key themes interpreted within the context of the study aims: to explore (1) what reablement interventions are currently being offered to people living with dementia in Australia, and (2) what are key factors that will contribute to enhanced uptake of reablement interventions in dementia practice. RESULTS: Four themes emerged: (1) ‘what reablement interventions are being offered’, outlined a range of exercise and cognitive/social interventions, with only a proportion generated from a clear evidence-base, (2) ‘what’s in a name’, illustrated the range of terms used to describe reablement, (3) ‘whose role is it’, highlighted the confusion around the range of health professionals involved in providing reablement interventions, and (4) ‘perceived barriers and enablers to providing reablement to people living with dementia’, described a range of factors that both hinder and support current reablement practice. CONCLUSIONS: Reablement interventions currently provided for people living with dementia in Australia are variable, with confusion around the definition of reablement, and apparently limited use of evidence-informed interventions. A multifaceted approach involving an evidence-informed and freely-accessible resource, and taking into account the varied levels of influence within the aged care sector would support uptake and implementation of reablement interventions for people living with dementia.

The Impact of Pharmacologic and Nonpharmacologic Interventions to Improve Physical Health Outcomes in People With Dementia: A Meta-Review of Meta-Analyses of Randomized Controlled Trials.
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D. Vancampfort, M. Solmi, J. Firth, M. Vandenbulcke and B. Stubbs.
J Am Med Dir Assoc 2020 Feb 18
We summarized and compared meta-analyses of pharmacologic and nonpharmacologic interventions targeting physical health outcomes among people with dementia. DESIGN: This is a systematic review and meta-analysis. SETTING AND PARTICIPANTS: People with dementia, confirmed through validated assessment measures. METHODS: Major databases were searched until October 21, 2019. Effect sizes [standardized mean difference (SMD)/Hedges g or risk ratio (RR)] were compared separately. RESULTS: Of 3773 search engine hits, 4 meta-analyses were included, representing 31 meta-analyzed trials and 10,054 study participants. Although meta-analyses were generally of adequate high quality, meta-analyzed studies were less so. Nutritional supplements were the only one to show a weight-increasing effect [SMD 0.53, 95% confidence interval (CI) 0.38-0.68, ie, medium effect; N = 12, n = 748]. Acetylcholinesterase inhibitors are associated with an increased risk for weight loss (RR 2.1, 95% CI 1.53.0; N = 9, n = 7010). For the treatment of pain, sensory stimulation has a medium effect (SMD -0.58, 95% CI -0.99 to -0.17; N = 6, n = 199), whereas physical activity has a small effect (SMD -0.24, 95% CI -1.06 to 0.59; N = 2, n = 75). When exploring the characteristics of the psychosocial interventions, group-based interventions demonstrated a medium (SMD -0.55, 95% CI -1.02 to -0.09; N = 6, n = 157) and individual psychosocial interventions a small effect (SMD -0.27, 95% CI -1.06 to 0.53; N = 2, n = 55). CONCLUSIONS AND IMPLICATIONS: Despite frequent physical comorbidities, the current evidence for pharmacologic and nonpharmacologic interventions in people with dementia to prevent and treat these conditions is still in its infancy, and larger trials targeting a wide range of physical health outcomes are urgently needed. Based on the SMDs and RRs, nutritional supplements can be recommended as an intervention to treat malnutrition. Clinicians should be careful in treating patients with acetylcholinesterase inhibitors, as it shows medium weight reducing effects. For the treatment of comorbid pain, sensory stimulation and psychosocial interventions are recommended.


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Organizational Culture and Change

Capturing the Role of Context in Complex System Change: An Application of the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to an Integrated Care Organisation in the UK.
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S. Asthana, F. Gradinger, J. Elston, S. Martin and R. Byng.
Int J Integr Care 2020 Feb 11;20(1):4
If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal. Methods: A case study method using embedded ‘Researchers in Residence’ to conduct action-based participatory research and deploying mixed qualitative methods. Results: The relative importance of some domains differ between the English and Canadian studies. In this case study, physical features (structural and geographic) were found to be very pertinent to the relative success of the Coastal Locality, as were empowered clinical leadership, with readiness for change being expressed through processes and cultures that were risk-enabling, strengths-based, person-/outcome-focused. Conclusions: The CCIC Framework provided a useful tool capturing key elements of complex system change with key domains being transferable across settings, while also finding local variation in the UK. This would encourage its wider application so that further comparisons can be made of the ways in which different contextual and implementation properties impact upon delivery and outcomes.

New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning.
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N. Cote, A. Freeman, E. Jean and J. L. Denis.
BMC Health Serv Res 2019 Nov 21;19(1):882-019-4731-8
Optimising health professionals’ contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada). METHODS: We used Giddens’ structuration theory to guide our study given its’ facilitation of the understanding of the dynamic between structural constraints and actors’ actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017. RESULTS: Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others’ inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs’ sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity). CONCLUSION: Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.

What do we really assess with organisational culture tools in healthcare? An interpretive systematic umbrella review of tools in healthcare.
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R. F. Malik, M. Buljac-Samardzic, N. Akdemir, C. Hilders and F. Scheele.
BMJ Open Qual 2020 Feb;9(1):10.1136/bmjoq-2019-000826
A toxic organisational culture (OC) is a major contributing factor to serious failings in healthcare delivery. Poor OC with its consequences of unprofessional behaviour, unsafe attitudes of professionals and its impact on patient care still need to be addressed. Although various tools have been developed to determine OC and improve patient safety, it remains a challenge to decide on the suitability of tools for uncovering the underlying factors which truly impact OC, such as behavioural norms, or the unwritten rules. A better understanding of the underlying dimensions that these tools do and do not unravel is required. OBJECTIVES: The aim of this study is to provide an overview of existing tools to assess OC and the tangible and intangible OC dimensions these tools address. METHODS: An interpretive umbrella review was conducted. Literature reviews were considered for inclusion if they described multiple tools and their dimensional characteristics in the context of OC, organisational climate, patient safety culture or climate. OC tools and the underlying dimensions were extracted from the reviews. A qualitative data analysis software program (MAX.QDA 2007) was used for coding the dimensions, which resulted in tangible and intangible themes. RESULTS: Fifteen reviews met our inclusion criteria. A total of 127 tools were identified, which were mainly quantitative questionnaires covering tangible key dimensions. Qualitative analyses distinguished nine intangible themes (commitment, trust, psychological safety, power, support, communication openness, blame and shame, morals and valuing ethics, and cohesion) and seven tangible themes (leadership, communication system, teamwork, training and development, organisational structures and processes, employee and job attributes, and patient orientation). CONCLUSION: This umbrella review identifies the essential tangible and intangible themes of OC tools. OC tools in healthcare do not seem to be designed to determine deeper underlying dimensions of culture. We suggest approaching complex underlying OC problems by focusing on the intangible dimensions, rather than putting the tangible dimensions up front.

Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses.
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P. Nilsen, I. Seing, C. Ericsson, S. A. Birken and K. Schildmeijer.
BMC Health Serv Res 2020 Feb 27;20(1):147-020-4999-8
Health care organizations are constantly changing as a result of technological advancements, ageing populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable environment. The present study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health care professionals that they deemed successful. METHODS: The study was based on semi-structured interviews with 30 health care professionals: 11 physicians, 12 registered nurses and seven assistant nurses employed in the Swedish health care system. An inductive approach was applied using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees’ experiences and perceptions of any changes that they considered to have affected their work, regardless of whether these changes were “objectively” large or small changes. The interviewees’ responses were analysed using directed content analysis. RESULTS: The analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the change; valuing the change. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were clearly communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to understand the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients. CONCLUSIONS: Organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.

A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Practice.
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J. Pittman, A. Cohee, S. Storey, et al.
Worldviews Evid Based Nurs 2019 Aug;16(4):271-280
Implementation and sustainability of a culture of evidence-based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts. AIMS: To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals. METHODS: A nonexperimental descriptive correlational design was used to conduct a web-based survey of direct-care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT). RESULTS: Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor’s or associate degree), role (direct-care nurses had lower Culture than managers and lower Social Capital), and work status (full-time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals). LINKING EVIDENCE TO ACTION: Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses’ contributions, balance nurses’ personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.

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Research Practice and Methodology

Innovations in framework synthesis as a systematic review method.
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G. Brunton, S. Oliver and J. Thomas.
Res Synth Methods 2020 Feb 23
Framework synthesis is one systematic review method employed to address health care practice and policy. Adapted from framework analysis methods, it has been used increasingly, using both qualitative and mixed-method systematic review methods. This article demonstrates a spectrum of approaches to framework synthesis that are dependent on the extent to which theory is tentative, emergent, refined, or established; and that stakeholder involvement may help to understand the topic’s complexity where theory is more nascent. The choice of approach depends on the degree of match with existing theories and, in the absence of existing theory, the scale and heterogeneity of the literature to be managed.

Resource allocation for biomedical research: analysis of investments by major funders.
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A. H. Ralaidovy, T. Adam and P. Boucher.
Health Res Policy Syst 2020 Feb 17;18(1):20-020-0532-0
Data on grants for biomedical research by 10 major funders of health research were collected from the World RePORT platform to explore what is being funded, by whom and where. This analysis is part of the World Health Organization Global Observatory on Health Research and Development’s work with the overall aim to enable evidence-informed deliberations and decisions on new investments in health research and development. The analysis expands on the interactive data visualisations of these data on the Observatory’s website and describes the methods used to enable the categorisation of grants by health categories using automated data-mining techniques. METHODS: Grants data were extracted from the World RePORT platform for 2016, the most recent year with data from all funders. A data-mining algorithm was developed in Java to categorise grants by health category. The analysis explored the distribution of grants by funder, recipient country and organisation, type of grant, health category, average grant duration, and the nature of collaborations between recipients of direct grants and the institutions they collaborated with. RESULTS: Out of a total of 69,420 grants in 2016, the United States of America’s National Institutes of Health funded the greatest number of grants (52,928; 76%) and had the longest average grant duration (6 years and 10 months). Grants for research constituted 70.4% (48,879) of all types of grants, followed by grants for training (13,008; 18.7%) and meetings (2907; 4.2%). Of grant recipients by income group, low-income countries received only 0.2% (165) of all grants. Almost three-quarters of all grants were for non-communicable diseases (72%; 40,035), followed by communicable, maternal, perinatal and nutritional conditions (20%; 11,123), and injuries (6%; 3056). Only 1.1% of grants were for neglected tropical diseases and 0.4% for priority diseases on the WHO list of highly infectious (R&D blueprint) pathogens. CONCLUSIONS: The findings highlight the importance of considering funding decisions by other actors in future health research and capacity-strengthening decisions. This will not only improve efficiency and equity in allocating scarce resources but will also allow informed investment decisions that aim to support research on public health needs and neglected areas.

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Assessing quality of life in older adults: psychometric properties of the OPQoL-brief questionnaire in a nursing home population.
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G. Haugan, J. Drageset, B. Andre, K. Kukulu, J. Mugisha and B. K. S. Utvaer.
Health Qual Life Outcomes 2020 Jan 2;18(1):1-019-1245-3
Well-adapted and validated quality-of-life measurement models for the nursing home population are scarce. Therefore, the aim of this study was to test the psychometrical properties of the OPQoL-brief questionnaire among cognitively intact nursing home residents. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered interrelated measurement properties. METHODS: Cross-sectional data were collected during 2017-2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home residents who met the inclusion criteria: (1) municipality authority’s decision of long-term nursing home care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. RESULTS: Principal component analysis and confirmative factor analyses indicated a unidimensional solution. Five of the original 13 items showed low reliability and validity; excluding these items revealed a good model fit for the one-dimensional 8-items measurement model, showing good internal consistency and validity for these 8 items. CONCLUSION: Five out of the 13 original items were not high-quality indicators of quality-of-life showing low reliability and validity in this nursing home population. Significant factor loadings, goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, nurse-patient interaction, and joy-of-life) supported the psychometric properties of the OPQoL-brief questionnaire. Exploring the essence of quality-of-life when residing in a nursing home is highly warranted, followed by development and validation of new tools assessing quality-of-life in this population. Such knowledge and well-adapted scales for the nursing home population are beneficial and important for the further development of care quality in nursing homes, and consequently for quality-of-life and wellbeing in this population.

Expectations and Needs of Families in Nursing Homes: An Integrative Review.
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C. Havreng-Thery, J. Giner-Perot, P. Zawieja, F. Bertin-Hugault, J. Belmin and M. Rothan-Tondeur.
Med Care Res Rev 2020 Feb 26:1077558720907183
A better understanding of the expectations and needs of the families of nursing home residents is needed for a constructive and sustainable relationship of mutual trust. The objective of this study was to understand the expectations of families of nursing home residents described in the literature. A systematic integrative review of the literature was conducted. After a rigorous selection made by two researchers, independently, 53 articles were selected out of 1,094 results. The expectations of families are quality care, consideration complying with human dignity of the resident, collaboration, honesty, and mutual confidence that ties together families, staff, and physicians. This study reveals that families consider themselves as a strength for a resident’s support services, in line with Gottlieb’s strength-based approach. This approach offers promising implications for practice and for a new type of management in nursing homes based on strong values.

Implementing a flexible endoscopic evaluation of swallowing at elderly care facilities to reveal characteristics of elderly subjects who screened positive for a swallowing disorder.
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M. Imaizumi, T. Suzuki, M. Ikeda, T. Matsuzuka, A. Goto and K. Omori.
Auris Nasus Larynx 2020 Feb 19
The risk of aspiration pneumonia has been reported to increase with age, especially in elderly residents of nursing homes. However, the characteristics of those with swallowing impairments at elderly care facilities have not yet been evaluated using reliable instrumental examinations. The aims of the current study were to investigate the frequency of swallowing impairment and determine the characteristics of the elderly with swallowing disorders residing at care facilities. METHODS: To reveal the characteristics of the elderly with swallowing disorders, questionnaires for dysphagia screening and flexible endoscopic evaluation of swallowing (FEES) were used. Regarding the dysphagia screening, two types of questionnaires were sent to 451 elderly persons aged 65 years and older who were living in facilities for the elderly in Japan. FEES was performed to assess swallowing impairment at each facility for those who were found to be positive for dysphagia by the questionnaires. The frequency of swallowing impairment and the characteristics of elderly subjects with swallowing disorders were investigated. RESULTS: Among 413 subjects who completed both questionnaires, 229 were screened positive for dysphagia, 160 of whom underwent FEES. Swallowing impairment was observed in 93 subjects. The subjects with swallowing impairment had a significantly high prevalence of fever, sputum, and/or history of aspiration pneumonia. Their oral intake ability and activities of daily living were significantly low. CONCLUSION: We demonstrated the frequency of swallowing disorders and the characteristics of elderly subjects with swallowing disorders living in care facilities using FEES. Our results suggest the importance of screening all elderly care facility residents for dysphagia.

Energy Intake and Severity of Dementia Are Both Associated with Health-Related Quality of Life among Older Long-Term Care Residents.
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S. Ks, S. Mh, K. H, R. Hm and P. Kh.
Nutrients 2019 Sep 20;11(10):10.3390/nu11102261
Our aim was to investigate how energy intake modifies the association of the stage of dementia with health related quality of life (HRQoL) among institutionalized older people. A cross-sectional sample of 538 older long-term care residents with dementia in Helsinki, Finland were assessed with HRQoL (15D), energy intake (from one to two days), and the stage of dementia by the clinical dementia rating (CDR) scale. The energy intakes were standardized by z-scores to include both men and women in the same analyses. Severity of dementia was associated with HRQoL (15D index in CDR 0.5-1: 0.65 (0.11), CDR 2: 0.60 (0.10), CDR 3: 0.52 (0.10)). When the three groups of dementia severity were divided according to their energy intake quartiles, there was an association between the HRQoL and the stage of dementia (p < 0.001) and energy intake (p = 0.013); however, no interaction was observed (p = 0.30). While partial correlation analysis showed that energy intake correlated with HRQoL among residents with very mild/mild or moderate dementia, this was not observed among those with severe dementia. In moderate dementia, the dimensions of mobility and usual activities correlated significantly with higher energy intake. Both energy intake and severity of dementia are associated with HRQoL.

Suicide Among Older Adults Living in or Transitioning to Residential Long-term Care, 2003 to 2015.
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B. Mezuk, T. M. Ko, V. A. Kalesnikava and D. Jurgens.
JAMA Netw Open 2019 Jun 5;2(6):e195627
Almost 25% of Medicare beneficiaries live in residential long-term care (LTC) (eg, independent or assisted living facility or nursing home). There are few reliable statistics on completed suicide in LTC, in part because of data limitations. Objectives: To estimate the number of suicides associated with residential LTC (ie, among persons in a facility, transitioning into or out of a facility, or otherwise associated with LTC) among adults 55 and older and, secondarily, to identify whether machine learning tools could improve the quality of suicide surveillance data. Design, Setting, and Participants: Cross-sectional epidemiologic study (conducted in 2018) of restricted-access data from the National Violent Death Reporting System (NVDRS) (2003-2015) using restricted-access case narratives from suicides and undetermined deaths among adults 55 years and older in 27 states. Participants were all suicides and undetermined deaths (N = 47759) among persons 55 years and older. Exposure: Long-term care cited in the coroner/medical examiner case narrative, whether as a reason for self-harm or the injury location, identified using machine learning natural language processing (NLP) algorithms plus manual review of texts. Main Outcomes and Measures: Number and characteristics (eg, demographics, health history, and means of injury) of suicides associated with LTC. The kappa statistic was used to estimate the reliability of the existing NVDRS injury location codes relative to cases identified by the algorithm. Results: Among 47759 persons 55 years and older (median age, 64 years; 77.6% male; 90.0% non-Hispanic white), this study identified 1037 suicide deaths associated with LTC, including 428 among older adults living in LTC, 449 among older adults transitioning to LTC, and 160 otherwise associated with LTC. In contrast, there were only 263 cases coded with the existing NVDRS location code “supervised residential facility,” which had poor agreement with cases that the algorithm identified as occurring in LTC (kappa statistic, 0.30; 95% CI, 0.26-0.35). Conclusions and Relevance: Over a 13-year period, approximately 2.2% of suicides among adults 55 years and older were associated with LTC in some manner. Clinicians, administrators, and policy makers should consider ways to promote the mental health and well-being of older adults experiencing functioning limitations and their families. Natural language processing may be a useful way to improve abstraction of variables in the NVDRS.

Nursing Home-Associated Pneumonia, Part II: Etiology and Treatment.
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J. M. Mylotte.
J Am Med Dir Assoc 2020 Mar;21(3):315-321
This is the second of 2 parts of a narrative review of nursing home-associated pneumonia (NHAP) that deals with etiology and treatment in the nursing home. In the 1980s and 1990s, the etiology of NHAP was considered to be similar to community-acquired pneumonia (CAP). This belief was reflected in CAP guidelines until 2005 when the designation healthcare-associated pneumonia or HCAP was introduced and nursing home residents were included in the HCAP category. Patients in the HCAP group were thought to be at high risk for pneumonia because of multidrug resistant organisms and required empiric broad-spectrum antibiotic therapy much like people with hospital-acquired infection. Subsequent studies of the etiology of NHAP using sophisticated diagnostic testing found limited evidence of resistant organisms such as methicillin-resistant Staphylococcus aureus or resistant gram-negative organisms or atypical organisms. In terms of management of NHAP in the nursing home there are several considerations that are discussed: hospitalization decision, initial oral or parenteral therapy, timing of switch to an oral regimen if parenteral therapy is initially prescribed, duration of therapy with an emphasis on shorter courses, and follow-up during therapy including the use of the “antibiotic time out” protocol. The oral and parenteral antibiotic regimens recommended for treatment of NHAP in this report are based on limited information because there are no randomized controlled trials to define the optimum regimen. In conclusion, most residents with pneumonia can be treated successfully in the nursing home. However, there is an urgent need for a specific NHAP diagnosis and treatment guideline that will give providers guidance in the management of this infection in the nursing home.

Inertial Training Improves Strength, Balance, and Gait Speed in Elderly Nursing Home Residents.
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M. Naczk, S. Marszalek and A. Naczk.
Clin Interv Aging 2020 Feb 7;15:177-184
The aim of the study was to evaluate the impact of inertial training on upper and lower extremity strength in the elderly. The study also assessed the influence of inertial training on their independence, balance, and speed and quality of gait. Methods: Twenty physically inactive older residents of a nursing home (6 women and 14 men; age, 76.7 +/- 8.77 years) were randomized to a training (T; n = 10) or control group (C; n = 10). The T group performed inertial training twice a week for 6 weeks using a Cyklotren inertial device. Each training session included 12 exercise sets involving the elbow and knee flexor and extensor muscles (3 sets per single muscle group). The training loads were 10 and 20 kg for the upper and lower extremities, respectively. Before and after training, the maximum force of trained muscles was evaluated under training conditions. Functional tests were also completed. Results: Participants from the T group had significantly increased (37.1-69.1%) elbow and knee flexor and extensor muscle strength. Improvement in upper and lower limb strength in non-specific conditions was also noted; 23.3% and 40.6%, respectively. Functional abilities improved significantly in the T group (Tinetti balance test: 29%, Tinetti gait tests: 18.6%, and gait speed (8-Foot Up-and-Go): 12.8%), while remaining unchanged in C. Conclusion: We strongly recommend a daily routine of inertial training for older adults. Benefits from inertial training can reduce the risk of falls and increase the safety and independence of the elderly.

The Effect of Using PARO for People Living With Dementia and Chronic Pain: A Pilot Randomized Controlled Trial.
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L. Pu, W. Moyle, C. Jones and M. Todorovic.
J Am Med Dir Assoc 2020 Feb 28
To evaluate the effect of interaction with a robotic seal (PARO) on pain and behavioral and psychological symptoms of people with dementia and chronic pain. DESIGN: A parallel pilot randomized controlled trial conducted between January 2018 and January 2019. SETTING: Three long-term care facilities in Australia. PARTICIPANTS: Forty-three participants aged >/=65 years living with dementia and chronic pain. INTERVENTION: Participants were randomized to the PARO group (individual, nonfacilitated, 30-minute sessions, 5 days per week for 6 weeks) or a usual care group using a computer-generated random number. MEASUREMENTS: The primary outcome was researcher-rated observational pain behaviors before and after each session. Secondary outcomes were staff-rated pain level, agitation, depression, and anxiety measured at baseline and the end of week 6. Medications regularly prescribed and as needed were recorded weekly. Analyses followed intention-to-treat, using the generalized estimating equation model. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202). RESULTS: Participants in the PARO group had a significantly lowered level of observed pain [-0.514, 95% confidence interval (CI) -0.774 to -0.254, P < .001] and used fewer pro re nata medications (-1.175, 95% CI -2.205 to -0.145, P = .025) than those in usual care after controlling for age, sex, cognitive function and medications. There were no significant differences in staff-rated pain, agitation, anxiety, and depression, nor regularly scheduled medications between intervention and control group. CONCLUSIONS AND IMPLICATIONS: PARO shows promise in reducing pain and medications for individuals with dementia and chronic pain in long-term care facilities. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Larger randomized controlled trials with longer time frames are needed to identify further and test the use of PARO in long-term care settings.

Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System

AARP Foundation, 2019
Many who are socially isolated or lonely and who do not have consistent interactions with others may never be identified in their own communities. However, nearly all persons 50 years of age or older interact with the health care system in some way. As a result, health care providers may be in the best position to identify older individuals who are at highest risk for social isolation or loneliness—individuals for whom the health care system may be their only point of contact with their broader community.

With support from the AARP Foundation, the National Academies of Sciences, Engineering, and Medicine formed an ad hoc committee to study how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low-income, underserved, and vulnerable subpopulations (or those considered “at risk”). In the resulting report, the committee identifies and recommends opportunities for clinical health care providers to help reduce the incidence and adverse health impacts of social isolation and loneliness and to examine ways to disseminate this information to health care practitioners.

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Events & Training Opportunities

UEval: Evaluation Course

8:30-16::30, 1-5 June, Edmonton, AB
Faculty of Extension, University of Alberta
An experiential learning course for students and community stakeholders to sustainably build student and community evaluation capacity. Course objectives have been developed to align with the Canadian Evaluation Society (CES) core competencies for evaluation work.

Measuring the quality of patient engagement as partners on research projects Webinar

Friday 27 March 13:00-13:45 MT
Presenter: Clayton Hamilton
Partnerships between researchers and patients to work together on projects is becoming increasingly central to health research in Canada. These partnerships seek to integrate the perspectives of patients, those most affected by health research findings, throughout the research process. When these partnerships are undertaken effectively, we expect an improved impact of research projects on health systems and target patient populations. To gain these benefits, however, these partnerships should be of good quality. In this talk, Clayon Hamilton highlights recent progress made in understanding how to measure the quality of patient engagement on research projects.

Learning objectives
• Understand the rationale for measuring the quality of patient engagement
• Identify components of good quality engagement
• Identify tools to measure the quality of patient engagement

Intimacy & Dementia:How Close Can We Get? Webinar

Tuesday 31 March 10:00-11:00 MT
Presenter: Sylvia Davidson, brianXchange
This webinar series will explore our own values and beliefs about intimacy and aging and the relationship between these sensitive topics when we are supporting persons with dementia. There are challenges presented by the desire for intimacy when faced with physical, mental, psychological, social and environmental barriers. Participants will be encouraged to share some of their unique situations and strategies will be shared and discussed.

This webinar is the first of a two part series in partnership with ASC / CCNA. Part two (which takes place Tuesday April 28) will use case examples to highlight some common challenges that arise when issues of intimacy arise in persons with dementia and strategies will be offered to help us support meaningful relationships.

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A framework to evaluate the impacts of research on policy and practice

What is meant by impact generation and how can it be facilitated, captured and shared? How can researchers be empowered to think beyond ‘instrumental’ impact and identify other changes generated by their work? How can the cloud of complexity be dispersed so that numerous factors affecting development of impacts can be seen? How can a way be opened for researchers to step back and reflect critically on what happened and what could be improved in the future? How can research teams and stakeholders translate isolated examples of impact and causes of impact into narratives for both learning and dissemination? We have developed a framework to evaluate research impact in a way that addresses these questions. It has been piloted on 12 case studies led by Forest Research, a government research agency in UK (Edwards and Meagher 2019) and is likely to be useful to researchers more generally, perhaps especially but not exclusively those in applied fields. To date the framework has been found to be user-friendly and fit for purpose.

Confronting indifference toward truth: Dealing with workplace bullshit

Many organizations are drowning in a flood of corporate bullshit, and this is particularly true of organizations in trouble, whose managers tend to make up stuff on the fly and with little regard for future consequences. Bullshitting and lying are not synonymous. While the liar knows the truth and wittingly bends it to suit their purpose, the bullshitter simply does not care about the truth. Managers can actually do something about organizational bullshit, and this Executive Digest provides a sequential framework that enables them to do so. They can comprehend it, they can recognize it for what it is, they can act against it, and they can take steps to prevent it from happening in the future. While it is unlikely that any organization will ever be able to rid itself of bullshit entirely, this article argues that by taking these steps, astute managers can work toward stemming its flood.

Analytical Capability Index

A tool to allow health and care organisations to measure and benchmark their current capability in using data analytics.

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Good processes create good results. Simple, but not easy.

The importance of measuring the impact of patient-oriented research

How to Be a Better Presenter

An International Perspective on Improving Physician Care in Nursing Homes

Women feature only rarely as first or last authors in leading journals

Using Models to Stay Calm in Charged Situations

Defining New Care Model Development

Leading Through Frightening Times

Shaping Research to Create More Social Impact

Outcome Mapping Thinking and Practices for Systems Change

The Bleak Job Landscape of Adjunctopia for Ph.D.s

7 ways to be a better communicator — by tweaking your body language

‘Pre-pandemic mode’: How Canadian long-term care homes are preparing for coronavirus

CMAJ drops paywall

Chronic staffing shortage, low wages to blame for Summerland seniors home woes: HEU

Improving care for older people with frailty and supporting their family/friend caregivers

International hires are helping but challenges remain for long-term care in Nova Scotia

Nursing home rationed diapers while residents suffered rashes, infections

How to reduce medication overload in long-term care

Nursing Homes Are Starkly Vulnerable to Coronavirus

How one reporter leveraged a conference opportunity to report dementia series

Next-generation dementia care could learn a lesson from cancer care

Science can’t fix dementia’s most heartbreaking problem

Defusing the devastating costs of dementia
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