Feb 24, 2012

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Abstracts
New KUSP article
What do we know about knowledge translation in the care of older adults? A scoping review.
Bostrom AM, Slaughter SE, Chojecki D, Estabrooks CA.
Journal of the American Medical Directors Association 2012 Mar;13(3):210-219

The recent emphasis on knowledge translation (KT) in health care is based on the premise that quality of care improves when research findings are translated into practice. This study aimed to identify the extent, nature, and settings of KT research pertaining to the care of older adults. DESIGN AND METHODS: We searched Medline, CINAHL, The Cochrane Library, and EMBASE for systematic reviews related to KT using the terms knowledge translation, research use, evidence-based practice, clinical practice guidelines, or diffusion of innovations. Then we searched the systematic reviews to identify included articles related to older adults. We used quantitative content analysis to summarize the information. RESULTS: Two of the 53 systematic reviews about KT focused on the care of older adults. One examined the impact of quality systems on care processes and outcomes for long term care residents. The other studied the effectiveness of active-mode learning programs on physician behavior. Sixty-one of the 1709 primary research articles (3.6%) pertained to the care of older adults. Thirty of these were conducted in long term care facilities, 26 in outpatient clinics, 2 in hospitals, and 3 in multiple settings. Most studies focused on KT interventions targeting professionals (eg, prescribing medications). Organizational interventions (eg, modifying roles) were few; financial and regulatory interventions were rare. CONCLUSION: We identified a gap in KT research pertaining to the care of older adults. KT intervention research focusing on organizational, financial, and regulatory areas is warranted. The connection between geriatrics and KT is fertile ground for future research.

New KUSP article
A Two Year Follow up of Nutrition Status Among Veterans in a Nursing Home Setting: The Impact on Mortality.
Faulder D, Bostrom A, Van Soest D, Kolewaski B, Faulder D, Milke DL, et al.
Journal of the American Medical Directors Association 2012 03/01;13(3):B20.

Introduction/Objective: In 2008, 55 veterans living in a nursing home were examined using the Mini Nutritional Assessment (MNA). (Bostrom AM, et al. Nutrition Status Among Residents Living in a Veterans’ Long-Term Care Facility in Western Canada: A Pilot Study. J Am Med Dir Assoc 2011; 12:217-225) The sample was 90% male and the mean age was 87 years. Based on MDS 2.0 data, most (80%) had moderate/severe dementia (≥3 on the Cognitive Performance Scale (CPS), nearly half (47%) scored ≥6 on the Depression Rating Scale (DRS) and a quarter (25%) had unstable health (scored ≥3 on the Changes in Health, End-stage disease and Symptoms and Signs (CHESS)). The assessment with the MNA tool found the majority were at risk for malnutrition (58%) or malnourished (31%). Three predictors were identified that were statistically significant: 1) depression (DRS scores), 2) severity of dementia (CPS scores), and 3) health instability (CHESS scores). The three factors explained 42.6% of the variance of the total MNA score. Care changes were instituted after the first data collection. Food and fluid intake was more frequently monitored and weight more regularly monitored. Results of the dietitian’s quarterly review of nutrition status were shared at team meetings. A nutritional supplement program was introduced for the veterans whose nutritional status was identified to be ‘high-risk’, i.e., a dose of the supplement was given 4 times daily when medications were administrated. The objectives of this follow-up study were to determine the impact of nutritional care changes, in particular in regards to introducing the nutritional supplement program for high-risk residents, and to examine whether nutritional status was a determining factor for residents who survived two years following the 2008 pilot study.

Call for Proposals
InSight: Visualizing Health Humanities Exhibition
May 15 to June 9, 2012 at the Fine Arts Building Gallery, University of Alberta, Edmonton.
Deadline: Wednesday, February 29, 2012

Health humanities is an emerging, interdisciplinary field that connects medicine, the arts, humanities and the social sciences to address the human needs and aspects of medicine and healthcare. It encompasses art, health design and communications, visual culture, drama, music, literature, narrative medicine, art therapy, health promotion, the history of medicine, medical anthropology, ethics, environment and health, and much more. This project will share diverse work in health humanities at or connected to the University of Alberta, through InSight, an interactive, exploratory exhibition of visual media to be held from May 15 to June 9, 2012 at the Fine Arts Building Gallery, University of Alberta, Edmonton

Grants & Awards
KT Canada: Research Project Stipend
Deadline: March 15, 2012, 11:59 PM ET, $15 000

KT Canada is once again offering the Student Research Project Stipend funding opportunity. This stipend is open to all registered KT Canada Graduate students (Masters and PhDs) and Post-Doctoral Fellows. The funding is to be used for research purposes only and is intended to assist with some of the costs associated with completing student-led research: thesis-related research by Graduate Students and research projects by Post-Doctoral Fellows.
Eligibility

  • Must be KT Canada trainee/student at one of the six sites
  • Must be supervised by a current KT Canada member
  • Must be enrolled in a graduate program or hold a post-doctoral fellowship at a Canadian University.
  • Have limited or no external funding

KT Canada students who receive no funding from KT Canada-funded projects or who are the recipient of a KT Canada Training Fellowship are also eligible.

Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Methodology
Health Care in Canada
Aging

KT
Some Thoughts on the Field of KTE.
Contandriopoulos D.
Healthcare Policy 2012 02/20;7(3):29-37

This paper offers a practice-oriented critical analysis of the scientific literature on knowledge transfer and exchange (KTE) derived from the results of a large-scale systematic review of knowledge exchange at the organizational and policy levels. Analysis is structured around four questions that must be answered to get a proper understanding of the KTE process and KTE intervention design and implementation, and of two core dimensions of context.

Information-seeking behaviour of nurses: where is information sought and what processes are followed?
O’Leary DF, Mhaolrunaigh SN.
Journal of Advanced Nursing 2012 Feb;68(2):379-390

This paper is a report of a study on how nurses inform their decision-making in the workplace. BACKGROUND: Despite the growing availability of research evidence, nurses have been slow to adopt it into their daily decision-making. METHOD: The study was undertaken in Ireland between 2006 and 2007 using a sequential mixed methods approach. In phase 1, the views of a quota sample of 29 nurses were explored using semi-structured interviews incorporating vignettes. Phase 2 involved the design and dissemination of a survey to a disproportionate stratified random sample of 1356 nurses. The response rate was 29%. FINDINGS: In decision-making, nurses accessed other people, especially nursing colleagues, the most frequently. Sources that provided prepackaged information such as guidelines were favoured over sources that provided access to original research. The process of information-seeking for routine and non-routine decisions was different. Nurses making routine decisions relied mostly on their experience and an assessment of the patient. In non-routine decision-making, participants experienced more uncertainty about their decisions. Accordingly, sources of information used were more varied and the information-seeking process more extensive. The study highlighted the complexities of establishing whether information used in decision-making is research based or not. CONCLUSION: Routine practices should be reviewed and updated regularly through organizational mandates, as nurses do not generally question them. Research information to inform non-routine decision-making must be easily available to nurses in their workplace, as information searches generally prioritize finding enough, rather than the best, information to make a decision.

Determining factors in evidence-based clinical practice among hospital and primary care nursing staff.
De Pedro-Gomez J, Morales-Asencio JM, Bennasar-Veny M, Artigues-Vives G, Perello-Campaner C, Gomez-Picard P.
Journal of advanced nursing 2012 Feb;68(2):452-459

The general aim of this study is to identify key factors perceived by nurses to influence evidence-based clinical practice at different centres. BACKGROUND: During the last decade, there has been an increased interest in the identification of factors that facilitate the transfer of knowledge into clinical practice, among health care professionals. Previous research states that a suitable organisational framework and practice environment seems to have influence on a greater use of scientific evidence by nurses, which can be directly observed in patient outcomes. In consequence, several authors suggest that strategies should be encouraged from managers and nurse executives to guarantee the existence of environments that avoid emotional exhaustion and improve satisfaction of nurses with their work, and at the same time, ensure the use of research-guided nursing decisions. METHODS: Following the Spanish validation of the Practice Environment Scale-Nursing Work Index and Evidence Based Practice Questionnaire, a descriptive observational cross-sectional study has been conceived, from 2010 to 2011, in order to identify determining factors in evidence-based clinical practice at different centres. In a second phase, a qualitative study has been designed, using focus groups, to identify practice factors that can lead to a successful implementation of evidence-based clinical practice. DISCUSSION: Organisational and attitudinal interventions are needed in order to implement evidence-based clinical practice that improves the quality of patient care.

A framework for disseminating evidence-based health promotion practices.
Harris JR, Cheadle A, Hannon PA, Forehand M, Lichiello P, Mahoney E, et al.
Preventing chronic disease 2012 Jan;9:E22

Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. To assist in developing these approaches, we created a practical framework drawn from the literature on dissemination and our experiences disseminating evidence-based practices. The main elements of our framework are 1) a close partnership between researchers and a disseminating organization that takes ownership of the dissemination process and 2) use of social marketing principles to work closely with potential user organizations. We present 2 examples illustrating the framework: EnhanceFitness, for physical activity among older adults, and American Cancer Society Workplace Solutions, for chronic disease prevention among workers. We also discuss 7 practical roles that researchers play in dissemination and related research: sorting through the evidence, conducting formative research, assessing readiness of user organizations, balancing fidelity and reinvention, monitoring and evaluating, influencing the outer context, and testing dissemination approaches.

Health Care Administration & Organization
Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.
Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF.
Medical care 2011 Dec;49(12):1047-1053

Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. OBJECTIVE: To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data. MAIN OUTCOME MEASURES: A 30-day inpatient mortality and failure-to-rescue. RESULTS: The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%. CONCLUSIONS: Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

Differences in intensive care unit work environments among and within hospitals using subscales and a composite measure of the Revised Nursing Work Index.
Cho SH, Mark BA, Yun SC, June KJ.
Journal of advanced nursing 2011 Dec;67(12):2637-2648

To examine variations in nurses’ perceptions of their work environments among hospitals and intensive care units, and to compare analytic findings from using subscales and a composite measure of the Revised Nursing Work Index at the hospital and intensive care unit levels.
BACKGROUND: A positive relationship has been found between the nurse work environment and outcomes for patients and nurses. Nurses’ perceptions of their work environments have been analysed using different analytic approaches. METHODS: A survey was conducted in August-October 2007 that included 817 staff nurses in 39 adult intensive care units of 15 hospitals in South Korea. Seven subscales of the Revised Nursing Work Index were identified from an exploratory factor analysis. The subscales and composite (mean of the seven subscales) for each hospital and intensive care unit were analysed using multilevel regression analyses and classified as good, moderate or poor environments. RESULTS: Considerable variations in the subscales were found among both hospitals and intensive care units. On the composite measure, 2 hospitals were rated as good, 10 moderate and 3 poor; 9 intensive care units were ranked as good, 24 moderate and 6 poor. Even intensive care units within hospitals exhibited variations in the subscales and composite. Most hospitals and intensive care units had mixed (i.e., good, moderate, poor) environments across the seven subscales and thus, subscales were not always congruent with the composite.CONCLUSION: Heterogeneity of the subscales and the composite measure, and the differences among intensive care units within hospitals imply that use of different analytic approaches may reveal different findings and perspectives of nurse work environments.

Health Care Innovation & Quality Assurance
Re-imagining Healthcare: The Northwest Territories Transitions to an Integrated Chronic Disease Management Strategy. canadian flag
Erin Leith, Christine Kirvan, Jennifer Y Verma, Kay Lewis and,Scott Robertson.
Healthcare Quarterly 2012 02/16;15(1):19-21

With the goal to improve healthcare services and delivery, Stanton Territorial Hospital in the Northwest Territories (NWT) invited the Canadian Health Services Research Foundation (CHSRF) to explore opportunities to collaborate in the redesign and improvement of the health system. This article describes the NWT’s efforts to transform its healthcare delivery to more appropriately care for people living with chronic diseases. It also sets the context for the initial meeting between the NWT and CHSRF and the collaborative journey that continues, with the bringing together of 40 health system managers, policy makers and clinicians, along with CHSRF staff and guest faculty, with a shared vision to redesign care to better meet the needs of people living with chronic diseases in the territory.

Cardiac Care Quality Indicators: A New Hospital-Level Quality Improvement Initiative for Cardiac Care in Canada.
Vanita Gorzkiewicz, Jeanie Lacroix and,Kori Kingsbury.
Healthcare Quarterly 2012 02/16;15(1):22-25

Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important. The Cardiac Care Quality Indicators are one such initiative, with the goal of supporting cardiac care centres in their quality improvement efforts by providing comparable facility-level information on a number of cardiac quality outcome indicators. Working together, the Canadian Institute for Health Information and the Cardiac Care Network of Ontario completed the pilot project for this initiative in Ontario and British Columbia in 2010. Based on the success of the pilot, a national expansion of the initiative is currently under way. This article details some of the processes that led to the success of the project and presents some high-level, de-identified results.

Role of Performance Measurement in a Major Redevelopment Project: The Case of the McGill University Health Centre Transition Support Office. canadian flag
Biron AD.
Healthcare Quarterly 2012 02/16;15(1):34-40

Healthcare is currently in the midst of a construction boom. An increasing number of hospitals are being constructed using the principles of evidence-based design to improve the quality and safety of patient care while at the same maximizing efficiency. As the McGill University Health Centre embarks on a redevelopment journey, performance measurement has been deemed to be a key requirement for monitoring progress toward established objectives. This article discusses the role played by performance measurement in supporting the redevelopment project. Specifically, the importance given to performance measurement, the need for a performance evaluation framework, a description of the framework and the measurement process are presented.

Hospital on a Page: Standardizing Data Presentation to Drive Quality Improvement. canadian flag
Michael Heenan, Michelle DiEmanuele, Kathryn Hayward-Murray and,Ladan Dadgar.
Healthcare Quarterly 2012 02/16;15(1):41-45

Over the past five years, the Credit Valley Hospital (CVH) invested time and financial and human resources into performance measurement systems. In doing so, CVH launched a number of data tools including electronic scorecards and dashboards. However, the processes and accountability structures associated with the tools struggled to gain credibility with clinical and administrative leadership as the performance measurement system was primarily driven by the technology rather than a sound information strategy. Although a corporate-level scorecard was regularly updated, program-related scorecards and other measurement tools were only populated when programs reported to the board, at the time of accreditation or as a result of regulatory requirements. In addition, information contained in data reports was often presented in a manner that did not engage clinical and corporate decision-makers in the key issues of quality, access and sustainability.

Work Life and Patient Safety Culture in Canadian Healthcare: Connecting the Quality Dots Using National Accreditation Results. canadian flag
Mitchell JI.
Healthcare Quarterly 2012 02/16;15(1):51-59

Fostering quality work life is paramount to building a strong patient safety culture in healthcare organizations. Data from two patient safety culture and work-life questionnaires used for Accreditation Canada’s national program were analyzed. Strong team leadership was reported in that units were doing a good job of identifying, assessing and managing risks to patients. Seventy-one percent of respondents gave their unit a positive overall grade on patient safety, and 79% of respondents felt that they could often do their best-quality work in their job. However, healthcare workers felt that they did not have enough time to do their jobs adequately and indicated that co-workers were cutting corners in patient care in order to save time. This article discusses engaging both senior leadership and the entire organization in the change process, ensuring supervisory support, and using performance measures to focus organizational efforts on key priorities all as improvement strategies relevant to these findings. These strategies can be used by organizations across sectors and jurisdictions and by healthcare leaders to positively affect work life and patient safety.

Review of the Quality of Care and Safety of Patients Requiring Access to Emergency Department Care and Cancer Surgery and the Role and Process of Physician Advocacy.
HQCA, Feb 2012

The Health Quality Council of Alberta has released its independent review of issues related to the quality of care and safety of patients requiring access to emergency department care, lung cancer surgery, physician advocacy adn the impact of physician intimidation.

Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol.
Jones PD, Chalmers LM, Wells SD, Ameratunga SP, Carswell PD, Ashton TP, et al.
BMC health services research 2012 Feb 21;12(1):45

In May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a performance measure has the potential to see improvements in the wider health system. However, the imposition of targets may have significant adverse consequences. There is little empirical work examining how the performance of the wider hospital system is affected by such a target. This project aims to answer the following questions: How has the introduction of the target affected broader hospital performance over time, and what accounts for these changes? Which initiatives and strategies have been successful in moving hospitals towards the target without compromising the quality of other care processes and patient outcomes? Is there a difference in outcomes between different ethnic and age groups? Which initiatives and strategies have the greatest potential to be transferred across organisational contexts? Methods/design The study design is mixed methods; combining qualitative research into the behaviour and practices of specific case study hospitals with quantitative data on clinical outcomes and process measures of performance over the period 2006-2012. All research activity is guided by a Kaupapa Maori Research methodological approach. A dynamic systems model of acute patient flows was created to frame the study. Consequences of the target (positive and negative) will be explored by integrating analyses and insights gained from the quantitative and qualitative streams of the study. DISCUSSION: At the time of submission of this protocol, the project has been underway for 12 months. This time was necessary to finalise both the case study sites and the secondary outcomes through key stakeholder consultation. We believe that this is an appropriate juncture to publish the protocol, now that the sites and final outcomes to be measured have been determined.

Organizational Change
Scale for classifying organizations as explorers, exploiters or ambidextrous
Popadiuk S.
International Journal of Information Management 2012;32(1):75-87

This paper presents a scale developed to classify organizations through cluster analysis as being exploiters, explores, ambidextrous or with no defined orientation. The theoretical framework helps identify that the concepts associated with exploration and exploitation may be classified into six practical dimensions: organizational knowledge practices, innovative practices, competition, strategic orientation, organizational efficiency and partnerships. After stripping the data, the scale was underpinned by 45 attributes related to these dimensions. Convergent and divergent validity statistics are presented resulting from a questionnaire being applied to 249 respondents from companies located in Brazil. © 2011 Elsevier Ltd. All rights reserved.

‘The way things are around here’: organisational culture is a concept missing from New Zealand healthcare policy, development, implementation, and research.
Scahill SL.
The New Zealand medical journal 2012 Jan 20;125(1348):79-89

Internationally, healthcare sectors are coming under increasing pressure to perform and to be accountable for the use of public funds. In order to deliver on stakeholder expectation, transformation will need to occur across all levels of the health system. Outside of health care it has been recognised for some time that organisational culture (OC) can have a significant influence on performance and that it is a mediator for change. The health sector has been slow to adopt organisational theory and specifically the benefits of understanding OC and impacts on performance. During a visit to health research units in the United Kingdom (UK) I realised the stark differences in the practice of health reform and its evaluation. OC is a firmly established concept within policy development, implementation and research in the UK. Unfortunately, the same cannot be said for New Zealand. There has been unrelenting reform and structural redesign, particularly of the primary healthcare sector under multiple governments over the past 20 to 30 years. However, there has been an underwhelming focus on the human aspects of organisational change. This seems set to continue and the aim of this viewpoint is to introduce the concept of OC and outline why New Zealand policy reformists and health services researchers should be thinking explicitly about OC. Culture is not solely the domain of the organisational scientist and current understandings of the influence of OC on performance are outlined in this commentary. Potential benefits of thinking about culture are argued and a proposed research agenda is presented.

Research Methodology
A simple method for estimating relative risk using logistic regression.
Diaz-Quijano FA.
BMC medical research methodology 2012 Feb 15;12(1):14

Odds ratios (OR) significantly overestimate associations between risk factors and common outcomes. The estimation of relative risks (RR) or prevalence ratios (PR) has represented a statistical challenge in multivariate analysis and, furthermore, some researchers do not have access to the available methods. Objective: To propose and evaluate a new method for estimating RR and PR by logistic regression. METHODS: A provisional database was designed in which events were duplicated but identified as non-events. After, a logistic regression was performed and effect measures were calculated, which were considered RR estimations. This method was compared with binomial regression, Cox regression with robust variance and ordinary logistic regression in analyses with three outcomes of different frequencies.RESULTS:ORs estimated by ordinary logistic regression progressively overestimated RRs as the outcome frequency increased. RRs estimated by Cox regression and the method proposed in this article were similar to those estimated by binomial regression for every outcome. However, confidence intervals were wider with the proposed method. CONCLUSION: This simple tool could be useful for calculating the effect of risk factors and the impact of health interventions in developing countries when other statistical strategies are not available.

The association between survey timing and patient-reported experiences with hospitals: results of a national postal survey.
Bjertnaes OA.
BMC medical research methodology 2012 Feb 15;12(1):13

Research on the effect of survey timing on patient-reported experiences and patient satisfaction with health services has produced contradictory results. The objective of this study was thus to assess the association between survey timing and patient-reported experiences with hospitals. METHODS: Secondary analyses of a national inpatient experience survey including 63 hospitals in the 5 health regions in Norway during the autumn of 2006. 10,912 (45%) patients answered a postal questionnaire after their discharge from hospital. Non-respondents were sent a reminder after 4 weeks. Multilevel linear regression analysis was used to assess the association between survey timing and patient-reported experiences, both bivariate analysis and multivariate analysis controlling for other predictors of patient experiences. RESULTS: Multivariate multilevel regression analysis revealed that survey time was significantly and negatively related to three of six patient-reported experience scales: doctor services (Beta = 0.424, p < 0.05), information about examinations (Beta = 0.566, p < 0.05) and organization (Beta = 0.528, p < 0.05). Patient age, self-perceived health and type of admission were significantly related to all patient-reported experience scales (better experiences with higher age, better health and routine admission), and all other predictors had at least one significant association with patient-reported experiences. CONCLUSIONS: Survey time was significantly and negatively related to three of the six scales for patient-reported experiences with hospitals. Large differences in survey time across hospitals could be problematic for between-hospital comparisons, implying that survey time should be considered as a potential adjustment factor. More research is needed on this topic, including studies with other population groups, other data collection modes and a longer time span.

Evidence summaries: the evolution of a rapid review approach
Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D.
Systematic Reviews 2012;1(1):10

Background: Rapid reviews have emerged as a streamlined approach to synthesizing evidence – typically for informing emergent decisions faced by decision makers in health care settings. Although there is growing use of rapid review ‘methods’, and proliferation of rapid review products, there is a dearth of published literature on rapid review methodology. This paper outlines our experience with rapidly producing, publishing and disseminating evidence summaries in the context of our Knowledge to Action (KTA) research program. Methods The KTA research program is a two-year project designed to develop and assess the impact of a regional knowledge infrastructure that supports evidence-informed decision making by regional managers and stakeholders. As part of this program, we have developed evidence summaries – our form of rapid review – which have come to be a flagship component of this project. Our eight-step approach for producing evidence summaries has been developed iteratively, based on evidence (where available), experience and knowledge user feedback. The aim of our evidence summary approach is to deliver quality evidence that is both timely and user-friendly. Results From November 2009 to March 2011 we have produced 11 evidence summaries on a diverse range of questions identified by our knowledge users. Topic areas have included questions of clinical effectiveness to questions on health systems and/or health services. Knowledge users have reported evidence summaries to be of high value in informing their decisions and initiatives. We continue to experiment with incorporating more of the established methods of systematic reviews, while maintaining our capacity to deliver a final product in a timely manner. Conclusions The evolution of the KTA rapid review evidence summaries has been a positive one. We have developed an approach that appears to be addressing a need by knowledge users for timely, user-friendly, and trustworthy evidence and have transparently reported these methods here for the wider rapid review and scientific community.

Health Care in Canada
Canadian Primary Healthcare Policy: The Evolving Status of Reform
CHSRF, Mable, Ann L.; Marriott, John, Jan 16, 2012

The key findings for decision-makers on the current state of Canadian primary healthcare (PHC) policies, and the perceptions thereof, offer insights for renewed direction and action.

  • All jurisdictions have maintained some focus on PHC policy. Although the extent and complexity of PHC application varies, the glass is half-full, not half-empty.
  • The combined information that can be found about PHC at the federal, provincial and territorial levels provides a foundation of PHC policy direction that could be built upon for a more cohesive PHC strategy across Canada.
  • The many links between current PHC activity and work done under prior national initiatives confirm the continuity and legitimacy of direction that, in turn, strengthen the foundations for current PHC reform.
  • The system would benefit from renewal of an overarching framework for PHC reform across Canada to provide guidance and a reference point for aligning with principles and objectives and understanding progress.
  • Different PHC delivery models, elements and capacity building—many showing considerable innovation—have emerged in jurisdictions across Canada. Their successes should be showcased and problems addressed from a high level to recognize good work and relieve pressures on the ground.
  • Given the diverse activity under way and issues of clarity about and between primary healthcare and primary care, there is a perception by key informants of a lack of coherence in reform across Canada.
  • Continued tensions between old and new ways of care delivery are affecting PHC reform progress at all levels and require resolution if reform is to achieve desired goals.
    Despite good work under way, the situation is not well served by the unsatisfactory state of data, lack of interoperable information systems and insufficient available research across the country.

Aging
Nursing aide reports of combative behavior by residents with dementia: results from a detailed prospective incident diary.
Morgan DG, Cammer A, Stewart NJ, Crossley M, D’Arcy C, Forbes DA, et al.
Journal of the American Medical Directors Association 2012 Mar;13(3):220-227

This study examined nursing aides’ (NAs) perspectives of specific incidents of combative behavior from nursing home residents with dementia, particularly their attributions for the behaviors. DESIGN: This research is part of a larger mixed-method study exploring combative behavior as experienced by NAs. The data for this component were collected using a cross-sectional survey design. NAs used a prospective event-reporting log or “diary” to record consecutive incidents of combative resident behaviors. SETTING: Eleven rural nursing homes located in a mid-Western Canadian province. PARTICIPANTS: Eighty-three full-time, part-time, and casual NAs. MEASUREMENTS: NAs used the diary instrument to document details of each incident of combative behavior over a 144-hour period. Findings from the diaries were explored in subsequent focus groups (reported elsewhere). RESULTS: The 83 NAs reported 409 incidents linked to residents with dementia, with a range of 1 to 28 incidents per aide. The frequency of incidents in the preceding month was reported as follows: none (11.1%), 1-5 times (58.7%), 6-10 times (11.1%), more than 10 times (19.0%). Most incidents occurred in residents’ rooms (65%) during personal care, with the most frequent behaviors reported as slapping, squeezing, punching or hitting, and shoving. The main perceived causes of the behavior were cognitive impairment and residents not wanting care. NAs reported they could control or modify the cause in only 3% of incidents, and they were not optimistic about preventing future combative behaviors. They continued to provide care in 89% of incidents. CONCLUSION: In the diaries, NAs identified resident-related factors (cognitive impairment and not wanting care) as the main causes of combative behavior, and they reported having no control over these factors. In the focus groups conducted to explore diary findings, NAs reported system-level factors, also beyond their control, which affected their practices and increased their risk of exposure to combative behavior. Taken together, the results of this research program suggest a need for a broad multifaceted strategy aimed at addressing the modifiable risk factors, which includes recognizing NAs as equal partners in a team process backed by strong organizational support and commitment.

Detection of delirium and its symptoms by nurses working in a long term care facility.
Voyer P, Richard S, McCusker J, Cole MG, Monette J, Champoux N, et al.
Journal of the American Medical Directors Association 2012 Mar;13(3):264-271.

To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium. DESIGN: A prospective, observational study with repeated measurements over a 6-month period. SETTING: Seven long term care settings in Montreal and Quebec City, Canada. PARTICIPANTS: Residents aged 65 and older, with or without dementia, admitted to long term care (not respite care) and able to communicate in English or French. MEASUREMENTS: Delirium and its symptoms were assessed using the Confusion Assessment Method. Ratings of delirium by nurses based on their observations during routine care were compared with delirium ratings by trained research assistants based on a one-time formal structured evaluation (Confusion Assessment Method and Mini Mental State Examination). This procedure was repeated for 10 delirium symptoms. Sensitivity, specificity, and positive and negative predictive values were calculated. The method of generalized estimating equations was used to identify factors associated with undetected delirium. RESULTS: Research assistants identified delirium in 43 (21.3%) of the 202 residents. Nurses identified delirium in 51% of the cases identified by the research assistants. However, for cases without delirium according to the research assistants, nurses identified 90% of them correctly. Detection rates for delirium symptoms ranged from 25% to 66.7%. Undetected delirium was associated with lower number of depressive symptoms manifested by the resident.CONCLUSION: Detection of delirium is a major issue for nurses. Strategies to improve nurse recognition of delirium could well reduce adverse outcomes for this vulnerable population.

Implementing INTERACT (Intervention to Reduce Avoidable Acute Care Transfer) Distance Learning Curriculum to Reduce Avoidable Acute Care Transfer and Improve the Quality of Care in a Skilled Nursing Facility.
Ye Y, Ye Y, Phippis A, Reiman S, Carr D, Parker RW.
Journal of the American Medical Directors Association 2012 03/01;13(3):B15.

Thousands of NH residents are hospitalized each year. In fact, 25% of Medicare patients discharged from an acute care hospital to a nursing home (NH) are readmitted to the hospital within 30 days. Recent reviews indicate that a substantial proportion of these hospitalizations may be avoidable, including hospital transfers for clinical conditions, such as heart failure, urinary tract infection, and pneumonia, that may be safely treated in the NH with early identification and appropriate management.

Sense of Competence in Dementia Care Staff (SCIDS) scale: development, reliability, and validity.
Schepers AK, Orrell M, Shanahan N, Spector A.
International psychogeriatrics / IPA 2012 Feb 20:1-10

Background: Sense of competence in dementia care staff (SCIDS) may be associated with more positive attitudes to dementia among care staff and better outcomes for those being cared for. There is a need for a reliable and valid measure of sense of competence specific to dementia care staff. This study describes the development and evaluation of a measure to assess “sense of competence” in dementia care staff and reports on its psychometric properties.Methods: The systematic measure development process involved care staff and experts. For item selection and assessment of psychometric properties, a pilot study (N = 37) and a large-scale study (N = 211) with a test-retest reliability (N = 58) sub-study were undertaken.Results: The final measure consists of 17 items across four subscales with acceptable to good internal consistency and moderate to substantial test-retest reliability. As predicted, the measure was positively associated with work experience, job satisfaction, and person-centered approaches to dementia care, giving a first indication for its validity.Conclusions: The SCIDS scale provides a useful and user-friendly means of measuring sense of competence in care staff. It has been developed using a robust process and has adequate psychometric properties. Further exploration of the construct and the scale’s validity is warranted. It may be useful to assess the impact of training and perceived abilities and skills in dementia care.

Perspectives on Ageing with Dementia
Joseph Rowntree Foundation, Feb 2013

This Perspectives paper explores the views and experiences of people living with dementia. Dot Weaks spoke to key group members about the formation, development, challenges and benefits of the Scottish Dementia Working Group (SDWG) over the past ten years.
Contributors talk about:

  • The challenges and opportunities for those living with dementia, and the ways in which the SDWG has worked to increase awareness.
  • Why people living with dementia are proud to be part of a group that campaigns to improve the lives of people with dementia.
  • The fact that the SDWG has achieved significant policy changes while also providing support, friendship and a sense of camaraderie.
  • Recruiting and supporting members, particularly when they become less able to participate. One member still participates despite living in residential care.

Long Term Care Family Experience Survey
Health Quality Council of Alberta, 2011

Published in November, 2011 by the Health Quality Council of Alberta. Using the CAHPS Nursing Home Survey: Family Member Instrument, the 2010/2011 Survey repeated a survey done in 2007/8, the first long term care experience survey done at the provincial level. The survey sought to:

  • identify areas of excellence and opportunities for improvement
  • compare information across the province
  • provide an opportunity for facilities to compare results from the previous survey

The questionnaire collected the following information:

  • resident and respondent characteristics
  • family experience and perceptions
  • family member ratings
  • willingness to recommend the home
  • suggestions for improvement

Events
Non UofA
Canadian Public Health Association Conference
June 11-14, 2013 Edmonton, AB

Public health and environmental health professionals, researchers, policy-makers, academics and students from across the country and around the world will meet in Edmonton, Alberta for the 2012 Annual Conference of the Canadian Public Health Association (CPHA).

Courses
Online
Demystifying Research: Simplifying Critical Appraisal
Wednesday, March 7, 2012 at 10:00 AM MT, 12:00PM EST

Are you often frustrated when you read research studies? Do you sometimes wonder why they are so challenging? Would you be interested in learning how to use the tool of research to help you improve your patient outcomes through evidence-based practice? If you answered yes to any of these questions, join us for the Webinar: Demystifying Research: Simplifying Critical Appraisal.
Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC, Chief Nurse of Wolters Kluwer Health / Lippincott Williams & Wilkins Journals and Ovid Technologies, and Maureen “Shawn” Kennedy, MA, RN, Editor-in-Chief of the American Journal of Nursing, will have a discussion with Dr. Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN, to address the steps to critically appraise research evidence and demonstrate how to embrace the process of distilling the pearls that research has to offer. Dr. Fineout-Overholt is currently Dean & Professor, Groner School of Professional Studies and Chair, Department of Nursing of East Texas Baptist University. Additionally, she is one of the authors of AJN’s, award winning, Evidence-Based Practice, Step by Step series. Don’t miss this important opportunity to enhance your knowledge and sharpen your skills about critical appraisal of evidence.

News
Health and Human Resources releases National Alzheimer’s Plan draft

This is the first National Plan. This plan includes a detailed listing of current federal activities and, as directed by NAPA, initial recommendations for priority actions to expand, eliminate, coordinate or condense programs. The activities outlined in this plan vary in scope and impact and include:

  1. immediate actions that the federal government will take;
  2. actions toward the goals that can be initiated by the federal government or its public and private partners in the near term; and
  3. longer-range goals that will require numerous actions to achieve.

This is a National Plan and not a federal plan. It will require the active engagement of public and private sector stakeholders to achieve. In the case of many of the long-range goals, the path forward will be contingent on resources, scientific progress, and focused collaborations across many 3 partners. Over time, HHS will work with the Advisory Council and stakeholders to add additional transformative actions.

Australia to make funded health research open access

The National Health and Medical Research Council (NHMRC) has joined other international health research funding bodies, both governmental (such as NIH) and philanthropic (such as the Wellcome Trust), in requiring that publications from research funded by us are placed in the public domain – so called “open access”. This also assists other researchers in planning and conducting their research. Open access is particularly important for researchers in low income countries.

Resources
Self-Learning Portal Continence Care

This online self-learning portal is intended to support the implementation of “Clinical Practice Guidelines for the Urinary Continence Management of Stroke Survivors in Acute and Rehabilitation Settings”. This online self-learning portal contains interactive learning modules, case scenarios, and learning assessments. Links to supporting assessment tools and protocols, best practice guidelines, education materials, and articles are included to further help you to implement these clinical practice guidelines in your setting.

Joseph Rowntree Foundation: A Better Life, Old Age, New Thoughts

From the Joseph Rowntree Foundation in the UK. A website that explores ageing. Old age isn’t about ‘them’, it’s about all of us. We’re all heading in that direction – the number of people over 85 in the UK will double in the next 20 years. More of us than ever are reaching old age and those who do face new challenges. But we rarely hear about this stage of life from the real experts. This site gives older people’s voices a platform. The sites hopes to highlight their experiences, resilience and ability to flourish across a century of huge change. And we want to find out what they can teach us about mutual support and positive thinking.

Consumer Assessment of Healthcare Providers and Systems Quality Improvement Podcasts

A few of these include: The Role of Human Resources Staff in Improvement Efforts, The Role of Leadership in Improvement Efforts, and Creating an Improvement Culture.

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