Merry Christmas and have a wonderful holiday season.
Congratulations to Adrian Wagg!!! Dr. Wagg’s research project Continence across Continents to Upend Stigma and Dependency is one of 6 international research projects funded under the European Research Area on Ageing, a joint initiative with CIHR. Adrian is a TREC investigator as well as holding an Endowed chair in Healthy Ageing at the University of Alberta. Way to go Adrian!!!!
Latest KUSP publications
A Data Quality Control Program for Computer-Assisted Personal Interviews
JE Squires, AM Hutchinson, AM Boström, K Deis,PG Norton, GG Cummings, CA Estabrooks
Nursing Research and Practice, 2012
Researchers strive to optimize data quality in order to ensure that study findings are valid and reliable. In this paper, we describe a data quality control program designed to maximize quality of survey data collected using computer-assisted personal interviews. The quality control program comprised three phases: (1) software development, (2) an interviewer quality control protocol, and (3) a data cleaning and processing protocol. To illustrate the value of the program, we assess its use in the Translating Research in Elder Care Study. We utilize data collected annually for two years from computer-assisted personal interviews with 3004 healthcare aides. Data quality was assessed using both survey and process data. Missing data and data errors were minimal. Mean and median values and standard deviations were within acceptable limits. Process data indicated that in only 3.4% and 4.0% of cases was the interviewer unable to conduct interviews in accordance with the details of the program. Interviewers’ perceptions of interview quality also significantly improved between Years 1 and 2. While this data quality control program was demanding in terms of time and resources, we found that the benefits clearly outweighed the effort required to achieve high-quality data.
BMC has created a collection of articles on TREC: Translating research in elder care: An applied program of health services research
Series Editors: Carole A. Estabrooks and Peter Norton
These articles describe the protocols for the Translating Research in Elder Care (TREC) program and the evolution of the approaches taken by the team in its first four years to feed research findings back to study participants as the team began to move toward an integrated knowledge translation model.
New Article by Shannon Scott: Do health care institutions value research? A mixed methods study of barriers and facilitators to methodological rigor in pediatric randomized trials.
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Hamm MP, Scott SD, Klassen TP, Moher D, Hartling L.
BMC medical research methodology 2012 Oct 18;12:158-2288-12-158
Pediatric randomized controlled trials (RCTs) are susceptible to a high risk of bias. We examined the barriers and facilitators that pediatric trialists face in the design and conduct of unbiased trials. METHODS: We used a mixed methods design, with semi-structured interviews building upon the results of a quantitative survey. We surveyed Canadian (n=253) and international (n=600) pediatric trialists regarding their knowledge and awareness of bias and their perceived barriers and facilitators in conducting clinical trials. We then interviewed 13 participants from different subspecialties and geographic locations to gain a more detailed description of how their experiences and attitudes towards research interacted with trial design and conduct. RESULTS: The survey response rate was 23.0% (186/807). 68.1% of respondents agreed that bias is a problem in pediatric RCTs and 72.0% felt that there is sufficient evidence to support changing some aspects of how trials are conducted. Knowledge related to bias was variable, with inconsistent awareness of study design features that may introduce bias into a study. Interview participants highlighted a lack of formal training in research methods, a negative research culture, and the pragmatics of trial conduct as barriers. Facilitators included contact with knowledgeable and supportive colleagues and infrastructure for research. CONCLUSIONS: A lack of awareness of bias and negative attitudes towards research present significant barriers in terms of conducting methodologically rigorous pediatric RCTs. Knowledge translation efforts must focus on these issues to ensure the relevance and validity of trial results.
New Article by Anne-Marie Boström: Moving the agenda forward: a person-centred framework in long-term care.
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McGilton KS, Heath H, Chu CH, Bostrom AM, Mueller C, M Boscart V, et al.
International journal of older people nursing 2012 Dec;7(4):303-309
Internationally, the role of the registered nurse (RN) in long-term care (LTC) settings has evolved in response to the demands of governmental and organisational priorities. In stark contrast to the regulatory mandates, a person-centred care approach in LTC settings would require different outcomes, processes and competencies of the RN. AIMS: This article explores the implications of defining the RN’s role in delivering person-centred care in LTC homes. METHODS: Based on a review of the literature, we present a framework that can be used to gather evidence on the outcomes, processes of care and competencies required of RNs to lead their teams to person-centred LTC homes. RESULTS: The development of the framework highlighted several issues: (i) current measures of quality in LTC settings focus on health outcomes and avoiding adverse events rather than on resident quality of life and well-being, which influences the RN’s practice; (ii) person-centred care has emerged as a focus of care, yet measures currently developed are limited, and thus, new outcomes are proposed; (iii) to practice in a person-centred way, RNs must work through others on their team to ensure that staff truly relate to their residents, tailor approaches based on the remaining abilities of the residents and manipulate environments to match the competence of the individual, while focusing on residents’ personhood and (iv) competencies of RNs to deliver person-centred care include leadership, facilitation, clinical excellence and critical thinking skills. CONCLUSIONS: RNs need to be supported, allowed and encouraged in redesigning their role, to work to their full capacity if they are truly to support person-centred care in LTC settings. © 2012 Blackwell Publishing Ltd.
New Article by Lars Wallin: Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework.
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Bergstrom A, Peterson S, Namusoko S, Waiswa P, Wallin L.
Implementation science 2012 Dec 3;7(1):117
BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this ‘know-do’ gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework–i.e., receptive context, culture, leadership, and evaluation–also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings–resources, community involvement, and commitment and informal payment–should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.
Recommended Article: Contributions of environment, comorbidity, and stage of dementia to the onset of walking and eating disability in long-term care residents.
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Slaughter SE, Hayduk LA.
Journal of the American Geriatrics Society 2012 Sep;60(9):1624-1631
To estimate the relative effects of environment, comorbidities, stage of dementia and other variables on disability onset. DESIGN: A 1-year prospective cohort study was conducted in which the walking and eating abilities of long-term care residents were observed fortnightly. Structural equation modeling was used to assess the contributions of individual and environmental factors to the onset of disability. SETTING: Fifteen nursing homes in western Canada. PARTICIPANTS: One hundred twenty residents with middle-stage Alzheimer disease or related dementia. MEASUREMENTS: Environmental quality was assessed using the Professional Environmental Assessment Protocol, comorbidity using the Charlson Comorbidity Index, and stage of dementia using the Global Deterioration Scale. RESULTS: More-advanced baseline dementia had a direct effect on onset of walking and eating disability (standardized maximum likelihood estimate (SMLE) = 0.24, P = .006). Resident environment (SMLE = -0.25, P = .007) and comorbidities (SMLE = 0.32, P < .001) influenced disability onset approximately as strongly as stage of dementia. Smaller and publicly owned facilities provided superior environmental quality, which indirectly contributed to a delay in onset of walking and eating disability. CONCLUSION: Environmental quality and extent of comorbidity are at least as important as progression of dementia in initiating or delaying the onset of disability. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
CALL FOR ABSTRACTS: Evidence Based Health Care Joint Conference: 2nd Conference of International Society for EBHL & 6th International Conference for EBHC Teachers and Developers
Taormina, Italay 30th October – 2nd November 2013
DEADLINE March 15, 2013
Contributions concerning one or more of 3 main issues of Conference are welcome:
CALL FOR ABSTRACTS: 41st Annual Meeting of the Statistical Society of Canada
May 26-29, 2013 Edmonton, AB
DEADLINE Jan 31, 2013
The University of Alberta is pleased to host the 41st Annual Meeting of the Statistical Society of Canada from May 26 to 29, 2013. This conference will bring together academic, government, and industrial researchers as well as users of statistics and probability. Workshops, invited sessions, and contributed sessions will feature all areas of statistics and probability.
CALL FOR ABSTRACTS: CAHSPR Conference 2013
Vancouver, BC May 28-39, 2013
DEADLINE: Thursday Jan 24, 2013
What will it take to achieve the Triple Aim in Canadian health care? Can we simultaneously increase population health and improve the patient and provider experience while constraining cost growth? The conference provides an opportunity to learn from improvement initiatives in Canada and other jurisdictions, to identify the factors necessary to drive improvements across the Canadian health system, and to explore what it means to pursue the triple aim within the promise of universal access.
CALL FOR ABSTRACTS: Critical Perspectives in Nursing and Health Care International
June 19-20, 2013 Vancouver, BC
DEADLINE January 31, 2013
We invite submission of abstracts related to the following themes for oral presentations:
– health, history and social justice
– critical cultural perspectives
– anti-oppressive and equity-informed approaches
– transformative knowledge
– reflective practice
– critical historical analysis
– citizens’ engagement in health
– critical knowledge translation
Grants & Awards
CIHR: Age+ Prize
DEADLINE: January 15, May 1st and October 1st
The CIHR-Institute of Aging Age+ Prize recognizes excellence in research on aging carried out by emerging Canadian scholars. Up to 15 awards are offered annually to meritorious authors of published, scientific articles on aging. The Age+ Prize is aimed at graduate students, postdoctoral fellows and residents from all disciplines, working in the field of aging.
CIHR: IHSPR Rising Star Award 2012-2013
DEADLINE: February 1, 2013
The CIHR Institute of Health Services and Policy Research (IHSPR) is dedicated to supporting graduate students and post-doctoral Fellows and to recognizing the research excellence and knowledge translation initiatives of these emerging health services and policy researchers at an early stage in their career.
- To recognize the research excellence and innovative knowledge translation (KT) initiatives of graduate students (M.A., M.Sc. and PhD) and post-doctoral fellows studying in health services and policy research at a Canadian institution or abroad;
- To recognize research and/or KT contributions for which a graduate student or post-doctoral fellow has had primary responsibility;
- To promote careers in health services and policy research.
CIHR: IHSPR Article of the Year Award 2012-2013
DEADLINE: February 1, 2013
The CIHR Institute of Health Services and Policy Research (IHSPR) is dedicated to supporting the advancement of health services and policy research in Canada. To this end, we are pleased to launch the 2012-13 competition of the IHSPR Article of the Year Award for health services and policy researchers.
This award is intended to recognize published research that has significantly contributed to the advancement of the field of health services and policy research in Canada. IHSPR will consider articles related to: research that has had a clear impact or potential impact on policy or practice (e.g., decision maker uptake, change management for improved practice); OR
research that breaks ground in the way health services or policy research is conducted (e.g., innovations in methodology, novel theory or application of theory, new approaches to existing problems).
University Conference Fund 2013 Competition
DEADLINE: Wednesday February 1, 2013 @ 15:00 MT
The Nursing Research Office is pleased to announce the University Conference Fund competition is now open. The Conference Fund supports conferences and symposia or colloquia (as distinct from visiting lectureships) that contribute to scholarship and are sponsored or hosted by the University of Alberta and within Alberta. A maximum amount that can be applied for is $3,000 per competition. Faculty of Nursing Tenure Track Faculty coordinating conferences, symposium or colloquium held March 1, 2013 –February 28, 2014 are eligible to apply to this fund.
WCHRI Summer Studentship Awards
DEADLINE January 31, 2013 at 4:00 p.m
WCHRI Summer Studentship awards provide academically gifted students an opportunity to participate in research related to women and children’s health for 3 to 4 months during the summer. Students work on specific projects under the supervision of WCHRI researchers. The program aims to foster a new generation of researchers to pursue careers in women and children’s health.
ACCFCR Early Career Transition Award
Maximum of $110,000
DEADLINE April 1st, 2013
The Early Career Transition Award enables highly qualified post-doctoral fellows or new investigators holding a first academic appointment to have protected time to launch a research career in an area of relevance to children and families that can inform policy, programs or practice. The Award recipient will be expected to enhance their research skills and to develop partnerships with policymakers and service providers in Alberta. Award holders will participate in Centre-related activities related to knowledge mobilization.
CIHR Institue of Aging: Trainee Travel Award
DEADLINE January 25, 2013
CIHR-IA seeks to encourage networking and exchange of ideas among emerging scholars working within its priority research areas.
How can we maximize nursing students’ learning about research evidence and utilization in undergraduate, preregistration programmes? A discussion paper.
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Christie J, Hamill C, Power J.
Journal of advanced nursing 2012 Dec;68(12):2789-2801
Aim. This article presents a discussion on how to maximize nursing students’ learning about research for evidence-based practice in undergraduate, preregistration programmes. Background. Evidence-based practice may use information from many sources, including research. Research utilization concerns the translation of research findings into practice. Thus, while evidence-base practice may not be solely research-based and hence more than research utilization, research remains an important ingredient in ensuring quality and cost-effective care and an academic requirement for nursing students undertaking a science degree-level qualification. Nevertheless, how educators can best support research-related learning and application remains uncertain and requires discussion. Data sources. MEDLINE, CINAHL, Social Science Citation Index, British Nursing Index, and Intute were searched for papers published 1980-2011 using the following search terms: research, research utilization, evidence-based practice, learning, teaching, education, training, nursing, health, and social care. Discussion. Nursing students need to be able to value the relevance, authority, and utility of nursing research for patient care through embedding research learning in both academic and practice-based settings. Students can be supported in learning how to access, understand, and appraise the authority of research through weaving these skills into enquiry-based learning. Furthermore, encouraging students to undertake research-based practice change projects can support research utilization and development skills. Conclusion. Research should be fully embedded throughout nursing curricula beyond the confines of ‘research classes’, integrating learning in academic and practice-based settings. Although this requires synergistic and integrated support of student learning by nurse educators, managers, clinical practitioners, researchers and policymakers; nurse educators have a pivotal role. © 2012 Blackwell Publishing Ltd.
Evaluating the Feasibility and Effect of Using a Hospital-Wide Coordinated Approach to Introduce Evidence-Based Changes for Pain Management.
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Williams AM, Toye C, Deas K, Fairclough D, Curro K, Oldham L.
Pain management nursing 2012 Dec;13(4):202-214
This action research project explored the feasibility and effect of implementing a hospital-wide coordinated approach to improve the management of pain. The project used a previously developed model to introduce three evidence-based changes in pain management. Part of this model included the introduction of 30 pain resource nurses (PRNs) to act as clinical champions for pain at a local level. Both quantitative and qualitative measures were used to assess the feasibility and effect of the changes introduced. Quantitative data were gathered through a hospital-wide document review and assessment of the knowledge and attitude of the PRNs at two time points: time 1 before the introduction of the PRNs and time 2 near completion of the project (11 months later). A statistically significant improvement in the documentation of pain scores on admission and each nursing shift was apparent. However, no difference was found in the percentage of patients who had been prescribed opioids for regular pain relief that had also been prescribed and dispensed a laxative/aperient. Neither were any statistically significant decreases in patient pain scores observed. An assessment of the knowledge and attitudes of the PRNs showed an improvement from time 1 to time 2 that was statistically significant. The qualitative data revealed that despite the barriers encountered, the role was satisfying for the PRNs and valued by other hospital staff. Overall, the results revealed that the new model of change incorporating PRNs was a useful and effective method for introducing and sustaining evidence-based organizational change. Copyright © 2012 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Facilitating implementation of the translational research pipeline in neurological rehabilitation.
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Current opinion in neurology 2012 Dec;25(6):676-681
Knowledge translation is a growing area of specialisation. This review summarises the field perspectives and highlights recent work that has particular relevance to neurological rehabilitation. RECENT FINDINGS: Research in knowledge translation can usefully be organised into three overlapping perspectives, namely a linear transfer of codified knowledge, a social interaction perspective, or a multilevel implementation perspective that incorporates contextual factors. Although systematic reviews remain foundational in supporting knowledge translation, they often lack structured updating and can be problematic to implement in complex cases. Knowledge brokers play an important role in evidence use; these may be managers or administrators of rehabilitation services. Organisational support that sustains and structures knowledge brokering roles has been found lacking. Numerous contextual factors influence knowledge translation, including leadership, fidelity monitoring, and divergent stakeholder perspectives. Integrative frameworks have been developed that consolidate the multiple contingencies. SUMMARY: Knowledge translation is a complex process with an incomplete knowledge base; its uniprofessional focus is particularly limiting for neurological rehabilitation. Developing accessible systematic reviews remains central, as well as supporting knowledge brokers, being aware of stakeholder absorptive capacity in developing translational strategies and using integrative frameworks to guide knowledge translation for complex interventions.
Barriers and facilitators to the implementation of clinical practice guidelines: A cross-sectional survey among physicians in Estonia.
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Taba P, Rosenthal M, Habicht J, Tarien H, Mathiesen M, Hill S, et al.
BMC health services research 2012 Dec 13;12(1):455
BACKGROUND: In an era when an increasing amount of clinical information is available to health care professionals, the effective implementation of clinical practice guidelines requires the development of strategies to facilitate the use of these guidelines. The objective of this study was to assess attitudes towards clinical practice guidelines, as well as the barriers and facilitators to their use, among Estonian physicians. The study was conducted to inform the revision of the clinical practice guideline development process and can provide inspiration to other countries considering the increasing use of evidence-based medicine. METHODS: We conducted an online survey of physicians to assess resource, system, and attitudinal barriers. We also asked a set of questions related to improving the use of clinical practice guidelines and collected free-text comments. We hypothesized that attitudes concerning guidelines may differ by gender, years of experience and practice setting. The study population consisted of physicians from the database of the Department of Continuing Medical Education of the University of Tartu. Differences between groups were analyzed using the Kruskal-Wallis non-parametric test. RESULTS: 41% (497/1212) of physicians in the database completed the questionnaire, comprising more than 10% of physicians in the country. Most respondents (79%) used treatment guidelines in their daily clinical practice. Lack of time was the barrier identified by the most physicians (42%), followed by lack of medical resources for implementation (32%). The majority of physicians disagreed with the statement that guidelines were not accessible (73%) or too complicated (70%). Physicians practicing in outpatient settings or for more than 25 years were the most likely to experience difficulties in guideline use. 95% of respondents agreed that an easy-to-find online database of guidelines would facilitate use. CONCLUSIONS: Use of updated evidence-based guidelines is a prerequisite for the high-quality management of diseases, and recognizing the factors that affect guideline compliance makes it possible to work towards improving guideline adherence in clinical practice. In our study, physicians with long-term clinical experience and doctors in outpatient settings perceived more barriers, which should be taken into account when planning strategies in improving the use of guidelines. Informed by the results of the survey, leading health authorities are making an effort to develop specially designed interventions to implement clinical practice guidelines, including an easily accessible online database.
Making Evidence on Health Policy Issues Accessible to the Media
Healthcare Policy 2012 04/12;8(2):37-45
The media shape consumer expectations and interpretations of health interventions, influencing how people think about their need for care and the sustainability of the system. EvidenceNetwork.ca is a non-partisan, web-based project funded by the Canadian Institutes of Health Research and the Manitoba Health Research Council to make the latest evidence on controversial health policy issues available to the media. This website links journalists with health policy experts. We publish opinion pieces on current health policy issues in both French and English. We track who follows and uses the EvidenceNetwork.ca website and monitor the impact of our efforts.
Implementation of Evidence-Based Practices in the Context of a Redevelopment Project in a Canadian Healthcare Organization.
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Lavoie-Tremblay M, Richer MC, Marchionni C, Cyr G, Biron AD, Aubry M, et al.
Journal of nursing scholarship 2012 Dec;44(4):418-427
Purpose: The recent introduction of a project management office (PMO) in a major healthcare center, led by a nurse, provides a unique opportunity to understand how a PMO facilitates successful implementation of evidence-based practices in care delivery. Design: A case study with embedded units (individuals, projects, and organization). In this study, the case is operationally defined as the PMO deployed in a Canadian healthcare center. Methods: The sources of evidence used in this study were diverse. They consisted of 38 individual interviews, internal documents, and administrative data. The data were collected from March 2009 to November 2011. Content analysis was used to analyze the qualitative data. Findings: PMO experts help improve practices, and the patients thus receive safer and better quality care. Several participants point out that they could not make the changes without the PMO’s support. They mention that they succeeded in changing their practices based on the evidence and acquired knowledge of change management with the PMO members that can be transferred to their practice. Conclusions: With the leadership of the nurse director of the PMO, members provide a range of expertise and fields in evidence-based change management, project management, and evaluation. Clinical Relevance: PMO facilitates the implementation of clinical and organizational practices based on evidence to improve the quality and safety of care provided to patients. © 2012 Sigma Theta Tau International.
Health Care Administration & Organization
Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: a retrospective study.
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Twigg D, Duffield C, Bremner A, Rapley P, Finn J.
Journal of advanced nursing 2012 Dec;68(12):2710-2718
Aims. This article is a report of a study of the association between skill mix and 14 nursing-sensitive outcomes following implementation of the nursing hours per patient day staffing method in Western Australian public hospitals in 2002, which determined nursing hours by ward category but not skill mix. Background. Findings from previous studies indicate that higher nurse staffing levels and a richer skill mix are associated with improved patient outcomes. Measuring skill mix at a hospital level for specific staffing methods and associated nursing-sensitive patient outcomes are important in providing staffing for optimal patient care. Design. The research design for the larger study was retrospectively analysing patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over 4 years. Methods. A subset of data was used to determine the impact of skill mix on nursing-sensitive outcomes following implementation of the staffing method. All patient records (N = 103,330) and nurse staffing records (N = 73,770) from nursing hours per patient day wards from October 2002-June 2004 following implementation were included. Results. Increases in Registered Nurse hours were associated with important decreases in eight nursing-sensitive outcomes at hospital level and increases in three nursing-sensitive outcomes. The lowest skill mix saw the greatest reduction in nursing-sensitive outcome rates. Conclusions. The skill mix of nurses providing care could impact patient outcomes and is an important consideration in strategies to improve nurse staffing. Levels of hospital nurse staffing and skill mix are important organizational characteristics when predicting patient outcomes. © 2012 Blackwell Publishing Ltd.
NHSRU: Retaining RPNs: Impact on Quality Care
Dianne Martin & Annette Weeres
A paucity of research on the work experiences of registered practical nurses (RPNs) in Ontario prompted the Registered Practical Nurses Association of Ontario (RPNAO) to conduct a province-wide study of RPNs in 2010. The research study used a mixed methods design that included surveys and interviews with a select number of survey respondents. This report presents the results of the interview phase of the study. Five focus groups were held with 31 RPNs across Ontario. Nurses were interviewed about their work experiences and asked to identify key factors that affect their ability to provide high-quality care.
Health Care Innovation and Quality Assurance
Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.
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Ouslander JG, Maslow K.
Journal of the American Geriatrics Society 2012 Dec;60(12):2313-2318
Reducing preventable hospitalizations is fundamental to the “triple aim” of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person’s health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health.
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Norton WE, McCannon CJ, Schall MW, Mittman BS.
Implementation science : IS 2012 Dec 6;7(1):118
BACKGROUND: Although significant advances have been made in implementation science, comparatively less attention has been paid to broader scale-up and spread of effective health programs at the regional, national, or international level. To address this gap in research, practice and policy attention, representatives from key stakeholder groups launched an initiative to identify gaps and stimulate additional interest and activity in scale-up and spread of effective health programs. We describe the background and motivation for this initiative and the content, process, and outcomes of two main phases comprising the core of the initiative: a state-of-the-art conference to develop recommendations for advancing scale-up and spread and a follow-up activity to operationalize and prioritize the recommendations. The conference was held in Washington, D.C. during July 2010 and attended by 100 representatives from research, practice, policy, public health, healthcare, and international health communities; the follow-up activity was conducted remotely the following year. DISCUSSION: Conference attendees identified and prioritized five recommendations (and corresponding sub-recommendations) for advancing scale-up and spread in health: increase awareness, facilitate information exchange, develop new methods, apply new approaches for evaluation, and expand capacity. In the follow-up activity, ‘develop new methods’ was rated as most important recommendation; expanding capacity was rated as least important, although differences were relatively minor. SUMMARY: Based on the results of these efforts, we discuss priority activities that are needed to advance research, practice and policy to accelerate the scale-up and spread of effective health programs.
The quality implementation framework: a synthesis of critical steps in the implementation process.
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Meyers DC, Durlak JA, Wandersman A.
American Journal of Community Psychology 2012 Dec;50(3-4):462-480
Implementation science is growing in importance among funders, researchers, and practitioners as an approach to bridging the gap between science and practice. We addressed three goals to contribute to the understanding of the complex and dynamic nature of implementation. Our first goal was to provide a conceptual overview of the process of implementation by synthesizing information from 25 implementation frameworks. The synthesis extends prior work by focusing on specific actions (i.e., the “how to”) that can be employed to foster high quality implementation. The synthesis identified 14 critical steps that were used to construct the Quality Implementation Framework (QIF). These steps comprise four QIF phases: Initial Considerations Regarding the Host Setting, Creating a Structure for Implementation, Ongoing Structure Once Implementation Begins, and Improving Future Applications. Our second goal was to summarize research support for each of the 14 QIF steps and to offer suggestions to direct future research efforts. Our third goal was to outline practical implications of our findings for improving future implementation efforts in the world of practice. The QIF’s critical steps can serve as a useful blueprint for future research and practice. Applying the collective guidance synthesized by the QIF to the Interactive Systems Framework for Dissemination and Implementation (ISF) emphasizes that accountability for quality implementation does not rest with the practitioner Delivery System alone. Instead, all three ISF systems are mutually accountable for quality implementation.
Association between Traditional Nursing Home Quality Measures and Two Sources of Nursing Home Complaints.
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Troyer JL, Sause W.
Health services research 2012 Dec 6
OBJECTIVE: To test for an association between traditional nursing home quality measures and two sources of resident- and caregiver-derived nursing home complaints. DATA SOURCES: Nursing home complaints to the North Carolina Long-Term Care Ombudsman Program and state certification agency from October 2002 through September 2006 were matched with Online Survey Certification and Reporting data and Minimum Data Set Quality Indicators (MDS-QIs). STUDY DESIGN: We examine the association between the number of complaints filed against a facility and measures of inspection violations, staffing levels, and MDS-QIs. DATA EXTRACTION: One observation per facility per quarter is constructed by matching quarterly data on complaints to OSCAR data from the same or most recent prior quarter and to MDS-QIs from the same quarter. One observation per inspection is obtained by matching OSCAR data to complaint totals from both the same and the immediate prior quarter. PRINCIPAL FINDINGS: There is little relationship between MDS-QIs and complaints. Ombudsman complaints and inspection violations are generally unrelated, but there is a positive relationship between state certification agency complaints and inspection violations. CONCLUSIONS: Ombudsman and state certification agency complaint data are resident- and caregiver-derived quality measures that are distinctive from and complement traditional quality measures. © Health Research and Educational Trust.
Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments.
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Brennan SE, Bosch M, Buchan H, Green SE.
Implementation science : IS 2012 Dec 17;7(1):121
BACKGROUND: Continuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments. METHODS: Data sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments, reference lists of systematic reviews, and citations and references of the main report of instruments. Study selection: The scope of the review was determined by a conceptual framework developed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). Papers reporting development or use of an instrument measuring a construct encompassed by the framework were included. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarising and comparing instruments. Instrument content was categorised using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care. RESULTS: We identified 186 potentially relevant instruments, 152 of which were analysed to develop the taxonomy. Eighty-four instruments measured constructs relevant to primary care, with content measuring CQI implementation and use (19 instruments), organizational context (51 instruments), and individual factors (21 instruments). Forty-one instruments were included for full review. Development methods were often pragmatic, rather than systematic and theory-based, and evidence supporting measurement properties was limited. CONCLUSIONS: Many instruments are available for evaluating CQI, but most require further use and testing to establish their measurement properties. Further development and use of these measures in evaluations should increase the contribution made by individual studies to our understanding of CQI and enhance our ability to synthesise evidence for informing policy and practice.
Organizational Change and Innovation
Organizational culture and the implementation of person centered care: Results from a change process in Swedish hospital care.
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Alharbi TS, Ekman I, Olsson LE, Dudas K, Carlstrom E.
Health policy (Amsterdam, Netherlands) 2012 Dec;108(2-3):294-301
Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Bayesian methods in clinical trials: a Bayesian analysis of ECOG trials E1684 and E1690.
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Ibrahim JG, Chen MH, Chu H.
BMC medical research methodology 2012 Nov 29;12(1):183
BACKGROUND: E1684 was the pivotal adjuvant melanoma trial for establishment of high-dose interferon (IFN) as effective therapy of high-risk melanoma patients. E1690 was an intriguing effort to corroborate E1684, and the differences between the outcomes of these trials have embroiled the field in controversy over the past several years. The analyses of E1684 and E1690 were carried out separately when the results were published, and there were no further analyses trying to perform a single analysis of the combined trials. METHOD: In this paper, we consider such a joint analysis by carrying out a Bayesian analysis of these two trials, thus providing us with a consistent and coherent methodology for combining the results from these two trials. RESULTS: The Bayesian analysis using power priors provided a more coherent flexible and potentially more accurate analysis than a separate analysis of these data or a frequentist analysis of these data. The methodology provides a consistent framework for carrying out a single unified analysis by combining data from two or more studies. CONCLUSIONS: Such Bayesian analyses can be crucial in situations where the results from two theoretically identical trials yield somewhat conflicting or inconsistent results.
A Comparison of Statistical Methods for Identifying Out-of-Date Systematic Reviews.
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Pattanittum P, Laopaiboon M, Moher D, Lumbiganon P, Ngamjarus C.
PloS one 2012;7(11):e48894
Systematic reviews (SRs) can provide accurate and reliable evidence, typically about the effectiveness of health interventions. Evidence is dynamic, and if SRs are out-of-date this information may not be useful; it may even be harmful. This study aimed to compare five statistical methods to identify out-of-date SRs. METHODS: A retrospective cohort of SRs registered in the Cochrane Pregnancy and Childbirth Group (CPCG), published between 2008 and 2010, were considered for inclusion. For each eligible CPCG review, data were extracted and “3-years previous” meta-analyses were assessed for the need to update, given the data from the most recent 3 years. Each of the five statistical methods was used, with random effects analyses throughout the study. RESULTS: Eighty reviews were included in this study; most were in the area of induction of labour. The numbers of reviews identified as being out-of-date using the Ottawa, recursive cumulative meta-analysis (CMA), and Barrowman methods were 34, 7, and 7 respectively. No reviews were identified as being out-of-date using the simulation-based power method, or the CMA for sufficiency and stability method. The overall agreement among the three discriminating statistical methods was slight (Kappa = 0.14; 95% CI 0.05 to 0.23). The recursive cumulative meta-analysis, Ottawa, and Barrowman methods were practical according to the study criteria. CONCLUSION: Our study shows that three practical statistical methods could be applied to examine the need to update SRs.
Auxiliary variables in multiple imputation in regression with missing X: a warning against including too many in small sample research.
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Hardt J, Herke M, Leonhart R.
BMC medical research methodology 2012 Dec 5;12(1):184
BACKGROUND: Multiple imputation is becoming increasingly popular. Theoretical considerations as well as simulation studies have shown that the inclusion of auxiliary variables is generally of benefit. METHODS: A simulation study of a linear regression with a response Y and two predictors X1 and X2 was performed on data with n = 50, 100 and 200 using complete cases or multiple imputation with 0, 10, 20, 40 and 80 auxiliary variables. Mechanisms of missingness were either 100% MCAR or 50% MAR + 50% MCAR. Auxiliary variables had low (r=.10) vs. moderate correlations (r=.50) with X’s and Y. RESULTS: The inclusion of auxiliary variables can improve a multiple imputation model. However, inclusion of too many variables leads to downward bias of regression coefficients and decreases precision. When the correlations are low, inclusion of auxiliary variables is not useful. CONCLUSION: More research on auxiliary variables in multiple imputation should be performed. A preliminary rule of thumb could be that the ratio of variables to cases with complete data should not go below 1 : 3.
Guidelines for guidelines: are they up to the task? A comparative assessment of clinical practice guideline development handbooks.
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Ansari S, Rashidian A.
PloS one 2012;7(11):e49864
We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. METHODS: We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. RESULT: Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. DISCUSSION: Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings help decision makers in identifying the necessary tasks for guideline development, provide an updated comparative list of guideline development handbooks, and provide a checklist to assess the comprehensiveness of guideline development processes.
Policy and program decisions typically involve selecting one choice from among a set of options, and research about the effect of those options can help inform the decision process. However, for the research to be useful, decision makers need a way of drawing accurate lessons from what often can be a large assortment of relevant studies. Systematic reviews can be particularly useful in this process because they identify, assess, and synthesize key pieces of evidence on policy or program effectiveness. This brief provides recommendations for conducting high quality systematic reviews. We hope that the recommendations will increase the number of such reviews, to provide decision makers with a greater number of useful evidence summaries that can inform decision making
Systematic archiving and access to health research data: rationale, current status and way forward
M Rani & BS Buckley
Bull World Health Organ 2012;90:932–939
Systematically archiving data from health research and large-scale surveys and ensuring access to databases offer economic benefits and can improve the accountability, efficiency and quality of scientific research. Recently, interest in data archiving and sharing has grown and, in developed countries, research funders and institutions are increasingly adopting data-sharing policies. In developing countries, however, there is a lack of awareness of the benefits of data archiving and little discussion of policy. Many databases, even those of large-scale surveys, are not preserved systematically and access for secondary use is limited, which reduces the return on research investment. Several obstacles exist: organizational responsibility is unclear; infrastructure and personnel with appropriate data management and analysis skills are scarce; and researchers may be reluctant to share. This article considers recent progress in data sharing and the strategies and models used to encourage and facilitate it, with a focus on the World Health Organization Western Pacific Region. A case study from the Philippines demonstrates the benefits of data sharing by comparing the number and type of publications associated with two large-scale surveys with different approaches to sharing. Advocacy and leadership are needed at both national and regional levels to increase awareness. A step-by-step approach may be the most effective: initially large national databases could be made available to develop the methods and skills needed and to foster a datasharing culture. Duplication of costs and effort could be avoided by collaboration between countries. In developing countries, interventions are required to build capacity in data management and analysis.
Health Care in Canada
Ivey International Centre for Health Innovation: Measuring What Matters: The Cost vs. Values of Health Care
There is a clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded. Canadian values have shifted substantially in recent years, towards a preference for greater autonomy and empowerment in managing their health care and management. Canadians’ values reflect the desire for a more “personalized” health care system, one that engages every individual patient in a collaborative partnership with health providers, to make decisions that support health, wellness, and quality of life. Yet, health systems are focused on performance management in terms of costs, operational inputs, such as services delivered, or quality measures such as medication errors, readmissions to hospital, and mortality rates. Health system effectiveness is not evaluated in terms of delivering value to Canadians.
Thinking inside the box? Intellectual structure of the knowledge base of innovation research (1988-2008)
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Strategic Management Journal 2013;34(1):62-93
Innovation is becoming increasingly popular as a concept as well as a field of research. As a field, it has accumulated a significant amount of scientific knowledge. Based on bibliometric data from four major social science disciplines-economics, sociology, psychology, and management-this study presents a ‘global view’ of the field by combining longitudinal and structural perspectives. It identifies major research traditions in the field, determines the content and disciplinary composition of each tradition, and maps the changes in the intellectual structure of the field over time. The study suggests that innovation research is becoming increasingly compartmentalized between economics and management disciplines and each segment is becoming increasingly self-contained. A strategy along with a framework is suggested for making research contribution to the field. © 2012 John Wiley & Sons, Ltd.
Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents.
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Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, et al.
Journal of the American Geriatrics Society 2012 Dec;60(12):2302-2307
To describe Confusion Assessment Method (CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care (LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status. DESIGN: Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months. SETTING: Seven LTC facilities in Montreal and Quebec City, Canada. PARTICIPANTS: Forty-one older LTC residents who had at least one CAM-defined incident episode of delirium. MEASUREMENTS: The Mini-Mental State Examination (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. The frequency, mean number, type, and duration of CAM core symptoms of delirium occurring before and after incident episodes were examined using descriptive statistics, frequency analysis, and survival analysis. RESULTS: CAM core symptoms of delirium preceded 38 (92.7%) episodes of delirium for many weeks; core symptoms followed 37 (90.2%) episodes for many weeks. Symptoms of inattention and disorganized thinking occurred most commonly. The mean number of symptoms was higher in residents with dementia but not significantly so. CONCLUSION: CAM core symptoms of delirium were frequent and protracted before and after most incident episodes of delirium in LTC residents with and without dementia. If replicated, these findings have potentially important implications for clinical practice and research in LTC settings. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
Supporting and promoting personhood in long term care settings: contextual factors.
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O Siegel E, A Anderson R, Calkin J, H Chu C, N Corazzini K, Dellefield ME, et al.
International journal of older people nursing 2012 Dec;7(4):295-302
The need for personhood-focused long-term care (LTC) is well-documented. A myriad of sociocultural, political, nursing/professional and organisational contexts facilitate or hinder registered nurses (RNs)’ capacity to ensure personhood-focused LTC. Complexities derive from the countless interrelated aspects of these contexts, blurring clear distinctions of causality, responsibility and accountability. Context-related complexities were highlighted at a recent international conference attended by invited experts in LTC leadership from six countries (Canada, USA, England, Northern Ireland, New Zealand and Sweden). The group was convened to explore the value and contributions of RNs in LTC (McGilton, , International Journal of Older People Nursing 7, 282). The purpose of this paper is to expand the discussion of personhood-focused care beyond RNs, to contexts that influence the RN’s capacity to ensure personhood-focused practices are embedded in LTC settings. Consistent with key topics covered at the international conference, we selected four major contexts for discussion in this paper: (i) sociocultural, (ii) public policy/financing/regulation, (iii) nursing/professional and (iv) organisational. For each context, we provide a brief description, literature and examples from a few countries attending the conference, potential impact on personhood-focused practices and RN strategies to facilitate personhood-focused care. The knowledge gained from attending to the influence of contextual factors on the RN’s role in facilitating personhood-focused practices provides critical insights and directions for interventions aimed to maximise RN role effectiveness in LTC. In practice, understanding linkages between the various contexts offers indispensable insight for LTC nurse leaders charged with managing day-to-day operations and leading quality improvement initiatives that promote personhood-focused practices. © 2012 Blackwell Publishing Ltd.
Bathing residents with dementia in long-term care: critical incidents described by personal support workers.
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D’Hondt A, Kaasalainen S, Prentice D, Schindel Martin L.
International journal of older people nursing 2012 Dec;7(4):253-263
Aim and objective. The aim of this study was to describe and gain insight into the critical incidents depicted by personal support workers (PSWs) in long-term care (LTC) related to bathing residents who have dementia. Background. Residents with dementia in LTC often display responsive/protective behaviours during bathing. Consequently, bathing is a source of stress for PSWs who provide most of the personal care for LTC residents in Ontario, Canada. Design. A qualitative descriptive study employing the critical incident technique (CIT) was used. Method. Eight PSWs were interviewed and 24 incidents were collected and analyzed using thematic content analysis. Results. Findings revealed that PSWs experience the following during bathing: managing responsive/protective behaviours, working with limited resources, and dealing with communication difficulties. Participants used various strategies to respond to these challenges; however, they reported limited strategies to manage the most challenging behaviours. Conclusions. Many of the bathing strategies described by the PSWs in this study are found in the literature about best bathing practices in dementia care. However, it is evident that further work is needed to support PSWs to manage the most difficult physical responsive/protective behaviours that occur during bathing. Implications for practice. This study has clear implications for knowledge translation. © 2011 Blackwell Publishing Ltd.
The association between malnutrition and oral health status in elderly in long-term care facilities: A systematic review.
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Van Lancker A, Verhaeghe S, Van Hecke A, Vanderwee K, Goossens J, Beeckman D.
International journal of nursing studies 2012 Dec;49(12):1568-1581
Malnutrition is a common problem in the elderly. It is not clear if oral health is associated to malnutrition in this population. The aim of this systematic review is to determine whether an association exists between oral health and malnutrition in the elderly in a long-term care facility. DESIGN: Systematic review. DATA SOURCE: Medline, Cochrane and Cinahl were systematically searched for to identify articles published between January 1985 and May 2011. Reference lists were checked for additional publications. REVIEW METHODS: Publications were included if they explored the association between oral health status and malnutrition. As no consensus about terminology was found, a sensitive filter was developed. The methodological quality of the studies was assessed. Two independent reviewers performed all methodological steps. RESULTS: Sixteen studies met the criteria for inclusion. Eleven studies used a multivariate approach; nine of these found an association between oral health status and malnutrition. Four studies found a relationship between masticatory problems and malnutrition. Five studies found an association between malnutrition and dental condition, number of oral problems, tongue alteration, problems with saliva flow, and candidiasis. Overall, the methodological quality of the studies was medium. CONCLUSIONS: Tentative evidence indicates an independent association between oral health status and malnutrition in the elderly residing in a long-term care facility. Caution is needed for the interpretation of these results because of the absence of a gold standard to define and assess malnutrition and oral health status and the presence of methodological limitations throughout the studies. Copyright © 2012 Elsevier Ltd. All rights reserved.
An investigation into which individual instrumental activities of daily living are affected by a home visiting nurse intervention.
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Li Y, Liebel DV, Friedman B.
Age and Ageing 2013 Jan;42(1):27-33
BACKGROUND: to our knowledge no research has investigated the effect of home visiting nurse (HVN) interventions on individual instrumental activities of daily living (IADL). OBJECTIVE: to investigate the effects of an HVN intervention on the difficulty or dependence in six individual IADLs. DESIGN: a secondary analysis of a randomised controlled study comparing an HVN intervention (n = 237) with usual care (n = 262) at 22 months after study entry. SETTING: home care linked to primary care. SUBJECTS: a total of 499 Medicare patients needing or receiving help with at least three IADLs or two ADLs, who had recent significant health-care use. METHODS: the intervention consisted of monthly home visits by trained nursing staff. Unadjusted and adjusted (binary and multinomial logistic regression) analyses were performed. RESULTS: unadjusted analyses found less difficulty or dependence for the HVN group for meal preparation, telephone use, shopping and ordinary housework, and more difficulty or dependence for medication management. After adjustment, in addition to an effect through health-care services use, the HVN group had less difficulty or dependence for meal preparation and shopping and more difficulty or dependence for medication management. CONCLUSIONS: an HVN intervention had mixed results for individual IADLs. The negative effect on medication management questions the validity of a total IADL score as an outcome measure, and implies that other medication management measures should be considered for outcome evaluation. Future research is needed to confirm and better understand these findings.
Medication management for nurses working in long-term care.
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Ellis W, Kaasalainen S, Baxter P, Ploeg J.
The Canadian journal of nursing research 2012 Sep;44(3):128-149
In long-term care (LTC), the complexity of residents’ conditions and their treatment requirements present challenges for nurses managing medications. The purpose of this qualitative descriptive study was to explore medication management as described by licensed nurses working in LTC. A total of 22 licensed nurses from 2 LTC facilities located in the Canadian province of Ontario participated in 4 focus groups. Thematic content analysis was used to organize data into themes and a conceptual model was developed. The overarching theme was that nurses are “racing against time” to manage medications and 3 subthemes described how they coped with this important care process: preparing to race, running the race, and finishing the race. Barriers to safe medication management included time restraints, knowledge limitations, interruptions and distractions, and poor communication. The findings can be used to better inform health-care providers and to guide future research. They also have the potential to directly impact outcomes related to safe medication management in LTC.
A nurse-led interdisciplinary leadership approach targeting pressure ulcer prevention in long-term care.
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Kennerly SM, Yap T, Miller E.
The health care manager 2012 Jul-Sep;31(3):268-275
Mounting evidence suggests that the quality of outcomes in long-term care can be improved by strengthening the leadership behaviors of nurses. Consequently, a reduction in the prevalence and incidence of pressure ulcers (PUs) is thought to be possible through a nurse-led, team-based approach. The purposes of this article were to (1) advocate for greater nurse-led interdisciplinary teamwork focusing on PU prevention and (2) describe how a transformational and practice-based framework can be used to guide the long-term care team to improve PU quality care outcomes. Application of nurse-led, team-conceptualized strategies enables interdisciplinary workers to partner and more effectively participate in PU prevention programs, thus deepening engagement in the organization’s overall approach to achieving quality outcomes.
Hospital admissions from nursing homes: a qualitative study of GP decision making.
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McDermott C, Coppin R, Little P, Leydon G.
The British journal of general practice 2012 Aug;62(601):e538-45
Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As ‘gatekeepers’ to NHS, GPs are expected to make best use of resources and may be criticised for ‘inappropriate’ admissions. Little is understood about the influences on GPs as they make such decisions. AIM: To explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital. DESIGN AND SETTING: A purposive sample of 21 GPs from two counties in the South of England. METHOD: Data from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method. RESULTS: This study suggests that while clinical assessment, perceived benefits and risks of admission, and patients’ and relatives’ preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable. CONCLUSION: Developing a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.
‘Finding home’: a grounded theory on how older people ‘find home’ in long-term care settings.
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International journal of older people nursing 2012 Sep;7(3):188-199
A link between residents ‘feeling at home’ in long-term care facilities and ‘quality of life’ is emerging in the literature. Few studies, however, have focused on what helps residents to find a home in long-term care settings. This study aimed to fill this gap. AIM: This study aimed to understand older peoples’ perceptions of ‘being at home’ in long-term care settings and the factors that influence these perceptions. DESIGN: Grounded theory guided the study design. Residents (n = 61) living in public or private long-term care settings were interviewed using unstructured interviews. FINDINGS: Four categories were identified as critical to finding a home in long-term care settings: ‘continuity’, ‘preserving personal identity’, ‘belonging’ and ‘being active and working’. ‘Finding Home’ was conceptualised as the core category. The potential to ‘find home’ was influenced by mediating and facilitating/constraining factors. CONCLUSIONS: The Theory of Finding Home was generated from the data. This theory describes the factors critical to ‘finding home’ in long-term care settings. IMPLICATIONS FOR PRACTICE: The Theory of Finding Home gives insight into what matters to older people living in long-term care settings. Strategies to help generate a feeling of home in long-term care settings are shared. © 2011 Blackwell Publishing Ltd.
Quality of life of residents with dementia in traditional versus small-scale long-term care settings: a quasi-experimental study.
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de Rooij AH, Luijkx KG, Schaafsma J, Declercq AG, Emmerink PM, Schols JM.
International journal of nursing studies 2012 Aug;49(8):931-940
The number of people living with dementia worldwide is increasing, resulting in a need for more residential care. In response to criticism of the traditional medical approach to residential dementia care, many large nursing homes are transforming their traditional care facilities into more home-like small-scale living facilities. OBJECTIVES: This study examined the assumed benefits of small-scale living for residents with dementia, compared to traditional long-term care in the Netherlands and Belgium. The primary outcome was quality of life, divided into nine different domains. DESIGN: The study had a longitudinal design within a one-year time interval. SETTINGS: Five long-term care settings in the Netherlands and Belgium containing four traditional and twelve small-scale living units participated in the study. PARTICIPANTS: Data were obtained from 179 residents with dementia (age< 65 years) (Dutch small-scale N=51, traditional N=51, Belgian small-scale N=47, traditional N=30). METHODS: Nurses and nursing assistants were trained to fill in the questionnaires. RESULTS: In the Dutch sample, residents in small-scale settings had higher mean scores on 'social relations', 'positive affect', and 'having something to do' than residents in traditional settings. Moreover, mean scores on 'caregiver relation' and 'negative affect' remained stable over time among residents in small-scale settings, but decreased in traditional settings. These differences could not be explained by differences in behavioural characteristics, behavioural interventions, or social interaction. In the Belgian sample, fewer differences were found between traditional and small-scale settings. Nevertheless, residents in small-scale settings were reported to experience less 'negative affect' than those in traditional settings, which could be explained by differences in depression. Over time, however, residents 'felt more at home' in traditional settings, whereas no such increase was found for small-scale settings. Moreover, the mean quality of life scores on 'restless behaviour', 'having something to do' and 'social relations' decreased in small-scale settings, but remained stable in traditional settings. CONCLUSIONS: Both small-scale and traditional settings appear to have beneficial effects on different domains of quality of life of residents with dementia. Future research should focus more on the quality and content of the care provided, than on the effects of the scale and design of the environment in long-term care settings. Copyright © 2012 Elsevier Ltd. All rights reserved.
How do issues of risk and trust affect decision-making in the care of older people? In the next 40 years the proportion of the population in retirement is estimated to rise significantly. This major demographic change makes it imperative to review the position of older people both as receivers and as givers of care and support. The report:
- examines the nature of decision-making;
- explores the ‘decision ecology’ – the multi-factored contextual backdrop to decisions about risk and trust in an ageing society;
- discusses factors that influence, improve and impede caring decisions taken by a range of actors;
- considers the role of narratives in improving decisions for, by and about older people and their care;
- appraises risk management and trust development strategies;
- investigates responsibility in decision-making.
How do risk, trust and confidence shape decision-making in caring and supportive relationships in an ageing society? This review considers the role of individual motivation and cognition in dealing with some of the challenges, choices and tensions confronted in daily life in relation to the issues of risk and trust. It looks at both informal and semi-formal caring and supportive relationships.
- asks what would help make people more confident to make better decisions about caring for and supporting each other;
- explores what helps or sustains people in local communities who offer help and support to others within their social network;
- examines how society’s capacity to support an ageing society could be strengthened;
- considers how formal social care structures interact with informal and semi-formal spheres, and what they can learn from them.
Privacy and Data Security in Clinical Research
WCHRI Lunch and Learn Series
Presenter: Dr. Lawrence Richer
Tuesday Jan 8, 2013 12:00-13:00 ECHA 4-036
Regulations, polcies, and opoinions on meeting privacy and data security requirements in clinical research can be very difficult to navigate. The Health Information Act of Alberta, while generally permissive to clinical research, has specific requirements that must be met. AHS has developed new research related policies. new and existing clinical information systems present an opportunity, but mechanisms to access data for research are yet to be developed. The clinical researcher is expected to meet obligations established by these regulations and policies and abide by ethical principles and best practices in research established by the Tri-Council Policy Statement.
Perceptions of Promise: Biotechnology, Society and Art
Until Jan 5, 2013 Enterprise Square, Thursdays and Fridays 12:00-18:00, Saturdays 12:00-16:00
Join U of A Museums downtown at Enterprise Square for Perceptions of Promise: Biotechnology, Society and Art, a touring exhibition that offers a compelling glimpse into a unique collaboration between scientists, scholars and nine Canadian and international artists working in a variety of mediums. This visually engaging exhibition challenges viewers to consider the positive and negative possibilities of biotechnology in general and stem cell research in particular.
Cochrane Collaboration’s 2013 Colloquium
Laval, PQ 19-23 September 2013
Call for abstracts and workshops will open on Feb 23, 2013.
Transforming Practice in LTC through Innovative Learning
Tuesday, February 12, 2013
The Baycrest Centre for Learning, Research and Innovation is proud to be hosting the inaugural conference of the Ontario Centres for Learning, Research and Innovation in Long-Term Care. The focus of the conference will be on innovative educational approaches to learning in long-term care settings with an emphasis on translating knowledge to practice.
Cochrane Canada Webinar: Supporting Evidence-Informed Policymaking: the Role of Health Systems Evidence,Stakeholder Dialogues and Other Initiatives
Wednesday, 23 January 2013 10:00-11:00 MT
Presenter: Dr. John Lavis
Four challenges confront those seeking to support evidence-informed policymaking:1) research competes with many other factors in the policymaking process; 2) research isn’t valued; 3) research isn’t relevant; and 4) research isn’t easy to use. A number of initiatives have been developed over the past five years to address these challenges, both in Canada and internationally. Two examples will be described in detail – Health Systems Evidence and stakeholder dialogues informed by evidence briefs – both of which draw on Cochrane systematic reviews. Select other examples will also be described.
Cochrane Canada Webinar: Evidence-Based Health Reporting
Wednesday 30 January 2013 10:00-11:00 MT
Presenter: Julia Belluz. Associate Editor, The Medical Post; Contributing Writer, Maclean’s; McMaster Health Forum Journalism Fellow.
Right now, there’s a gap between what is known in health research and how it’s implemented in practice and health policy, and used by patients. The media often fill that gap and communicate health research—but they often get it wrong. This presentation will focus on how to bridge the gap between reporting and research, highlighting examples from around the world of better evidence-informed health reporting.
Qualitative Research Methods courses at University of Oxford 2013
- Introduction to Qualitative Research Methods May 20-24, 2013 This one week course, run by the Health Experiences Research Group, provides an overview of the use of qualitative methods using a combination of practical workshops, group discussions and formal lectures.
- Introduction to Media Content Analysis March 8, 2013 This one day course, run by the Health Experiences Research Group, aims to introduce researchers to the method of manifest and latent content analysis using a combination of practical workshops, group discussions and formal lectures.
- Introduction to Qualitative Interviewing February 21-22, 2013 This two day course, run by the Health Experiences Research Group, aims to introduce researchers to the method of qualitative interviewing using a combination of practical workshops, group discussions and formal lectures.
- Introduction to Focus Groups March 1, 2013 Focus groups are increasingly used in qualitative research as a method for exploring people’s experiences of specific topics. This one day course, run by the Health Experiences Research Group, aims to introduce participants to the principles and practice of organising, moderating and analysing focus groups. The course uses a combination of practical workshops, group discussions and formal lectures.
- Analysing Qualitative Interviews February 7-8 2013 OR April 11-12, 2013 This two day course, run by the Health Experiences Research Group, aims to introduce the principles and practice of qualitative interview data analysis, with particular emphasis on thematic analysis techniques. It uses a combination of practical workshops, group discussions and formal lectures.
- Qualitative Data Analysis Clinic May 3, 2013 This intensive one day course, run by the Health Experiences Research Group, provides an opportunity for students to work on analysing data from their qualitative research projects under the guidance of experienced qualitative researchers. The course is open to those who have previously attended our one week Introduction to Qualitative Research Methods course or our 2 day Analysing Qualitative Interviews course and who are using a thematic approach to data analysis.
International Nursing Summer School Programme at Oxford
July 21-Aug 3, 2013 Oxford, UK
This is an exciting new opportunity to attend a two-week residential programme at Oxford Brookes University. The programme will be delivered at both undergraduate and postgraduate level and will focus on evidence based practice, care and compassion, reflective practice and research. Our internationally published authors will take you through their latest research and insights in these areas. Social events may include a visit to Blenheim Palace, punting and a picnic on the Thames, a visit to London, a visit to the theatre, a visit to Bicester Village. This Oxford experience is open to UK and International student nurses, qualified nurses and staff who wish to continue their professional development, obtaining either a certificate of attendance or gaining undergraduate/postgraduate credit on submission of an assignment.
NHS hospitals and care homes in England will be subject to league tables similar to those used to rate the performance of schools, as part of a new drive to improve standards, the health secretary, Jeremy Hunt, has announced. Hunt said that the new system of ratings would work in the same way as those for schools produced by the Office for Standards in Education, Children’s Services and Skills (Ofsted), acting as an “engine for improvement” and giving patients more certainty that poor care would be spotted and dealt with “before standards collapse.”
New tools are challenging the monopoly of impact factors as the sole measure of research quality, but are they up to the job?
- Systematic reviews, protocols and rapid reviews relating to the prevention and treatment of obesity; and systematic reviews, protocols and rapid reviews relating to the treatment and management of dementia.
- New developments in the conduct and reporting of diagnostic and prognostic systematic reviews.
Submission of all article types on these topics is encouraged details of which can be found in their instructions for authors.
Documenting a patient’s case history to inform physicians how the patient has been evaluated and the subsequent progression of his or her disease is arguably the oldest method of communicating medical evidence. And in the 21st century case reports play an equally important role. BioMed Central acknowledges the value of case reports to the scientific record. To strengthen this commitment they have developed a valuable new resource – Cases Database, a continuously-updated, freely-accessible database of over 10 000 medical case reports from multiple publishers, including Springer, BMJ and PubMed Central. By aggregating case reports together and facilitating comparison, Cases Database provides clinicians, researchers, regulators and patients a simple resource to explore content, and identify emerging trends.
This app is designed to make reader-friendly view of articles in PMC archive (this includes all of the BMC journals including Implementation Science). It works with the browsers: Firefox, Chrome, and Safari. And you can use it on your iPad (with Safari/Chrome) or Android tablet (with Chrome/Android browser).
CNA and ACEN have partnered to develop a co-ordinated system to collect nurse sensitive data to evaluate care being provided in health care sectors, with funding from Canada Health Infoway. Dr. Diane Doran, one of the project Co-Leads, will oversee the NNQR-C analysis and reports developed at the NHSRU. This project will result in methodological advances in measuring nursings contribution to quality health care. The pilot is taking place with the long-term goal of establishing a sustainable national nursing quality report for all jurisdictions in Canada. As part of this pilot the Canadian National Nursing Quality Report, or NNQR-C, is currently collaborating with Canadian Patient Safety Institute as a host for collecting the NNQR indicators through the Patient Safety Metrics system. Unit-level nurse staffing structural indicators, and processes of care data, as well nursing sensitive outcomes measures, will be submitted on a quarterly basis from acute care, long-term care/complex continuing care, and mental health in four provinces. The NNQR-C will also collect nurse job satisfaction and work environment survey data as part of an annual, web-based survey. The pilot phase includes an evaluation which will be completed by March 2014.
Alberta Health Services has cut the time caregivers can spend with home care clients in Edmonton in order to deal with a budget deficit.
As of Jan 2013, CIHR-funded researchers will be required to make their peer-reviewed publications freely accessible within 12 months of publication – at the latest. Options for OA publishing include publishing in an OA journal or a journal that allows for OA articles, deposit in PubMed Central Canada or deposit to an institutional repository such as ERA at the UofA.
Fewer people are dying in Canada’s acute care facilities after admission, according to the latest hospital mortality data from the Canadian Institute for Health Information (CIHI).
The Health Council of Canada has developed a series of videos to provide an overview of clinical practice guidelines (CPGs) in Canada through the eyes of those who design, disseminate, and use them. CPGs are evidence-based recommendations that help health care professionals make better clinical decisions. When designed and used properly, CPGs can play an important role in the Canadian health care system. These videos are meant to offer greater insight into what CPGs are, how they are used, how they are disseminated and implemented, and what impact they can have.
This website provides tips and tricks for scientists to work effectively with the news media. It includes information on print, radio, and tv.
This practical tool represents what we know about spread and adoption. It will help you increase the scale and pace of the spread and adoption of innovation in the NHS.
The Nova Scotia Cochrane Resource Centre
The Department of Community Health and Epidemiology (http://che.medicine.dal.ca/) and the Nova Scotia Cochrane Resource Centre (http://cochrane.che.dal.ca/) at Dalhousie University are seeking a Postdoctoral Fellowship candidate to work within an evidence synthesis research program. The successful applicant will work on systematic review and rapid response research projects, and evidence synthesis methodological investigations.
Manager, Knowledge Translation Strategy
DEADLINE: January 8, 2012 $92,819-$116,016
The purpose of this role is to support CIHR in achieving the Knowledge Translation (KT) component of its mandate by managing the development and implementation of strategies, evaluation and ongoing improvement of knowledge translation elements in CIHR programs and initiatives in collaboration with internal and external CIHR stakeholders. This role provides strategic and practical KT expertise, advice and support to CIHR’s institutes, branches, strategic initiatives, portfolios and partners. The incumbent, reporting to the Director of Science, Knowledge Translation and Ethics oversees relevant grants and awards budgets and leads and manages a team of direct reports responsible for efficient and effective leadership and implementation of KT strategies and initiatives.
CLIR/DLF Postdoctoral Fellowship in the Curation of Confidential Health Data
University of Alberta Libraries
DEADLINE: Dec 31, 2012 17:00 ET
University of Alberta Libraries (UAL) seeks a postdoctoral fellow to engage with and contribute to its innovative services in research data curation and digital preservation. Working with professional staff within UAL, the University of Alberta Research Ethics Office, and the University of Alberta Health Law Institute, this fellowship position will be responsible for investigating data management practices, norms, policies, and infrastructure in health research that would improve methods for sharing sensitive, private, or proprietary data.