New article by Anne-Marie Boström & Lars Walin
Factors associated with evidence-based practice among registered nurses in Sweden: a national cross-sectional study
Bostrom AM, Rudman A, Ehrenberg A, Gustavsson JP, Wallin L.
BMC health services research 2013 May 4;13:165-6963-13-165
Background Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses’ (RNs’) practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation. Methods A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models. Results Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 – 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 – 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 – 2.0). Conclusions To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.
New article by Lars Walin
Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial.
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Persson LA, Nga NT, Malqvist M, Thi Phuong Hoa D, Eriksson L, Wallin L, et al.
PLoS medicine 2013 May;10(5):e1001445
BACKGROUND: Facilitation of local women’s groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period
New article by Shannon Scott
Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations.
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Albrecht L, Archibald M, Arseneau D, Scott SD.
Implementation science : IS 2013 May 16;8:52-5908-8-52
BACKGROUND: Influenced by an important paper by Michie et al., outlining the rationale and requirements for detailed reporting of behavior change interventions now required by Implementation Science, we created and refined a checklist to operationalize the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations in systematic reviews. The WIDER recommendations provide a framework to identify and provide detailed reporting of the essential components of behavior change interventions in order to facilitate replication, further development, and scale-up of the interventions. FINDINGS: The checklist was developed, applied, and improved over the course of four systematic reviews of knowledge translation (KT) strategies in a variety of healthcare settings conducted by Scott and associates. The checklist was created as one method of operationalizing the work of the WIDER in order to facilitate comparison across heterogeneous studies included in these systematic reviews. Numerous challenges were encountered in the process of creating and applying the checklist across four stages of development. The resulting improvements have produced a ‘user-friendly’ and replicable checklist to assess the quality of reporting of KT interventions in systematic reviews using the WIDER recommendations. CONCLUSIONS: With journals, such as Implementation Science, using the WIDER recommendations as publication requirements for evaluation reports of behavior change intervention studies, it is crucial to find methods of examining, measuring, and reporting the quality of reporting. This checklist is one approach to operationalize the WIDER recommendations in systematic review methodology.
New article by Shannon Scott
Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.
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Jabbour M, Curran J, Scott SD, Guttman A, Rotter T, Ducharme FM, et al.
Implementation science 2013 May 22;8(1):55
BACKGROUND: The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways.Design/methods: We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. DISCUSSION: This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways.Trial registration: ClinicalTrials.gov: NCT01815710https://register.clinicaltrials.gov.
Article recommended by Dr. Carole Estabrooks
Knowledge translation within a population health study: how do you do it?
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Kitson A, Powell K, Hoon E, Newbury J, Wilson A, Beilby J.
Implementation science 2013 May 21;8(1):54
BACKGROUND: Despite the considerable and growing body of knowledge translation (KT) literature, there are few methodologies sufficiently detailed to guide an integrated KT research approach for a population health study. This paper argues for a clearly articulated collaborative KT approach to be embedded within the research design from the outset. DISCUSSION: Population health studies are complex in their own right, and strategies to engage the local community in adopting new interventions are often fraught with considerable challenges. In order to maximise the impact of population health research, more explicit KT strategies need to be developed from the outset. We present four propositions, arising from our work in developing a KT framework for a population health study. These cover the need for an explicit theory-informed conceptual framework; formalizing collaborative approaches within the design; making explicit the roles of both the stakeholders and the researchers; and clarifying what counts as evidence. From our deliberations on these propositions, our own co-creating (co-KT) Framework emerged in which KT is defined as both a theoretical and practical framework for actioning the intent of researchers and communities to co-create, refine, implement and evaluate the impact of new knowledge that is sensitive to the context (values, norms and tacit knowledge) where it is generated and used. The co-KT Framework has five steps. These include initial contact and framing the issue; refining and testing knowledge; interpreting, contextualising and adapting knowledge to the local context; implementing and evaluating; and finally, the embedding and translating of new knowledge into practice. SUMMARY: Although descriptions of how to incorporate KT into research designs are increasing, current theoretical and operational frameworks do not generally span a holistic process from knowledge co-creation to knowledge application and implementation within one project. Population health studies may have greater health impact when KT is incorporated early and explicitly into the research design. This, we argue, will require that particular attention be paid to collaborative approaches, stakeholder identification and engagement, the nature and sources of evidence used, and the role of the research team working with the local study community.
Article recommended by Dr. Carole Estabrooks
Health-related quality-of-life instruments for Alzheimer’s disease and mixed dementia.
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Perales J, Cosco TD, Stephan BC, Haro JM, Brayne C.
International psychogeriatrics 2013 May;25(5):691-706
BACKGROUND: Over the last 20 years, a number of instruments developed for the assessment of health-related quality of life (HRQL) in dementia have been introduced. The aim of this review is to synthesize evidence from published reviews on HRQL measures in dementia and any new literature in order to identify dementia specific HRQL instruments, the domains they measure, and their operationalization. METHODS: An electronic search of PsycINFO and PubMed was conducted, from inception to December 2011 using a combination of key words that included quality of life and dementia. RESULTS: Fifteen dementia-specific HRQL instruments were identified. Instruments varied depending on their country of development/validation, dementia severity, data collection method, operationalization of HRQL in dementia, psychometric properties, and the scoring. The most common domains assessed include mood, self-esteem, social interaction, and enjoyment of activities. CONCLUSIONS: A number of HRQL instruments for dementia are available. The suitability of the scales for different contexts is discussed. Many studies do not specifically set out to measure dementia-specific HRQL but do include related items. Determining how best to operationalize the many HRQL domains will be helpful for mapping measures of HRQL in such studies maximizing the value of existing resources.
Article recommended by Dr. Carole Estabrooks
Selecting the best instruments to measure quality of end-of-life care and quality of dying in long term care.
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van Soest-Poortvliet MC, van der Steen JT, Zimmerman S, Cohen LW, Reed D, Achterberg WP, et al.
Journal of the American Medical Directors Association 2013 Mar;14(3):179-186
OBJECTIVES: To compare available instruments and investigate which best measure the quality of end-of-life care (QOC) and quality of dying (QOD) in long term care settings, in terms of validity, reliability, and feasibility. DESIGN: Family and professional caregivers of long term care decedents completed postdeath interviews and questionnaires between November 2007 and April 2009. SETTING: Nursing home and residential care/assisted living settings in the United States and the Netherlands. PARTICIPANTS: Two hundred and sixty four families of decedents with (48%) and without (52%) dementia in the United States, and 70 families and 103 professional caregivers of decedents with dementia in The Netherlands. MEASUREMENTS: Ten instruments to evaluate the QOC and QOD in long term care, an additional overall assessment of QOC/QOD, and an assessment of the perception of the relevance and ease of use of each instrument. Criteria for validity, reliability, and feasibility were set forth for good, intermediate, and poor performance. RESULTS: None of the instruments scored positively on all criteria. In both countries, of the QOC instruments, the End-of-Life in Dementia-Satisfaction With Care (EOLD-SWC) best met the criteria, followed by the Family Assessment of Treatment at the End-of-Life Short Version, the Family Perception of Care Scale, and Family Perception of Physician-Family Caregiver Communication. Of the QOD instruments, the End-of-Life in Dementia-Comfort Assessment at Dying (EOLD-CAD) and Mini-Suffering State Examination (MSSE) met more of the criteria than others. The EOLD-CAD performed better on content and construct validity than the MSSE. The MSSE performed better on feasibility. CONCLUSION: We recommend the EOLD-SWC to measure QOC, and the EOLD-CAD and MSSE to measure QOD in populations with dementia and in mixed long term care populations of nursing home or residential care home/assisted living residents, because they performed best in both countries. Use of the same instruments allows for comparison of the results between studies. Copyright © 2013. Published by Elsevier Inc.
CALL FOR PAPERS: Health Care: The Journal of Delivery Science and Innovation.
DEADLINE: 1 August 2013
Health Care publishes cutting edge research on a quarterly basis focused on: patient-centered clinical innovation, quality improvement, payment reform and applied health information technology. This issue will specifically highlight innovations in applied information technology to improve delivery of care.
CALL FOR ABSTRACTS: Qualitative Health Research (QHR) Conference
27-29 Oct 2013 Halifax NS
DEADLINE: May 30, 2013
The aim is to help researchers navigate the challenges of designing, conducting and disseminating qualitative research.
CALL FOR POSTERS: First Global Conference on Research Integration and Implementation
8-11 September 2013 Canberra Australia
DEADLINE: 12 August 2013
Bringing together researchers and educators who use systems-based, action-oriented, multidisciplinary, interdisciplinary, or transdisciplinary approaches. Learning from case studies which tackle complex real-world problems such as climate change, organised crime, aged care. Compiling effective concepts and methods for synthesising knowledge, managing risk and other unknowns, and supporting policy and practice change.
Grants & Awards
AIHS Collaborative Research and Innovation Opportunities (CRIO)
LOI DEADLINE: 28 June 2013 16:00
To foster and support a large interdisciplinary collaborative team or network with national or international stature. The complexity of the health issues of interest will require the involvement of many stakeholder groups.
Increasing the influence of one’s research on policy
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Dwan KM, McInnes PC.
Australian Health Review 2013;37(2):194-198.
This article published in the Australian Health Review looks at ways to improve exchange at the interface between research and policy, focusing on knowledge transfer as a way to promote evidence-informed decisionmaking. The article provides tips on increasing the impact of research, and advises researchers to choose compelling subjects and build productive relationships with research users.
Sustainability of knowledge translation interventions in healthcare decision-making: protocol for a scoping review.
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Tricco AC, Cogo E, Ashoor H, Perrier L, McKibbon KA, Grimshaw JM, et al.
BMJ open 2013 May 14;3(5):10.1136/bmjopen-2013-002970.
INTRODUCTION: Knowledge translation (KT also known as research utilisation, translational medicine and implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health. After the implementation of KT interventions, their impact on relevant outcomes should be monitored. The objectives of this scoping review are to: (1) conduct a systematic search of the literature to identify the impact on healthcare outcomes beyond 1 year, or beyond the termination of funding of the initiative of KT interventions targeting chronic disease management for end-users including patients, clinicians, public health officials, health services managers and policy-makers; (2) identify factors that influence sustainability of effective KT interventions; (3) identify how sustained change from KT interventions should be measured; and (4) develop a framework for assessing sustainability of KT interventions. METHODS AND ANALYSIS: Comprehensive searches of relevant electronic databases (eg, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), websites of funding agencies and websites of healthcare provider organisations will be conducted to identify relevant material. We will include experimental, quasi-experimental and observational studies providing information on the sustainability of KT interventions targeting chronic disease management in adults and focusing on end-users including patients, clinicians, public health officials, health services managers and policy-makers. Two reviewers will pilot-test the screening criteria and data abstraction form. They will then screen all citations, full articles and abstract data in duplicate independently. The results of the scoping review will be synthesised descriptively and used to develop a framework to assess the sustainability of KT interventions. DISCUSSION AND DISSEMINATION: Our results will help inform end-users (ie, patients, clinicians, public health officials, health services managers and policy-makers) regarding the sustainability of KT interventions. Our dissemination plan includes publications, presentations, website posting and a stakeholder meeting.
The real world journey of implementing fall prevention best practices in three acute care hospitals: a case study.
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Ireland S, Kirkpatrick H, Boblin S, Robertson K.
Worldviews on evidence-based nursing 2013 May;10(2):95-103
BACKGROUND: Globally, falls are the second leading cause of unintentional injury. In Canada, falls that occur in hospitals have been ranked second as an area of patient safety concern. Many Canadian hospitals seeking to achieve patient safety, accreditation and resource containment goals are implementing evidence-based practices in fall prevention. However, best practices are reported to be only variably effective in reducing hospital fall rates, indicating a potential gap in our understanding of the implementation process. This study was designed to provide insight into the real world of implementation of best practices in fall prevention in acute care Canadian hospitals. APPROACH: Using case study methodology, ninety-five administrative and point-of-care nurses at three hospitals participated in interviews or focus groups and provided documents and artifacts that described their implementation of a falls prevention guideline. FINDINGS AND IMPLICATIONS: Four recommendations with potential to guide others in fall prevention were identified: (1) the need to listen to and recognize the expertise and clinical realities of staff, (2) the importance of keeping the implementation process simple, (3) the need to recognize that what seems simple becomes complex when meeting individual patient needs, and (4) the need to view the process as one of continuous quality improvement. © Sigma Theta Tau International.
Icelandic nurses’ beliefs, skills, and resources associated with evidence-based practice and related factors: a national survey.
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Worldviews on evidence-based nursing 2013 May;10(2):116-126
BACKGROUND: Evidence-based practice (EBP) is essential to the improvement of patient outcomes and the quality of care. Nurses’ use of evidence in practice, however, remains limited. Assessing nurses’ readiness for EBP where it is not as prominent as in countries leading EBP research was of particular interest. PURPOSE: To determine Icelandic registered nurses’ (RNs’) ability to provide care based on evidence as measured by their beliefs, perception of skills, and access to resources associated with EBP. METHODS: A descriptive survey was used in which a random sample of 540 Icelandic RNs completed the translated and modified version of the Information Literacy for Evidence-Based Nursing Practice and the translated EBP Beliefs Scale. Descriptive statistics, correlations, chi-square tests, t tests and one-way ANOVAs were used to analyze the data. RESULTS: Participants strongly believed in the value of EBP for patient care, but were less confident regarding their own knowledge and skills needed for EBP. Most (82%) of the respondents (i.e., RNs) turned to peers when in need of information, rather than peer-reviewed resources. Although over half of the RNs (54%) had received instructions in the use of electronic databases, only a third indicated success in using them. They considered “lack of search skills” as the primary barrier to use of research in practice. Using research findings in practice was associated with positive EBP beliefs, familiarity with EBP and other EBP-related activities. Clinical RNs were found to be at a disadvantage when it came to access to EBP-related resources and participated less frequently in EBP-related activities other than using research in practice. CONCLUSION AND IMPLICATIONS: Icelandic RNs’ beliefs regarding EBP are similar to those of RNs in other countries. Their access to EBP resources is generally good, but they lack the skills and knowledge needed for EBP. Strategies aimed at changing the organizational and practice context need to be developed. © Sigma Theta Tau International.
Supporting the uptake of nursing guidelines: what you really need to know to move nursing guidelines into practice.
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Matthew-Maich N, Ploeg J, Dobbins M, Jack S.
Worldviews on evidence-based nursing 2013 May;10(2):104-115
BACKGROUND: There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. METHODS: Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. RESULTS: Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. CONCLUSIONS: A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG. © Sigma Theta Tau International.
A formative evaluation of nurses’ use of electronic devices in a home care setting
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Doran DM, Reid-Haughian C, Chilcote A, Bai YQ.
Canadian Journal of Nursing Research 2013;45(1):54-73
The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting.The researchers used a mixedmethod design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses’ age at time 1. Social capital was positively associated with user satisfaction at time 2.Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions.This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting. © Ingram School of Nursing, McGill University.
Complexity sciences: Towards an alternative approach to understanding the use of academic research
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Lemay MA, Sá C.
Evidence and Policy 2012;8(4):473-494
Academic research is increasingly linked to a range of socioeconomic benefits. With increasing investments in academic research, there is growing pressure to improve the uses of research and demonstrate its impacts. From theoretical and methodological perspectives, the use of research is not well understood. This paper examines the limitations of the widely accepted conventional framework for understanding research use and explores the potential for conceptualising research use as a complex social process. The paper argues that properties and behaviours of complex systems are relevant to building a realistic and more complete understanding of the research use process. © The Policy Press 2012.
Intensive care pain treatment and sedation: Nurses’ experiences of the conflict between clinical judgement and standardised care: An explorative study.
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Woien H, Bjork IT.
Intensive & critical care nursing 2013 Jun;29(3):128-136
OBJECTIVES: To examine nurses’ experiences of performing clinical judgements of patient pain and sedative requirements after implementation of assessment tools, and how the tools influenced these judgements. BACKGROUND: Clinical judgement in ICU pain and sedation management is complex. There appears to be a gap between knowledge, attitudes and practice, reflecting an overall lack of adherence among nurses to standardised care. DESIGN: Exploratory qualitative investigation based on principles from Tanner’s Clinical Judgment Model, using focus group interviews. METHODS: Fourteen ICU nurses were included in two focus groups and interviewed twice during the implementation period. The interviews reflected central themes on the use of assessment tools related to the nurses’ clinical experience in ICU pain treatment and sedation, and were interpreted through a systematic classification process of coding and identification of themes and patterns. FINDINGS: Four themes emerged as central: (1) balancing clinical judgement and the use of tools; (2) improvement of collaboration, documentation and goal achievement; (3) enhanced evaluation of the patient’s response and (4) emphasis on the ICU patient’s characteristics. CONCLUSION: The use of tools was perceived to improve the quality of pain control and sedation, and supported nurses in their decision-making. Great importance was attached to personal knowledge and experience. Copyright © 2012 Elsevier Ltd. All rights reserved.
From intervention to innovation: applying a formal implementation strategy in community primary care.
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Wallace AS, Sussman AL, Anthoney M, Parker EA.
Nursing research and practice 2013;2013:605757
Objective. To describe a comprehensive strategy for implementing an effective diabetes self-management support intervention incorporating goal-setting and followup support in community health clinics (CHCs) serving vulnerable patients. Methods. The Replicating Effective Programs (REP) framework was applied to develop an intervention strategy. In order to create a strategy consistent with the REP framework, four CHCs engaged in an iterative process involving key-informant interviews with clinic staff, ongoing involvement of clinic staff facilitating translational efforts, feedback from national experts, and an instructional designer. Results. Moving through the REP process resulted in an implementation strategy that aims to facilitate commitment, communication, and change at the clinic level, as well as means of providing interactive, time-limited education about patient behavior change and support to health care providers. Conclusion. The REP offered a useful framework for providing guidance toward the development of a strategy to implement a diabetes self-management intervention in CHCs serving medically underserved and underrepresented patient populations.
Impact of clinical and health services research projects on decision-making: a qualitative study.
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Solans-Domenech M, Adam P, Guillamon I, Permanyer-Miralda G, Pons JM, Escarrabill J.
Health research policy and systems 2013 May 10;11:15-4505-11-15
BACKGROUND: This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. METHODS: A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. RESULTS: Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. CONCLUSIONS: In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved.
Strategies from Bedside Nurse Perspectives in Conducting Evidence-based Practice Projects to Improve Care.
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Shaffer ST, Zarnowsky CD, Green RC, Chen Lim ML, Holtzer BM, Ely EA.
The Nursing clinics of North America 2013 Jun;48(2):353-361
This article presents the bedside nurses’ perspectives on their experience with conducting an evidence based practice project. This is especially important in the climate of hospitals working to achieve Magnet Recognition. The facilitators and barriers to project design and completion are discussed in detail. Strategies to overcome barriers are presented. Facilitators for bedside nurses include motivation and professional development. Most common barriers were lack of time and limited knowledge about the process. Interventions aimed at research utilization can be successful when mindful of commonly understood barriers to project completion with steps taken to resolve those barriers. Copyright © 2013 Elsevier Inc. All rights reserved.
Recognizability: a strategy for assessing external validity and for facilitating knowledge transfer in qualitative research.
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Konradsen H, Kirkevold M, Olson K.
Advances in nursing science 2013 Apr-Jun;36(2):E66-76
In this article, we argue in favor of quality assessment for qualitative studies and propose using a strategy we have labeled recognizability to assess external validity and facilitate knowledge transfer. To test our idea, we gathered data about recognizability in relation to a specific study on facial disfigurement. Four categories were identified: full recognition; partial recognition; recognition in others; and no recognition. In this article, we show how we used these categories both to evaluate the quality of our study and to assess its external validity. We also discuss the implications of recognizability for knowledge transfer.
Health Care Administration and Organization
Service-based Health Human Resources Planning for Older Adults.
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Tomblin Murphy G, Mackenzie A, Rigby J, Rockwood K, Gough A, Greeley G, et al.
Journal of the American Medical Directors Association 2013 May 8
OBJECTIVES: To test a service-based health human resources (HHR) planning approach for older adults in the context of home and long term care (LTC); to create a practical template/tools for use in various jurisdictions and/or health care settings. DESIGN: The most serious health needs of seniors in 2 Canadian jurisdictions were identified and linked to the specific services and associated competencies required of health care providers (HCPs) to address those needs. The amounts of each service required were quantified and compared against the capacity of HCPs to perform the services, measured using a self-assessment survey, by using a previously developed analytical framework. SETTING: Home and LTC sectors in Nova Scotia and Nunavut, Canada. PARTICIPANTS: Regulated and nonregulated HCPs were invited to complete either an online or paper-based competency self-assessment survey. RESULTS: Survey response rates in Nova Scotia and Nunavut were 11% (160 responses) and 20% (22 responses), respectively. Comparisons of the estimated number of seniors likely to need each service with the number who can be served by the workforces in each jurisdiction indicated that the workforces in both jurisdictions are sufficiently numerous, active, productive, and competent to provide most of the services likely to be required. However, significant gaps were identified in pharmacy services, ongoing client assessment, client/family education and involvement, and client/family functional and social supports. CONCLUSION: Service-based HHR planning is feasible for identifying gaps in services required by older adults, and can guide policy makers in planning hiring/recruitment, professional development, and provider education curricula. Implementation will require commitment of policy makers and other stakeholders, as well as ongoing evaluation of its effectiveness. More broadly, the ongoing effectiveness of the approach will depend on workforce planning being conducted in an iterative way, driven by regular reevaluation of population health needs and HHR effectiveness. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.
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Paquet M, Courcy F, Lavoie-Tremblay M, Gagnon S, Maillet S.
Worldviews on evidence-based nursing 2013 May;10(2):82-94
BACKGROUND: Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. QUESTION: What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. METHODS: The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. RESULTS: The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one’s work team, and effort/reward balance. CONCLUSIONS: This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.
Identification of the Psychometric Properties of the Leadership Influence Over Professional Practice Environments Scale.
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Adams JM, Nikolaev N, Erickson JI, Ditomassi M, Jones DA.
The Journal of nursing administration 2013 May;43(5):258-265
This study uses the qualitatively developed Adams Influence Model© (AIM) and concepts from the psychometrically validated Revised Professional Practice Environment scale to guide the development of the Leadership Influence Over Professional Practice Environments Scale. Nurse executives and others can use this scale individually or in conjunction with instruments targeting staff or patient perceptions of their influence as part of health services research, leadership development, and professional practice environment enhancement strategy.
Expanding the Role of Advanced Nurse Practitioners — Risks and Rewards
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New England journal of medicine 2013 May 16;368(20):1935-1941.
In the context of projections of growing physician shortages in the United States, the author reviews the IOM recommendations regarding a greater role for nurses and discusses controversial proposals to expand the scope of practice of NPs in states with restrictive laws.
Nurses’ workarounds in acute healthcare settings: a scoping review.
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Debono DS, Greenfield D, Travaglia JF, Long JC, Black D, Johnson J, et al.
BMC genomics 2013 May 10;14(1):322
BACKGROUND: Workarounds circumvent or temporarily ‘fix’ perceived workflow hindrances to meet a goal or to achieve it more readily. Behaviours fitting the definition of workarounds often include violations, deviations, problem solving, improvisations, procedural failures and shortcuts. Clinicians implement workarounds in response to the complexity of delivering patient care. One imperative to understand workarounds lies in their influence on patient safety. This paper assesses the peer reviewed empirical evidence available on the use, proliferation, conceptualisation, rationalisation and perceived impact of nurses’ use of workarounds in acute care settings. METHODS: A literature assessment was undertaken in 2011–2012. Snowballing technique, reference tracking, and a systematic search of twelve academic databases were conducted to identify peer reviewed published studies in acute care settings examining nurses’ workarounds. Selection criteria were applied across three phases. 58 studies were included in the final analysis and synthesis. Using an analytic frame, these studies were interrogated for: workarounds implemented in acute care settings by nurses; factors contributing to the development and proliferation of workarounds; the perceived impact of workarounds; and empirical evidence of nurses’ conceptualisation and rationalisation of workarounds. RESULTS: The majority of studies examining nurses’ workarounds have been published since 2008, predominantly in the United States. Studies conducted across a variety of acute care settings use diverse data collection methods. Nurses’ workarounds, primarily perceived negatively, are both individually and collectively enacted. Organisational, work process, patient-related, individual, social and professional factors contribute to the proliferation of workarounds. Group norms, local and organisational culture, ‘being competent’, and collegiality influence the implementation of workarounds. CONCLUSION: Workarounds enable, yet potentially compromise, the execution of patient care. In some contexts such improvisations may be deemed necessary to the successful implementation of quality care, in others they are counterproductive. Workarounds have individual and cooperative characteristics. Few studies examine nurses’ individual and collective conceptualisation and rationalisation of workarounds or measure their impact. The importance of displaying competency (image management), collegiality and organisational and cultural norms play a role in nurses’ use of workarounds.
Role Definition as a Moderator of the Relationship Between Safety Climate and Organizational Citizenship Behavior Among Hospital Nurses
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Clark OL, Zickar MJ, Jex SM.
Journal of Business and Psychology 2013:1-10
Purpose: This field study investigated the moderating influence of role definitions on the association between safety climate and employees’ organizational citizenship behavior (OCB). Design/Methodology: Data were obtained from 94 hospital nurse dyads. Focal nurses and their peers completed paper surveys. All predictor measures were self-reported; whereas the OCB ratings were provided by nurses’ peers. Findings: Nurses’ perceptions of job requirements regarding OCB (i.e., OCB-specific role definitions) moderated the relationship between psychological safety climate and peer-rated OCB. The correlation between psychological safety climate and OCB was significant when nurses’ role definitions were narrow but non-existent when role definitions were broad. Implications: This study links managerial commitment to safety to nurses’ pro-social behavior and identifies an important boundary condition. Originality-Value: The link between safety climate and safety compliance has been firmly established. We investigated a less well-researched association between safety and OCB and proposed a theoretical foundation for this positive association. © 2013 Springer Science+Business Media New York.
The relationship between nursing staff levels, skill mix, and deficiencies in Maryland nursing homes.
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The health care manager 2013 Apr-Jun;32(2):123-128
The objective of this data analysis was to explore whether nurse staffing levels and skill mix influenced the number and severity of nursing home deficiencies in Maryland nursing homes. Nursing staff levels and skill mix in relation to quality outcomes in nursing homes have been explored with inconsistent results. Two multiple regression analyses were done to explore factors influencing deficiencies and the severity of the deficiencies found during the annual survey process. The factors influencing the number of deficiencies were the number of nursing home beds (β = .29), nursing assistant hours per patient-day (β = -.206), and the location of the nursing home (β = -.138). The only factor influencing the severity of the deficiencies was RN hours per patient-day (β = -.199). In conclusion, it was determined that RN staffing, although not associated with the number of deficiencies, is associated with deficiency severity.
Health Care Innovation and Quality Assurance
Continuous Quality Improvement: A Shared Governance Model That Maximizes Agent-Specific Knowledge
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Nursing leadership 2013 03/05;26:7-16
Motivate, Innovate, Celebrate: an innovative shared governance model through the establishment of continuous quality improvement (CQI) councils was implemented across the London Health Sciences Centre (LHSC). The model leverages agent-specific knowledge at the point of care and provides a structure aimed at building human resources capacity and sustaining enhancements to quality and safe care delivery. Interprofessional and cross-functional teams work through the CQI councils to identify, formulate, execute and evaluate CQI initiatives. In addition to a structure that facilitates collaboration, accountability and ownership, a corporate CQI Steering Committee provides the forum for scaling up and spreading this model. Point-of-care staff, clinical management and educators were trained in LEAN methodology and patient experience-based design to ensure sufficient knowledge and resources to support the implementation.
Nursing home administrator self-assessed preparedness.
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Siegel EO, Leo MC, Young HM, Castle NG.
Health care management review 2013 May 6
BACKGROUND:: Nursing home administrators (NHAs) are in key positions to improve nursing home quality. NHAs require state-level licensure, which involves passing a national NHA licensure examination and fulfilling state-level licensure requirements that vary widely across states. With multiple pathways to NHA licensure, little is known about NHAs’ preparation and training to meet the complex demands of this position. PURPOSE:: The aim of this study was to explore NHAs’ self-assessed person-job fit based on NHAs’ self-rated preparedness and the importance of the activities that supported their preparation. METHODOLOGY/APPROACH:: A descriptive cross-sectional design was used to collect data from NHAs (N = 175) randomly recruited from nursing homes in five states, with a mailed self-administered questionnaire. Data analysis included descriptive statistics, correlations, and t tests/ANOVA. FINDINGS:: Thirty percent of respondents reported they were well prepared, overall, for their first NHA position. The findings suggest NHA preferences for more formalized ways to develop their entry-level competencies, with lower preference for On-the-job training, Previous job experience, and Self-study and higher preference for Administrator-in-training, Bachelor’s degree programs, and Mentoring. PRACTICE IMPLICATIONS:: There is an urgent need for NHAs who are well prepared to effectively address our nation’s mandates for nursing home quality improvement. With multiple pathways to NHA licensure, this exploratory study provides initial insights about NHAs’ self-assessed preparation and training. The findings suggest that NHAs prefer more formalized ways to prepare for the NHA position. Research is needed to identify specific teaching/learning practices and on-the-job training that maximize the NHAs’ preparation to meet their job demands.
Specialty care delivery: bringing infectious disease expertise to the residents of a veterans affairs long-term care facility.
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Jump RL, Olds DM, Jury LA, Sitzlar B, Saade E, Watts B, et al.
Journal of the American Geriatrics Society 2013 May;61(5):782-787
OBJECTIVE: To initiate a long-term care facility (LTCF) infectious disease (LID) service that provides on-site consultations to LTCF residents to improve the care of residents with possible infections. DESIGN: Clinical demonstration project. SETTING: A 160-bed LTCF affiliated with a tertiary care Veterans Affairs (VA) hospital. PARTICIPANTS: Residents referred to the LID team. MEASUREMENTS: The reason for and source of LTCF residents’ referral to the LID team and their demographic characteristics, infectious disease diagnoses, interventions, and hospitalizations were determined. RESULTS: Between July 2009 and December 2010, the LID consultation service provided 291 consultations for 250 LTCF residents. Referrals came from LTCF staff (75%) or the VA hospital’s ID consult service (25%). The most common diagnoses were Clostridium difficile infection (14%), asymptomatic bacteriuria (10%), and urinary tract infection (10%). More than half of referred residents were receiving antibiotic therapy when they first saw the LID team; 46% of residents required an intervention. The most common interventions, stopping (32%) or starting (26%) antibiotics, were made in accordance with principles of antibiotic stewardship. CONCLUSION: The LID team represents a novel and effective means to bring subspecialty care to LTCF residents. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
A systematic review of the effectiveness of advanced practice nurses in long-term care.
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Donald F, Martin-Misener R, Carter N, Donald EE, Kaasalainen S, Wickson-Griffiths A, et al.
Journal of advanced nursing 2013 Mar 25
AIM: To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long-term care residential settings. BACKGROUND: Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted. DESIGN: Quantitative systematic review. DATA SOURCES: Twelve electronic databases were searched (1966-2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group. REVIEW METHODS: Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria. RESULTS: Four prospective studies conducted in the USA and reported in 15 papers were included. Long-term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services. CONCLUSION: Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long-term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff. © 2013 Blackwell Publishing Ltd.
Lower Mortality for Abdominal Aortic Aneurysm Repair in High-Volume Hospitals Is Contingent upon Nurse Staffing.
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Wiltse Nicely KL, Sloane DM, Aiken LH.
Health services research 2013 Jun;48(3):972-991
OBJECTIVE: To determine whether and to what extent the lower mortality rates for patients undergoing abdominal aortic aneurysm (AAA) repair in high-volume hospitals is explained by better nursing. DATA SOURCES: State hospital discharge data, Multi-State Nursing Care and Patient Safety Survey, and hospital characteristics from the AHA Annual Survey. STUDY DESIGN: Cross-sectional analysis of linked patient outcomes for individuals undergoing AAA repair in four states. DATA COLLECTION: Secondary data sources. PRINCIPAL FINDINGS: Favorable nursing practice environments and higher hospital volumes of AAA repair are associated with lower mortality and fewer failures-to-rescue in main-effects models. Furthermore, nurse staffing interacts with volume such that there is no mortality advantage observed in high-volume hospitals with poor nurse staffing. When hospitals have good nurse staffing, patients in low-volume hospitals are 3.4 times as likely to die and 2.6 times as likely to die from complications as patients in high-volume hospitals (p < .001). CONCLUSIONS: Nursing is part of the explanation for lower mortality after AAA repair in high-volume hospitals. Importantly, lower mortality is not found in high-volume hospitals if nurse staffing is poor. © Health Research and Educational Trust.
IHI: Lists That Work: The Healthcare Leader’s Role in Implementation
Checklists — distillations of processes into reminders of critical steps and safeguards — are quickly becoming a patient safety stalwart. IHI’s Don Goldmann, who contributed to the article, “believes checklists, bundles, and standing order sets are the three most useful approaches to improving evidence-based practice at the point of care.” This article describes the experiences of several health care organizations in implementing checklists to improve patient safety, and the critical role leaders play in supporting this work.
In 2012, the Global Forum on Innovation in Health Professional Education held its first two workshops, focusing on linkages between Interprofessional education (IPE) and collaborative practice. The workshops set the stage for defining and understanding IPE and provided living histories of speakers from around the world who shared experiences working in and between Interprofessional education and Interprofessional or collaborative practice. This report summarizes the workshops.
Strategies for obtaining unpublished drug trial data: a qualitative interview study.
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Wolfe N, Gotzsche PC, Bero L.
Systematic reviews 2013 May 16;2(1):31
BACKGROUND: Authors of systematic reviews have difficulty obtaining unpublished data for their reviews. This project aimed to provide an in-depth description of the experiences of authors in searching for and gaining access to unpublished data for their systematic reviews, and to give guidance on best practices for identifying, obtaining and using unpublished data. METHODS: This is a qualitative study analyzing in-depth interviews with authors of systematic reviews who have published Cochrane reviews or published systematic reviews outside of The Cochrane Library. We included participants who 1) were the first or senior author of a published systematic review of a drug intervention, 2) had expertise in conducting systematic reviews, searching for data, and assessing methodological biases, and 3) were able to participate in an interview in English. We used non-random sampling techniques to identify potential participants. Eighteen Cochrane authors were contacted and 16 agreed to be interviewed (89% response rate). Twenty-four non-Cochrane authors were contacted and 16 were interviewed (67% response rate). RESULTS: Respondents had different understandings of what was meant by unpublished data, including specific outcomes and methodological details. Contacting study authors was the most common method used to obtain unpublished data and the value of regulatory agencies as a data source was underappreciated. Using the data obtained was time consuming and labor intensive. Respondents described the collaboration with other colleagues and/or students required to organize, manage and use the data in their reviews, generally developing and using templates, spreadsheets and computer programs for data extraction and analysis. Respondents had a shared belief that data should be accessible but some had concerns about sharing their own data. Respondents believed that obtaining unpublished data for reviews has important public health implications. There was widespread support for government intervention to ensure open access to trial data. CONCLUSIONS: Respondents uniformly agreed that the benefit of identifying unpublished data was worth the effort and was necessary to identify the true harms and benefits of drugs. Recent actions by government, such as increased availability of trial data from the European Medicines Agency, may make it easier to acquire critical drug trial data.
Policymakers who rely on CERs and other systematic reviews as the basis for policy (including health insurance companies, health care organizations, research funders, and guideline makers) expressed the need to see changes in review process as well as outcomes clearly marked, (with changes in outcomes and conclusions preferably shown in graphic form), while at the same time having access to the entire set of data and the analyses on which the conclusions were based. The small group of clinicians preferred to see the skeleton of the report (Key Questions, conceptual framework, inclusion/exclusion criteria) as well as the outcomes and conclusions presented entirely in graphic form for ease of reading.
To generate individual treatment effects (ITEs), clinical investigators have taken several tacks, including subgroup analysis, matched pairs designs, and n-of-1 trials. Of these, n-of-1 trials provide the most direct route to estimating the effect of a treatment on the individual. In this chapter, we introduce n-of-1 trials by providing definitions and a rationale, delineating indications for use, describing key design elements, and addressing major opportunities and challenges.
Defining publication bias: protocol for a systematic review of highly cited articles and proposal for a new framework.
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Muller KF, Briel M, D Amario A, Kleijnen J, Marusic A, Wager E, et al.
Systematic reviews 2013 May 21;2(1):34
BACKGROUND: Selective publication of studies, which is commonly called publication bias, is widely recognized. Over the years a new nomenclature for other types of bias related to non-publication or distortion related to the dissemination of research findings has been developed. However, several of these different biases are often still summarized by the term ‘publication bias’. METHODS: As part of the OPEN Project (To Overcome failure to Publish nEgative fiNdings) we will conduct a systematic review with the following objectives:- To systematically review highly cited articles that focus on non-publication of studies and to present the various definitions of biases related to the dissemination of research findings contained in the articles identified.- To develop and discuss a new framework on nomenclature of various aspects of distortion in the dissemination process that leads to public availability of research findings in an international group of experts in the context of the OPEN Project.We will systematically search Web of Knowledge for highly cited articles that provide a definition of biases related to the dissemination of research findings. A specifically designed data extraction form will be developed and pilot-tested. Working in teams of two, we will independently extract relevant information from each eligible article.For the development of a new framework we will construct an initial table listing different levels and different hazards en route to making research findings public. An international group of experts will iteratively review the table and reflect on its content until no new insights emerge and consensus has been reached. DISCUSSION: Results are expected to be publicly available in mid-2013. This systematic review together with the results of other systematic reviews of the OPEN project will serve as a basis for the development of future policies and guidelines regarding the assessment and prevention of publication bias.
Health Care in Canada
Includes summaries of home care and long term care.
Who pays for and who uses publicly financed health care in Canada? Does it affect income inequality? This report explores these questions and sheds light on the patterns that emerge when health care costs and associated tax payments are examined over the life course.
The Higher Care At Discharge Index (HCDI): Identifying older patients at risk of requiring a higher level of care at discharge.
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Lakhan P, Jones M, Wilson A, Gray LC.
Archives of Gerontology and Geriatrics 2013 May 9
A screening index, administered at admission, can be useful in identifying older hospitalised patients at risk of requiring a higher level care at discharge. The objective of this study was to describe the development of a risk stratification index for allocating patients into lower and higher risk of requiring higher level care at discharge. A prospective cohort study of general medical patients, aged ≥70 years admitted to three metropolitan acute care hospitals in Brisbane, Australia was conducted. Derivation cohort (n=360) was used to: identify significant predictive factors associated with discharge to a higher level care; and develop a screening index to stratify patients into lower and higher risk. Predictive performance of the index was examined in the validation cohort (n=142). Five independent factors associated with requiring higher level care (identified using stepwise logistic regression analysis) were used to develop the HCDI: no support person to assist with living in the community; received assistance with finances; received assistance with hygiene; short term memory problems; hospitalised in 90 days prior to current hospital admission. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the dichotomised risk scores of the HCDI were: 76.3%; 73.3%; 36.0%; and 94.0% respectively; correctly classified 73.8%. In the validation cohort, sensitivity was 81.8%; specificity 68.7%; PPV 18.0%; NPV 97.8%, correctly classified 69.7%. Requirement for a higher level care at discharge has important consequences for health service delivery. The HCDI can be used to identify patients at higher risk. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003-2007.
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Temkin-Greener H, Zheng NT, Xing J, Mukamel DB.
Journal of the American Medical Directors Association 2013 May 7
CONTEXT: The proportion of US deaths occurring in nursing homes (NHs) has been increasing in the past 2 decades and is expected to reach 40% by 2020. Despite being recognized as an important setting in the provision of end-of-life (EOL) care, little is known about the quality of care provided to dying NH residents. There has been some, but largely anecdotal evidence suggesting that many US NHs transfer dying residents to hospitals, in part to avoid incurring the cost of providing intensive on-site care, and in part because they lack resources to appropriately serve the dying residents. We assessed longitudinal trends and geographic variations in place of death among NH residents, and examined the association between residents’ characteristics, treatment preferences, and the probability of dying in hospitals. METHODS: We used the Minimum Data Set (NH assessment records), Medicare denominator (eligibility) file, and Medicare inpatient and hospice claims to identify decedent NH residents. In CY2003-2007, there were 2,992,261 Medicare-eligible NH decedents from 16,872 US Medicare- and/or Medicaid-certified NHs. Our outcome of interest was death in NH or in a hospital. The analytical strategy included descriptive analyses and multiple logistic regression models, with facility fixed effects, to examine risk-adjusted temporal trends in place of death. FINDINGS: Slightly more than 20% of decedent NH residents died in hospitals each year. Controlling for individual-level risk factors and for facility fixed effects, the likelihood of residents dying in hospitals has increased significantly each year between 2003 through 2007. CONCLUSIONS: This study fills a significant gap in the current literature on EOL care in US nursing homes by identifying frequent facility-to-hospital transfers and an increasing trend of in-hospital deaths. These findings suggest a need to rethink how best to provide care to EOL nursing home residents. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved
Safe Home Program: A Suite of Technologies to Support Extended Home Care of Persons With Dementia.
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McKenzie B, Bowen ME, Keys K, Bulat T.
American Journal of Alzheimer’s Disease and Other Dementias 2013 May 15
Objective:To report the implementation/adoption of the Safe Home Program to support caregivers of persons with dementia in (1) ongoing surveillance, (2) provision of care, (3) prevention of injuries, and (4) improving home safety.Methods: For this demonstration project 4 assessment questionnaires (Safety Assessment Scale, Vigilance Scale, Peace of Mind Scale, and Sleep Disorders Inventory) were administered to each dyad to understand their technological needs. After identification and installation of appropriate technologies and education of the caregiver, a final visit (at 3 months) determined whether technologies were useful and being used.Results:The majority of caregivers utilized technologies for ongoing surveillance; other technologies included an identification program and medication organizer.Conclusion:Technologies focused on ongoing surveillance for persons with dementia at the home are needed. These technologies could be quickly adopted by caregivers to ameliorate some of the stress and burden associated with providing care for persons with dementia.
Pilot program provides oral health services to long term care facility residents through service learning and community partnership.
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Journal of the American Medical Directors Association 2013 May;14(5):363-366
Old Dominion University School of Dental Hygiene in Norfolk, Virginia, created an innovative preventive oral health program at Lake Taylor Transitional Care Hospital, a long term care facility located in coastal Virginia. The program had two main short-term goals: to increase the number of residents who receive preventive and therapeutic oral health services and to enhance future dental hygienists’ learning experience with this diverse vulnerable population through service learning. The anticipated long-term goals are to improve quality of oral health care and overall health of long term care residents, to prevent potential disease, and to reproduce this model at other long term care facilities to improve access to care. Published by Elsevier Inc.
Gender differences in home care clients and admission to long-term care in Ontario, Canada: a population-based retrospective cohort study.
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Gruneir A, Forrester J, Camacho X, Gill SS, Bronskill SE.
BMC geriatrics 2013 May 16;13(1):48
BACKGROUND: Home care is integral to enabling older adults to delay or avoid long-term care (LTC) admission. To date, there is little population-based data about gender differences in home care users and their subsequent outcomes. Our objectives were to quantify differences between women and men who used home care in Ontario, Canada and to determine if there were subsequent differences in LTC admission. METHODS: This is a population-based retrospective cohort study. We identified all adults aged 76+ years living in Ontario and receiving home care on April 1, 2007 (baseline). Using the Resident Assessment Instrument — Home Care (RAI-HC) linked to other databases, we characterized the cohort by living condition, health and functioning, and identified all acute care and LTC use in the year following baseline. RESULTS: The cohort consisted of 51,201 women and 20,102 men. Women were older, more likely to live alone, and more likely to rely on a child or child-in-law for caregiver support. Men most frequently identified a spouse as caregiver and their caregivers reported distress twice as often as women’s caregivers. Men had higher rates of most chronic conditions and were more likely to experience impairment. Men were more likely to be admitted to hospital, to have longer stays in hospital, and to be admitted to LTC. CONCLUSIONS: Understanding who uses home care and why is critical to ensuring that these programs effectively reduce LTC use. We found that women outnumbered men but that men presented with higher levels of need. This detailed gender analysis highlights how needs differ between older women, men, and their respective caregivers.
We identified three small studies addressing cleansing of pressure ulcers. One reported a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline solution, a further study reported no statistically significant change in healing was seen when wounds were cleaned with water was compared with saline. A final study compared pulsatile lavage with sham and found a significantly greater reduction in ulcer volume at the end of the study period in the lavage group compared with the sham group. The authors conclude that there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.
This guide aims to address both the social factors which can put someone at risk of malnutrition and ensure early intervention and treatment of malnutrition in local communities.
We reviewed 7,274 titles and abstracts and 1,836 full-length articles. We included 174 studies (trials and observational studies) addressing the effectiveness and/or harms of different treatments for pressure ulcers. These studies examined a wide range of interventions, but sample sizes often were small. We found moderate-strength evidence that some interventions were associated with wound improvement, including the use of air-fluidized beds (compared with other support surfaces), protein-containing nutritional supplements (compared with placebos or other routine measures of nutritional support), radiant heat dressings (compared with other dressings), and electrical stimulation (compared with a sham treatment). Several other interventions had limited evidence of effectiveness (strength of evidence rated as low). Only a minority of studies examined complete wound healing as an outcome. In general, the evidence about the harms of any of these treatments was limited.
The Collaborating Across Borders is the premier North American conference that focuses on interprofessional education and collaborative practice in health care.
Save the date: Inaugural Canadian ‘Culture Change in Aging’ conference
31 March & April 1, 2014 Toronto ON
The Research Institute for Aging, in part through the Schlegel Centre for Learning, Research and Innovation in Long-Term Care (Schlegel CLRI), will host the first national conference on culture change. The purpose of this inaugural conference is to bring 450 diverse stakeholders together, including elders, professionals and researchers, to learn with and from each other about how to support culture change in Canada. There are many exciting initiatives and projects underway in Canada that are shifting, in significant and positive ways, the culture of aging and long-term care.
NICHE: Establishing a Baseline for Improving Geriatric Care at the Hospital of the University of Pennsylvania
Friday 7 June 2013 11:00 MT NICHE Site: free, Non-NICHE Site: $99
This webinar will allow participants to understand how Hospital of the University of Pennsylvania (HUP) approached this initiative and the lessons learned in implementing it. This webinar will detail the rationale for establishing a baseline, the process undertaken, the challenges encountered, the lessons learned, as well as next steps and recommendations for colleagues in similar clinical settings.
The Critical Appraisal Skills Programme (CASP)UK 3 Day: Introduction to Critical Appraisal & Train the Trainer Event
17-29 November 2013, Oxford UK £660+VAT
This 3 day training event is a shortened, more intense version of our International Training Week. Including an introduction to Evidence-Based Health Care (Covering study designs & the critical appraisal of Randomised Controlled Trials & Systematic Reviews) followed ‘Training the Trainer’ (TtT) workshops. The broad aim of the TtT days are designed to help participants develop the competence and confidence to teach critical appraisal skills and run a CASP-style workshop.
University of Oxford: Introduction to Statistics for Health Care Research
24 June-30 Aug, Costs £1500
This online statistics course is designed for busy health and social care professionals who need to understand the basics of health statistics without becoming statisticians. Students can study at the time of day and week that is best for them. Online discussion forums enable students to communicate with each other and with the tutor to analyse and understand real-life scenarios.
Patient-centered outcomes research (PCOR) aims to empower patients and their caregivers by providing the evidence needed to make truly informed decisions about their health and health care. In November 2012, PCORI’s Board of Governors adopted comprehensive standards for conducting patient-centered outcomes research. The purpose of this webinar is to help researchers understand how the PCORI Methodology Committee hopes the standards will be used to support high quality, scientifically rigorous patient-centered outcomes research, and to provide examples of the standards.
LATER this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion. The charges are familiar: the manual medicalizes garden-variety distress, leads doctors to prescribe unnecessary medications, serves as a cash cow for the association, and so forth. But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.
Editors have noted a “certain level of sloppiness” creeping into research papers, the executive editor of the Nature Publishing Group has said.
Any day now, the Canadian government is going to announce a website that federal health minister Leona Aglukkaq is calling a coup for transparency and patient access. The soon-to-be-launched database of clinical trials happening in Canada will go live before the end of May (Health Canada could not confirm the date), which means Canadians will soon have a one-stop shop for information about what pharmaceutical products are being tested on humans in this country.
Alberta Health Services came under heavy criticism today over a controversial policy proposed for seniors’ care in the province.
British Columbia, Alberta and Ontario have followed distinct paths to earn “A” grades in overall health performance, according to The Conference Board of Canada’s Paving the Road to Higher Performance: Benchmarking Provincial Health Systems.
BioMed Central supports initiatives to improve performance and reporting of clinical trials and an ever increasing number of medical journals require registration of clinical trials before publication. The ISRCTN trial register, part of BioMed Central, offers clinical trial registration services. Established in 2000, more than 11,000 trials have been registered and annually over 230,000 people use the site as either a trialist, researcher, systematic reviewer, health policy maker or patient. To reflect the changes in clinical trial registration requirements since 2000, we would like to update and redesign our services. Therefore we would greatly appreciate if you could complete this short survey about what you require from a public trial register site.
A recent OECD Recommendation on the Governance of Clinical Trials issued in December 2012 could improve the outlook for fighting deadly diseases around the world. Here is how.
Government says move will save money, but pharmacists and drug companies cry foul.
The story of Professor Diederik Stapel, a well-regarded Dutch academic, who created the data for much of his research. Please don’t get any ideas from this.
New Editor of the Milbank Quarterly Announced
Howard Markel, M.D., Ph.D., will become Editor-in-Chief of The Milbank Quarterly on October 1, 2013, succeeding Bradford H. Gray, Ph.D.
One winner will be awarded a $1,500 travel grant to attend the research conference of their choice. Contest deadline is 25 June 2013.
More than 150 researchers and 75 scientific groups issued a declaration on Thursday against the widespread use of journal “impact factors,” blaming the practice for dangerous distortions in financing and hiring in science.
This website provides information on the province’s current health research strategy.
This page highlights KT resources available from CIHR. Also includes list of contacts involved with KT at CIHR.
Wolters Kluwer Health/Lippincott Williams & Wilkins seeks nurses to serve as Clinical Editors for books in the award-winning Incredibly Easy Series, as well as other popular reference titles. As Clinical Editor, you will aid with a book’s revision by identifying items that require updating, soliciting contributors and reviewers, performing review, and ensuring a high-quality product. An honorarium is paid, and the Clinical Editor’s name will appear on the cover of the book and in front matter.