December 2, 2013


Abstracts
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Abstracts

New article by Matthias Hoben, Janet Squires, & Dr. Carole Estabrooks
German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned.
Non UofA Access
Hoben M, Mahler C, Bar M, Berger S, Squires JE, Estabrooks CA, et al.
BMC health services research 2013 Nov 16;13(1):478

D: Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers. METHODS: Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing. RESULTS: We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge. CONCLUSION: Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus.

New article by Carole Estabrooks
Organizational readiness for knowledge translation in chronic care: a review of theoretical components.
Non UofA Access
Attieh R, Gagnon MP, Estabrooks CA, Legare F, Ouimet M, Roch G, et al.
Implementation science : IS 2013 Nov 28;8(1):138

The purpose of this study is to review and synthesize the existing evidence on conceptual models/frameworks of Organizational Readiness for Change (ORC) in healthcare as the basis for the development of a comprehensive framework of OR for KT in the context of CC (Chronic Care). DATA SOURCES: We conducted a systematic review of the literature on OR for KT in CC using Pubmed, Embase, CINAHL, PsychINFO, Web of Sciences (SCI and SSCI), and others. Search terms included readiness; commitment and change; preparedness; willing to change; organization and administration; and health and social services.Study selection: The search was limited to studies that had been published between the starting date of each bibliographic database (e.g., 1964 for PubMed) and November 1, 2012. Only papers that refer to a theory, a theoretical component from any framework or model on OR that were applicable to the healthcare domain were considered. We analyzed data using conceptual mapping.Data extraction: Pairs of authors independently screened the published literature by reviewing their titles and abstracts. Then, the two same reviewers appraised the full text of each study independently. RESULTS: Overall, we found and synthesized 10 theories, theoretical models and conceptual frameworks relevant to ORC in healthcare described in 38 publications. We identified five core concepts, namely organizational dynamics, change process, innovation readiness, institutional readiness, and personal readiness. We extracted 17 dimensions and 59 sub-dimensions related to these 5 concepts. CONCLUSION: Our findings provide a useful overview for researchers interested in ORC and aims to create a consensus on the core theoretical components of ORC in general and of OR for KT in CC in particular. However, more work is needed to define and validate the core elements of a framework that could help to assess OR for KT in CC.

New article by Shannon Scott
A randomized controlled trial of storytelling as a communication tool.
Non UofA Access
Hartling L, Scott SD, Johnson DW, Bishop T, Klassen TP.
PloS one 2013 Oct 25;8(10):e77800

Stories may be an effective tool to communicate with patients because of their ability to engage the reader. Our objective was to evaluate the effectiveness of story booklets compared to standard information sheets for parents of children attending the emergency department (ED) with a child with croup. METHODS: Parents were randomized to receive story booklets (n=208) or standard information sheets (n=205) during their ED visit. The primary outcome was change in anxiety between triage to ED discharge as measured by the State-Trait Anxiety Inventory. Follow-up telephone interviews were conducted at 1 and 3 days after discharge, then every other day until 9 days (or until resolution of symptoms), and at 1 year. Secondary outcomes included: expected future anxiety, event impact, parental knowledge, satisfaction, decision regret, healthcare utilization, time to symptom resolution. RESULTS: There was no significant difference in the primary outcome of change in parental anxiety between recruitment and ED discharge (change of 5 points for the story group vs. 6 points for the comparison group, p=0.78). The story group showed significantly greater decision regret regarding their decision to go to the ED (p<0.001): 6.7% of the story group vs. 1.5% of the comparison group strongly disagreed with the statement “I would go for the same choice if I had to do it over again”. The story group reported shorter time to resolution of symptoms (mean 3.7 days story group vs. 4.0 days comparison group, median 3 days both groups; log rank test, p=0.04). No other outcomes were different between study groups. CONCLUSIONS: Stories about parent experiences managing a child with croup did not reduce parental anxiety. The story group showed significantly greater decision regret and quicker time to resolution of symptoms. Further research is needed to better understand whether stories can be effective in improving patient-important outcomes. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN39642997 (http://www.controlled-trials.com/ISRCTN39642997).

CALL FOR ABSTRACTS:
CAHSPR Conference Convergence of Health Policy and Evidence – Bridge Over Troubled Water
12-15 May 2014 Toronto ON
DEADLINE 9 January 2014

CAHSPR’s annual conference features a wide range of work related to health services and health policy. Abstracts do not have to be on the conference theme. We therefore encourage all research producers, users, and brokers to submit abstracts for presentation formats that are appropriate to their work.

CALL FOR ABSTRACTS:
AcademyHealth Annual Research Meeting
8-10 June 2014 San Diego CA
DEADLINE 16 January 2013

Presentation of cutting-edge health services research is the cornerstone of the Annual Research Meeting, offering researchers the opportunity to share important findings with policymakers and providers who can put the research into action. Abstracts are invited for four categories: (1) Call for Papers, (2) Call for Research Panels, (3) Call for Policy Roundtables, and (4) Call for Posters.

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Grants & Awards

CIHR: Age+ Prize
DEADLINES: 15 January 2014 & 15 July 2014

The CIHR-Institute of Aging Age+ Prize recognizes excellence in research on aging carried out by emerging Canadian scholars. Up to 10 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.

Michael Smith Foundation for Health Research: Knowledge Translation Funding Opportunity
DEADLINE 16 December 2013

MSFHR, along with the British Columbia Ministry of Health, First Nations Health Authority, Interior Health, and Island Health have identified 14 science policy fellowship assignments. Science Policy Fellowships give health researchers and trainees the opportunity to gain real world experience in evidence-based health policy making by embedding a health research fellow within a policy setting. Researchers from all areas of heath can apply to spend six to twelve months in a policy setting where they can participate and contribute to policy making processes while learning first-hand how evidence-informed policy making works.
This funding opportunity is open to candidates at the doctoral, post-doctoral, and new investigator stages.

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Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice & Methodology
Aging

KT

Is evidence guiding practice? Reported versus observed adherence to contact precautions: A pilot study.
Non UofA Access
Jessee MA, Mion LC.
American Journal of Infection Control 2013 Nov;41(11):965-970

Hospital-acquired infections are a major patient safety issue. We examined staff members’ knowledge, attitudes, reported and observed adherence to guidelines, and perceptions of barriers to use of contact precautions. METHODS: A survey and nonparticipant observation study was used to examine knowledge, attitudes, perceptions, and actual behavior of staff on 3 medical/surgical units at a 600-bed Magnet-designated academic medical center (MDAMC) and a 110-bed community medical center (CMC) in the southeastern United States. RESULTS: Correct knowledge answers ranged from 75% (CMC) to 100% (MDAMC). CMC participants were less likely to perceive time as a barrier (5% vs 25%; P = .050); more MDAMC participants were motivated by supervisors’ recognition (87% vs 33%; P = .001). No statistically significant differences existed between groups on reported behaviors. Upon observation, fewer CMC participants demonstrated 4 of 5 evidence-based contact precaution behaviors compared with MDMC participants (P < .001). Hand hygiene before glove application was similarly low at both sites. CONCLUSIONS: Despite a decade of focus on improving patient safety, low adherence to evidence-based practice guidelines for implementation of contact precautions remains. Ongoing efforts are needed both at the system and practitioner level to improve practice adherence. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Comparison of the use of self-report surveys and organizational documents in knowledge translation research Canada-flat-icon
Non UofA Access
Boyko JA, Dobbins M, DeCorby K, Hanna S.
Canadian Journal of Program Evaluation 2013 Spring2013;28(1):67-85

We compared the same outcome data obtained from two different sources (self-report surveys and organizational documents) in order to examine their relative performance in evaluating the ef-fect of knowledge translation strategies on evidence-informed decision-making. Our data came from a randomized controlled trial that evaluated the impact of knowledge translation strategies on promoting evidence-informed decision-making in public health units across Canada. We found that self-report surveys identified more outcome data than organizational documents; the types of documents that identified the most outcome data were evaluation plans, operational plans, work plans, and evaluation data; the types of documents that identified the least outcome data were meeting minutes, statistics/annual reports, and strategic plans; and evaluation plans, operational plans, and work plans together provide more outcome data than other combinations. Overall, our study suggests that evidence-informed decision-making may be appropriately measured by using multiple data sources in order to compare data across sources and to gain a more accurate representation of the results. Our findings also suggest that if organizational documents are used as a source of data in knowledge translation research, then specific types should be used in order to maximize the likelihood of identifying measures of effectiveness.

Knowledge translation in Iranian universities: need for serious interventions
Non UofA Access
Gholami J, Ahghari S, Motevalian A, Yousefinejad V, Moradi G, Keshtkar A, et al.
Health research policy and systems 2013 Nov 13;11(1):43

The aim of this study was to assess the status of knowledge translation (KT) in Iranian medical science universities in order to assess the strengths and weaknesses of the most important organizations responsible for producing knowledge in the country. METHODS: The KT activities were assessed qualitatively and quantitatively in nine universities using the Self-Assessment Tool for Research Institutes. RESULTS: The strengths and weaknesses of universities were determined using seven main themes: priority setting; research quality and timeliness; researchers’ KT capacities; interaction with research users; the facilities and prerequisites of KT; the processes and regulations supporting KT; and promoting and evaluating the use of evidence.The quantitative and qualitative results showed that the Iranian universities did not have an appropriate context for KT. There were significant shortcomings in supportive regulations, facilities for KT activities, and the level of interaction between the researchers and research users. CONCLUSIONS: The shortcomings in KT were mostly in the area of stewardship and policymaking (macro level), followed by planning and implementation at the universities. In order to strengthen KT in Iran, it should occupy a prominent and focused role in the strategies of the country’s health research system.

Cluster randomized adaptive implementation trial comparing a standard versus enhanced implementation intervention to improve uptake of an effective re-engagement program for patients with serious mental illness.
Non UofA Access
Kilbourne AM, Abraham KM, Goodrich DE, Bowersox NW, Almirall D, Lai Z, et al.
Implementation science 2013 Nov 20;8(1):136

Persons with serious mental illness are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage.Methods/design: This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services.

The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics
Non UofA Access
Solberg LI, Crain AL, Jaeckels N, Ohnsorg KA, Margolis KL, Beck A, et al.
Implementation science 2013 Nov 16;8(1):135

This paper reports how and the degree to which collaborative care process changes were implemented and maintained for the 75 primary care clinics participating in the DIAMOND Initiative (Depression Improvement Across Minnesota–Offering a New Direction). METHODS: Each clinic was trained to implement seven components of the model and participated in ongoing evaluation and facilitation activities. For this study, assessment of clinical process implementation was accomplished via completion of surveys by the physician leader and clinic manager of each clinic site at three points in time. The physician leader of each clinic completed a survey measure of the presence of various practice systems prior to and one and two years after implementation. Clinic managers also completed a survey of organizational readiness and the strategies used for implementation. RESULTS: Survey response rates were 96% to 100%. The systems survey confirmed a very high degree of implementation (with large variation) of DIAMOND depression practice systems (mean of 24.4 +/- 14.6%) present at baseline, 57.0 +/- 21.0% at one year (P = <0.0001), and 55.9 +/- 21.3% at two years. There was a similarly large increase (and variation) in the use of various quality improvement strategies for depression (mean of 29.6 +/- 28.1% at baseline, 75.1 +/- 22.3% at one year (P = <0.0001), and 74.6 +/- 23.0% at two years. CONCLUSIONS: This study demonstrates that under the right circumstances, primary care clinics that are prepared to implement evidence-based care can do so if financial barriers are reduced, effective training and facilitation are provided, and the new design introduces the specific mental models, new care processes, and workers and expertise that are needed.

Evaluation of a web-based intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process analysis of the GRACE/INTRO randomised controlled trial.
Non UofA Access
Yardley L, Douglas E, Anthierens S, Tonkin-Crine S, O Reilly G, Stuart B, et al.
Implementation science 2013 Nov 15;8(1):134

The aim was to understand how the interventions were implemented and to examine effects of the interventions on general practitioners’ (GPs’) and patients’ attitudes. METHODS: GPs were cluster randomised to one of three intervention groups or a control group. The intervention groups received web-based training in either use of the C-reactive protein (CRP) test, communication skills and use of a patient booklet, or training in both. GP attitudes were measured before and after the intervention using constructs from the Theory of Planned Behaviour and a Website Satisfaction Questionnaire. Effects of the interventions on patients were assessed by a post-intervention questionnaire assessing patient enablement, satisfaction with the consultation, and beliefs about the risks and need for antibiotics. RESULTS: GPs in all countries and intervention groups had very positive perceptions of the intervention and the web-based training, and felt that taking part had helped them to reduce prescribing. All GPs perceived reducing prescribing as more important and less risky following the intervention, and GPs in the communication groups reported increased confidence to reduce prescribing. Patients in the communication groups who received the booklet reported the highest levels of enablement and satisfaction and had greater awareness that antibiotics could be unnecessary and harmful.

Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems.
Non UofA Access
Palinkas LA, Holloway IW, Rice E, Brown CH, Valente TW, Chamberlain P.
Implementation science 2013 Nov 14;8(1):133

Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice. METHODS: Semi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions. RESULTS: Of those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network. CONCLUSION: Although the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies.Trial registration: NCT00880126.

A KT intervention including the evidence alert system to improve clinician’s evidence-based practice behavior—a cluster randomized controlled trial.
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Campbell LB, Novak I, McIntyre S, Lord SJ.
Implementation science 2013 Nov 13;8(1):132

This is an evaluator-blinded, cluster randomized controlled trial conducted in an Australian community-based cerebral palsy service. 135 AHPs (physiotherapists, occupational therapists, speech pathologists, psychologists and social workers) from four regions were cluster randomized (n = 4), to either the KT intervention group (n = 73 AHPs) or the control group (n = 62 AHPs), using computer-generated random numbers, concealed in opaque envelopes, by an independent officer. The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers (paid EBP time, mentoring, system changes and access to an online research synthesis tool). Primary outcome (self- and peer-rated EBP behavior) was measured using the Goal Attainment Scale (individual level). Secondary outcomes (knowledge and attitudes) were measured using exams and the Evidence Based Practice Attitude Scale. RESULTS: The intervention group’s primary outcome scores improved relative to the control group, however when clustering was taken into account, the findings were non-significant: self-rated EBP behavior [effect size 4.97 (95% CI -10.47, 20.41)(p = 0.52)]; peer-rated EBP behavior [effect size 5.86 (95% CI -17.77, 29.50)(p = 0.62)]. Statistically significant improvements in EBP knowledge were detected [effect size 2.97 (95% CI 1.97, 3.97(p < 0.0001)]. Change in EBP attitudes was not statistically significant.

Knowledge of and perceived need for evidence-based education about antipsychotic medications among nursing home leadership and staff.
Non UofA Access
Lemay CA, Mazor KM, Field TS, Donovan J, Kanaan A, Briesacher BA, et al.
Journal of the American Medical Directors Association 2013 Dec;14(12):895-900

Survey of leadership and direct care staff of nursing homes in Connecticut was conducted in June 2011. Questionnaire domains included knowledge of antipsychotic risks, attitudes about caring for residents with dementia, satisfaction with current behavior management training, beliefs about antipsychotic effectiveness, and need for staff training about antipsychotics and behavior management. RESULTS: A total of 138 nursing home leaders and 779 direct care staff provided useable questionnaires. Only 24% of nursing home leaders identified at least 1 severe adverse effect of antipsychotics; 13% of LPNs and 12% of RNs listed at least 1 severe adverse effect. Fifty-six percent of direct care staff believed that medications worked well to manage resident behavior. Leaders were satisfied with the training that staff received to manage residents with challenging behaviors (62%). Fifty-five percent of direct care staff felt that they had enough training on how to handle difficult residents; only 37% felt they could do so without using medications. CONCLUSIONS: Findings suggest that a comprehensive multifaceted intervention designed for nursing homes should aim to improve knowledge of antipsychotic medication risks, change beliefs about appropriateness and effectiveness of antipsychotics for behavior management, and impart strategies and approaches for nonpharmacologic behavior management. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Technology transfer from biomedical research to clinical practice: measuring innovation performance.
Non UofA Access
Balas EA, Elkin PL.
Evaluation & the health professions 2013 Dec;36(4):505-517

Studies documented 17 years of transfer time from clinical trials to practice of care. Launched in 2002, the National Institutes of Health (NIH) translational research initiative needs to develop metrics for impact assessment. A recent White House report highlighted that research and development productivity is declining as a result of increased research spending while the new drugs output is flat. The goal of this study was to develop an expanded model of research-based innovation and performance thresholds of transfer from research to practice. Models for transfer of research to practice have been collected and reviewed. Subsequently, innovation pathways have been specified based on common characteristics. An integrated, intellectual property transfer model is described. The central but often disregarded role of research innovation disclosure is highlighted. Measures of research transfer and milestones of progress have been identified based on the Association of University Technology Managers 2012 performance reports. Numeric milestones of technology transfer are recommended at threshold (top 50%), target (top 25%), and stretch goal (top 10%) performance levels. Transfer measures and corresponding target levels include research spending to disclosure (0.81), patents to start-up (>0.1), patents to licenses (>2.25), and average per license income (>$48,000). Several limitations of measurement are described. Academic institutions should take strategic steps to bring innovation to the center of scholarly discussions. Research on research, particularly on pathways to disclosures, is needed to improve R&D productivity. Researchers should be informed about the technology transfer performance of their institution and regulations should better support innovators.

Systematic realist review of key factors affecting the successful implementation and sustainability of the liverpool care pathway for the dying patient.
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McConnell T, O’Halloran P, Porter S, Donnelly M.
Worldviews on evidence-based nursing 2013 Nov;10(4):218-237

To identify and investigate factors that help or hinder successful implementation and sustainability of the LCP. RESULTS: Fifty-eight papers were included in the review. Key factors identified were: a dedicated facilitator, education and training, audit and feedback, organisational culture, and adequate resources. DISCUSSION: We discuss how these factors change behaviour by influencing the beliefs, attitudes, motivation and confidence of staff in relation to end of life care, and how contextual factors moderate behaviour change. CONCLUSIONS: The implementation process recommended by the developers of the LCP is necessary but not sufficient to ensure successful implementation and sustainability of the pathway. The key components of the intervention (a dedicated facilitator, education and training, audit and feedback) must be configured to influence the beliefs of staff in relation to end of life care, and increase their motivation and self-efficacy in relation to using the LCP. The support of senior managers is vital to the release of necessary resources, and a dominant culture of cure, which sees every death as a failure, works against effective communication and collaboration in relation to the LCP. © 2013 Sigma Theta Tau International.

Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia.
Non UofA Access
El-Mallakh P, Howard PB, Rayens MK, Roque AP, Adkins S.
Journal of psychosocial nursing and mental health services 2013 Nov 1;51(11):35-44

Organizational support is essential for successful implementation of evidence-based practice (EBP) in clinical settings. This 3-year study used a mixed qualitative and quantitative design to implement a medication management EBP in the treatment of schizophrenia in six community mental health clinics in a south-central state of the United States. Findings from organizational fidelity assessments indicate that support for EBP implementation was moderate. Organizational support was highest for prescriber access to relevant patient information at each medication visit, scheduling flexibility for patients’ urgent problems, and availability of medication guidelines. Organizational support was lowest for medication availability and identification of treatment refractory patients. Findings suggest that leadership is essential to support successful implementation. Nurse educators can incorporate implementation research and leadership training into graduate nursing programs to facilitate successful EBP implementation in practice settings. Copyright 2013, SLACK Incorporated.

Research Utilization in the Social Sciences: A Comparison of Five Academic Disciplines in Australia
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Cherney A, Head B, Boreham P, Povey J, Ferguson M.
Science Communication 2013;35(6):780-809

Social science disciplines generate diverse forms of research utilization, given the various contexts in which disciplinary knowledge is produced and translated for the fields of policy and practice. We examine this issue from the perspective of academic researchers in the social sciences across education, economics, sociology, political science, and psychology. We use survey data from a study of university-based social science researchers in Australia to examine factors that influence perceptions of the policy uptake of social research. Our results show that disciplinary and methodological context matters when it comes to understanding the translation, dissemination, and utilization of academic social research. © 2013 SAGE Publications.

An exploration of context and the use of evidence-based nonpharmacological practices in emergency departments.
Non UofA Access
Wente SJ, Kleiber C.
Worldviews on evidence-based nursing 2013 Nov;10(4):187-197

The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices (EBPs) in healthcare settings may improve patient conditions such as pain and decrease the cost of health care. The relationship between context in the practice environment and uptake of EBP remains an understudied area. AIMS: This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPPs) using an existing data set of RNs and providers, defined as doctors of medicine and osteopathy, nurse practitioners, and physician assistants caring for children in the emergency department. METHODS: A secondary data analysis was conducted using correlation and regression. RESULTS: Initial analysis identified several significant positive correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and magnet status and EBNPP for RNs or providers. RN regression analyses found that knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the RN and provider models. A pooled regression analysis with RNs and providers found that RNs had a significant increased use of EBNPP when compared to providers. CONCLUSIONS: Regression analyses found that overall context significantly predicted the use of EBPPM for RNs and providers although no one element-individual, unit, or hospital-was identified as more important. The effect of context on EBNPP did not differ by profession in this sample. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP. © 2013 Sigma Theta Tau International.

Healthcare reform: implications for knowledge translation in primary care.
Non UofA Access
Dadich A, Hosseinzadeh H.
BMC health services research 2013 Nov 25;13(1):490

The primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector. METHODS: 431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed. RESULTS: All six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources — both double-sided A4-placards — had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care. CONCLUSIONS: Findings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.

Alliance for Useful Evidence: The Challenges of Evidence (UK)
November 2013

This paper provides an overview of the pros and cons of evidence-based decision-making, identifying three main characteristics of evidentiary findings (time lag, good practice, and attributions of causality) to aid policymakers and practitioners. The paper points out that evidence is always contingent on context, sources, perceptions and timing.

AHRQ: Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence (US)
November 2013

This review examined how to best communicate and disseminate evidence, including uncertain evidence, to inform health care decisions. The review focused on three primary objectives—comparing the effectiveness of: (1) communicating evidence in various contents and formats that increase the likelihood that target audiences will both understand and use the information (KQ 1); (2) a variety of approaches for disseminating evidence from those who develop it to those who are expected to use it (KQ 2); and (3) various ways of communicating uncertainty-associated health-related evidence to different target audiences (KQ 3). A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. Across the KQs, many of the comparisons yielded insufficient evidence to draw firm conclusions. For KQ 1, we found that investigators frequently blend more than one communication strategy in interventions. For KQ 2, we found that, compared with single dissemination strategies, multicomponent dissemination strategies are more effective at enhancing clinician behavior, particularly for guideline adherence. Key findings for KQ 3 indicate that evidence on communicating overall strength of recommendation and precision was insufficient, but certain ways of communicating directness and net benefit may be helpful in reducing uncertainty.

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Health Care Administration and Organization

Evaluation of organisational culture and nurse burnout: A study of how perceptions of the work environment affect morale found that workplaces considered by employees as innovative and supportive had a positive effect on their wellbeing
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Watts J, Robertson N, Winter R, Leeson D.
Nursing management 2013;20(6):24-29

A survey of nurses working with older adults across three NHS trusts was conducted to explore how perceptions of the workplace affect nurse wellbeing. Standardised validated measures were used to assess burnout, perceived organisational support and organisational culture. Significant associations were found between innovative organisational culture and nurses’ sense of personal accomplishment, which reduce the likelihood of burnout. Multiple regression showed experience of burnout to be predicted by the nature of organisational culture. It seems therefore that nurses’ wellbeing may be affected by their perceptions of the working environment. Applications of this knowledge and suggestions for future research are discussed. © 2013 RCN Publishing Ltd.

Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff. Canada-flat-icon
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McGilton KS, Boscart VM, Brown M, Bowers B.
International journal of nursing studies 2013 Oct 27

Turnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses). OBJECTIVE: The main objective of this study was to understand factors that influence nurses’ intentions to remain employed at their current job. DESIGN: Qualitative descriptive study. SETTINGS: Seven nursing homes in Ontario, Canada. PARTICIPANTS: A convenience sample of forty-one licensed LTC nurses. METHODS: Data were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes. RESULTS: Work conditions were a salient element affecting nurses’ intention to stay and included impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses’ willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay. CONCLUSIONS: Nurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address attrition of licensed nurses in LTC may be the most successful strategy for improving retention of highly skilled staff in this sector. Copyright © 2013 Elsevier Ltd. All rights reserved.

WHO: A Universal Truth: No Health Without a Workforce
November 2013

The report presents a case that the health workforce is central to attaining, sustaining and accelerating progress on universal health coverage and suggests three guiding questions for decision-makers. What health workforce is required to ensure effective coverage of an agreed package of health care benefits? What health workforce is required to progressively expand coverage over time? How does a country produce, deploy and sustain a health workforce that is both fit for purpose and fit to practice in support of universal health coverage?

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Health Care Innovation and Quality Assurance

Features of computerized clinical decision support systems supportive of nursing practice: a literature review.
Non UofA Access
Lee S.
Computers, informatics, nursing : CIN 2013 Oct;31(10):477-95

This study aimed to organize the system features of decision support technologies targeted at nursing practice into assessment, problem identification, care plans, implementation, and outcome evaluation. It also aimed to identify the range of the five stage-related sequential decision supports that computerized clinical decision support systems provided. MEDLINE, CINAHL, and EMBASE were searched. A total of 27 studies were reviewed. The system features collected represented the characteristics of each category from patient assessment to outcome evaluation. Several features were common across the reviewed systems. For the sequential decision support, all of the reviewed systems provided decision support in sequence for patient assessment and care plans. Fewer than half of the systems included problem identification. There were only three systems operating in an implementation stage and four systems in outcome evaluation. Consequently, the key steps for sequential decision support functions were initial patient assessment, problem identification, care plan, and outcome evaluation. Providing decision support in such a full scope will effectively help nurses’ clinical decision making. By organizing the system features, a comprehensive picture of nursing practice-oriented computerized decision support systems was obtained; however, the development of a guideline for better systems should go beyond the scope of a literature review.

Communication and effectiveness in a US nursing home quality-improvement collaborative.
Non UofA Access
Arling PA, Abrahamson K, Miech EJ, Inui TS, Arling G.
Nursing & health sciences 2013 Nov 21

In this study, we explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. Survey and interview data were collected from nursing home clinicians participating in a quality-improvement collaborative. Quality-improvement outcomes were evaluated using US Federal and State minimum dataset measures. Models were specified evaluating the relationships between resident outcomes, staff perceptions of communication patterns, and staff perceptions of collaborative effectiveness. Interview data provided deeper understanding of the quantitative findings. Reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings, and where respondents perceived that the collaborative kept them informed and provided new ideas. Clinicians observed that participation in a quality-improvement collaborative positively influenced the ability to share innovative ideas and expand the quality-improvement program within their nursing home. For practitioners, a high level of communication, both inside and outside of meetings, was key to making measurable gains in resident health outcomes.© 2013 Wiley Publishing Asia Pty Ltd.

Implementation strategies: recommendations for specifying and reporting
Proctor E, Powell B, McMillen C.
Implementation Science 2013;8(1):139

Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.

NHS: Engagement in research: an innovative three-stage review of the benefits for health-care performance (UK)
October 2013

There is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence. An hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included in the focused review if the concept of ‘engagement in research’ was an input and some measure of ‘performance’ an output. Of the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs.

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Organizational Change

Conference Board of Canada: Culture and Innovation: The Secret Sauce Canada-flat-icon

Innovative organizational culture needs to be directly managed if Canadian companies want to improve their innovation performance. Find out how in this report, which provides a framework and suggests effective managerial approaches.

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Bibliometrics

What can article-level metrics do for you?
Non UofA Access
Fenner M.
PLoS biology 2013 Oct;11(10):e1001687

Article-level metrics (ALMs) provide a wide range of metrics about the uptake of an individual journal article by the scientific community after publication. They include citations, usage statistics, discussions in online comments and social media, social bookmarking, and recommendations. In this essay, we describe why article-level metrics are an important extension of traditional citation-based journal metrics and provide a number of example from ALM data collected for PLOS Biology.

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Aging

Infection Prevention and Control Standards in Assisted Living Facilities: Are Residents’ Needs Being Met?
Non UofA Access
Kossover RA, Chi CJ, Wise ME, Tran AH, Chande ND, Perz JF.
Journal of the American Medical Directors Association 2013 Nov 13

Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. OBJECTIVES: Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. METHODS: We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. RESULTS: Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating. CONCLUSIONS: There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries.
Non UofA Access
Afram B, Stephan A, Verbeek H, Bleijlevens MH, Suhonen R, Sutcliffe C, et al.
Journal of the American Medical Directors Association 2013 Nov 12

To explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries. DESIGN: An explorative cross-sectional study was conducted in 8 European countries. Mainly patient-related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%), and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in most countries. Besides patient-related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analyzed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared with child-caregivers. CONCLUSION: Multiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Differential impacts of care-giving across three caregiver groups in Canada: end-of-life care, long-term care and short-term care. Canada-flat-icon
Non UofA Access
Williams AM, Wang L, Kitchen P.
Health & social care in the community 2013 Oct 31

Using data from Statistic Canada’s General Social Survey Cycle 21 (GSS 2007), this study explores whether differences exist in the impacts of care-giving among three groups of caregivers providing informal care either in the caregiver’s or recipient’s home, or in other locations within the community: (i) those providing end-of-life (EOL) care (n = 471); (ii) those providing long-term care (more than 2 years) for someone with a chronic condition or long-term illness (n = 2722); and (iii) those providing short-term care (less than 2 years) for someone with a chronic condition or long-term illness (n = 2381). All three groups of caregivers shared a number of sociodemographic characteristics, including being female, married, employed and living in a Census Metropolitan Area (CMA). With respect to health, EOL caregivers were found to have significantly higher levels of ‘fair or poor’ self-assessed health than the other two groups. Overall, the findings suggest that EOL caregivers are negatively impacted by the often additional role of care-giving, more so than both short-term and long-term caregivers. EOL caregivers experienced a higher proportion of negative impacts on their social and activity patterns. Furthermore, EOL caregivers incurred greater financial costs than the other two types of informal caregivers. The impacts of EOL care-giving also negatively influence employment for caregivers when compared with the other caregiver groups. Consequently, EOL caregivers, overall, experienced greater negative impacts, including negative health outcomes, than did long-term or short-term caregivers. This provides the evidence for the assertion that EOL care-giving is the most intense type of care-giving, potentially causing the greatest caregiver burden; this is shown through the greater negative impacts experienced by the EOL caregivers when compared with the short-term and long-term caregivers. © 2013 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.

Scaling functional status within the interRAI suite of assessment instruments
Non UofA Access
Morris JN, Berg K, Fries BE, Steel K, Howard EP.
BMC geriatrics 2013 Nov 21;13(1):128

As one ages, physical, cognitive, and clinical problems accumulate and the pattern of loss follows a distinct progression. The first areas requiring outside support are the Instrumental Activities of Daily Living and over time there is a need for support in performing the Activities of Daily Living. Two new functional hierarchies are presented, an IADL hierarchical capacity scale and a combination scale integrating both IADL and ADL hierarchies. METHODS: A secondary analyses of data from a cross-national sample of community residing persons was conducted using 762,023 interRAI assessments. The development of the new IADL Hierarchy and a new IADL-ADL combined scale proceeded through a series of interrelated steps first examining individual IADL and ADL item scores among persons receiving home care and those living independently without services. A factor analysis demonstrated the overall continuity across the IADL-ADL continuum. Evidence of the validity of the scales was explored with associative analyses of factors such as a cross-country distributional analysis for persons in home care programs, a count of functional problems across the categories of the hierarchy, an assessment of the hours of informal and formal care received each week by persons in the different categories of the hierarchy, and finally, evaluation of the relationship between cognitive status and the hierarchical IADL-ADL assignments. RESULTS: Using items from interRAI’s suite of assessment instruments, two new functional scales were developed, the interRAI IADL Hierarchy Scale and the interRAI IADL-ADL Functional Hierarchy Scale. The IADL Hierarchy Scale consisted of 5 items, meal preparation, housework, shopping, finances and medications. The interRAI IADL-ADL Functional Hierarchy Scale was created through an amalgamation of the ADL Hierarchy (developed previously) and IADL Hierarchy Scales. These scales cover the spectrum of IADL and ADL challenges faced by persons in the community. CONCLUSIONS: An integrated IADL and ADL functional assessment tool is valuable. The loss in these areas follows a general hierarchical pattern and with the interRAI IADL-ADL Functional Hierarchy Scale, this progression can be reliably and validly assessed. Used across settings within the health continuum, it allows for monitoring of individuals from relative independence through episodes of care.

interRAI home care quality indicators.
Non UofA Access
Morris JN, Fries BE, Frijters D, Hirdes JP, Steel RK.
BMC geriatrics 2013 Nov 19;13(1):127

This paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI’s widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality problem is specified has been refined, the covariate structure updated, and two summary scales introduced. METHODS: Two data sets were used: at the client and home-care site levels. Client-level data were employed to identify HC-QI covariates. This sample consisted of 335,544 clients from Europe, Canada, and the United States. Program level analyses, where client level data were aggregated at the site level, were also based on the clients from the samples from Europe, Canada, and the United States. There were 1,654 program-based observations — 22% from Europe, 23% from the US, and 55% from Canada.The first task was to identify potential HC-QIs, including both change and prevalence measures. Next, they were reviewed by industry representatives and members of the interRAI network. A two-step process adjustment was followed to identify the most appropriate covariance structure for each HC-QI. Finally, a factor analytic strategy was used to identify HC-QIs that cluster together and thus are candidates for summary scales. RESULTS: The set of risk adjusted HC-QIs are multi-dimensional in scope, including measures of function, clinical complexity, social life, distress, and service use. Two factors were identified. The first includes a set of eleven measures that revolve around the absence of decline. This scale talks about functional independence and engagement. The second factor, anchored on nine functional improvement HC-QIs, referenced positively, this scale indicates a return to clinical balance. CONCLUSIONS: Twenty-three risk-adjusted, HC-QIs are described. Two new summary HC-QI scales, the “Independence Quality Scale” and the “Clinical Balance Quality Scale” are derived. In use at a site, these two scales can provide a macro view of local performance, offering a way for a home care agency to understand its performance. When scales perform less positively, the site then is able to review the HC-QI items that make up the scale, providing a roadmap for areas of greatest concern and in need of targeted interventions.

Pressure ulcer prevention in nursing homes: Nurse descriptions of individual and organization level factors.
Non UofA Access
Dellefield ME, Magnabosco JL.
Geriatric nursing (New York, N.Y.) 2013 Oct 14

Sustaining pressure ulcer prevention (PUP) in nursing homes has been difficult to achieve. Implementation science researchers suggest that identification of individual staff and organizational factors influencing current practices is essential to the development of an effective and customized plan to implement practice changes in a specific setting. A mixed methods approach was used to describe nurses’ perceptions of individual and organization-level factors influencing performance of PUP in two Veterans Health Administration (VHA) nursing homes prior to implementation of a national VHA initiative on Hospital Acquired Pressure Ulcers (HAPUs). Individual interviews of 16 nursing staff were conducted. Individual factors influencing practice were a personal sense of responsibility to Veterans and belief in the effectiveness and importance of preventive measures. Organizational factors were existence of cooperative practices between nursing assistants and licensed nurses in assessing risk; teamwork, communication, and a commitment to Veterans’ well-being. Integration and reinforcement of such factors in the development and maintenance of customized plans of PUP initiatives is recommended. Copyright © 2013 Mosby, Inc. All rights reserved.

The character of behavioural symptoms on admission to three Canadian long-term care homes. Canada-flat-icon
Non UofA Access
Brazil K, Maitland J, Walker M, Curtis A.
Aging & mental health 2013 Nov;17(8):1059-1066

We determined the prevalence and nature of behavioural symptoms at the time of admission to a long-term care home (LTCH) and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission. Method: The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. Three LTCHs located in Ontario, Canada participated in the study. Results: During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia (mean = 3.79, SD = 3.32 versus mean = 2.56, SD = 2.24, respectively; t(200) = 1.91; p = 0.059). Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was ‘resisting care’. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident. Conclusion: A standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management.

A Systematic Review of Malnutrition Screening Tools for the Nursing Home Setting
Non UofA Access
van Bokhorst–de van der Schueren MA, Guaitoli PR,Jansma EP, de Vet HC
Journal of the American Medical Directors Association epub 02 December 2013

Malnutrition screening among nursing home residents is often performed with tools developed for use among older subjects, and sometimes with tools designed for an adult population. Only a few tools have been designed specifically for the nursing home setting. This systematic review assesses the criterion and predictive validity of malnutrition screening tools used in nursing homes. The search yielded 8313 references. Of these, 24 met the inclusion criteria and were available; 2 extra manuscripts were retrieved by reference checking. Twenty tools were identified. Seventeen studies reported on criterion validity, and 9 on predictive validity. Four of the tools had been designed specifically for use in long term care. None of the tools, not even the ones specifically designed for the nursing home setting, performed (on average) better than “fair” in either assessing the residents’ nutritional status or in predicting malnutrition-related outcomes.

CDC: Dementia Special Care Units in Residential Care Communities: United States, 2010
November 2013

Key findings
In 2010, 17% of residential care communities had dementia special care units.
-Beds in dementia special care units accounted for 13% of all residential care beds.
-Residential care communities with dementia special care units were more likely than those without to have more beds, be chain-affiliated, and be purposely built as a residential care community, and less likely to be certified or registered to participate in Medicaid.
-Residential care communities with dementia special care units were more likely than those without to be located in the Northeast and in a metropolitan statistical area, and less likely to be in the West.

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Events

Non UofA

IHI: Frail Older Adults: Building a Care System
9-10 April 2014 Chicago, IL

After this seminar, participants will be able to:
-Describe a community-based system of care for older adults with complex needs that is reliable and achieves optimal well-being and lowered system costs
-Identify and plan actions they can take now — in their organization and in their community — to establish the building blocks toward the ideal system of care

AIHS: Plain Language Workshop
6-7 February 2014 Edmonton

Plain language is about clarity in writing. In this intensive two-day workshop, Wordsmith Associates will teach you how to apply plain language skills to write effective:
-emails, letters, and memos,
-KT proposals and plans,
-grant applications,
-lecture notes, and
-publications.

AIHS: Scientist Knowledge Translation Training Workshop
13-14 March 2014 Edmonton

This highly-regarded, two-day workshop helps participants build essential skills in knowledge translation. Join trainers Dr. Melanie Barwick and Dr. Donna Lockett to:
-understand the theory behind knowledge translation
-understand evidence-based knowledge translation strategies and evaluation methods
-develop knowledge translation plans
-communicate research findings to multiple audiences including the media
-link with policy and decision-makers
This workshop is of interest to scientists, KT professionals, practitioners, educators, and decision makers in community-based organizations and government who wish to develop their knowledge translation (KT) skills. While the focus is on health, the course material is relevant to individuals working in all sectors.

Online

KT Canada: Interdisciplinary Knowledge Translation in Critical Care Rehabilitation
Thursday 12 December 2013 10:00-11:00 MT

Learning Objectives:
• Understand the state of current best evidence for interdisciplinary Rehabilitation in the ICU
• Understand barriers and facilitators to providing rehabilitation in the ICU
• Identify opportunities for interdisciplinary ICU rehabilitation knowledge translation activities

AHRQ: The principles and utility of the Theory of Planned Behavior in implementation research
Wednesday 11 December 2013 11:00-12:30 MT

One key aspect of quality improvement initiatives focuses on changing clinical behaviors of health professionals. Dr. Légaré will discuss the relevance of socio cognitive theories for PBRNs and quality improvement initiatives, and will review the main socio cognitive theories that have been found useful in the study of health professional clinical behaviors. Dr. Légaré will also provide examples of implementation research using the Theory of Planned Behavior and other related socio cognitive theories.

Cochrane Canada Free Live Webinars

Overviews of reviews – what they are, what they aren’t, and how and when to do one
Thursday 5 December 2013 10:00-11:00 MT

In this webinar, Dr. Lisa Hartling and Denise Thomson from the Child Health Field will cover the process for conducting an overview: defining a viable topic, assembling the author team, managing the scope, etc. We will also discuss the strengths of overviews, and the differences in time, methods and scope between overviews, systematic reviews and network meta-analyses.
Introduction to concepts in network meta-analysis
Thursday 16 January 2013 10:00-11:00 MT

This webinar will provide attendees with an overview of network meta-analysis and will discuss advantages that it can offer over the traditional pairwise approach to meta-analysis. In this session, examples from the literature will be used to familiarize researchers with situations where network meta-analysis can be helpful, to introduce terminology and methodologic concepts which are involved with this approach to evidence synthesis, and to suggest helpful resources which can guide systematic reviewers with regard to both transparent reporting and critical appraisal of network meta-analyses. Join Dr. Brian Hutton from the Ottawa Hospital Research Institute and Dr. David Moher’s Network Meta-Analysis research team for the discussion.
An introduction to rapid reviews
Thursday 30 January 2014 10:00-11:00 MT

A rapid review (RR) is a type of literature review produced using accelerated and streamlined systematic review (SR) methods. In this webinar, we will cover: a) the role of the Knowledge Synthesis Group of the Ottawa Hospital Research Institute (OHRI) in rapid reviews including contexts in which rapid review work is conducted; b) their approach to rapid review methods and end products; c) their involvement with development of the Cochrane Response Rapid Reviews; and d) challenges, opportunities and lessons learned. Presented by Adrienne Stevens and David Moher of the OHRI.

Technology Evaluation in the Elderly: Annual Scientific Meeting
21-23 September 2013

Who should attend: Researchers, Educators, Students, KT and Training Experts, Health Care Decision Makers and Administrators and Community Organizations interested in improving care for the seriously ill, frail elderly.

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News

New Ontario Health Innovation Council Created Canada-flat-icon

The new Ontario Health Innovation Council unites experts from the health care, community, home care, medical device, non-profit, mental health, research, academic and business sectors. The Ontario government created the council to improve the sustainability of the health care system and accelerate Ontario innovations into practice and within the global marketplace. The council will identify opportunities for evidence-based innovation and strategies in health care to:
-Improve health, health care and well-being in Ontario.
-Spur innovation that lowers health care costs.
-Increase quality of patient care.
-Stimulate the environment needed for job creation in this sector.
-Attract the best and brightest researchers and entrepreneurs to Ontario.

International Makeup of U.S. Health Care Workforce Brings Vitality, Challenges

Foreign-educated and foreign-born health professionals play a vital role in providing patient care in this country, but strategic shifts such as changes in immigration laws may be needed to stabilize the nation’s health workforce, according to a new RAND Corporation study.

News about CIHR’s Planning and Dissemination Programs Canada-flat-icon

The Planning Grants and Dissemination Events programs will no longer be offered in their current format after the Fall 2013 competition. CIHR recognizes the importance of planning and dissemination activities and will continue to support these activities through the Institute Community Support (ICS) Program going forward.

Why it’s time to make ‘alarm fatigue’ in hospitals a key health-care priority

Anyone who has been a patient or a visitor to a hospital knows they are noisy places. But rarely do we acknowledge that the cacophony, in addition to being a source of irritation, can be downright dangerous.

5.3 million Canadians (15.3% of the country’s population) are now aged 65+ Canada-flat-icon

StatsCan releases Annual Demographic Estimates: Canada, Provinces and Territories. This publication presents annual estimates of the total population and annual estimates by age and sex for Canada, provinces and territories. It also presents estimates of the following components of population change: births, deaths, immigration, emigration, returning emigration, net temporary emigration, net non-permanent residents and inter-provincial migration, the latter by origin and destination.

Who will care for America’s aging population?

Nearly 70 percent of Americans who reach age 65 will, at some point, be unable to care for themselves without assistance. Issues of long-term care also affect millions of younger people with significant cognitive or physical functional limitations. Yet long-term care gets neither the public attention nor the policy focus that it deserves.

Atlantic provinces are becoming a region for the aging, says Statistics Canada Canada-flat-icon

Nova Scotia posted both the highest proportion of seniors and the lowest share of youth, according to the latest numbers from Statistics Canada.

New Name for RTNA Canada-flat-icon

As of October 10, 2013 the Health Research Network of Alberta (RTNA) will be called the Knowledge Translation Network (KTN).

Aboriginal Seniors among Canada’s most vulnerable citizens Canada-flat-icon

The Health Council says that little attention has been paid to date to the health care needs of Aboriginal seniors in either research or public policy. Yet in comparison to the larger Canadian population, a significantly higher proportion of Aboriginal seniors live on low incomes and in poor health, with multiple chronic conditions and disabilities.

Canada’s nurses push Parliament for new seniors’ commission Canada-flat-icon

The Canadian Nurses Association (CNA) wants the federal government to establish a collaborative aging and seniors care commission of Canada (ASCCC) to promote the health and well-being of Canadians as they age, enhance chronic disease prevention and management, and increase system capacity around frailty and vulnerability.

Rising seniors’ poverty rate sends warning Canada-flat-icon

Poverty rates among seniors rose in Canada between 2007 and 2010, the OECD says in a report this week. This is despite these rates falling in many other countries over the same period, and the Canadian Medical Association says this underlines the country’s need for a national seniors’ care strategy.

Aboriginal long-term care experts call for beds, housing Canada-flat-icon

Experts in Aboriginal health say that home care for seniors is failing to meet the needs of remote First Nations communities, citing needs for more beds, better housing and greater cultural sensitivity.

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Resources

SEDL: Introduction to KT Concepts

The module introduces the process of knowledge translation (KT) and its relationship to the more familiar terms dissemination and utilization (D&U). The KT process includes D&U, but is more expansive as it promotes
-“the effective use of science-based knowledge, technologies, and applications to inform disability and rehabilitation policy, improve practice, and enhance the lives of individuals with disabiilties.
-The KT process actively engages disability researchers, researchers from other disciplines, service providers, policymakers, and persons with disabilities and their families in the interchange, synthesis, and application of rehabilitation research knowledge (NIDRR Long-Range Plan for Fiscal Years 2005-09, Executive Summary).

Making Data Talk: A Workbook

This workbook helps you select and communicate quantitative data in ways that everyone can understand. It reviews basic communications concepts, presents an easy-to-understand framework for communicating data, and shows how to apply that framework to actual public health situations. The workbook also includes practice exercises and real-world examples.

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Opportunities

Tenure-track professor in interprofessionalism in health care and social services Canada-flat-icon
Faculté de médecine, Université Laval
DEADLINE: 6 December 2013

We are seeking a researcher in the field of interprofessional collaboration in health care and social services to join our team and to contribute to the research and teaching efforts within the Faculty of Medicine and the Collaborative Network on Interprofessional Practices in Health and Social services (RCPI).

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