CALL FOR POSTERS: Health Research Data Symposium: An Alberta Perspective on Access, Management and Linkage
Thursday 29 May Lister Centre, University of Alberta
DEADLINE 14 May
This one-day symposium will explore aspects of health research data access, management, and linkage in Alberta. Ample time will be provided after presentations for questions and group discussion. We encourage faculties, researchers, students, health system managers, clinicians, not-for-profit organizations, and government officials to register and participate in this event. Specific information on the Call for Posters is available here.
Grants & Awards
CIHR Partnership Award
DEADLINE 1 May
The CIHR Partnership Award annually recognizes a partnership that exemplifies excellence. The recipients receive a $25,000 award in the form of a one-year research grant for advancing the research or knowledge translation activities of the partnership.
These partnerships involve organizations from the private, voluntary or public sectors. They bring health research communities together:
-to create innovative approaches to research questions;
-to develop research agendas that are responsive to the health needs, concerns and priorities of Canadians and/or the global community; and
-to accelerate the translation of knowledge for the benefit of Canadians and/or the global community.
Lost in translation? ‘Evidence’ and the articulation of institutional logics in integrated care pathways: from positive to negative boundary object?
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Sociology of health & illness 2014
This article examines the translation of a clinical governance concept – integrated care pathways (ICPs) – into an infrastructural technology. Building on previous work, the application of boundary object theory is extended in this article to argue that stakeholder enrolment in pathway methodology may be less thoroughgoing than originally assumed. Pathways have effectively aligned management and nursing interests around a quality agenda and nurses have emerged as the leaders in this field, but doctors have rather lower levels of engagement. It is suggested that the contradictory logics inherent in pathway philosophy (primarily as these relate to ‘evidence’) and the social organisation of ICP development foster a transformation of the concept when this is translated into the technology, creating a negative boundary object from the perspective of doctors. Medicine is a powerful actor in health care, which is consequential for whether pathways, as designated boundary objects, become boundary objects-in-use. It also has implications for the diffusion of the concept as a mechanism of clinical governance and the credibility of nurses as emergent leaders in this field. Qualitative case studies of ICP development processes undertaken in the UK National Health Service and ethnographic research on the ICP community provide the empirical foundations for the analysis.
Factors Influencing Critical Care Nurses’ Adoption of the AACN Practice Alert on Verification of Feeding Tube Placement
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Bourgault AM, Heath J, Hooper V, Sole ML, Waller JL, Nesmith EG.
American Journal of Critical Care 2014 Mar;23(2):134-144
Clinical practice guidelines are intended to bridge the research-practice gap, yet little is known about how critical care nurses adopt guidelines. Feeding tube verification practices remain variable and have led to patient harm and death. Objectives To examine factors influencing critical care nurses’ adoption of the American Association of Critical-Care Nurses (AACN) practice alert on verification of feeding tube placement and its 4 recommended clinical practices. Methods Critical care nurses were invited to participate in a national, online questionnaire, guided by Rogers’ diffusion of innovation framework. Descriptive statistics and logistic regression were used for data analysis. Alpha level was set at 0.05. Results Fifty-five percent of the 370 participating nurses were aware of the practice alert, and 45% had adopted it in practice. Only 29% of the adopters had also implemented all 4 clinical practices. Significant predictors of adoption included BSN or higher nursing education and guideline characteristics of observability and trialability. Predictors of implementation of the clinical practices included staff nurse/charge nurse role, academic medical center, research/web-based information sources, and perception of a policy. Policy was the only significant predictor of implementation of all 4 practices. Adoption of the practice alert was also a predictor for 2 of 4 clinical practices. Conclusions Personal and organizational factors influenced implementation of practices associated with an AACN practice alert. Although a research-practice gap exists, the practice alert was a significant source of information for 2 of the clinical practices.
Evidence based practice beliefs and implementation among nurses: a cross-sectional study.
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Stokke K, Olsen NR, Espehaug B, Nortvedt MW.
BMC nursing 2014 Mar 25;13(1):8
Having a positive attitude towards evidence-based practice and being able to see the value of evidence-based practice for patients have been reported as important for the implementation of evidence-based practice among nurses.The aim of this study was to map self-reported beliefs towards EBP and EBP implementation among nurses, and to investigate whether there was a positive correlation between EBP beliefs and EBP implementation. METHOD: We carried out a cross-sectional study among 356 nurses at a specialist hospital for the treatment of cancer in Norway. The Norwegian translations of the Evidence-based Practice Belief Scale and the Evidence-based Practice Implementation Scale were used. RESULTS: In total, 185 nurses participated in the study (response rate 52%). The results showed that nurses were positive towards evidence-based practice, but only practised it to a small extent. There was a positive correlation (r) between beliefs towards evidence-based practice and implementation of evidence-based practice (r = 0.59, p = 0.001).There was a statistical significant positive, but moderate correlation between all the four subscales of the EBP Beliefs Scale (beliefs related to: 1) knowledge, 2) resources, 3) the value of EBP and 4) difficulty and time) and the EBP Implementation Scale, with the highest correlation observed for beliefs related to knowledge (r = 0.38, p < .0001). Participants who had learned about evidence-based practice had significantly higher scores on the Evidence-based Practice Belief Scale than participants who were unfamiliar with evidence-based practice. Those involved in evidence-based practice working groups also reported significantly higher scores on the Evidence-based Practice Belief Scale than participants not involved in these groups. CONCLUSION: This study shows that nurses have a positive attitude towards evidence-based practice, but practise it to a lesser extent. There was a positive correlation between beliefs about evidence-based practice and implementation of evidence-based practice. Beliefs related to knowledge appear to have the greatest effect on implementation of evidence-based practice. Having knowledge and taking part in evidence-based practice working groups seem important.
Translating Infection Control Guidelines Into Practice: Implementation Process Within a Health Care Institution.
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Raveis VH, Conway LJ, Uchida M, Pogorzelska-Maziarz M, Larson EL, Stone PW.
Qualitative health research 2014 Mar 5
Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants’ narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate.
Health Care Administration and Organization
Top nurse-management staffing collapse and care quality in nursing homes.
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Hunt SR, Corazzini K, Anderson RA.
Journal of applied gerontology 2014 Feb;33(1):51-74
Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided.
Direct Care Worker’s Perceptions of Job Satisfaction Following Implementation of Work-Based Learning.
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Lopez C, White DL, Carder PC.
Journal of applied gerontology 2014 Feb;33(1):97-120
The purpose of this study was to understand the impact of a work-based learning program on the work lives of Direct Care Workers (DCWs) at assisted living (AL) residences. The research questions were addressed using focus group data collected as part of a larger evaluation of a work-based learning (WBL) program called Jobs to Careers. The theoretical perspective of symbolic interactionism was used to frame the qualitative data analysis. Results indicated that the WBL program impacted DCWs’ job satisfaction through the program curriculum and design and through three primary categories: relational aspects of work, worker identity, and finding time. This article presents a conceptual model for understanding how these categories are interrelated and the implications for WBL programs. Job satisfaction is an important topic that has been linked to quality of care and reduced turnover in long-term care settings.
This independent review makes a number of recommendations on how the training and support of both healthcare assistants who work in hospitals, and social care support workers who are employed in care homes and people’s own homes, can be improved to ensure they provide care to the highest standard. The review proposes that all healthcare assistants and social care support workers should undergo the same basic training, and get a ‘certificate of fundamental care’ before they can care for people unsupervised. The review was carried out in the wake of the Francis Inquiry into Mid-Staffordshire NHS Trust.
Health Care Innovation and Quality Assurance
Finding Gertrude: The Resident’s Voice in Minimum Data Set 3.0
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Thomas KS, Wysocki A, Intrator O, Mor V.
Journal of the American Medical Directors Association 2014
The new Minimum Data Set 3.0 was designed to improve the assessment process by requiring nursing home (NH) staff to attempt to interview residents with scripted questions to assess subjective states such as pain, mood, and cognitive functioning. Although the case has been made that resident self-report is important, it is unknown whether facilities are doing so in practice. We examined the frequency of attempts to interview residents to elucidate the types of residents able to be interviewed about their clinical conditions and facility characteristics related to the likelihood of attempt. Design and Methods Data come from Minimum Data Set 3.0 annual assessments for 757,044 residents in 15,030 NHs during 2011–2012 and the 2011 Online Survey, Certification, and Reporting database. Hierarchical generalized linear models were conducted to test the association between resident and facility characteristics and the attempt rate of resident interview for 3 clinical domains (cognition, mood, and pain). Results Over 83% of long-stay residents attempted all 3 self-report clinical items. The rates of attempt for mood, cognition, and pain were 88%, 89%, and 92%, respectively. Results from hierarchical generalized linear models suggest that certain resident characteristics are related to the likelihood of participating in interviews, in particular neither having a diagnosis of dementia nor cognitive impairment, not exhibiting signs of delirium, nor a documented prognosis of 6 months or less to live. Residents in smaller, chain-affiliated nursing homes with fewer Medicare residents and fewer assessments per administrative nurse and registered nurse were more likely to attempt the resident interview items. Implications This article documents the high rate of NH residents’ participation in interviews about their clinical states. Furthermore, we identify types of residents for whom additional investigation into ways to achieve higher rates of participation is required and facility resources that are related to the likelihood of high rates of attempt.
Evidence-based organization and patient safety strategies in European hospitals.
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Sunol R, Wagner C, Arah OA, Shaw CD, Kristensen S, Thompson CA, et al.
International journal for quality in health care 2014 Feb 26
To explore how European hospitals have implemented patient safety strategies (PSS) and evidence-based organization of care pathway (EBOP) recommendations and examine the extent to which implementation varies between countries and hospitals. DESIGN: Mixed-method multilevel cross-sectional design in seven countries as part of the European Union-funded project ‘Deepening our Understanding of Quality improvement in Europe’ (DUQuE). SETTING AND PARTICIPANTS: Seventy-four acute care hospitals with 292 departments managing acute myocardial infarction (AMI), hip fracture, stroke, and obstetric deliveries.Main outcome measureFive multi-item composite measures-one generic measure for PSS and four pathway-specific measures for EBOP. RESULTS: Potassium chloride had only been removed from general medication stocks in 9.4-30.5% of different pathways wards and patients were adequately identified with wristband in 43.0-59.7%. Although 86.3% of areas treating AMI patients had immediate access to a specialist physician, only 56.0% had arrangements for patients to receive thrombolysis within 30 min of arrival at the hospital. A substantial amount of the total variance observed was due to between-hospital differences in the same country for PSS (65.9%). In EBOP, between-country differences play also an important role (10.1% in AMI to 57.1% in hip fracture). CONCLUSIONS: There were substantial gaps between evidence and practice of PSS and EBOP in a sample of European hospitals and variations due to country differences are more important in EBOP than in PSS, but less important than within-country variations. Agencies supporting the implementation of PSS and EBOP should closely re-examine the effectiveness of their current strategies.
Opening the “black box” of plan-do-study-act cycles: achieving a scientific yet pragmatic approach to improving patient care.
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McNicholas C, Bell D, Reed J.
BMJ quality & safety 2014 Apr;23(4):352-2014-002893.11
The Plan-Do-Study-Act cycle method is a common approach taken in improvement initiatives to test changes in a pragmatic and scientific fashion. The effectiveness and application of the method, however, is varied with a recent systematic review outlining a lack of adherence to key functions of the methods approach. To understand how to achieve good quality use of the method it is necessary to assess the attainment of these key functions of its use in frontline improvement initiatives, opening the method’s “black box”. This research aims to further develop and apply a theoretical framework to assess the conduct of improvement initiatives: understanding both the conduct of the PDSA method and the improvement context of an organization that supports its use. METHODS: A qualitative study of three separate healthcare organizations is underway to assess the PDSA cycle conduct of improvement initiatives, including iterative development, prediction-based tests of change, use of regular data over time, starting on a small scale and collaborative working. Semi-structured interviews with improvement initiative members and senior organizations leaders are being conducted and complemented with participant observation and document analysis of initiatives’ day-today work to gain an in-depth understanding of how PDSA methods are applied and perceived by healthcare professionals and to gain an understanding of broader organizational context for improvement work. RESULTS: The study is due for complete in early 2014, however, initial findings can be highlighted. Whilst the recognition of the functions of PDSA is widespread in the improvement initiatives observed, be it implicitly or explicitly, the achievement of these is varied. The utilization of regular data over time to influence progression of PDSA cycles is a key challenge when using the PDSA cycle approach, both in collecting the data and collaboratively critiquing it to iterate a change. This leaves teams stuck in the Plan-Do stages of the cycle and prevents effective cycle completion. Whilst the concept of testing change is supported by most individuals involved directly in improvement initiatives not all participants are necessarily aware or engaged with the PDSA cycle approach and tests of change of occur without using the 4 stages or are retrospectively documented as PDSA cycles. DISCUSSION: This work presents a framework to assess the effective application and supporting context for improvement initiatives using the PDSA cycle approach. Whilst the benefit of testing change in a scientific and pragmatic manner is evident in the views of healthcare staff the improvement of organizational learning mechanisms to support this is necessary. Both internal and external support to an organization can benefit from reflecting on the framework and address data and staff training needs to ensure patient care is improved in an effective and efficient manner.
Antipsychotic medication use in nursing homes: a proposed measure of quality.
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Lucas JA, Chakravarty S, Bowblis JR, Gerhard T, Kalay E, Paek EK, et al.
International journal of geriatric psychiatry 2014 Mar 20
The potential misuse of antipsychotic medications (APMs) is an ongoing quality concern in nursing homes (NHs), especially given recent black box warnings and other evidence regarding the risk of APMs when used in NH populations. One mechanism regulators could use is public reporting of APM use by NHs; however, there is currently no agreed-upon measure of guideline-inconsistent APM use. In this paper, we describe a proposed measure of quality of APM use that is based on Centers for Medicare and Medicaid Services (CMS) Interpretive Guidelines, Food and Drug Administration (FDA) indications for APMs, and severity of behavioral symptoms. METHODS: The proposed measure identifies NH residents who receive an APM but do not have an approved indication for APM use. We demonstrate the feasibility of this measure using data from Medicaid-eligible long-stay residents aged 65 years and older in seven states. Using multivariable logistic regressions, we compare it to the current CMS Nursing Home Compare quality measure. RESULTS: We find that nearly 52% of residents receiving an APM lack indications approved by CMS/FDA guidelines compared with 85% for the current CMS quality measure. APM guideline-inconsistent use rates vary significantly across resident and facility characteristics, and states. Only our measure correlates with another quality indicator in that facilities with higher deficiencies have significantly higher odds of APM use. Predictors of inappropriate use are found to be consistent with other measures of NH quality, supporting the validity of our proposed measure. CONCLUSION: The proposed measure provides an important foundation to improve APM prescribing practices without penalizing NHs when there are limited alternative treatments available. Copyright © 2014 John Wiley & Sons, Ltd.
Connections Matter: How Personal Network Structure Influences Biomedical Scientists’ Engagement in Medical Innovation (Spain & France)
INGENIO (CSIC‐UPV) Working Paper Series 2014‐02
In this study, we analyze the determinants of biomedical scientists’ participation in various types of activities and outputs related to medical innovation. More specifically, we argue that scientists occupying brokerage positions among their contacts will in a more favorable position to deliver medical innovation outcomes, compared to scientists embedded in more dense networks. However, we also theorize that beyond a threshold, the coordination costs of brokerage may surpass its potential benefits. In addition to that, we study the influence of two individual-level attributes as potential determinants of the participation in medical innovation activities: cognitive breadth and perceived beneficiary impact. We situate our analysis within the context of the Spanish biomedical research framework, where we analyze a sample of 1,292 biomedical scientists.
This report presents the adaptation of the Consolidated Framework for Implementation Research (CFIR) to three complex system interventions involving (1) process redesign for improved efficiency and reduced costs (PR); (2) patient-centered medical homes (PCMH); and (3) care transitions. The purpose of the adapted frameworks— the PR Framework, PCMH Framework, and Care Transitions Framework—is to guide research on how, why, and where these interventions succeed or fail to achieve intended outcomes. Data sources. MEDLINE™. Additional studies were identified through the gray literature and technical experts. Methods. The adaptation was informed by the findings from a scan of selected literature on PR, PCMH, and care transitions, which included articles in MEDLINE, the published and gray literature, and recommendations of content experts at the Agency for Healthcare Research and Quality. A Technical Expert Panel (TEP) for each topic reviewed the draft of the contextual frameworks and provided input on the structure and content through a series of 2-hour calls. In addition, the PR and PCMH Frameworks were reviewed by two separate TEPs for usability. In total, five TEPs were convened for this work. Results. While retaining much of the CFIR’s original structure and most of its original concepts, the revised frameworks address distinctive features of each of the three interventions. We added concepts relevant to each topic area, and more explicitly addressed the iterative and interactive nature of complex system change. We also modified nearly all the definitions of the CFIR constructs to incorporate terminology and examples tailored to the specific interventions. Two new domains were added to each of the frameworks—one for intermediary outcomes related to the implementation and one for outcomes of the interventions themselves. Several CFIR domains and constructs were renamed to be more resonant with the intervention’s research target group. None of the original CFIR constructs were dropped, but several dozen new constructs were added across the three new frameworks. As these were iterative products, with initial PR and PCMH Frameworks informing the Care Transitions Framework, many of these new constructs overlap across the frameworks. Conclusions. These contextual frameworks provide a foundational taxonomy and conceptualization of key implementation constructs that researchers can use across studies to enhance their comparability and synthesis, thereby better informing the generalizability and replicability of specific interventions. In adapting the CFIR for complex system interventions, we thought it critical to include input from both research and practice stakeholders to ensure that the content is understandable and applicable to the intervention strategy of interest.
Effective networks for improvement Developing and managing effective networks to support quality improvement in healthcare (UK)
The Health Foundation, March 2014
Networks play many roles in healthcare. Some drive change across organisations; others simply unite individuals with common interests. But not all networks are equally effective, and healthcare improvement can be achieved through other means. It is difficult to measure their impact and to know when a network might have advantages over other types of organisation. In agreement with the Health Foundation, the research team chose seven healthcare networks as case studies (see Table 1 overleaf) and then tested their observations in the existing literature. All but one of the networks were based in the UK, and all were connected or relevant to the NHS, though not necessarily part of it. The team sought the widest range of network types and settings.
Why and How Do Nursing Homes Implement Culture Change Practices? Insights From Qualitative Interviews in a Mixed Methods Study
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Shield RR, Looze J, Tyler D, Lepore M, Miller SC.
Journal of applied gerontology 2013 Jul 19
To understand the process of instituting culture change (CC) practices in nursing homes (NHs). NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail. Results: The themes include: (a) Reasons for implementing CC practices vary; (b) NH approaches to implementing CC practices are diverse; (c) NHs consider resident mix in deciding to implement practices; (d) NHAs note benefits and few costs to implementing CC practices; (e) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; (f) Education and communication efforts are vital ways to institute change; and (g) NHA and other staff leadership is key to implementing changes. Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations.
Research Practice & Methodology
Strategies to recruit and retain older adults in intervention studies: A quantitative comparative study
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Michelet M, Lund A, Sveen U.
Archives of Gerontology and Geriatrics 2014
Recruitment and retention of participants in RCTs drawn from the older population is challenging, and studies have shown that poor recruitment and retention may lead to biased samples and results. Several strategies to improve the participation of older adults in research are outlined in the literature. The objective was to identify factors associated with participation in an RCT aiming at preventing depressive symptoms and social isolation in a later phase following a stroke, in an older population living in their homes. Strategies to improve participation were applied in the RCT “Lifestyle intervention for older adults in rehabilitation after stroke: Development, implementation and evaluation”. Quantitative data collected on participants (n = 99) and non-participants (n = 56) in the trial were compared using statistical analyses. The findings are in line with earlier studies in that the participants were younger (p = 0.01) and received less help in the home (p = 0.01) than did non-participants. The results differ from earlier studies in that participants had a higher rate of depressive symptoms (participation rate was 57% with HAD depression scale score 0-2, 61% with score 3–4, 62% with score 5-6 and 79% with a score 7 or above). The findings also illustrate a poorer health-related quality of life among the participants in the role physical domain on Short Form-36 (p = 0.01). The results indicate that the use of targeted strategies to enhance participation may lead to a less biased sample as well as the inclusion of more subjects who seem to meet the aims of the intervention.
Developing a checklist for research proposals to help describe health service interventions in UK research programmes: a mixed methods study.
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Dorling H, White D, Turner S, Campbell K, Lamont T.
Health research policy and systems 2014 Mar 4;12(1):12
One of the most common reasons for rejecting research proposals in the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme is the failure to adequately specify the intervention or context in research proposals. Examples of failed research proposals include projects to assess integrated care models, use of generic caseworkers, or new specialist nurse services. These are all important service developments which need evaluation, but the lack of clarity about the intervention and context prevented these research proposals from obtaining funding. The purpose of the research presented herein was to develop a checklist, with key service intervention and contextual features, for use by applicants to the NIHR HS&DR Programme to potentially enhance the quality of research proposals. METHODS: The study used mixed methods to identify the need for and develop and test a checklist. Firstly, this included assessing existing checklists in peer-reviewed literature relevant to organisational health research. Building on existing work, a new checklist was piloted. Two reviewers used a small sample (n = 16) of research proposals to independently assess the relevance of the checklist to the proposal and the degree of overlap or gaps between the constructs. The next two stages externally validated the revised checklist by collecting qualitative feedback from researchers and experts in the field. RESULTS: The initial checklist was developed from existing checklists which included domains of intervention and context. The constructs and background to each were developed through review of existing literature. Eight researchers provided feedback on the checklist, which was generally positive. This iterative process resulted in changes to the checklist, collapsing two constructs and providing more prompts for others; the final checklist includes six constructs. CONCLUSIONS: Features relating to intervention and context should be well described to increase the quality of research proposals and enhance the chances of the research receiving funding. Existing checklists do not have enough focus on areas relevant to research proposals in complex health service interventions, such as workforce. A formative checklist has been developed, and tested by end users. Tentative findings suggest usefulness and acceptability of such a tool but further work is needed for full validation.
Methods for documenting systematic review searches: a discussion of common issues
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Rader T, Mann M, Stansfield C, Cooper C, Sampson M.
Research Synthesis Methods 2013
As standardized reporting requirements for systematic reviews are being adopted more widely, review authors are under greater pressure to accurately record their search process. With careful planning, documentation to fulfill the Preferred Reporting Items for Systematic Reviews and Meta-Analyses requirements can become a valuable tool for organizing a systematic review literature search and planning updates. Methods A working group of information specialists convened to discuss current practice and were informed by a Web-based survey of over 260 systematic review authors, trials search coordinators, librarians, and other information specialists conducted in February/March 2011. Discussion Survey responses provided insight into current practices and difficulties of reporting searches. These included a lack of time, tools, clear understanding of the requirements, and uncertainty about responsibility for documenting these elements. This paper will present some of the practical aspects of documenting the systematic literature search. Section 1 provides background information and rationale for this paper. Section 2 discusses issues and recommendations arising from survey results. Section 3 outlines specific elements to be recorded. Section 2 guides the reader through the information management process. Section 2 concludes with implications for future research and practice. These principles are applicable to any large literature search for systematic reviews, health technology assessments, and guideline development. Copyright © 2013 John Wiley & Sons, Ltd.
How health technology assessment agencies address the issue of unpublished data.
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Kreis J, Panteli D, Busse R.
International Journal of Technology Assessment in Health Care 2014 Jan;30(1):34-43
Reporting bias potentially threatens the validity of results in health technology assessment (HTA) reports. Our study aimed to explore policies and practices of HTA agencies regarding strategies to include previously unpublished data in their assessments, focusing on requests to industry for unpublished data. Methods: We included international HTA agencies with publicly available methods papers as well as HTA reports. From the methods papers and recent reports we extracted information on requests to industry and on searches in trial registries, regulatory authority Web sites and for conference abstracts. Results: Eighteen HTA agencies and seventy-three reports were included. Agencies’ methods papers showed variability regarding requests to industry (requests are routinely carried out in seven cases, not mentioned in six, at the discretion of HTA authors in three, and based on manufacturer applications in two), which were reflected in the reports investigated. As reporting of requests was limited, it often remained unclear whether unpublished data had been received. Searches in trial registries, at regulatory authorities or for conference abstracts are described as a routine or optional part of the search strategy in the methods papers of 9, 11, and 8 included agencies, respectively. A total of 52 percent, 39 percent, and 16 percent of reports described searches in trial registries, at regulatory agencies, and hand searching of conference proceedings. Conclusion: International HTA agencies currently differ considerably in their efforts to address the issue of unpublished data. Requests to industry may constitute one strategy to access and include unpublished data, while agencies can learn from each other concerning successful practice.
Online social media tools can be some of the most rewarding and informative resources for scientists-IF you know how to use them.
Clinical trial participants’ experiences of completing questionnaires: a qualitative study
Holmberg C, Karner JJ, Rappenecker J, Witt CM.
BMJ Open 2014;4(3)
To improve clinical study developments for elderly populations, we aim to understand how they transfer their experiences into validated, standardised self-completed study measurement instruments. We analysed how women (mean 78±8 years of age) participating in a randomised controlled trial (RCT) cognised study instruments used to evaluate outcomes of the intervention. Setting The interview study was nested in an RCT on chronic neck pain using common measurement instruments situated in an elderly community in Berlin, Germany, which comprised of units for independent and assisted-living options. Participants The sample (n=20 women) was selected from the RCT sample (n=117, 95% women, mean age 76 (SD±8) years). Interview participants were selected using a purposive sampling list based on the RCT outcomes. Outcomes We asked participants about their experiences completing the RCT questionnaires. Interviews were analysed thematically, then compared with the questionnaires. Results Interviewees had difficulties in translating complex experiences into a single value on a scale and understanding the relationship of the questionnaires to study aims. Interviewees considered important for the trial that their actual experiences were understood by trial organisers. This information was not transferrable by means of the questionnaires. To rectify these difficulties, interviewees used strategies such as adding notes, adding response categories or skipping an item. Conclusions Elderly interview participants understood the importance of completing questionnaires for trial success. This led to strategies of completing the questionnaires that resulted in ‘missing’ or ambiguous data. To improve data collection in elderly populations, educational materials addressing the differential logics should be developed and tested. Pilot testing validated instruments using cognitive interviews may be particularly important in such populations. Finally, when the target of an intervention is a subjective experience, it seems important to create a method by which participants can convey their personal experiences. These could be nested qualitative studies. Trial registration number ISRCTN77108101807.
Systematic Review of the Use of Online Questionnaires of Older Adults.
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Remillard ML, Mazor KM, Cutrona SL, Gurwitz JH, Tjia J.
Journal of the American Geriatrics Society 2014 Mar 17
To describe methodological approaches to population targeting and sampling and to summarize limitations of Internet-based questionnaires in older adults. DESIGN: Systematic literature review. SETTING: Studies using online questionnaires in older adult populations. PARTICIPANTS: English-language articles using search terms for geriatric, age 65 and over, Internet survey, online survey, Internet questionnaire, and online questionnaire in PubMed and EBSCO host between 1984 and July 2012. Inclusion criteria were study population mean age 65 and older and use of an online questionnaire for research. Review of 336 abstracts yielded 14 articles for full review by two investigators; 11 articles met inclusion criteria. MEASUREMENTS: Articles were extracted for study design and setting, participant characteristics, recruitment strategy, country, and study limitations. RESULTS: Eleven articles were published after 2001. Studies had populations with a mean age of 65 to 78, included descriptive and analytical designs, and were conducted in the United States, Australia, and Japan. Recruiting methods varied widely from paper fliers and personal e-mails to use of consumer marketing panels. Investigator-reported study limitations included the use of small convenience samples and limited generalizability. CONCLUSION: Online questionnaires are a feasible method of surveying older adults in some geographic regions and for some subsets of older adults, but limited Internet access constrains recruiting methods and often limits study generalizability. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
The impact of funding deadlines on personal workloads, stress and family relationships: a qualitative study of Australian researchers
Herbert DL, Coveney J, Clarke P, Graves N, Barnett AG.
BMJ Open 2014;4(3)
To examine the impact of applying for funding on personal workloads, stress and family relationships. Design Qualitative study of researchers preparing grant proposals. Setting Web-based survey on applying for the annual National Health and Medical Research Council (NHMRC) Project Grant scheme. Participants Australian researchers (n=215). Results Almost all agreed that preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. Almost all researchers agreed that they became stressed by the workload (93%) and restricted their holidays during the grant writing season (88%). Most researchers agreed that they submitted proposals because chance is involved in being successful (75%), due to performance requirements at their institution (60%) and pressure from their colleagues to submit proposals (53%). Almost all researchers supported changes to the current processes to submit proposals (95%) and peer review (90%). Most researchers (59%) provided extensive comments on the impact of writing proposals on their work life and home life. Six major work life themes were: (1) top priority; (2) career development; (3) stress at work; (4) benefits at work; (5) time spent at work and (6) pressure from colleagues. Six major home life themes were: (1) restricting family holidays; (2) time spent on work at home; (3) impact on children; (4) stress at home; (5) impact on family and friends and (6) impact on partner. Additional impacts on the mental health and well-being of researchers were identified. Conclusions The process of preparing grant proposals for a single annual deadline is stressful, time consuming and conflicts with family responsibilities. The timing of the funding cycle could be shifted to minimise applicant burden, give Australian researchers more time to work on actual research and to be with their families.
Of the 299 abstracts and 80 full-text articles reviewed, 24 addressed in some fashion the benefits, challenges, measurement or evaluation of stakeholder engagement. Benefits cited included identifying and prioritizing topics for research; providing pragmatic feedback on the research protocol; aiding in recruitment of research participants; helping the researchers understand the research subject’s perspective; ensuring that findings are interpreted with the end user in mind and that final products are readable and accessible; and facilitating wider dissemination and uptake of research findings. There was almost no discussion of measurement or evaluation of the impact of stakeholder engagement. Of the 60 KIs we invited, 34 agreed to participate, we conducted 12 discussion sessions (60 to 90 minutes per session) with between one and four participants each. Indeed, it was not uncommon for stakeholders to represent more than one perspective. Overarching themes from our KI interviews were organized according to the three guiding questions of this white paper: (1) What are the potential or expected benefits of involving stakeholders in systematic reviews? (2) What are the challenges of involving stakeholders in systematic reviews? (3) How can we measure the impact of stakeholder engagement in systematic reviews? iv Conclusions/Recommendations. Although it is recognized by many as an important next step, to date there have been few efforts to measure the benefits/tradeoffs of specific stakeholder engagement processes or differing approaches to selecting and engaging differing stakeholder types. In order to refine our processes for efficiently and effectively engaging stakeholders, we need to develop methods to evaluate the impact of stakeholder engagement based on a more concrete understanding of the specific benefits we are hoping to achieve. Toward this end, we reviewed the existing literature and conducted a series of KI interviews in an effort to more explicitly define the expected benefits of engaging stakeholders in systematic reviews.
Healthcare in Canada
Association of hospital spending intensity with mortality and readmission rates in Ontario hospitals.
Non UofA Access
Stukel TA, Fisher ES, Alter DA, Guttmann A, Ko DT, Fung K, et al.
JAMA 2012 Mar 14;307(10):1037-1045
The extent to which better spending produces higher-quality care and better patient outcomes in a universal health care system with selective access to medical technology is unknown. OBJECTIVE: To assess whether acute care patients admitted to higher-spending hospitals have lower mortality and readmissions. DESIGN, SETTING, AND PATIENTS: The study population comprised adults (>18 years) in Ontario, Canada, with a first admission for acute myocardial infarction (AMI) (n = 179,139), congestive heart failure (CHF) (n = 92,377), hip fracture (n = 90,046), or colon cancer (n = 26,195) during 1998-2008, with follow-up to 1 year. The exposure measure was the index hospital’s end-of-life expenditure index for hospital, physician, and emergency department services. MAIN OUTCOME MEASURES: The primary outcomes were 30-day and 1-year mortality and readmissions and major cardiac events (readmissions for AMI, angina, CHF, or death) for AMI and CHF. RESULTS: Patients’ baseline health status was similar across hospital expenditure groups. Patients admitted to hospitals in the highest- vs lowest-spending intensity terciles had lower rates of all adverse outcomes. In the highest- vs lowest-spending hospitals, respectively, the age- and sex-adjusted 30-day mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF; fully adjusted relative 30-day mortality rates were 0.93 (95% CI, 0.89-0.98) for AMI, 0.81 (95% CI, 0.76-0.86) for CHF, 0.74 (95% CI, 0.68-0.80) for hip fracture, and 0.78 (95% CI, 0.66-0.91) for colon cancer. Results for 1-year mortality, readmissions, and major cardiac events were similar. Higher-spending hospitals had higher nursing staff ratios, and their patients received more inpatient medical specialist visits, interventional (AMI cohort) and medical (AMI and CHF cohorts) cardiac therapies, preoperative specialty care (colon cancer cohort), and postdischarge collaborative care with a cardiologist and primary care physician (AMI and CHF cohorts). CONCLUSION: Among Ontario hospitals, higher spending intensity was associated with lower mortality, readmissions, and cardiac event rates.
What the Loss of the Health Council of Canada Means for Canadians
Essays 2014 03/18.
On March 31, 2014, the Health Council of Canada will close its doors for good. The council was established in the 2003 health accord, and the 10 years of its existence have been both progressive and tumultuous, not unlike the ups and downs of Canada’s healthcare systems more generally. Whether or not you agree with the decision to close the council, or whether you care, there is a need to assess what will be lost.
Preventive Home Visits for Mortality, Morbidity, and Institutionalization in Older Adults: A Systematic Review and Meta-Analysis
Non UofA Access
Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P.
PloS one 2014 Mar 12;9(3):e89257
Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. METHODS AND FINDINGS: Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. Data Extraction and Synthesis: Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures: Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. RESULTS: Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01]) and physical functioning (SMD = -0.10 [-0.17 to -0.03]) respectively, but these may not be clinically important. CONCLUSIONS: Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.
The Facade of Stability in Assisted Living.
Non UofA Access
Morgan LA, Rubinstein RL, Frankowski AC, Perez R, Roth EG, Peeples AD, et al.
The journals of gerontology.Series B, Psychological sciences and social sciences 2014 Mar 18
The study sought to identify the varied types of change arising from internal and external influences in assisted living (AL) settings, expanding upon the literature’s limited focus on resident decline and staff turnover and clarifying the importance of changes to life and work there.Method.This analysis employed qualitative interviews and observations from 4 studies involving 17 ALs to identify elements of change largely absent from the literature. Case material identified by the research team members relating to persons, groups, and settings exemplifying typical changes, as well as variations across settings, are presented. RESULTS: Multiple domains of AL change were identified, to include those in: (a) the external economic or competitive environments; (b) ownership, management, or key personnel; and (c) physical health or cognition of the aggregate resident population. In many cases, the changes influenced residents’ satisfaction and perceived fit with the AL environment.Discussion.Change of many types is a regular feature of AL; many changes alter routines or daily life; raise concerns of staff, residents, or families; or modify perceptions of residential normalcy. Environmental gerontology should more often extend the environment to include the social and interpersonal characteristics of collective living sites for elders.
Implementation of observational pain management protocol to improve pain management for long-term institutionalized older care residents with dementia: study protocol for a cluster-randomized controlled trial.
Non UofA Access
Liu JY, Lai C.
Trials 2014 Mar 13;15(1):78-6215-15-78
Systematic use of observational pain tools has been advocated as a means to improve pain management for care home residents with dementia. Pain experts suggest that any observational tool should be used as part of a comprehensive pain management protocol, which should include score interpretation and verification with appropriately suggested treatments. The Observational Pain Management Protocol (Protocol) was therefore developed. This study aims to investigate the extent to which the implementation of this Protocol can improve pain management in care home residents with dementia. METHODS/DESIGN: In this two-group, single-blinded, cluster-randomized controlled trial, 122 care home residents with dementia and pain-related diagnoses will be recruited from eight care homes (that is 15 to 16 residents from each care home). Invitations will be sent to all local care homes who meet the home selection criteria. The eight care homes will be randomly selected from all care homes that agree to join this trial. They will then be randomized to either the control or experimental conditions. Participants from each care home will be placed into their home’s corresponding group to avoid ‘contamination’ effects across participants. Each intervention cycle will take 16 weeks (that is, baseline assessment and care home staff training for 4 weeks and Protocol implementation for 12 weeks). The Protocol will guide the pain management of the participants in the experimental care homes. Meanwhile, the control care homes will continue their usual pain management strategies. Intervention effects will be measured weekly during the protocol implementation period and compared with the baseline measurements, as well as between the experimental and control conditions. DISCUSSION: Although similar pain protocols have been suggested previously, the recommendations were based on experts’ opinions rather than evaluation of research studies. The feasibility and effectiveness of this kind of pain management protocol, tailored to older people with dementia, remains unknown. The findings of this trial will offer strong evidence that better strategies for pain management should be used in the care home daily routine.
Certified nursing assistants’ perspectives of nursing home residents’ pain experience: communication patterns, cultural context, and the role of empathy.
Non UofA Access
Dobbs D, Baker T, Carrion IV, Vongxaiburana E, Hyer K.
Pain management nursing 2014 Mar;15(1):87-96
This study explored the following issues related to pain management among nursing home (NH) residents: 1) communication patterns between NH residents and certified nursing assistants (CNAs) about pain; 2) how race and ethnicity influence NH residents’ pain experiences; and 3) CNAs’ personal experiences with pain that may affect their empathy toward the resident’s pain experience. The study consisted of a convenience sample of four focus groups (n = 28) from a NH in central Florida. A content analysis approach was used. Data were analyzed with the use of Atlas.ti version 6.2. The content analysis identified four main themes: 1) attitudes as barriers to communication about resident pain care; 2) cultural, religious, and gender influences of resident pain care by CNAs; 3) the role of empathy in CNAs care of residents with pain; and 4) worker strategies to detect pain. Attitudes among CNAs about resident cognitive status and perceived resident burden need to be recognized as barriers to the detection and reporting of pain by CNAs and should be addressed. In addition, NHs should consider a person-centered approach to pain that is culturally competent given the cultural influences of both residents and staff. Finally, educational programs for CNAs that include empathy-inducing scenarios could potentially improve the care provided by CNAs when dealing with residents’ pain. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Toward a Model Long-Term Services and Supports System: State Policy Elements.
Non UofA Access
The Gerontologist 2014 Mar 10
In response to a new Federal initiative to improve the U.S. long-term services and supports (LTSS) system, this commentary discusses an array of policies and practices that could potentially improve LTSS provision by shifting from institutional to community-based services, increasing equity across populations, offering consumers more choice and control, improving conditions for workers and caregivers, and promoting improved consumer-level outcomes. Policy areas include access to publicly funded LTSS, support for consumer direction, workforce development, caregiver support, transition from institutions to the community, diversion from institutional placement, and quality and outcome measurement. Policy considerations apply both to programs and to the managed care organizations that are increasingly responsible for LTSS provision. Additional policy areas related to managed LTSS include financial risk and capitation rates, enrollment strategies, assessment, outcomes monitoring, care coordination, and support for independent living goals.
Double Compression: A Vision for Compressing Morbidity and Caregiving in Dementia.
Non UofA Access
The Gerontologist 2014 Mar 11
The anticipated rise of dementia prevalence due to global aging may be tackled by morbidity compression through lifestyle changes (i.e., consistent participation in physical and intellectual activities) that promote cognitive reserve. A hypothetical model of cognitive decline due to Alzheimer’s disease (AD) and modulation of the clinical trajectory by cognitive reserve is presented. People with higher cognitive reserve are expected to show delay of the mild cognitive impairment phase but faster conversion to AD thereafter. Once conversion to AD is evident, there would be even faster deterioration, resulting in compression of morbidity. When morbidity is compressed, not only is prevalence reduced but the caregiving load is also compressed; this is referred to as “double compression.” Research and policy directions are discussed.
The relationship between apathy and participation in therapeutic activities in nursing home residents with dementia: Evidence for an association and directions for further research
Non UofA Access
Ellis JM, Doyle CJ, Selvarajah S.
Apathy is one of the most frequent and early symptoms of dementia. Because apathy is characterised by lack of initiative and motivation, it leads to considerable burden being placed on carers to ensure that the person living with dementia has a reasonable quality of life. The aim of this study was to investigate the relationship between apathy and participation in therapeutic activities for older people with dementia living in nursing homes. Ninety residents were recruited into the study, and apathy was measured by nursing home staff using the Apathy Evaluation Scale Clinician version. Staff also compiled data on each resident’s involvement in therapeutic activities. Among this sample, the mean age was 84.8 years, and mean length of stay in the nursing home was 1.8 years. The mean apathy score was 50.4, indicating that on average the residents had a moderate level of apathy. Overall, residents participated in six activities per week and those residents who were involved in the most activities had the lowest levels of apathy. This paper provides evidence that residents involved in therapeutic activities have lower levels of apathy. Further research should be conducted on the direction of causality, whether apathy levels can be changed through participation in therapeutic activities, the relationship between dementia severity and modifiability of apathy, and the intensity of therapeutic activities required to maintain functioning.
A methodological critique of the National Institute of Aging and Alzheimer’s Association Guidelines for Alzheimer’s disease, dementia, and mild cognitive impairments
Non UofA Access
Garrett MD, Valle R.
In 2011, the U.S. National Institute on Aging published guidelines for clinical diagnostics for Alzheimer’s disease dementia. These guidelines define a continuum with three stages—an early, pre-clinical stage with no symptoms, followed by mild cognitive impairment, and a final stage of Alzheimer’s disease dementia. This methodological critique examines the validity of this continuum. No studies exist showing the progression of these biomarkers to Alzheimer’s disease. There is also a lack of empirical evidence showing how biomarkers determine mild cognitive impairment, which has multiple etiologies. The guidelines fail to explain anomalies where there are biomarkers but no expression of Alzheimer’s disease.
2014 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. This information includes definitions of the various types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving and use and costs of care and services. The Special Report discusses women and Alzheimer’s disease.
International Health Data Linkage Conference
28-30 April Vancouver BC
This conference is intended to highlight what is happening in the world of linked population-based data as it applies to public policy regarding the health of populations. What are the new and exciting data sources? What fields are furthest ahead in capitalizing on data to produce evidence for public policy? What evidence are they producing? What can we learn from use of big data in the private sector? Where will we be 10 years from now? Come join us and help chart that future.
AMDA Webinar: Psychiatric Issues in LTC: Antipsychotic Use Reduction
Tuesday 29 April 17:00 MT
Although antipsychotics have the best evidence base for efficacy amongst pharmacological management of behavioral disturbances in dementia that interfere with necessary care or compromise quality of life, antipsychotics have multiple troubling side-effects including excess mortality. Regulatory pressure and societal pressure are additional factors that are contributing to a desire to minimize the use of antipsychotics. This program will present the tools necessary for implementing a successful antipsychotic reduction program. Non-pharmacological interventions are the mainstay of therapy, and a strategy of staff and family education, along with a willingness to try multiple non-pharmacological approaches in an attempt to personalize therapy, are the foundation of a successful antipsychotic reduction program. Alternative pharmacological strategies will be reviewed, but the emphasis will not be in replacing antipsychotics with other off-label treatments, but rather the emphasis will be to consider drug therapy a temporary intervention to be used as a last resort, with medications chosen to minimize the chance that there will be harm to the patient.
Knowledge Exchange: Concept + Planning + Evaluation = Impact training course
6-7 May Edinburgh, Scotland Cost £220
Instructor: Melanie Barwick
A well-developed Knowledge Translation/Knowledge Exchange (KE) plan is emerging as a proposal requirement for research funding agencies worldwide. Research use and research impact are becoming increasingly important in getting recognition and funding for research, particularly with the new REF impact requirements, which will probably become enhanced in the future. This training course is based on an extremely successful model developed in Canada. The material is relevant to individuals working in all sectors, particularly those with an interest in sharing research knowledge with audiences beyond the traditional academic community and increasing the impact potential of their research.
Spring workshops on population health
populationdataBC Courses are being offered from April to August
-Health Services Program Monitoring and Evaluation
-Spatial Perspectives in Population Health
-Longitudinal Data Analysis: Latent Growth Curve Modelling with Mplus
-Towards the World’s Best Infrastructure for Child Development Statistics
-Governance of Researchable Data Repositories
Innovative Trial Design Short Course
21-23 May SickKids Research Institute, Toronto Canada
This three day intermediate-level course takes an integrative approach to trial design by teaching a conceptual framework that includes outcome selection and measurement, value of information, cost effectiveness, risk of bias, appropriate trials designs, and choice of comparators. Mastery of these concepts enables students to prepare winning grant proposals in the face of uncertainty. Each day will include a mix of plenary sessions, group discussion, breakout sessions, and computer-based tutorials. The course will also feature an interactive half-day session for consultation where attendees can discuss their clinical trial design questions with leading trial methodologists in child health: Professor’s Martin Offringa, Terry Klassen, Andy Willan, Wendy Ungar and Maarten Boers
This blog post discusses a recent article in NEJM that reports on what happened in Ontario after the government there mandated that hospitals adopt a surgical checklist.
The BC government has appointed, Isobel Mackenzie, a Victoria care administrator with 20 years experience working with and serving the elderly as the provincial seniors advocate.
What would happen if researchers were given more control over their own funding and the funding of others? This article looks at the results from an article that makes the case for a collective approach to the allocation of science funding. By funding people directly rather than projects, money and time would be saved and researchers would be given more freedom than the current system.
In this essay, Gerda Saunders describes her coming realization and eventual diagnosis of dementia.
The framework, developed with funding from the government of Canada’s Foreign Credential Recognition Program, is based on a focused literature review and a broad consultation that included surveys and focus groups. It contains a model that illustrates the complexity of the decision-making process and guides staff mix decision-making with questions related to each phase of the nursing process (assessment, planning, implementation and evaluation).
Risk. It’s a dirty word in the nursing home industry, and in the face of recent and high-profile incidents – like deadly fires, assaults on residents by other residents and allegations of abuse – governments and nursing homes are turning to extreme measures to try to reduce risk and calm public concerns.
“An alarming statistic is that the number one cause of death in long term care facilities is acquired pneumonia,” says Dr. Natalie Archer, a Toronto dentist. With more than four million people in Canada needing the help of someone else to care for their teeth, confidence and training are critical – and Dr. Archer is committed to improving both. Through a series of videos, Dr. Archer gives tips to increase confidence, awareness and education levels among caregivers helping others with their oral health.
There’s a pattern of discrimination and ageism brewing in Ontario hospitals, and people are not getting the rehabilitative therapies and convalescent care they need, according to a new study released in Hamilton Thursday. Pushed Out of Hospital, Abandoned at Home: After Twenty Years of Budget Cuts, Ontario’s Health System is Failing Patients was commissioned by the Ontario Council of Hospital Unions and recounts the experiences of hundreds of patients and their families from across Ontario who called a 1-800 patient hotline.
As Canada deals with a sharp increase in the number of frail, elderly patients, the medical subspecialty that was created to care for these patients is proving a hard sell with new physicians.
A surprising 12 per cent of Canadians say they are directly caring for someone with dementia. The survey asked 1,824 Canadians 18 years of age and over if they were caregivers to someone diagnosed with Alzheimer’s disease or dementia. The results surprised even the poll takers. “That’s a lot of people affected by this,” said Lorne Bozinoff of Forum Research.
Marc Wortmann is Executive Director of Alzheimer’s Disease International, a federation of Alzheimer’s organisations providing a global voice for the Alzheimer’s community and affiliated with the BioMed Central journal Alzheimer’s Research & Therapy. Three months after the G8 summit on dementia concluded, which brought together health ministers and researchers as well as pharmaceutical companies and charities, Wortmann reflects on the outcomes and tell us his thoughts.
The U15 Group of Canadian Research Universities has joined the pre-eminent global network of leading research universities from America, Europe, Asia and Australia to tackle challenges facing research-intensive universities around the world.
The USPSTF concludes that not enough is known to make a recommendation about screening for cognitive impairment in older adults.
Tools for Change is a resource that was created by the Quality Palliative Care in Long Term Care (QPC-LTC) Alliance to guide long term care homes in Canada that are creating their own formalized palliative care programs. The Alliance consists of 30 researchers & knowledge brokers, 50 community organizational partners, and students along with several nursing homes. The model of care for palliative care in long term care is supported by multiple quality improvement interventions for implementing education, direct care, community partnerships, and policy and program development.
The toolkit modules include:
Module #1: Introduction
Module #2: Palliative Care in Long Term Care Philosophy
Module #3: Process for Change
Module #4: Module, Tools and Innocations
Chief Specialist Scientist
South African Cochrane Centre (SACC) Parow, Cape Town
An appropriately qualified and experienced senior researcher is required to join our team on a fulltime basis (3 year contract) with the objective of playing a lead role in conceptualizing and implementing innovative research, managing our research projects and supporting capacity development. The South African Cochrane Centre (SACC), a research unit based at the South African Medical Research Council, conducts and disseminates systematic reviews of healthcare interventions, and promotes the application of evidence-based decision-making in policy and practice both nationally and internationally.
PhD studentships in Medical Humanities
University of Sheffield, Sheffield UK
Medical Humanities Sheffield is pleased to offer an exciting opportunity to apply for three PhD studentships in a linked network studying the impacts of disease on personal identity, and the roles of shame and stigma.
Healthy Debate LiKa Shing Knowledge Institute
DEADLINE 7 April
Healthy Debate is an established website that produces analysis and commentary about the Ontario and Alberta health care systems. The Researcher-Writer is an important member of the Healthy Debate team, who synthesizes research and interviews about health policy issues and collaborates with editors to produce weekly flagship articles for the website. The Researcher-Writer is also responsible for a number of administrative activities associated with the website.