June 9, 2014


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Congratulations to Dr. Greta Cummings!!!

Greta was awarded with one of eight TVN Catalyst Grants. Her project entitled, Development and testing of a standardized communication form to improve transitions for nursing home residents, draws on findings from OPTIC. This program will explore the use of a communication form during health care transitions of elderly patients. Way to go!!!

Abstracts

CALL FOR ABSTRACTS:
Qualitative Health Research (QHR) Conference
21-23 October Victoria BC
DEADLINE 26 June

What can qualitative researchers learn from the past to shape the methodologies, disciplines, philosophies, and theories needed for the future? How can we adapt our methods to the global challenges, healthcare innovations, and technologies, we now face? Join the world’s qualitative health research community at the premier interdisciplinary conference forum to reflect, learn and build on the past to meet the challenge of leading qualitative research methods into the future.

CALL FOR ABSTRACTS:
Health Affairs Health Care And Medical Innovation Theme Issue
DEADLINE for abstracts 25 June 2014
DEADLINE for papers 2 September 2014

Health Affairs is planning a theme issue on health care and medical innovation in early-2015. The issue will span the fields of medical technology and also cover public policy and private sector innovations that promote improvements in the delivery of care, lower costs, increased efficiency, etc. We plan to publish 15-20 peer-reviewed articles including research, analyses, and commentaries from leading researchers and scholars, analysts, industry experts, and health and health care stakeholders.

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Publications

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

KT

Beyond two communities – from research utilization and knowledge translation to co-production?
Non UofA Access
Wehrens R.
Public health 2014 May 19

In recent public health discourse, the relations between researchers, policy makers, and professionals are often described as ‘gaps’, illustrating the (cultural) differences between these domains. Such descriptions seem to be part of a ‘two communities’-logic: a perception that researchers and policy makers or professionals stem from strictly separated worlds, with distinctive logics, rationales and incentives. In this paper, the author will argue that this prevalent conceptual framework of ‘two communities’, whilst having been extremely helpful in theorizing the difficulties of connecting policy needs with research findings, bears several important limitations when analysing structural collaboratives between researchers and policy makers or professionals. The paper outlines several problematic assumptions and neglected elements that are generally perceivable within this tradition, such as the analytical a priori separation of research, policy and practice domains and the overemphasis on both the heterogeneity between domains and the homogeneity within these domains. Inductively developed insights from the field of science and technology studies (STS) show that the boundaries between research and policy are often much more fluid (and largely rhetorical) than the two communities tradition seems to acknowledge. What needs to be analysed is not only how the boundaries can be bridged, but how – and at what moments – these boundaries are maintained, redrawn or re-established – and for what purposes. This paper focuses on these questions by utilizing the alternative conceptual framework of coproduction. It draws on long term qualitative research to structural collaborations (the Dutch Academic Collaborative Centres for Public Health) to illustrate these points. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Towards a programme theory for fidelity in the evaluation of complex interventions.
Non UofA Access
Masterson-Algar P, Burton CR, Rycroft-Malone J, Sackley CM, Walker MF.
Journal of evaluation in clinical practice 2014 May 19

This paper addresses the challenge of investigating fidelity in the implementation of a complex rehabilitation intervention designed to increase the level of independence in personal activities of daily living of stroke patients living in UK care homes. A programme theory of intervention fidelity was constructed to underpin a process evaluation running alongside a cluster randomized trial of the rehabilitation intervention. METHODS: The programme theory has been constructed drawing on principles of realist evaluation. Using data from in-depth semi-structured interviews (n = 17) with all occupational therapists (OTs) and critical incident reports from the trial (n = 20), and drawing from frameworks for implementation, the programme theory was developed. RESULTS: The programme theory incorporates four potential mechanisms through which fidelity within the trial can be investigated. These four programme theory areas are (1) the balancing of research and professional requirements that therapists performed in a number of areas while delivering the study interventions; (2) the OTs rapport building with care home staff; (3) the work focused on re-engineering the personal environments of care home patients; and (4) the learning about the intervention within the context of the trial and its impacts over time. CONCLUSIONS: These findings characterize the real-world nature of fidelity within intervention research, and specifically the negotiated nature of implementation within clinical settings, including individual patients’ needs. This research adds to the evidence base because current frameworks for fidelity neglect the importance of learning over time of individuals and across the time span of a trial. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

The role of interpersonal communication in the process of knowledge mobilization within a community-based organization: a network analysis.
Non UofA Access
Gainforth HL, Latimer-Cheung AE, Athanasopoulos P, Moore S, Ginis KA.
Implementation science 2014 May 22;9(1):59

Diffusion of innovations theory has been widely used to explain knowledge mobilization of research findings. This theory posits that individuals who are more interpersonally connected within an organization may be more likely to adopt an innovation (e.g., research evidence) than individuals who are less interconnected. Research examining this tenet of diffusion of innovations theory in the knowledge mobilization literature is limited. The purpose of the present study was to use network analysis to examine the role of interpersonal communication in the adoption and mobilization of the physical activity guidelines for people with spinal cord injury (SCI) among staff in a community-based organization (CBO). METHODS: The study used a cross-sectional, whole-network design. In total, 56 staff completed the network survey. Adoption of the guidelines was assessed using Rogers’ innovation-decision process and interpersonal communication was assessed using an online network instrument. RESULTS: The patterns of densities observed within the network were indicative of a core-periphery structure revealing that interpersonal communication was greater within the core than between the core and periphery and within the periphery. Membership in the core, as opposed to membership in the periphery, was associated with greater knowledge of the evidence-based physical activity resources available and engagement in physical activity promotion behaviours (ps < 0.05). Greater in-degree centrality was associated with adoption of evidence-based behaviours (p < 0.05). CONCLUSIONS: Findings suggest that interpersonal communication is associated with knowledge mobilization and highlight how the network structure could be improved for further dissemination efforts. Keywords: diffusion of innovations; network analysis; community-based organization; knowledge mobilization; knowledge translation, interpersonal communication.

Moving improvement research closer to practice: the Researcher-in-Residence model.
Non UofA Access
Marshall M, Pagel C, French C, Utley M, Allwood D, Fulop N, et al.
BMJ quality & safety 2014 Jun 3

The traditional separation of the producers of research evidence in academia from the users of that evidence in healthcare organisations has not succeeded in closing the gap between what is known about the organisation and delivery of health services and what is actually done in practice. As a consequence, there is growing interest in alternative models of knowledge creation and mobilisation, ones which emphasise collaboration, active participation of all stakeholders, and a commitment to shared learning. Such models have robust historical, philosophical and methodological foundations but have not yet been embraced by many of the people working in the health sector. This paper presents an emerging model of participation, the Researcher-in-Residence. The model positions the researcher as a core member of a delivery team, actively negotiating a body of expertise which is different from, but complementary to, the expertise of managers and clinicians. Three examples of in-residence models are presented: an anthropologist working as a member of an executive team, operational researchers working in a front-line delivery team, and a Health Services Researcher working across an integrated care organisation. Each of these examples illustrates the contribution that an embedded researcher can make to a service-based team. They also highlight a number of unanswered questions about the model, including the required level of experience of the researcher and their areas of expertise, the institutional facilitators and barriers to embedding the model, and the risk that the independence of an embedded researcher might be compromised. The Researcher-in-Residence model has the potential to engage both academics and practitioners in the promotion of evidence-informed service improvement, but further evaluation is required before the model should be routinely used in practice.

Implementation of a nurse-led behaviour change intervention to support medication taking in type 2 diabetes: beyond hypothesised active ingredients (SAMS Consultation Study)
Non UofA Access
Hardeman W, Lamming L, Kellar I, De Simoni A, Graffy J, Boase S, et al.
Implementation science 2014 Jun 5;9(1):70

Implementation of trial interventions is rarely assessed, despite its effects on findings. We assessed the implementation of a nurse-led intervention to facilitate medication adherence in type 2 diabetes (SAMS) in a trial against standard care in general practice. The intervention increased adherence, but not through the hypothesised psychological mechanism. This study aimed to develop a reliable coding frame for tape-recorded consultations, assessing both a priori hypothesised and potential active ingredients observed during implementation, and to describe the delivery and receipt of intervention and standard care components to understand how the intervention might have worked. METHODS: 211 patients were randomised to intervention or comparison groups and 194/211 consultations were tape-recorded. Practice nurses delivered standard care to all patients and motivational and action planning (implementation intention) techniques to intervention patients only. The coding frame was developed and piloted iteratively on selected tape recordings until a priori reliability thresholds were achieved. All tape-recorded consultations were coded and a random subsample double-coded. RESULTS: Nurse communication, nurse-patient relationship and patient responses were identified as potential active ingredients over and above the a priori hypothesised techniques. The coding frame proved reliable. Intervention and standard care were clearly differentiated. Nurse protocol adherence was good (M (SD) = 3.95 (0.91)) and competence of intervention delivery moderate (M (SD) = 3.15 (1.01)). Nurses frequently reinforced positive beliefs about taking medication (e.g., 65% for advantages) but rarely prompted problem solving of negative beliefs (e.g., 21% for barriers). Patients’ action plans were virtually identical to current routines. Nurses showed significantly less patient-centred communication with the intervention than comparison group. CONCLUSIONS: It is feasible to reliably assess the implementation of behaviour change interventions in clinical practice. The main study results could not be explained by poor delivery of motivational and action planning components, definition of new action plans, improved problem solving or patient-centred communication. Possible mechanisms of increased medication adherence include spending more time discussing it and mental rehearsal of successful performance of current routines, combined with action planning. Delivery of a new behaviour change intervention may lead to less patient-centred communication and possible reduction in overall trial effects.Trial registration: ISRCTN30522359.

The cost of a knowledge silo: a systematic re-review of water, sanitation and hygiene interventions.
Non UofA Access
Loevinsohn M, Mehta L, Cuming K, Nicol A, Cumming O, Ensink JH.
Health policy and planning 2014 May 29

Divisions between communities, disciplinary and practice, impede understanding of how complex interventions in health and other sectors actually work and slow the development and spread of more effective ones. We test this hypothesis by re-reviewing a Cochrane-standard systematic review (SR) of water, sanitation and hygiene (WASH) interventions’ impact on child diarrhoea morbidity: can greater understanding of impacts and how they are achieved be gained when the same papers are reviewed jointly from health and development perspectives? Using realist review methods, researchers examined the 27 papers for evidence of other impact pathways operating than assumed in the papers and SR. Evidence relating to four questions was judged on a scale of likelihood. At the ‘more than possible’ or ‘likely’ level, 22% of interventions were judged to involve substantially more actions than the SR’s label indicated; 37% resulted in substantial additional impacts, beyond reduced diarrhoea morbidity; and unforeseen actions by individuals, households or communities substantially contributed to the impacts in 48% of studies. In 44%, it was judged that these additional impacts and actions would have substantially affected the intervention’s effect on diarrhoea morbidity. The prevalence of these impacts and actions might well be found greater in studies not so narrowly selected. We identify six impact pathways suggested by these studies that were not considered by the SR: these are tentative, given the limitations of the literature we reviewed, but may help stimulate wider review and primary evaluation efforts. This re-review offers a fuller understanding of the impacts of these interventions and how they are produced, pointing to several ways in which investments might enhance health and wellbeing. It suggests that some conclusions of the SR and earlier reviews should be reconsidered. Moreover, it contributes important experience to the continuing debate on appropriate methods to evaluate and synthesize evidence on complex interventions. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Patient Safety: Perspectives on Evidence, Information and Knowledge Transfer.
Zipperer L, ed. London, UK: Gower Publishing; 2014.

This book provides information about utilizing safety science and disseminating published evidence, staff knowledge, and other data to enable safety improvement and organizational learning from error.

The Health Foundation: Spreading improvement ideas: Tips from empirical research (UK)
May 2014

Within the NHS there are many pockets of good practice and examples of successful innovation and improvement. Sometimes these good ideas are not adopted by the wider system, or take a long time to spread. This evidence scan provides examples from the published empirical literature of techniques for spreading innovation and improvement. The focus is on identifying practical things that teams and organisations can do to publicise and spread new ideas and ways of working. The scan addresses two key questions:
-What research evidence is there about the best ways to spread health care innovations and improvement?
-What does the research evidence suggest contributes to the successful spread of a health care improvement or innovation?
The scan draws on the empirical research to present a number of tips for spreading good practice.

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Health Care Administration and Organization

Improving skills and care standards in the support workforce for older people: a realist review
Non UofA Access
Rycroft-Malone J, Burton C, Hall B, McCormack B, Nutley S, Seddon D, et al.
BMJ open 2014 May 30;4(5):e005356-2014-005356

In the context of a population that is growing older, and a number of high-profile scandals about care standards in hospital and community settings, having a skilled and knowledgeable workforce caring for older people is an ethical and policy imperative. Support workers make up the majority of the workforce in health and social care services for older people (aged 65 years and over), and yet little is known about the best way to facilitate their development. Given this gap, this review will draw on evidence to address the question: how can workforce development interventions improve the skills and the care standards of support workers within older people’s health and social care services? METHODS AND ANALYSIS: As we are interested in how and why workforce development interventions might work, in what circumstances and with whom, we will conduct a realist review, sourcing evidence from health, social care, policing and education. The review will be conducted in four steps over 18 months to (1) construct a theoretical framework, that is, the review’s programme theories; (2) retrieve, review and synthesise evidence relating to interventions designed to develop the support workforce guided by the programme theories; (3) ‘test out’ our synthesis findings and refine the programme theories, establish their practical relevance/potential for implementation and (4) formulate recommendations about improvements to current workforce development interventions to contribute to the improvement of care standards in older people’s health and social care services, potentially transferrable to other services. ETHICS AND DISSEMINATION: Ethical approval is not required to undertake this review. Knowledge exchange activities through stakeholder engagement and online postings are embedded throughout the lifetime of the project. The main output from this review will be a new theory driven framework for skill development for the support workforce in health and social care for older people. TRIAL REGISTRATION NUMBER: CRD42013006283.
More information on this program of research is available here (thanks to Lynne Williams for letting me know about this).

Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives.
Non UofA Access
Godfrey MM, Andersson-Gare B, Nelson EC, Nilsson M, Ahlstrom G.
Journal of nursing management 2014 May;22(4):452-464

To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives. BACKGROUND: Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia. METHODS: Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities. RESULTS: Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support. CONCLUSIONS: All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement. © 2013 John Wiley & Sons Ltd.

Errors of Omission: Missed Nursing Care.
Non UofA Access
Kalisch BJ, Xie B.
Western journal of nursing research 2014 Apr 29

A series of studies on missed nursing care (i.e., required standard nursing care that is not completed) is summarized. Missed nursing care is substantial and similar levels are found across hospitals. Reasons for missed nursing care are staffing resources, material resources, and communication and these are also similar across hospitals. The higher the staffing levels, the fewer occurrences of missed nursing care. Magnet status and higher levels of teamwork are associated with less missed nursing care, and more missed care leads to a lower level of staff satisfaction. Missed nursing care has been found to be a mediator between staffing levels and patient falls. Patient identified missed nursing care predicts adverse events (i.e., falls, pressure ulcers, new infections etc.).

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Health Care Innovation and Quality Assurance

Using quality measures for quality improvement: the perspective of hospital staff.
Non UofA Access
Aghaei Hashjin A, Ravaghi H, Kringos DS, Ogbu UC, Fischer C, Azami SR, et al.
PloS one 2014 Jan 23;9(1):e86014

This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. STUDY DESIGN: A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness) indicators. POPULATION STUDIED: 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. PRINCIPAL FINDINGS: On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05). CONCLUSIONS: There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and effectiveness indicators is needed to support internal quality improvement processes at hospital level.

Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach.
Non UofA Access
Lin H.
Journal of health economics 2014 May 30;37C:13-24

This paper revisits the relationship between nurse staffing and quality of care in nursing homes using an instrumental variables approach. Most prior studies rely on cross-sectional evidence, which renders causal inference problematic and policy recommendations inappropriate. We exploit legislation changes regarding minimum staffing requirements in eight states between 2000 and 2001 as exogenous shocks to nurse staffing levels. We find that registered nurse staffing has a large and significant impact on quality of care, and that there is no evidence of a significant association between nurse aide staffing and quality of care. A comparison of the IV estimation to the OLS estimation of the first-difference model suggests that ignoring endogeneity would lead to an underestimation of how nurse staffing affects quality of care in nursing homes. Copyright © 2014 Elsevier B.V. All rights reserved.

Outcomes of a Quality Improvement Project for Educating Nurses on Medication Administration and Errors in Nursing Homes.
Non UofA Access
Tenhunen ML, Tanner EK, Dahlen R.
Journal of continuing education in nursing 2014 May 28:1-6

The Institute of Medicine has provided recommendations for preventing medication errors in nursing homes that include nursing education. Support for education on medication administration is derived from evidence, primarily in settings other than nursing homes. This quality improvement project implemented an educational program for licensed nurses to increase knowledge of medication administration and to decrease medication-related errors. METHOD: A descriptive study of 72 licensed nurses in two nursing homes was used for this project. Medication resources were provided at nursing stations in both facilities. Licensed nurses took a pretest and then watched a 35-minute education presentation. One month later, they took a posttest. RESULTS: Percentage scores on the tests were calculated. Paired t tests demonstrated an increase in nursing knowledge in one facility (p = 0.04) and no significant increase in nursing knowledge in the second. CONCLUSION: Mandatory participation by all staff members who administer medications would increase participation in the project. Multiple factors influence knowledge and medication administration in nursing homes and need further study. Copyright 2014, SLACK Incorporated.

The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes.
Non UofA Access
Winters S, Kool RB, Klazinga NS, Huijsman R.
International journal for quality in health care 2014 May 28

To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. DESIGN: A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. SETTING: In total, 169 residential care homes for the elderly in the Netherlands. MAIN OUTCOME MEASURES: Change between 2007 and 2009 in client-reported and professional indicators. RESULTS: A middle-size corporate structure was associated with QI. The QI activity ‘multidisciplinary team meetings’ was positively correlated with the indicator ‘safety environment’ for somatic and psycho-geriatric care. The QI activities ‘educational material’ and ‘direct work instructions’ were associated negatively with the indicator ‘availability of personnel’ for somatic clients, but positively for psycho-geriatric clients. QI activities such as ‘health plan activities’, ‘clinical lessons’ and ‘financial activities’ had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. CONCLUSION: This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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 May;69(3):431-441

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.

An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities.
Non UofA Access
Davison TE, Snowdon J, Castle N, McCabe MP, Mellor D, Karantzas G, et al.
International psychogeriatrics 2012 Apr;24(4):631-641

Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression. METHODS: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument. RESULTS: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9-13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change. CONCLUSIONS: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.

A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update five years later. Canada-flat-icon
Non UofA Access
Vida S, Monette J, Wilchesky M, Monette M, Friedman R, Nguyen A, et al.
International psychogeriatrics 2012 Apr;24(4):599-605

While antipsychotic (AP) medications are frequently used in long-term care, current evidence suggests that the risks may offset the benefits, necessitating periodic reassessment of their use. The aims of this present study were: (1) to assess rates of AP use five years after our first intervention to determine the long-term impact; and (2) to implement an updated AP reduction educational intervention program at the same center five years later in order to determine whether AP use could be further reduced. METHODS: Participants were residents with dementia receiving AP medication. The educational program component included separate lectures on pharmacologic and non-pharmacologic treatment of behavioral and psychological symptoms of dementia (BPSD). Completion of the Nursing Home Behavior Problems Scale (NHBPS), physician interviews concerning AP treatment plans for subjects with dementia, and AP administration and dose assessment occurred both at baseline and again between four to five months after the educational program. RESULTS: Of 308 long-term residents with dementia, 53 (17.2%) were receiving regular APs, primarily for agitation, aggressivity, other behavioral problems and psychosis. Of these, six died and one was transferred, leaving 46 participants. At five months, ten (21.7%) residents were no longer receiving APs and seven (15.2%) were on a lower dose; thus, 17 (37.0%) were either discontinued or on a lower dose. There was no worsening of NHBPS scores. CONCLUSION: Despite the low prevalence (17.2%) of AP users at the beginning of the current study compared to that observed five years prior (30.5%), it is still possible to further decrease the proportion of users.

The Nursing Home Five Star Rating: How Does It Compare to Resident and Family Views of Care?
Non UofA Access
Williams A, Straker JK, Applebaum R.
The Gerontologist 2014 May 21

In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a five-star rating system of nursing homes in the United States. These star ratings have been widely publicized both by CMS and the national and state media. Although the components of the star rating system take into account various dimensions of quality, satisfaction of nursing home residents and their families is not taken into consideration. DESIGN AND METHODS: The current study compares the CMS star rating system to nursing home satisfaction data reported by residents and their families in Ohio. RESULTS: Findings indicate that the star rating system does not adequately reflect consumer satisfaction. IMPLICATIONS: We recommend that the star system be refined to include a consumer component. © The Author 2014.

A patient-centered network approach to multidisciplinary-guideline development: a process evaluation
Non UofA Access
Den Breejen EM, Hilbink MA, Nelen WL, Wiersma TJ, Burgers JS, Kremer JA, et al.
Implementation science : IS 2014 Jun 4;9(1):68

Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals’ experiences, and time invested. METHODS: The network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. The guideline development addressed patient-centered, organizational, and medical-technical key questions derived from interviews with patients and professionals. These questions were elaborated and distributed among the groups. We evaluated the project performance, participants’ perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key figures, and a written questionnaire survey among 35 participants. RESULTS: Within 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. The multidisciplinary guideline included recommendations for the main medical-technical matters and for organizational and patient-centered issues in clinical care pathways. The project was carried out as planned except for minor modifications and three extra consensus meetings. The participants were enthusiastic about the approach, the respect for autonomy, the project coordinator’s role, and patient involvement. Suggestions for improvement included timely communication about guideline formats, the timeline, participants’ responsibilities, and employing a librarian and more support staff. The 35 participants spent 4497 hours in total on this project. CONCLUSIONS: The novel patient-centered network approach is feasible for simultaneously and collaboratively developing a harmonized set of multidisciplinary and monodisciplinary guidelines around clinical care pathways for patients with fertility problems. Further research is needed to compare the efficacy of this approach with more traditional approaches.

Health Quality Council of Albert: Review of Quality Assurance in Continuing Care Health Services in Alberta Canada-flat-icon
April 2014

For a healthcare system to function safely and well, all aspects of that system must be continuously monitored and evaluated so that areas needing improvement are identified and acted upon. At the request of the Minister of Health, the Health Quality Council of Alberta (HQCA) has closely examined the adequacy and monitoring of quality assurance processes and quality management within continuing care. This included the structures and processes that support the quality and safety of publicly funded continuing care (home care, supportive living, and long‐term care services).

Networked innovation in the health sector: comparative qualitative study of the role of Collaborations for Leadership in Applied Health Research and Care in translating research into practice (UK)
Scarbrough H, D’Andreta D, Evans S, Marabelli M, Newell S, Powell J, Swan J.
Health Services and Delivery Research 2014;2(13)

Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were an initiative of the National Institute for Health Research in response to a new research and development strategy in the NHS: ‘Best Research for Best Health’. They were designed to address the ‘second gap in translation’ identified by the Cooksey review; namely, the need to improve health care in the UK by translating clinical research into practice more effectively. Nine CLAHRCs, each encompassing a university in partnership with local NHS bodies, were funded over the period 2008–13. Aims The aim of this report is to provide an independent and theory-based evaluation of CLAHRCs as a new form of networked innovation in the health sector. This evaluation is based on an intensive research study involving three CLAHRCs in the UK and three international organisations (one in the USA and two in Canada). This study was carried out over two overlapping time phases so as to capture changes in the CLAHRCs over time. Networked innovation in the health sector is conceptualised as involving the translation of knowledge via informal social networks. Methods A mix of research methods was used to help ensure the validity and generalisability of the study. These methods addressed the development of each CLAHRC over time, over multiple levels of analysis, and with particular reference to the translation of knowledge across the groups involved, and the quality of the informal underpinning network ties that supported such translation. Research methods, therefore, included a qualitative enquiry based on case studies and case analysis, cognitive mapping methods, and social network analysis. Findings Through our study, we found that each one of our samples of CLAHRCs appropriated the CLAHRC idea in a particular way, depending on their different interpretations or ‘visions’ of the CLAHRC’s role in knowledge translation (KT), and different operating models of how such visions could be achieved. These helped to shape the development of social networks (centralised vs. decentralised) and each CLAHRC’s approach to KT activity (‘bridging’ vs. ‘blurring’ the boundaries between professional groups). Through a comparative analysis, we develop an analytical model of the resultant capabilities which each case, including our international sites, developed for undertaking innovation, encompassing a combination of both ‘integrative capability’ (the ability to move back and forth between scientific evidence and practical application) and ‘relational capability’ (the ability of groups and organisations to work together). This extends previous models of KT by highlighting the effects of leadership and management, and the emergence of social network structures. We further highlight the implications of this analysis for policy and practice by discussing how network structures and boundary-spanning roles and activities can be tailored to different KT objectives. Conclusions Different interpretations and enactments of the CLAHRC mission ultimately led to differingcapabilities for KT among our studied initiatives. Further research could usefully explore how these different capabilities are produced, and how they may be more or less appropriate for particular national health-care settings, with a view to improving the design blueprint for future KT initiatives.

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Research Practice & Methodology

Failure to address potential bias in non-randomised controlled clinical trials may cause lack of evidence on patient-reported outcomes: a method study.
Non UofA Access
Peinemann F, Labeit AM, Thielscher C, Pinkawa M.
BMJ open 2014 Jun 4;4(6):e004720-2013-004720

We conducted a workup of a previously published systematic review and aimed to analyse why most of the identified non-randomised controlled clinical trials with patient-reported outcomes did not match a set of basic quality criteria. SETTING: There were no limits on the level of care and the geographical location. PARTICIPANTS: The review evaluated permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer and compared that intervention with alternative procedures such as external beam radiotherapy, radical prostatectomy and no primary therapy. PRIMARY OUTCOME MEASURE: Fulfilment of basic inclusion criteria according to a Participants, Interventions, Comparisons, Outcomes (PICO) framework and accomplishment of requirements to contain superimposed risk of bias. RESULTS: We found that 21 of 50 excluded non-randomised controlled trials did not meet the PICO inclusion criteria. The remaining 29 studies showed a lack in the quality of reporting. The resulting flaws included attrition bias due to loss of follow-up, lack of reporting baseline data, potential confounding due to unadjusted data and lack of statistical comparison between groups. CONCLUSIONS: With respect to the reporting of patient-reported outcomes, active efforts are required to improve the quality of reporting in non-randomised controlled trials concerning permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer.

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Aging

Apathy Among Institutionalized Stroke Patients: Prevalence and Clinical Correlates.
Non UofA Access
van Almenkerk S, Smalbrugge M, Depla MF, Eefsting JA, Hertogh CM.
The American Journal of Geriatric Psychiatry 2014 Mar 30

Apathy is a frequent neuropsychiatric consequence of stroke. In the under-researched population of institutionalized stroke patients, we aimed to explore the prevalence of apathy, its clinical correlates, and the relation to the amount of stimulating activities in the nursing home (NH). DESIGN: A cross-sectional, observational study. SETTING: Dutch NHs. PARTICIPANTS: 274 chronic stroke patients. MEASUREMENTS: Data were collected through observation lists that were filled out in structured interviews with qualified nurse assistants who knew the residents well. The lists comprised the NH-version of the Apathy Evaluation Scale (AES10), the Barthel Index, the Neuropsychiatric Inventory Questionnaire, and sections of the Resident Assessment Instrument for Long-Term Care Facilities. Attending physicians and therapists provided additional information. RESULTS: Apathy (AES10 score ≥30) was present in 28% of residents. Multilevel regression analyses revealed that this apathy was independently related to (moderate, severe) cognitive impairment (odds ratio [OR] 11.30 [95% confidence interval (CI): 4.96-25.74], OR 5.54 [95% CI: 2.48-12.40]), very severe ADL-dependency (OR 12.10 [95% CI: 1.35-108.66]), and being >12 hours per day in bed (OR 2.10 [95% CI: 1.07-4.13]). It was not related to depressive mood symptoms (OR 1.75 [95% CI: 0.91-3.37]). Only in residents aged less than 80 years were a higher amount of activities independently related to a lower AES10 score (-0.70 [95% CI: -1.18 to -0.20] points per four extra activities in a 4-week period). CONCLUSIONS: Apathy is prevalent in largely one-quarter of institutionalized stroke patients, and that is most strongly related to cognitive impairment in this explorative study. We discuss the need for research on the relation with distinct dimensions of depression and fatigue as partly overlapping constructs, and on (individualized) stimulating activities as a possible intervention method. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Racial and Ethnic Disparities in Social Engagement Among US Nursing Home Residents.
Non UofA Access
Li Y, Cai X.
Medical care 2014 Apr;52(4):314-321

The numbers and proportions of racial and ethnic minorities have increased dramatically in US nursing homes in recent years. Concerns exist about whether nursing homes can serve appropriately the clinical and psychosocial needs of patients with increasingly diverse ethnic and cultural backgrounds. This study determined racial and ethnic disparities in social engagement among nursing home long-term residents. METHODS: We analyzed the 2008 national Minimum Data Set supplemented with the Online Survey, Certification, and Reporting File and the Area Resource File. We estimated multivariable logistic regressions to determine disparities and how disparities were explained by individual, facility, and geographic factors. Stratified analyses further determined persistent disparities within patient and facility subgroups. RESULTS: Compared with white residents (n=690,228), black (n=123,116), Hispanic (n=37,099), and other (n=17,568) residents showed lower social engagement, with overall scores (mean±SD) being 2.5±1.7, 2.2±1.6, 2.0±1.6, and 2.1±1.6, respectively. Disparities were partially explained by variations in individual, facility, and geographic covariates, but persisted after multivariable adjustments. Stratified analyses confirmed that disparities were similar in magnitude across patient and facility subgroups. CONCLUSIONS: Although nursing home residents showed overall low social engagement levels, racial/ethnic minority residents were even less socially engaged than white residents. Efforts to address disparities in psychosocial well-being and quality of life of nursing home residents are warranted.

Depressive Symptoms and Longitudinal Changes in Cognition: Women’s Health Initiative Study of Cognitive Aging.
Non UofA Access
Goveas JS, Espeland MA, Hogan PE, Tindle HA, Shih RA, Kotchen JM, et al.
Journal of geriatric psychiatry and neurology 2014 Feb 28;27(2):94-102

Elevated depressive symptoms (DS) are associated with incident mild cognitive impairment and probable dementia in postmenopausal women. We examined the association of elevated DS with domain-specific cognitive changes and the moderating role of cardiovascular risk factor severity and cardiovascular disease (CVD). A total of 2221 elderly women who participated in the Women’s Health Initiative Study of Cognitive Aging were separated into those with (N = 204) and without (N = 2017) elevated DS. The DS and multidomain cognitive outcomes were measured annually for an average follow-up of 5.04 years. Women with elevated DS showed baseline multidomain cognitive deficits but longitudinal declines in global cognition only. Persistent DS was related to greater global cognition, verbal knowledge and fluency, and memory declines. Significant DS-CVD interactions were observed cross-sectionally (but not longitudinally) for figural memory and fine motor speed. Future studies should investigate the role of nonvascular mechanisms linking DS and cognitive decline. © The Author(s) 2014.

Effective health care for older people resident in care homes: the optimal study protocol for realist review
Non UofA Access
Goodman C, Gordon AL, Martin F, Davies SL, Iliffe S, Bowman C, et al.
Systematic reviews 2014 May 24;3(1):49

Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. METHODS: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. DISCUSSION: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112.

Development of the psychometric property of a Minimum Data-Set-Based Depression Rating Scale for use in long-term care facilities in Taiwan.
Non UofA Access
Hsiao CY, Lan CF, Chang PL, Li IC.
Aging & mental health 2014 Jun 4:1-7

Our aim is to develop the psychometric property of the Minimum Data-Set-Based Depression Rating Scale (MDS-DRS) to ensure its use to assess service needs and guide care plans for institutionalized residents. Methods: 378 residents were recruited from the Haoran Senior Citizen Home in northern Taiwan. The MDS-DRS and GDS-SF were used to identify observable features of depression symptoms in the elderly residents. Results: A total of 378 residents participated in this study. The receiver operating characteristic (ROC) curve indicated that the MDS-DRS has a 43.3% sensitivity and a 90.6% specificity when screening for depression symptoms. The total variance, explained by the two factors ‘sadness’ and ‘distress,’ was 58.1% based on the factor analysis. Conclusions: Reliable assessment tools for nurses are important because they allow the early detection of depression symptoms. The MDS-DRS items perform as well as the GDS-SF items in detecting depression symptoms. Furthermore, the MDS-DRS has the advantage of providing information to staff about care process implementation, which can facilitate the identification of areas that need improvement. Further research is needed to validate the use of the MDS-DRS in long-term care facilities.

Beyond family satisfaction: Family-perceived involvement in residential care.
Non UofA Access
Irving J.
Australasian journal on ageing 2014 May 29

Family involvement is an important element of providing individualised care to people living in residential aged care facilities. To date, involvement from the perspective of the family has remained effectively unmeasured. AIM: To explore perceived family involvement and its relationship with satisfaction and facility impressions. METHOD: A questionnaire was posted to residents’ next of kin from four South Australian residential aged care facilities. RESULTS: One hundred and fifty next of kin participated in the survey. Family-perceived involvement was significantly and positively correlated with satisfaction and facility impressions. CONCLUSION: The findings of this study add to the limited body of research into family involvement in long-term residential care. Feedback from the family regarding particular aspects of involvement may also improve the experience of long-term care for both family and resident, and assist with the identification of specific issues towards which organisations may target their quality improvement efforts. © 2014 ACOTA.

The effects of increased therapy time on cognition and mood in frail patients with a stroke who rehabilitate on rehabilitation units of nursing homes in the Netherlands: a protocol of a comparative study.
Non UofA Access
Huijben-Schoenmakers M, Rademaker A, van Rooden P, Scherder E.
BMC geriatrics 2014 May 23;14:68-2318-14-68

Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients. METHODS: A comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients’ cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home. DISCUSSION: The present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes. TRIAL REGISTRATION: TNR Our study has been documented in the Dutch Trial Registration, TC = 3871.

Coming to Grips With Challenging Behavior: A Cluster Randomized Controlled Trial on the Effects of a Multidisciplinary Care Program for Challenging Behavior in Dementia.
Non UofA Access
Zwijsen SA, Smalbrugge M, Eefsting JA, Twisk JW, Gerritsen DL, Pot AM, et al.
Journal of the American Medical Directors Association 2014 May 27

The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. DESIGN: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. SETTING: Seventeen dementia special care units of different nursing homes. PARTICIPANTS: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. INTERVENTION: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. MEASUREMENTS: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. RESULTS: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [-2.4 CMAI points, 95% confidence interval (CI) -4.3 to -0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI -2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37- 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44-0.94). No effect on use of restraints was observed. CONCLUSIONS: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. Copyright © 2014 American Medical Directors Association, Inc. All rights reserved. Published by Elsevier Inc. All rights reserved.

The development and evaluation of mutual support groups in long-term care homes. Canada-flat-icon
Non UofA Access
Theurer K, Wister A, Sixsmith A, Chaudhury H, Lovegreen L.
Journal of applied gerontology 2014 Jun;33(4):387-415

This article describes the development of a new mutual support group intervention for long-term care homes (LTCH); evaluates the processes, structure, and content of the intervention; and addresses replication and sustainability. Tom Kitwood’s model of personhood is used as the basis for developing a weekly discussion group using themes chosen by participants and theme-associated music, readings, and photographs. A mixed-methods qualitative process evaluation design encompasses focus groups, systematic observation of six resident groups, individual resident interviews (N = 65), and staff interviews (N = 7) in three LTCH in British Columbia, Canada. Resident reports and observations indicate positive benefits including a decrease in loneliness, the development of friendships, and increased coping skills, understanding, and support. Participating staff reported numerous benefits and described how the unique group structure fosters active participation of residents with moderate-severe cognitive impairment. This preliminary study suggests that mutual support groups have potential to offset loneliness, helplessness, and depression within LTCH.

Joseph Rowntree Foundation: Commissioning Relationsip-Centred Care in Essex: An Evaluation (UK)
June 2014

This report reviews the improvements Essex County Council made to the commissioning of its care home services for older people. Specifically, the report evaluates the implementation and outcomes of the My Home Life Essex programme, introduced to improve the relationship between commissioners and care home providers, and to enable care home managers to focus on providing relationship-centred care. The study found that: Support networks established through My Home Life Essex resulted in better quality commissioning and an increase in managers’ ability to motivate staff to provide relationship-centred care to residents; Essex County Council’s corporate ownership of the new approach led to positive changes in the relationship between the council and the county’s care home sector, investment in the care sector, a focus on quality improvement rather than monitoring compliance, effective leadership and a support network for managers.

Health Quality Council of Albert: Review of Alberta Health Services’ Continuing Care Wait List: First Available Appropriate Living Option Policy
March 2014
Canada-flat-icon

In this review we examined the quality and patient safety implications of Alberta Health Services’ policy “Continuing Care Wait List: First Available Appropriate Living Option”. Our findings and analysis discuss critical operational topics such as capacity planning, measurement data, and policy development. However at its core, the report is focused on people. We provide practical recommendations about how the healthcare system can and should consistently respond to patients’ and families’ needs for an acceptable and appropriate process for decision‐making about their future home. We have outlined steps to equip both family members and care providers with tools and information so they are prepared to make these decisions and can support individuals through this challenging transition.

Eurodiaconia: Demographic Change: Ageing and Long-Term Care (EU)
2014

On May 27, 2014, Eurodiaconia launched its new policy paper, entitled Demographic Change: Ageing and Long-term care, which outlines the main challenges for ensuring older people have access to quality long-term care. The paper also explores how older adults can live a dignified life from the perspective of diaconal organisations and then makes recommendations to meet those challenges. The topics the report covers include preventive care; tackling isolation and poverty; Independent living, Assistive Technologies and Ambient Assisted Living; comprehensive, accessible, integrated care systems; understanding the needs of older people and personalised care; informal and family carers and jobs in the care sector; and, intergenerational understanding and solidarity.

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Events

Non UofA

Alberta Association on Gerontology AGM
Faculty Club, UofA
Tuesday 10 June 5pm

Guest Speakers:
Brenda Huband, Interim AHS President and CEO
Topic: “Alberta Health Services Plan to Improve Seniors’ Services”
John Pray, President of Alberta Continuing Care Association, and
President and CEO of Shepherd’s Care Foundation Topic: “Alberta Continuing Care Association and Operators’ Plan to Improve Seniors’ Services”

Using Research to Improve Health Care – Change, Challenge and Opportunity in Knowledge Translation
Monday 22 September Vancouver BC

This conference has been designed to provide educational and networking opportunities to create relationships across the research and practice communities in the areas of health services research. It is intended that relationships built through this event will foster new synergies over time.

Online

CDRAKE and the Alzheimer Society of Canada: Creating a Queer Positive Environment
Wednesday 11 June 10:00-11:00 MT

Our presenters will:
-provide participants with tools and vocabulary for working with older LGBT people
-provide participants with knowledge of the history, situation, issues and concerns of older LGBT people
-identify and expose myths associated with older LGBT people
-provide participants with tips for best practice both at an individual and organizational level

The impact of tailored, knowledge translation and exchange interventions on EIDM
Tuesday 10 June 10:00 MT

From 2009-2013, Health Evidence partnered with three Ontario health departments on a Canadian Institutes of Health Research (CIHR) “Partnerships for Health System Improvement” grant, studying the impact of tailored, knowledge translation and exchange interventions on evidence-informed decision making in public health. Dr. Maureen Dobbins will present the results from this study and lead an interactive discussion on the implications for this work to a broader public health and knowledge translation audience.

CIHR Foundation Scheme Stage 1 Application Information Session
9 June 08:30-10:30

Presentations by:
Robyn Tamblyn, PhD, James McGill Professor, Department of Medicine and Department of Epidemiology and Biostatistics; Scientific Director, CIHR Institute of Health Services and Policy Research
Paul Lasko, PhD, Professor, Department of Biology, Associate Member, Goodman Cancer Research Centre, Scientific Director, CIHR Institute of Genetics

The Canadian Cochrane Centre is hosting a live Twitter discussion on Canada’s aging population
Wednesday 11 June 10:00-11:00 MT
Moderator: @CndCochraneCtr
Hashtag: #CochraneChat

The Ontario provincial election is right around the corner, and there are many important issues being discussed that will have a great impact on our future. One of these issues is Canada’s aging population. In 2013, it was estimated that over 5 million Canadians (15 per cent of the country’s population) are age 65 and over. Of those 5 million, 89 per cent are living with at least one chronic condition. It is crucial to examine the evidence before making important healthcare decisions in order to provide seniors with efficient, high-quality care. Cochrane has published many reviews on the management of chronic conditions, such as home-based care, long-term care facilities, prescribing habits, etc. We want to know what your opinion is on the current healthcare support for Canadian seniors and what direction you think our healthcare system needs to better tackle the issue of our aging population.

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Courses

Introduction to Qualitative Methods Research Workshop
Monday 16 June 08:00-16:00 ECHA, University of Alberta, Edmonton
Instructor: Dr. Maria Mayan

Learn the foundations,various methods and corresponding analytic techniques which will best suit your research design. This workshop is part of the Thinking Qualitatively Conference. You’ll need to register for 1 day attendance to the conference.

Online

KTDRR Webinar Series: Systematic Reviews
Free, Various dates in June and July

SEDL’s Center on KTDRR’s Community of Practice (CoP) on Evidence for Disability and Rehabilitation (D&R) Research is sponsoring a series of webinars that will address systematic reviews, with a special focus on what is considered evidence and why, and how evidence is qualified, synthesized, and turned into recommendations for clinicians and other practitioners.
Session 1: June 4, 2014 13:00–14:30 MT
A blast from the past: Systematic reviews and the traditional evidence pyramid. An overview of the process and tools of systematic reviewing, with a focus on assessment and synthesis of evidence, and the idea of a research design-based pyramid of evidence underlying conclusions and recommendations
Session 2: June 18, 2014 13:00–14:30 MT
Going beyond design and intervention: The American Academy of Neurology (AAN) Clinical Practice Guideline process and other approaches. A discussion of how AAN and others have brought in research design details and quality of research implementation in grading evidence, and have gone beyond intervention research.
Session 3: July 2, 2014 13:00–14:30 MT
Bringing in the patient/client: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A presentation on the GRADE approach, with its emphasis on the values and preferences of patients/clients, and flexibility in grading evidence. How does it fit with disability and rehabilitation research?
Session 4: July 16, 2014 13:00–14:30 MT
There is more to be done: Future possibilities… will we ever get there? A discussion of future developments in qualifying evidence that might benefit disability/rehabilitation practice.

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News

Government of Canada helps seniors in the Vancouver area identify and reduce their risk of abuse Canada-flat-icon

The Joyce Station Area Planning Association is receiving more than $22,500 in NHSP community-based funding for its Knock Knock! Who’s There? and Other Questions Seniors Have About Their Safety project. Through workshops, seniors will have the opportunity to participate in activities involving community groups and organizations. Seniors will learn about elder abuse prevention strategies and about the positive role played by the Vancouver Police Department in helping them to reduce their risk of being mistreated and to seek assistance if needed.

University of Lethbridge appoints Dr. Majid Mohajerani as the Brain Health and Dementia Chair Canada-flat-icon

Dr. Mohajerani is the third of four new research Chairs being added to the University of Lethrbridge as part of the Government of Alberta’s Campus Alberta Innovation Program (CAIP) Chairs plan. The government is contributing $1 million for four Chairs, over the course of seven years, for a total investment of $7 million. The CAIP Chairs plan is part of the Government of Alberta’s Campus Alberta collaborative initiative and will provide research Chairs to Alberta’s four Comprehensive Academic and Research Intensive (CARI) institutions: the University of Lethbridge, Athabasca University, the University of Alberta and the University of Calgary.

Meet the new CEO of Alberta Health Services Canada-flat-icon

“I don’t think leaders have to be born, but I think sometimes they are and I had assumed leadership roles right through school and my life,” Kaminski laughs. “In high school, for example, I was the first female president of student council in Sudbury [Ontario]. And we had this strong-minded male principal who was furious that his school was going to be the first. It was sort of a slap in his face, I think.”

Overwhelming reluctance to seek help about dementia

More than 40 per cent of people affected by dementia have kept concerns about the condition bottled up, according to a poll carried out by Alzheimer’s Society.

Coordinated national strategy needed to address the growing number of people with Dementia, says CMA President Canada-flat-icon

The rising tide of dementia patients is destabilizing hospital care in Canada, the incoming president of the Canadian Medical Association told a health conference in Whistler on May 26th.

In nursing homes, seniors are being drugged needlessly Canada-flat-icon

Those living in a regulated nursing home are likely in the frailest condition of their lives. Their individual reasons for entering a home are many, but commonly, residents require intense personal care for an indefinite period of time. As such, they rely heavily on the home for their protection and well-being.

Alberta backs off cuts to disabled seniors care Canada-flat-icon

Criticism of cuts to nurses and other services for vulnerable residents of Red Deer’s Michener Centre has prompted the Progressive Conservative government to back off the plan, the province’s associate minister for persons with disabilities said late Monday.

World Dementia Council pledges to delay onset and progress of dementia by one year in less than a decade Canada-flat-icon

The World Dementia Council has today (Friday 30 May) announced their statement of purpose, outlining what they hope to achieve to tackle dementia globally. Following on from the pledge made at the G8 dementia summit in December, the council has pledged that within seven years we should have delayed the onset and progress of the disease by at least one quality-adjusted life year. By 2025, they expect this to have risen to at least two added years.

Seniors who died after developing severe infections at nursing home received appropriate care, review finds Canada-flat-icon

Two residents of a Calgary nursing home who died last year after developing severe infections received appropriate care, according to a review commissioned by the facility’s owner.

Quebec passes landmark end-of-life-care bill Canada-flat-icon

Terminally ill patients in Quebec now have the right to choose to die. The non-partisan Bill 52, also known as an act respecting end-of-life care, passed Thursday afternoon in a free vote at the National Assembly in Quebec City.

Beware of hospital ‘discharge planners’: Goar Canada-flat-icon

Lawyer specializing in elder care punctures the myths hospitals use to push out “bed blockers.”

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Resources

BrowZine
Free for UofA Staff, Students, & Faculty

Use BrowZine to easily find, read, and monitor thousands of scholarly journals available from your university library, or through Open Access publishers, covering all disciplines.

RAND: Dementia’s Mounting Toll on the U.S. Economy Infographic

This infographic visually shows the costs of dementia to the American economy.

Baycrest memory experts launch ‘thermometer’ for the mind Canada-flat-icon

If you are in the 50 to 79 age bracket, worried about your memory changes and whether you need to see a doctor, there is a free online brain health test developed by the memory experts at Baycrest Health Sciences that will help you with that decision.

CFHI: Patient Engagement Resource Hub Canada-flat-icon

This collection of existing resources and accessible tools will get you on your way to partner effectively with patients and families to improve the quality of care in your organization.

Royal College of Nursing: Caring for Dementia patients in hospital guide

This resource guide was developed to supporting the further implementation of its five principles for improving the quality of care. These five principles form a shared commitment to improving care. Based on evidence gathered from people with dementia, carers and practitioners, each principle is considered essential to ensure the appropriate delivery of care. Each principle has a checklist to help identify achievements and areas for further development.

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Opportunities

Senior Research Fellow (1 position) & Research Fellow (2 positions) in eLearning/evidence synthesis (clinical or non-clinical)
WHO LKC Medicine in Singapore

This is an exceptional opportunity to join a multidisciplinary research team that will conduct state-of-the-art evidence syntheses, health technology assessments and develop for the World Health Organization Guidelines for use of eLearning in health professional education. You will join an international research team working across: LKCMedicine, new joint Medical School of Imperial College and Nanyang Technological University, National Healthcare Group, Singapore; Karolinska Institutet, Stockholm, Sweden; Global eHealth Unit, Imperial College London; and the World Health Organization, Geneva. We will further collaborate with Coursera, edX, Blackboard, etc. and international education leaders and policymakers.

Social Science Analyst position for the Healthcare Cost and Utilization Project
AHRQ Rockville, MD
DEADLINE 13 June

The Center for Delivery, Organizations, and Markets (CDOM), in the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), is recruiting an experienced Social Science Analyst to undertake tasks in AHRQ’s priority program areas of health care cost, resource use, and affordability.

Research Manager
TVN Kingston ON
DEADLINE 16 June

TVN is seeking a Research Manager, responsible for maintaining and administering all aspects of the research program, research funding, research progress tracking and reporting of Technology Evaluation in the Elderly Network (TVN), a national Networks of Centres of Excellence.

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