New Article by Dr. Kim Fraser
Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings
Sales A, Fraser K, Baylon M, O’Rourke H, Gao G, Bucknall T, et al.
Implementation Science 2015;10(1):20
Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. Methods We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. Results We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. Conclusions We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.
CALL FOR ABSTRACTS:
Sixth Pan-Pacific Nursing Conference and First Colloquium on Chronic Illness Care
2-4 March 2016 Hong Kong
DEADLINE 15 July
Abstracts for oral/poster presentations relating to any of the following conference sub-themes are invited:
-Contemporary health issues and emerging challenges
-Acute care nursing practice
-Cancer, palliative and end-of-life care
-Infectious disease management
-Health promotion and disease prevention
-Complementary and alternative medicine
-Evidence-based practice in nursing and healthcare, and knowledge translation
-Aged care, chronic illness care, and social care
-Innovative health and social care
-Chronic illness management and rehabilitative care
-Healthy ageing and aged care
-Transformational leadership and reforms in healthcare system
-Healthcare policy and leadership
We encourage you to present your work and engage in discussion and debate among international and local health and social care providers, policy makers, academics and researchers on strategies and initiatives to achieve transformational and sustainable development in health and social care in local and global contexts.
CALL FOR ABSTRACTS:
UK Knowledge Mobilisation Forum 2015
13-14 April Edinburgh UK
DEADLINE 2 March
Following on from the success of last year’s event, the 2nd Annual UK Knowledge Mobilisation Forum is being held on 13th-14th April 2015 at the Royal College of Physicians of Edinburgh. The more effectively we use the knowledge we produce through research and practice the better our services, processes and products will be. The UK Knowledge Mobilisation Forum provides a space for knowledge producers, knowledge brokers and knowledge users to come together to learn from each other, sharing good (and bad) practice about improving what we do and help maximise the impact of all types of knowledge in practice.
CALL FOR ABSTRACTS:
23rd Cochrane Colloquium – Call for Abstracts
3-7 October Vienna Austria
DEADLINE 25 March
Come to Vienna and share your work and talent! Submit your research abstract for an oral or poster presentation or propose a 90-minute workshop idea with your colleagues.
CALL FOR PAPERS:
Special Issue on Healthcare Management and Culture
JOURNAL Perspectives in Public Health IF 1.035
DEADLINE 7 April
The issue will be led by Professor Heather Hartwell, Honorary Editor, along with guest editors and guidance from the Institute of Healthcare Management, and will be published in autumn 2015. We are interested in receiving papers on all aspects of healthcare management and culture. These could range from scientific reviews and evaluations to clinical challenges, interventions and future
Topics of particular interest include, but are not limited to:
-Organisational culture and managing organisational change
-Assessing and improving the quality of healthcare
-Evaluating management systems
-Health system reform
-Case studies </p.
Grants & Awards
AIHS: Graduate Studentships
DEADLINE 1 April
The Graduate Studentship provides opportunities for support for individuals undertaking health-related research areas in pursuit of a Master’s or PhD at an Alberta university.
AIHS: Visiting Scientist
DEADLINE 2 March
The Visiting Scientist program is intended to bring productive scientists having expertise not currently available in provincial institutions to Alberta. This expertise may consist of:
-new approaches to research, and
-the management of new technology.
Allow Alberta-based institutions to sponsor Alberta scientists:
-to visit major medical or health research centres, and
-to acquire knowledge about new research concepts or technology.
CIHR Team Grant : Late Life Issues
LOI DEADLINE 13 April
This funding opportunity aims to build knowledge and capacity in the field of Late Life Issues research, and to provide high-quality evidence to inform health and social care professionals, as well as policy-makers. Teams will be required to be multidisciplinary in nature, and will require a training and knowledge translation component. The funding of these teams will ensure that Canada emerges as a leader in this area, creating knowledge and effective dissemination strategies where there is currently limited research evidence.
Physiotherapists’ Perceived Motivators and Barriers for Organizing Physical Activity for Older Long-Term Care Facility Residents.
Non UofA Access
Baert V, Gorus E, Guldemont N, De Coster S, Bautmans I.
Journal of the American Medical Directors Association 2015 Feb 7
Information regarding factors that hinder or stimulate older adults in long-term care facilities (LTCF) for being physically active is available in the literature, but much less is known regarding perceived motivators and barriers among physiotherapists (PTs) to organize physical activity (PA) in LTCF. OBJECTIVE: The main purpose of this study was to examine factors influencing PTs to organize PA in LTCF for older adults. A secondary goal was to examine the PTs’ knowledge about and their barriers at the PA guidelines for older adults of the World Health Organization (WHO). METHODS: A mixed qualitative and quantitative study was carried out using semistructured interviews (n = 24) followed by an online survey (n = 254). As a frame the social-ecological model (McLeroy) was used, distinguishing factors at the intrapersonal, interpersonal, and community level. RESULTS: In the qualitative component the PTs reported 41 motivators and 35 barriers for organizing PA in LTCF. The survey revealed that although the majority of the respondents (71%) are convinced of the usefulness of PA in LTCF, 84% are not familiar with the WHO-guidelines. Seventy-five percent of the respondents believe that the WHO-guidelines are not feasible for LTCF-residents. The strongest motivators on the intrapersonal level were maintaining the independence of the residents (98%), reducing the risk of falling (98%), and improving the physical (93%) and psychological (90%) wellbeing of LTCF-residents. The social interaction among LTCF-residents (91%) during PA was the strongest motivator on the interpersonal level. Motivators on the community level are the belief that PA is the basis of their physiotherapeutic work (89%) and that offering varied activities avoids PA becoming monotonous (71%). Barriers on the intra- and interpersonal level were of less influence. On the community level, they felt hindered to organize PA because of lack of time (38%) and the overload of paperwork (33%). CONCLUSIONS: This study described different motivators and barriers for PTs to organize PA in LTCFs. The majority does not know the WHO guidelines regarding the amount of PA for adults aged 65 and over. Although they agree that the guidelines are useful, they believe the guidelines are not feasible. There is a need for a multifactorial strategy that acts on different determinants in order to stimulate PA in LTCF. Copyright © 2015 AMDA
Sacred cow gone to pasture: a systematic evaluation and integration of evidence-based practice.
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Hanrahan K, Wagner M, Matthews G, Stewart S, Dawson C, Greiner J, et al.
Worldviews on evidence-based nursing 2015 Feb;12(1):3-11
Sacred cows (SC) are old habits in practice, considered routine and above dispute, regardless of evidence to the contrary. PURPOSE: This is the first known report that aims to conduct a systematic evaluation of practices that have been described in the literature as SC and strategies for planned implementation of evidence-based practices (EBP). METHODS: A large, complex, academic medical center department of nursing compared SC to EBP. Nurses systematically reviewed and rated the degree to which current practices adhered to best-evidence versus SC. This initiative, “Sacred Cow: Gone to Pasture,” was developed, structured, and implemented according to the Iowa Model of Evidence-Based Practice to Promote Quality Care, as well as Everett Rogers’ Diffusions of Innovations Theory. Implementation of EBP followed a phase plan using the Implementation Strategies for Evidence-Based Practice to help to support adoption and integration. RESULTS: Review of organization-specific policies and procedures and reports of actual practices revealed that SC persist, even in a center internationally recognized as a leader in EBP. The SC initiative caught the attention of busy clinicians, and raised awareness of SC and the importance of adherence to EBP. The SC initiative resulted in policy and practice changes and sparked new EBP and research, resulting in numerous improvements, including a significant decline in catheter-associated urinary tract infections and shifting from basins to commercially prepared cloths for patient bathing. LINKING EVIDENCE TO ACTION: A strategic approach is crucial to eliminating SC and integrating EBP. This report calls nurses globally to action, to identify and abandon ineffective healthcare practices. Further research should compare and test the efficacy of implementation strategies, in particular how to sustain EBP in clinical settings. © 2015 Sigma Theta Tau International.
Empowering nurses with evidence-based practice environments: surveying magnet®, pathway to excellence®, and non-magnet facilities in one healthcare system.
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Wilson M, Sleutel M, Newcomb P, Behan D, Walsh J, Wells JN, et al.
Worldviews on evidence-based nursing 2015 Feb;12(1):12-21
Nurses have an essential role in implementing evidence-based practices (EBP) that contribute to high-quality outcomes. It remains unknown how healthcare facilities can increase nurse engagement in EBP. PURPOSE: To determine whether individual or organizational qualities could be identified that were related to registered nurses’ (RNs’) readiness for EBP as measured by their reported EBP barriers, ability, desire, and frequency of behaviors. METHODS: A descriptive cross-sectional survey was used in which a convenience sample of 2,441 nurses within one United States healthcare system completed a modified version of the Information Literacy for Evidence-Based Nursing questionnaire. Descriptive statistics, t tests, one-way ANOVA, and regression modeling were used to analyze the data. RESULTS: RNs employed by facilities designated by the American Nurses Credentialing Center (ANCC) as Magnet® or Pathway to Excellence® reported significantly fewer barriers to EBP than those RNs employed by non designated facilities. RNs in Magnet organizations had higher desire for EBP than Pathway to Excellence or non designated facilities. RNs educated at the baccalaureate level or higher reported significantly fewer barriers to EBP than nurses with less education; they also had higher EBP ability, desire, and frequency of behaviors. A predictive model found higher EBP readiness scores among RNs who participated in research, had specialty certifications, and engaged in a clinical career development program. LINKING EVIDENCE TO ACTION: Education, research, and certification standards promoted by the Magnet program may provide a nursing workforce that is better prepared for EBP. Organizations should continue structural supports that increase professional development and research opportunities so nurses are empowered to practice at their full capacity.
Implementation of evidence-based practice in relation to a clinical nursing ladder system: a national survey in Taiwan.
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Weng YH, Chen C, Kuo KN, Yang CY, Lo HL, Chen KH, et al.
Worldviews on evidence-based nursing 2015 Feb;12(1):22-30
Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. METHODS: A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. RESULTS: Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. LINKING EVIDENCE TO ACTION: The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation. © 2015 The Authors.
Developing a checklist for guideline implementation planning: review and synthesis of guideline development and implementation advice
Gagliardi A, Marshall C, Huckson S, James R, Moore V.
Implementation Science 2015;10(1):19
Developers, users and others have requested or advocated for guidance on how to plan for, and implement guidelines concurrent to their development given that existing resources are lacking such information. The purpose of this research was to develop a guideline implementation planning checklist. Methods Documents that described or evaluated the processes of planning or undertaking implementation were identified in several publications that had systematically identified such resources, and by searching medical literature databases (MEDLINE, EMBASE). Data that described implementation planning; how to develop guideline versions or tools that would support user implementation; and options and mechanisms for disseminating or implementing guidelines were independently extracted from eligible documents by the principal investigator and a trained research assistant. Data were integrated to create a unique list of guideline implementation planning processes and considerations. Results Thirty-five documents were eligible. Of these, 16 (45.7%) provided sparse information on implementation planning, 25 (71.4%) mentioned different versions or tools for implementation, and 30 (85.7%) listed options for dissemination or implementation. None provided instructions for operationalizing implementation strategies. Data were integrated into a multi-item Guideline Implementation Planning Checklist including considerations for implementation planning (12), development of implementation tools (8), types of implementation tools (12), and options for dissemination (11) and implementation (12). Conclusions Developers or users can apply the Guideline Implementation Planning Checklist to prepare for and/or undertake guideline implementation. Further development of the checklist is warranted to elaborate on all components. In ongoing research, we will consult with the international guideline community to do so. At the same time, guideline implementation is complex, so developers and users would benefit from training, and by including knowledge translation experts and brokers on implementation planning committees.
Boundary Discontinuity in a Constellation of Interconnected Practices
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Public Administration 2014 06;92(2):307
This article uses the theory of ‘communities of practice’ to explore the discontinuity of knowledge sharing across different groups co-located within a collaborative research partnership. It presents the findings of a qualitative case study conducted within one of the Collaborations for Leadership in Applied Health Research and Care ( CLAHRCs)-large-scale UK-based knowledge mobilization initiatives bringing together the producers and users of health research. Focusing on the boundaries emerging between and within the research and implementation strands of the CLAHRC, the article describes how differences between communities of practice give rise to discontinuities in knowledge sharing. Its findings highlight the role of fragmented organizational design, divergent meanings and identities, and dysfunctional boundary bridges in the (re)production, legitimization, and protection of boundaries between groups. Finally, the article questions the role of research implementation as a boundary practice bridging the gap between academic research and clinical practice.
Translating Evidence-Based Dementia Caregiving Interventions into Practice: State-of-the-Science and Next Steps
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Gitlin LN, Marx K, Stanley IH, Hodgson N.
The Gerontologist 2015 02/17
Over the past 3 decades, more than 200 dementia caregiver interventions have been tested in randomized clinical trials and found to be efficacious. Few programs have been translated for delivery in various service contexts, and they remain inaccessible to the 15+ million dementia family caregivers in the United States. This article examines translational efforts and offers a vision for more rapid advancement in this area. We summarize the evidence for caregiver interventions, review published translational efforts, and recommend future directions to bridge the research-practice fissure in this area. We suggest that as caregiver interventions are tested external to service contexts, a translational phase is required. Yet, this is hampered by evidentiary gaps, lack of theory to understand implementation challenges, insufficient funding and unsupportive payment structures for sustaining programs. We propose ways to advance translational activities and future research with practical applications.
Knowledge Translation in Men’s Health Research: Development and Delivery of Content for Use Online.
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Lohan M, Aventin A, Oliffe JL, Han CS, Bottorff JL.
Journal of medical Internet research 2015 Jan 29;17(1):e31
Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men’s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation. OBJECTIVE: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men’s health. METHODS: We present experiences of KT across two case studies of men’s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men’s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men’s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled “If I Were Jack”. RESULTS: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men’s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset. CONCLUSIONS: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.
Use of modified delphi to plan knowledge translation for decision makers: an application in the field of advanced practice nursing.
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Carter N, Lavis JN, MacDonald-Rencz S.
Policy, politics & nursing practice 2014 Aug;15(3-4):93-101
Disseminating research to decision makers is difficult. Interaction between researchers and decision makers can identify key messages and processes for dissemination. To gain agreement on the key findings from a synthesis on the integration of advanced practice nurses, we used a modified Delphi process. Nursing decision makers contributed ideas via e-mail, discussed and clarified ideas face to face, and then prioritized statements. Sixteen (89%) participated and 14 (77%) completed the final phase. Priority key messages were around access to care and outcomes. The majority identified “NPs increase access to care” and “NPs and CNSs improve patient and system outcomes” as priority messaging statements. Participants agreed policy makers and the public were target audiences for messages. Consulting with policy makers provided the necessary context to develop tailored policy messages and is a helpful approach for research dissemination. © The Author(s)
Implementing Oral Care Practices and Policy Into Long-Term Care: The Brushing up on Mouth Care Project
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McNally M, Martin-Misener R, McNeil K, Brillant M, Moorhouse P, Crowell S, et al.
Journal of the American Medical Directors Association 2014 Oct 8
Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. OBJECTIVE: The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. DESIGN: A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. SETTING AND PARTICIPANTS: The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. INTERVENTION: A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. MEASUREMENTS: Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. RESULTS: The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a “champion” was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. CONCLUSIONS: Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy. Copyright © 2014 AMDA
Fast tracking the design of theory-based KT interventions
through a consensus process
Bussieres A, Al Zoubi F, Quon J, Ahmed S, Thomas A, Stuber K, et al.
Implementation Science 2015;10(1):18
Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains. Methods Individual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention. Results Nine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients’ treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors. Conclusions A multifaceted KT educational intervention targeting chiropractors’ management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.
Locally based research and development units as knowledge brokers and change facilitators in health and social care of older people in Sweden
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Nyström M, Hansson J, Garvare R, Andersson-Bäck M.
Evidence & Policy; 2015 11(1): 57-80
This article investigates the role of locally based research and development units (R&Ds) focusing on health and social services. Nearly 300 local R&Ds are funded by the Swedish government with the intention to facilitate knowledge transfer and development of high quality and effective health and social care organisations. Based on analyses of archival data on aims, activities and outputs of R&Ds focusing on care for older people the authors argue that local R&Ds have potentials to act as knowledge brokers, change agents and researchers, but these overlapping roles need clarified strategies and enactment of a variety of skills.
A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project
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Powell B, Waltz T, Chinman M, Damschroder L, Smith J, Matthieu M, et al.
Implementation Science 2015;10(1):21
Identifying, developing, and testing implementation strategies are important goals of implementation science. However, these efforts have been complicated by the use of inconsistent language and inadequate descriptions of implementation strategies in the literature. The Expert Recommendations for Implementing Change (ERIC) study aimed to refine a published compilation of implementation strategy terms and definitions by systematically gathering input from a wide range of stakeholders with expertise in implementation science and clinical practice. Methods Purposive sampling was used to recruit a panel of experts in implementation and clinical practice who engaged in three rounds of a modified Delphi process to generate consensus on implementation strategies and definitions. The first and second rounds involved Web-based surveys soliciting comments on implementation strategy terms and definitions. After each round, iterative refinements were made based upon participant feedback. The third round involved a live polling and consensus process via a Web-based platform and conference call. Results Participants identified substantial concerns with 31% of the terms and/or definitions and suggested five additional strategies. Seventy-five percent of definitions from the originally published compilation of strategies were retained after voting. Ultimately, the expert panel reached consensus on a final compilation of 73 implementation strategies. Conclusions This research advances the field by improving the conceptual clarity, relevance, and comprehensiveness of implementation strategies that can be used in isolation or combination in implementation research and practice. Future phases of ERIC will focus on developing conceptually distinct categories of strategies as well as ratings for each strategy’s importance and feasibility. Next, the expert panel will recommend multifaceted strategies for hypothetical yet real-world scenarios that vary by sites’ endorsement of evidence-based programs and practices and the strength of contextual supports that surround the effort.
To know is not enough: research knowledge and its use
Review of Education 2013;1(1):2-31
This paper is about the relationship between research, policy and practice in education. It outlines reasons for the increased interest in research and its impact and describe some of the difficulties in studying this relationship. A conceptualization of the knowledge mobilization process is presented that identifies three overlapping and interacting domains – the production of research, the end use of research, and the intermediary processes that link these two. The paper reviews current research and develops ideas about all three of these aspects, identifying areas of understanding and gaps in current knowledge.
Health Care Administration and Organization
Acceptability of an e-Learning Program to Help Nursing Assistants Manage Relationship Conflict in Nursing Homes.
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Marziali E, Mackenzie CS, Tchernikov I.
American Journal of Alzheimer’s Disease and Other Dementias 2015 Feb;30(1):55-60
Management of nursing assistants’ (NAs) emotional stress from relationship conflicts with residents, families, and coworkers is rarely the focus of educational programs. Our objective was to gather feedback from NAs and their nursing supervisors (NSs) about the utility of our e-learning program for managing relationship stress. METHODS: A total of 147 NAs and their NSs from 17 long-term care homes viewed the educational modules (DVD slides with voice-over), either individually or in small groups, and provided feedback using conference call focus groups. RESULTS: Qualitative analysis of NA feedback showed that workplace relationship conflict stress was associated with workload and the absence of a forum for discussing relationship conflicts that was not acknowledged by NSs. CONCLUSION: This accessible e-learning program provides NAs with strategies for managing stressful emotions arising from workplace relationship conflict situations and underscores the importance of supervisory support and team collaboration in coping with emotionally evoked workplace stress. © The Author(s) 2014.
Co-Learning With Home Care Aides and Their Clients: Collaboratively Increasing Individual and Organizational Capacities.
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Muramatsu N, Madrigal J, Berbaum ML, Henderson VA, Jurivich DA, Zanoni J, et al.
Gerontology & geriatrics education 2015 Feb 11
Changes in health care provide unprecedented opportunities for collaboration across research, education, and practice for the common goal of enhancing the well-being of older adults and their caregivers. This article describes how a pilot project, “Promoting Seniors’ Health with Home Care Aides,” has synergistic education, research and practice effects that enhance individual and organizational capacities. This pilot is an innovative partnership with home care aides to deliver a safe physical activity program appropriate for frail seniors in a real-life public home care program. The intervention and research occur in older adults’ homes and thus provide rare opportunities for the research team and partners to learn from each other about dynamics of home care in older adults’ life contexts. Co-learning is essential for continuous quality improvement in education, research and practice. We propose to establish “Teaching Home Care” to ensure ongoing co-learning in gerontology and geriatrics.
Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides.
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Sprangers S, Dijkstra K, Romijn-Luijten A.
Clinical interventions in aging 2015 Jan 20;10:311-319
Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides’ communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides’ (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides’ communication, caregiver distress, and job satisfaction and residents’ psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff.
Health Care Innovation and Quality Assurance
Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.
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McFadden KL, Stock GN, Gowen CR,3rd.
Health care management review 2015 Jan-Mar;40(1):24-34
Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. PURPOSE: We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. METHODOLOGY/APPROACH: The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. FINDINGS: The results provide empirical evidence that a safety climate, which is connected to the chief executive officer’s transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. PRACTICAL IMPLICATIONS: The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.
Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents.
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Torma J, Winblad U, Saletti A, Cederholm T.
The journal of nutrition, health & aging 2015;19(1):70-76
Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation (EF) and educational outreach visits (EOVs), in order to introduce nutritional guidelines (e.g. screening, food quality and mealtime ambience), into a nursing home (NH) setting and to evaluate the clinical outcomes. DESIGN: A controlled study with baseline and follow-up measurements. SETTING: Four NHs. PARTICIPANTS: A total of 101 NH residents. INTERVENTION: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. MEASUREMENTS: The outcomes were nutritional status (Mini Nutritional Assessment-Short Form, MNA-SF), body mass index (BMI), functional ability (Barthel Index, BI), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life (EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. RESULTS: After a median of 18 months, nutritional parameters (MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group (p=0.008). Multiple linear regression analyses indicated that the intervention group assignment (EF) was independently from other potentially related factors associated with less cognitive decline. CONCLUSION: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.
An Overview of Potential Labor-Saving and Quality-Improving Innovations in Long-Term Care for Older People.
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Thoma-Lurken T, Bleijlevens MH, Lexis MA, Hamers JP, de Witte LP.
Journal of the American Medical Directors Association 2015 Feb 10
Increasing demands in long-term care for older people and a decrease in workforce availability can be expected in the future. These developments challenge the sustainability and quality of long-term care for older people. To address these challenges, long-term care organizations are forced to innovate. The aim of this study is to provide an overview of potential labor-saving and quality-improving innovations long-term care organizations are working on and to assess the self-reported extent of effectiveness. DESIGN: This is a descriptive cross-sectional study. METHODS: In total, 32 long-term care organizations in the region of Limburg in The Netherlands were invited to participate in the study. The inventory was performed by means of semistructured interviews with chief executive officers, managers, and staff members of the long-term care organizations. Based on the interview data, all innovations were described in a standardized form and subsequently checked by the participants. All innovations were clustered into product, process, organizational, and marketing innovations. RESULTS: In total, 26 long-term care organizations delivering home and/or institutional long-term care for older people participated in the study. Overall, 228 innovations were identified; some innovations were described in a similar way by different organizations. The majority of innovations were product innovations (n = 96), followed by organizational innovations (n = 75), and process innovations (n = 42). In addition to the main types, 15 other innovations incorporating characteristics of different types of innovations were detected. Little evidence about the effectiveness of the innovations was reported by the organizations. CONCLUSIONS: This study shows that a large number and a broad variety of innovations have been implemented or are currently being developed in long-term care organizations for older people. However, according to the organizations, there is relatively little (scientific) evidence confirming the effectiveness of these innovations. More research is needed to evaluate the effects of the innovations and to indicate whether they provide real solutions to future challenges. Copyright © 2015 AMDA
Quantitative assessment of organizational culture within hospitals and its relevance to infection prevention and control strategies.
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Borg MA, Waisfisz B, Frank U.
The Journal of hospital infection 2015 Jan 15
It has been suggested that organizational culture (OC) is an important driver of infection prevention and control (IPC) behaviour among healthcare workers. This study examined OC in seven European hospitals using a validated assessment tool based on Hofstede’s model, and identified significant variations in OC scores. Hospitals with low prevalence of meticillin-resistant Staphylococcus aureus (MRSA) exhibited high scores for change facilitation and change readiness, whereas hospitals with high prevalence of MRSA exhibited low scores for these determinants. It is possible to use tools, available outside health care, to study OC within hospitals and gain better insight into IPC behaviour change strategies. Copyright © 2015 The Healthcare Infection Society
Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries.
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Secanell M, Groene O, Arah OA, Lopez MA, Kutryba B, Pfaff H, et al.
International journal for quality in health care 2014 Apr;26 Suppl 1:5-15
This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. DESIGN: DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. SETTING AND PARTICIPANTS: We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. MAIN OUTCOME MEASURES: A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). RESULTS: Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. CONCLUSIONS: This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.
The associations between organizational culture, organizational structure and quality management in European hospitals.
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Wagner C, Mannion R, Hammer A, Groene O, Arah OA, Dersarkissian M, et al.
International journal for quality in health care 2014 Apr;26 Suppl 1:74-80
To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. DESIGN: A multi-method, multi-level, cross-sectional observational study. SETTING AND PARTICIPANTS: As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. MAIN OUTCOME MEASURES: Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. RESULTS: Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. CONCLUSION: The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.
Research Practice and Methodology
A Framework for Enhancing the Value of Research for Dissemination and Implementation.
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Neta G, Glasgow RE, Carpenter CR, Grimshaw JM, Rabin BA, Fernandez ME, et al.
American Journal of Public Health 2015 Jan;105(1):49-57
A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers.
National survey of physicians to determine the effect of unconditional incentives on response rates of physician postal surveys.
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Abdulaziz K, Brehaut J, Taljaard M, Emond M, Sirois MJ, Lee JS, et al.
BMJ open 2015 Feb 18;5(2):e007166-2014-007166
Physicians are a commonly targeted group in health research surveys, but their response rates are often relatively low. The goal of this paper was to evaluate the effect of unconditional incentives in the form of a coffee card on physician postal survey response rates. DESIGN: Following 13 key informant interviews and eight cognitive interviews a survey questionnaire was developed. PARTICIPANTS: A random sample of 534 physicians, stratified by physician group (geriatricians, family physicians, emergency physicians) was selected from a national medical directory. SETTING: Using computer generated random numbers; half of the physicians in each stratum were allocated to receive a coffee card to a popular national coffee chain together with the first survey mailout. INTERVENTIONS: The intervention was a $10 Tim Hortons gift card given to half of the physicians who were randomly allocated to receive the incentive. RESULTS: 265 (57.0%) physicians completed the survey. The response rate was significantly higher in the group allocated to receive the incentive (62.7% vs 51.3% in the control group; p=0.01). CONCLUSIONS: Our results indicate that an unconditional incentive in the form of a coffee gift card can substantially improve physician response rates. Future research can look at the effect of varying amounts of cash on the gift cards on response rates.
What should we know about dementia in the 21st Century? A Delphi consensus study.
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Annear MJ, Toye C, McInerney F, Eccleston C, Tranter B, Elliott KE, et al.
BMC geriatrics 2015 Feb 6;15(1):5
Escalating numbers of people are experiencing dementia in many countries. With increasing consumer needs, there is anticipated growth in the numbers of people providing diagnostic evaluations, treatments, and care. Ensuring a consistent and contemporary understanding of dementia across all of these groups has become a critical issue. This study aimed to reach consensus among dementia experts from English speaking countries regarding essential and contemporary knowledge about dementia.Methods An online Delphi study was conducted to examine expert opinion concerning dementia knowledge with three rounds of data collection. A sample of dementia experts was selected by a panel of Australian experts, including a geriatrician and three professors of aged care. Purposive selection was initially undertaken with the sample expanded through snowballing. Dementia experts (N¿=¿19) included geriatricians, psychologists, psychiatrists, neuroscientists, dementia advocates, and nurse academics from the United Kingdom, United States, and Australia. In the first round, these participants provided open-ended responses to questions determining what comprised essential knowledge about dementia. In the second round, responses were summarised into 66 discrete statements that participants rated on the basis of importance. In the third round, a rank-ordered list of the 66 statements and a group median were provided and participants rated the statements again. The degree of consensus regarding importance ratings was determined by assessing median, interquartile range, and proportion of experts scoring above predetermined thresholds. Correlation scores were calculated for each statement after the final round to identify changes in statement scores.Results The Delphi experts identified 36 statements about dementia that they considered essential to understanding the condition. Statements about care for a person experiencing dementia and their care giver represented the largest response category. Other statements, for which full or very high consensus was reached, related to dementia characteristics, symptoms and progression, diagnosis and assessment, and treatment and prevention.Conclusions These results summarise knowledge of dementia that is considered essential across expert representatives of key stakeholder groups from three countries. This information has implications for the delivery of care to people with the condition and the development of dementia education programs.
Functional Improvement Among Short-Stay Nursing Home Residents in the MDS 3.0.
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Wysocki A, Thomas KS, Mor V.
Journal of the American Medical Directors Association 2015 Feb 3
To examine the completeness of the activities of daily living (ADL) items on admission and discharge assessments and the improvement in ADL performance among short-stay residents in the newly adopted Minimum Data Set (MDS) 3.0. DESIGN: Retrospective analysis of MDS admission and discharge assessments. SETTING: Nursing homes from July 1, 2011, to June 30, 2012. PARTICIPANTS: New nursing home residents admitted from acute hospitals with corresponding admission and discharge assessments between July 1, 2011, and June 30, 2012, who had a length of stay of 100 days or less. MEASUREMENTS: ADL self-performance items, including bed mobility, transfer, walking in room, walking in corridor, locomotion on unit, locomotion off unit, dressing, eating, toilet use, and personal hygiene, at admission and discharge. RESULTS: The ADL self-performance items are complete at both admission and discharge, with less than 1% missing for any item. More than 60% of residents improved over the course of their post-acute stay. New short-stay nursing home residents with conditions such as cognitive impairment, delirium, dementia, heart failure, and stroke showed less improvement in ADL performance during their stay. CONCLUSION: The discharge assessment data in the MDS 3.0 provide new information to researchers and providers to examine and track ADL performance. Nursing homes can identify and track patients who require more intensive therapies or targeted interventions to achieve functional improvement during their stay. Future research can examine facility-level measures to better understand how ADL improvement varies across facilities. Copyright © 2014 AMDA
Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.
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Schussler S, Dassen T, Lohrmann C.
Aging clinical and experimental research 2014 Dec 20
Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. METHODS: A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. RESULTS: Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. CONCLUSION: These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents’ independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.
Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff.
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Towsley GL, Hirschman KB, Madden C.
Journal of palliative medicine 2015 Feb 6
Care in nursing homes (NHs) often overlooks individual values and preferences. Residents’ voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. Objective: The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. Methods: We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants’ conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n=16), family (n=12), and interdisciplinary staff (n=10) from four NHs. Results: The overarching theme-missed conversations-describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry (“No one asked”); assumptions (presence of an advance directive [AD], “They know me”); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. Conclusions: Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.
Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan.
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Arai H, Ouchi Y, Toba K, Endo T, Shimokado K, Tsubota K, et al.
Geriatrics & gerontology international 2015 Feb 5
The demographic structure of a country changes dramatically with increasing trends toward general population aging and declining birth rates. In Japan, the percentage of the elderly population (aged ≥65 years) reached 25% in 2013; it is expected to exceed 30% in 2025 and reach 39.9% in 2060. The national total population has been decreasing steadily since its peak reached in 2008, and it is expected to fall to the order of 80 million in 2060. Of the total population, those aged ≥75 years accounted for 12.3% as of 2013, and this is expected to reach 26.9% in 2060. As the demographic structure changes, the disease structure changes, and therefore the medical care demand changes. To accommodate the medical care demand changes, it is necessary to secure a system for providing medical care. Japan has thus far attained remarkable achievements in medical care, seeking a better prognosis for survival; however, its medical care demand is anticipated to change both qualitatively and quantitatively. As diseases in the elderly, particularly in the old-old population, are often intractable, conventional medical care must be upgraded to one suitable for an aged society. What is required to this end is a shift from “cure-seeking medical care” focusing on disease treatment on an organ-specific basis to “cure and support-seeking medical care” with treatments reprioritized to maximize the quality of life (QOL) for the patient, or a change from “hospital-centered medical care” to “community-oriented medical care” in correlation with nursing care and welfare.
A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia.
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Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al.
Health technology assessment (Winchester, England) 2014 Jun;18(39):1-226, v-vi
Agitation is common, persistent and distressing in dementia and is linked with care breakdown. Psychotropic medication is often ineffective or harmful, but the evidence regarding non-pharmacological interventions is unclear. OBJECTIVES: We systematically reviewed and synthesised the evidence for clinical effectiveness and cost-effectiveness of non-pharmacological interventions for reducing agitation in dementia, considering dementia severity, the setting, the person with whom the intervention is implemented, whether the effects are immediate or longer term, and cost-effectiveness. DATA SOURCES: We searched twice using relevant search terms (9 August 2011 and 12 June 2012) in Web of Knowledge (incorporating MEDLINE); EMBASE; British Nursing Index; the Health Technology Assessment programme database; PsycINFO; NHS Evidence; System for Information on Grey Literature; The Stationery Office Official Documents website; The Stationery National Technical Information Service; Cumulative Index to Nursing and Allied Health Literature; and The Cochrane Library. We also searched Cochrane reviews of interventions for behaviour in dementia, included papers’ references, and contacted authors about ‘missed’ studies. We included quantitative studies, evaluating non-pharmacological interventions for agitation in dementia, in all settings. REVIEW METHOD: We rated quality, prioritising higher-quality studies. We separated results by intervention type and agitation level. As we were unable to meta-analyse results except for light therapy, we present a qualitative evidence synthesis. In addition, we calculated standardised effect sizes (SESs) with available data, to compare heterogeneous interventions. In the health economic analysis, we reviewed economic studies, calculated the cost of effective interventions from the effectiveness review, calculated the incremental cost per unit improvement in agitation, used data from a cohort study to evaluate the relationship between health and social care costs and health-related quality of life (DEMQOL-Proxy-U scores) and developed a new cost-effectiveness model. RESULTS: We included 160 out of 1916 papers screened. Supervised person-centred care, communication skills (SES = -1.8 to -0.3) or modified dementia care mapping (DCM) with implementing plans (SES = -1.4 to -0.6) were all efficacious at reducing clinically significant agitation in care home residents, both immediately and up to 6 months afterwards. In care home residents, during interventions but not at follow-up, activities (SES = -0.8 to -0.6) and music therapy (SES = -0.8 to -0.5) by protocol reduced mean levels of agitation; sensory intervention (SES = -1.3 to -0.6) reduced mean and clinically significant symptoms. Advantages were not demonstrated with ‘therapeutic touch’ or individualised activity. Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily living or quality-of-life outcomes found no improvement, even when agitation had improved. We identified two health economic studies. Costs of interventions which significantly impacted on agitation were activities, £80-696; music therapy, £13-27; sensory interventions, £3-527; and training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM, £31-339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory (CMAI), the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities, £4 for music therapy, £24 to £143 for sensory interventions, and £6 to £62 for training paid caregivers in person-centred care or communication skills with or without behavioural management training and DCM. Health and social care costs ranged from around £7000 over 3 months in people without clinically significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores. A multicomponent intervention in participants with mild to moderate dementia had a positive monetary net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000. LIMITATIONS: Although there were some high-quality studies, there were only 33 reasonably sized (> 45 participants) randomised controlled trials, and lack of evidence means that we cannot comment on many interventions’ effectiveness. There were no hospital studies and few studies in people’s homes. More health economic data are needed. CONCLUSIONS: Person-centred care, communication skills and DCM (all with supervision), sensory therapy activities, and structured music therapies reduce agitation in care-home dementia residents. Future interventions should change care home culture through staff training and permanently implement evidence-based treatments and evaluate health economics. There is a need for further work on interventions for agitation in people with dementia living in their own homes. PROTOCOL REGISTRATION: The study was registered as PROSPERO no. CRD42011001370.
Results from the multisite implementation of STAR-VA: a multicomponent psychosocial intervention for managing challenging dementia-related behaviors of veterans.
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Karlin BE, Visnic S, McGee JS, Teri L.
Psychological services 2014 May;11(2):200-208
Dementia is often associated with challenging behaviors that can significantly impact the quality of life of individuals with dementia and pose great difficulty for long-term care staff. Antipsychotic medications, historically the mainstay approach for managing such behaviors, have increasingly been associated with limited efficacy and increased death risk with older dementia patients. In an effort to promote and realize the promise of nonpharmacological management of challenging dementia-related behaviors, the U.S. Department of Veterans Affairs (VA) health care system has developed and implemented STAR-VA, an interdisciplinary behavioral intervention for managing challenging dementia-related behaviors of veterans, in 17 VA nursing homes, as part of a pilot implementation initiative. Sixty-four veterans with challenging behaviors associated with dementia participated in the STAR-VA intervention coordinated by Mental Health Providers completing specialized training. Challenging behaviors clustered into 6 behavior types: resistance to care, agitation, violence/aggression, vocalization, wandering, and other. Results indicate that STAR-VA led to significant reductions in the frequency and severity of challenging dementia-related behaviors, with overall effect sizes of approximately 1. In addition, the intervention led to significant reductions in depression and anxiety. Overall, the results support the feasibility and effectiveness of STAR-VA for managing challenging dementia-related behaviors in veterans in real-world, nursing home settings.
Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study.
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Fain KM, Rosenberg PB, Pirard S, Bogunovic O, Spira AP.
Journal of the American Medical Directors Association 2015 Feb 14
Many nursing home residents have cognitive impairment that affects their decision making. In order to identify potential markers of impaired decision making, we investigated the association between a range of nursing home resident characteristics and impaired decision making in a population-based sample. METHODS: Participants were 13,013 residents in the 2004 National Nursing Home Survey. We used logistic regression to determine the association between resident characteristics (ie, gender, age, race, mood, recent pain, falls, fractures, or hospitalizations, length of stay, number of activities of daily living (ADL) requiring help, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making. RESULTS: After controlling for depression and anxiety diagnoses, as well as gender, age, race, and recent hospitalization or pain, characteristics associated with impaired decision making included depressed, sad, or anxious mood [“mild” odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.23-1.58; “severe” OR = 2.69, 95% CI = 2.27-3.20); diagnosed dementia or living on a dementia hall (OR = 5.07, 95% CI = 4.52-5.67); number of ADL requiring assistance (with 5 ADL, OR = 10.69, 95% CI = 6.82-16.75); length of nursing home stay [101-365 days (OR = 1.60, 95% CI = 1.36-1.89); 366 days-2 years (OR = 1.60, 95% CI = 1.34-1.90); >2 years (OR = 2.25, 95% CI = 1.92-2.63)]; and history of falls or fractures in the last 6 months (OR = 1.19, 95% CI = 1.07-1.32)]. Residents reporting pain in the last week were less likely to have impaired decision making (OR = 0.58, 95% CI = 0.52-0.66). CONCLUSIONS: We found several independent markers of impaired decision making in nursing home residents, including depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for ADL assistance. Some of these factors, in particular mood, are modifiable and addressing them may help improve decision making. These markers should be explored further to help identify residents with impaired decision making. Copyright © 2015 AMDA
Comfort goal of care and end-of-life outcomes in dementia: A prospective study.
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van Soest-Poortvliet MC, van der Steen JT, de Vet HC, Hertogh CM, Deliens L, Onwuteaka-Philipsen BD.
Palliative medicine 2015 Feb 17
Many people with dementia die in a nursing home. A comfort care goal may be beneficial. Little research has examined the relationship between care goals and outcome. AIM: To investigate whether family satisfaction with end-of-life care and quality of dying is associated with whether or not dementia patients have a comfort goal shortly after admission. DESIGN AND SETTING: Prospective data collection from 28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in Dementia-Satisfaction with Care scale; range: 10-40) and quality of dying (End-of-Life in Dementia-Comfort Assessment in Dying; range: 14-42). We performed generalized estimating equations regression analyses to analyze whether these outcomes are associated with a comfort goal established shortly after admission compared with another or no care goal as reported by the physician. RESULTS: Families of patients were more satisfied with end-of-life care when a comfort goal was established shortly after admission. We found this pattern only for patients who died within 6 months of admission (adjusted b: 4.5; confidence interval: 2.8, 6.3 vs -1.2; confidence interval: -3.0, 0.6 for longer stay). For quality of dying, no such association was found. CONCLUSION: We found that family satisfaction with care is related to a comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at an early stage may be important to the family. Advance care planning interventions should be studied for their effects on patient and family outcome. © The Author(s) 2015.
Predictive and Concurrent Validity of the Braden Scale in Long-Term Care: A Meta-Analysis.
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Wilchesky M, Lungu O.
Wound repair and regeneration 2015 Feb 11
Pressure ulcer prevention is an important long-term care (LTC) quality indicator. While the Braden Scale is a recommended risk assessment tool, there is a paucity of information specifically pertaining to its validity within the LTC setting. We therefore undertook a systematic review and meta-analysis comparing Braden Scale predictive and concurrent validity within this context. We searched the Medline, EMBASE, PsychINFO and PubMed databases from 1985-2014 for studies containing the requisite information to analyze tool validity. Our initial search yielded 3,773 articles. Eleven datasets emanating from 9 published studies describing 40,361 residents met all meta-analysis inclusion criteria and were analyzed using random effects models. Pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were 86%, 38%, 28% and 93%, respectively. Specificity was poorer in concurrent samples as compared to predictive samples (38% vs 72%), while PPV was low in both sample types (25% and 37%). Though random effects model results showed that the scale had good overall predictive ability [RR, 4.33; 95% CI, 3.28-5.72], none of the concurrent samples were found to have “optimal” sensitivity and specificity. In conclusion, the appropriateness of the Braden Scale in LTC is questionable given its low specificity and PPV, in particular in concurrent validity studies. Future studies should further explore the extent to which the apparent low validity of the scale in LTC is due to the choice of cut-off point and/or preventive strategies implemented by LTC staff as a matter of course.
Unmet needs of caregivers of individuals referred to a dementia care program.
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Jennings LA, Reuben DB, Evertson LC, Serrano KS, Ercoli L, Grill J, et al.
Journal of the American Geriatrics Society 2015 Feb;63(2):282-289
To characterize caregiver strain, depressive symptoms, and self-efficacy for managing dementia-related problems and the relationship between these and referring provider type. DESIGN: Cross-sectional observational cohort. SETTING: Urban academic medical center. PARTICIPANTS: Caregivers of community-dwelling adults with dementia referred to a dementia care management program. MEASUREMENTS: Caregivers were surveyed and completed the Patient Health Questionnaire (PHQ-9) about themselves; the Modified Caregiver Strain Index; the Neuropsychiatric Inventory Questionnaire, which measures patient symptom severity and related caregiver distress; and a nine-item caregiver self-efficacy scale developed for the study. RESULTS: Of 307 patient-caregiver dyads surveyed over a 1-year period, 32% of caregivers reported confidence in managing dementia-related problems, 19% knew how to access community services to help provide care, and 28% agreed that the individual’s provider helped them work through dementia care problems. Thirty-eight percent reported high levels of caregiver strain, and 15% reported moderate to severe depressive symptoms. Caregivers of individuals referred by geriatricians more often reported having a healthcare professional to help work through dementia care problems than those referred by internists, family physicians, or other specialists, but self-efficacy did not differ. Low caregiver self-efficacy was associated with higher caregiver strain, more caregiver depressive symptoms, and caring for an individual with more-severe behavioral symptoms. CONCLUSION: Most caregivers perceived inadequate support from the individual’s provider in managing dementia-related problems, reported strain, and had low confidence in managing caregiving. New models of care are needed to address the complex care needs of individuals with dementia and their caregivers. © 2015
“We Had a Beautiful Home . . . But I Think I’m Happier Here”: A Good or Better Life in Residential Aged Care
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Minney MJ, Hons BA, Ranzijn R.
The Gerontologist 2015 02/11
This qualitative study investigates residents’ perspectives on whether a “good life” is possible for older people living in residential aged care (RAC) and offers insight into the services and support needed to sustain their good life. Design and Methods: Thirteen aged care residents (2 male, 11 female) ranging in age from 77 to 95 years, participated in semi-structured interviews in 2 RAC facilities in Adelaide, South Australia. Both facilities employed a model of aged care based on active aging and positive psychology principles called the partners in positive aging (PiPA) model. Results: Interpretative phenomenological analysis showed that residents’ perception of a good life was centred on the service providers’ ability to enhance their physical, social, and psychological well-being while allowing them to maintain their sense of identity. Counter-stereotypically, findings suggest that the aged care environment can provide older people who are physically frail but cognitively intact with a better life than when they were living in their own homes. Implications: Psychological good life theory needs to be adapted and modified when considering the needs of cognitively intact older adults in residential care.
There is much ambiguity regarding the term “nursing home” in the international literature. The definition of a nursing home and the type of assistance provided in a nursing home is quite varied by country. The International Association of Gerontology and Geriatrics and AMDA foundation developed a survey to assist with an international consensus on the definition of “nursing home.”
Facing the facts: The truth about ageing and development (UK)
This publications brings together 25 high profile thought leaders, development experts and academics to discuss the impact of an ageing world on international development. Facing the facts contains 21 articles, divided into four sections. These sections focus on:
-Challenging preconceptions about ageing;
-Understanding health and care needs;
-Recognizing that ageing is about more than older people; and,
COMET V Meeting
20-21 May Calgary
The COMET (Core Outcome Measures in Effectiveness Trials) Initiative will hold its fifth meeting in Calgary, Alberta. Planning is now underway and we are preparing an exciting programme. This will bring together individuals interested in the development and application of “core outcome sets” in many different areas of health care. There is no registration fee for the meeting, and lunch and the meeting dinner will be provided free of charge. The number of spaces is limited, which may mean that we have to close registration some time in advance of the meeting. We therefore encourage early registration to av
CADTH Lecture Series – Dr. Murray Krahn
Thursday 12 March Ottawa
Will also be presented online
Register before 17:00 9 March
CADTH is hosting a series of lectures by prominent scholars and opinion leaders to share their perspectives on some of the most pressing issues facing health technology assessment (HTA) and health care today. As we continue our series into 2015, we invite you to attend the next talk, featuring Dr. Murray Krahn, Director of THETA — Toronto Health Economics and Technology Assessment — Collaborative. Clinical and health policy decision-making requires careful consideration of a range of clinical, ethical, societal, and economic values, compounded by great uncertainty. There is a need to balance benefits and risks, weigh competing objectives, and manage within budget constraints. Join Dr. Murray Krahn, 2014 recipient of the Dr. Jill M. Sanders Award of Excellence in Health Technology Assessment, for a discussion of the factors to be considered in developing a fair, transparent, and values-based framework for decisions about the adoption and use of health technologies.
Use of theory in implementation research; Pragmatic application and scientific advancement
Wednesday 25 February 13:00-14:00 MT
Laura Damschroder will lead this session. The session will include approximately 35 minutes of discussion from our speaker and 25 minutes for engaged discussion and Q&A with the audience. Below are references that will provide good background and foundational knowledge for this topic—please review the article(s) and come with your questions and thoughts for discussion.
The brainXchange & Alzheimer Society of Canada: Dementia and End of Life Care
Wednesday 4 March 10:00-11:00 MT
This webinar will talk about death, within the context of a diagnosis of Dementia; the expected trajectory of decline, planning and conversations that need to take place and The Final Days. Focus will be on anticipating the needs of the family and the person with dementia, how to recognize the signs and symptoms as death nears, how to respond to difficult questions. The personal story of one of the presenters will be shared from a personal and professional perspective: what was helpful for the person dying, the family and caregivers, the importance of Advance Care Directives and what to do when death has occurred.
KT Canada: Designing and evaluating interventions to improve transitions in pediatric emergency care
Thursday March 12 10:00-11:00 MT
Presenter: Dr. Janet Curran, School of Nursing, Dalhousie
Will be presented in ECHA 4-099
Outline a plan to develop theory-based discharge communication strategies for pediatric emergency care;
Share preliminary findings from exploratory work to identify barriers and enablers for achieving best practice in discharge communication;
Discuss opportunities for engaging parents in designing discharge communication strategies.
CFHI Webinar Understanding the ‘Lay of the Land’: Assessing Organizational Improvement Capability
Wednesday 25 February 10:00-11:00 MT
Ready to begin your journey to become a high performing healthcare organization or health system? Join us as we share useful tools and approaches for assessing organizational improvement capability. Let us help you assess your organization’s readiness and capacity to accelerate healthcare improvement with these evidence-informed levers found in CFHI’s Assessment ToolTM for Healthcare Delivery Organizations and Systems.
Innovative Trial Design Short Course
SickKids Research Institute, Toronto ON 8-10 April
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, Andy Willan, Wendy Ungar and Dorcas Beaton.
Certificate Program in Implementation Science: Translating Evidence into Practice, Policy and Public Health
UCSF Training in Clinical Research (TICR) Program
DEADLINE for applications 16 March
This one-year, part-time program offers a series of courses focused on applied methods of implementation, particularly as they relate to developing more effective interventions to translate specific evidence-based findings into everyday practice. The program is designed for people from a broad range of professional settings who are currently engaged in the development, implementation, and evaluation of programs to promote and improve health and health care quality, including clinical and public health researchers, quality improvement officers, community-based clinic staff, public health and public policy practitioners, and clinicians.
Implementation Science Masterclass
1-2 June London UK
CLAHRC South London are hosting this informative two-day course looking at:
-What Implementation Science is,
-How can implementation science methods help make sure health services routinely offer treatment and care that is informed by the most recent research, and
-What is the best way to plan an implementation science project?
The Masterclass includes lectures, group work and guidance to help participants work more effectively on their own implementation projects.
IWH Spring 2015 Systematic Review Workshop
6-8 May Toronto
The Institute for Work & Health (IWH) has been offering systematic review workshops since 2001. The workshops are designed to teach participants how to plan, conduct and communicate the results of a systematic review.
Upon completion of a workshop, participants should have the knowledge and skills necessary to:
-plan and carry out a basic systematic review
-understand the appropriate methods for more complex analysis
-interpret the results of a meta-analysis
-accurately communicate the results and interpretation of a review.
The Care Quality Commission has produced a pamphlet that sets out what relatives in England need to consider. It includes advice on gaining permission from the person being cared for and where it can be done. The CQC said opinion was divided about hidden cameras but it was publishing the guidance in recognition of the fact some people were already using them.
The Government of Canada has honoured Ethel Johns, founding director of the UBC School of Nursing, as a Person of National Historic Significance.
The EQUATOR (Enhancing the Quality and Transparency of Health Research) Network has launched a Canadian branch – EQUATOR Canada – led by Dr. David Moher, based at the Ottawa Hospital Research Institute. The inaugural meeting, held in October, 2014, emphasized the problems with reproducibility and usability of health research and their impact on patient health. The primary remit of EQUATOR Canada is to improve the trustworthiness of what biomedical journals publish by targeting authors, editors, and peer reviewers.
Residents in two of Saskatoon’s long-term care homes will soon have better access to enhanced health service support with the launch of a new pilot project inspired by Saskatoon Health Region’s Better Every Day 14 Day Challenge. The pilot is intended to deliver enhanced non-emergency and emergency medical services to residents at Luther Special Care Home and Porteous Lodge.
The Miramichi Evangelical Ministerial Association says 37 per cent of hospital beds in the city are occupied by seniors with nowhere else to go and it’s a situation, they say, needs to change
LTCG, the leader in business process outsourcing for long term care insurance, has just released its annual Cost of Care Study. This data-driven analysis reveals important industry insights on the costs of long term care (LTC) services and facilities. The study identifies and compares costs associated with receiving LTC services in the home, in nursing homes and in assisted living facilities across different geographic areas nationwide.
The BC Patient Safety & Quality Council is inviting residential care & assisted living teams from across BC to participate in its Releasing Time to Care (RT2C) initiative. RT2C is part of the Productive Series, originally developed by the NHS in England. The program provides organizations with an opportunity to engage point-of-care staff in leading change to improve care for patients, clients or residents. RT2C has improved patient, client and resident experience and health outcomes while supporting the development of communication, problem-solving and quality improvement skills within care teams.
Canada gets B grade overall in Conference Board of Canada report.
For many teenagers, taking on the responsibility of caring for an adult may seem unimaginable, especially when that adult is a parent. But when she was 14, Claire Poirier of Toronto says she had to quickly step into the role of caregiver for her mother, Jane Holland-Poirier, who has early-onset Alzheimer’s disease.
A new report issued by the National Partnership to Improve Dementia Care in Nursing Homes — a public-private coalition under the direction of the Centers for Medicare & Medicaid Services (CMS) — shows a greater-than-expected decrease in the national prevalence of antipsychotic medication use in long-stay nursing home residents over the last three years.
The Quebec government is making automatic sprinklers mandatory in most seniors’ residences following the coroner’s report into the L’Isle-Verte tragedy.
This week the Centers for Medicare and Medicaid Services (CMS) announced they will be making revisions to the Nursing Home Compare 5-Star Quality Rating system. The 5-Star Quality Rating system offers a comprehensive overview of nursing home quality in the U.S. based on specific data collected by CMS.
Kent Anderson writing for the Scholarly Kitchen (“What’s Hot and Cooking in Scholarly Publishing”) asks, “Why is science suffering in the modern age?” Among the causes of the crisis of public confidence in science:
Political and societal dysfunction.
Mass media dysfunction.
Admitting the complexities of the first three, Anderson observes of the last: “Scientists need to become better communicators.”.
Pat Thomson has put together a blog version of her academic writing course. It’s broken down into sections. And is a good resource for organizing/thinking about your writing:
The Methods Section
Structuring the Results/Discussion Section
Common Problems with the Results/Discussion Section
This interactive website was designed to help researchers and practitioners to select the D&I Model that best fits their research question or practice problem, adapt the model to the study or practice context, fully integrate the model into the research or practice process, and find existing measurement instruments for the model constructs. The term ‘Models’ is used to refer to both theories and frameworks that enhance dissemination and implementation of evidence-based interventions more likely.
Peer review is an intricate system, based on trust and professionalism, as colleagues try to evaluate an ever-increasing volume of papers on short timeframes. On the one hand, the process looks simple: manuscripts are sent out to external experts with a request for evaluation, upon which an editorial decision is then based. But anyone who has been involved in the process knows that peer review includes many intricacies and special cases. In this post, Brian Johnson, managing editor of The Chemical Record addresses some of the issues faced by reviewers, from the perspective of an editor’s seat.
This brief tip sheet from Annals of Long-Term Care, published in March 2014, provides healthcare providers with tips on how to conduct an examination of the oral cavity in elderly patients who have dentures (or other removable devices). The tip sheet includes step by step instructions with pictures – beginning with examining the oral cavity with the dentures in the mouth, then with the dentures removed from the mouth, and finally recommended procedures for a swallowing test.
Senior Lecturer Implementation Science
King’s College London
DEADLINE 8 March
The purpose of the role of Lecturer/Senior Lecturer is to take a lead in the design, planning, organisation and delivery of high quality programmes of study in implementation, translation and improvement science to support workforce development and build capacity in this new research field. The post holder will work with multiple stakeholders to ensure successful programme delivery whilst undertaking high-quality research in the subject area and actively contributing to teaching and relevant administration. A particular requirement of this role is to lead a new MSc programme in Implementation Science (subject to validation).
The successful applicant will receive doctoral study fees (UK/EU) and maintenance full-time for three years starting in October 2015. Projects may be based in University of Cambridge or University of Hertfordshire or University of East Anglia. The successful applicants can expect first class academic supervision and mentoring as well as a programme of formal training in research skills, leadership and project management. They will also have opportunities to work alongside research teams that are working on nationally and internationally funded dementia, frailty and end of life care research projects that use a range of research approaches and methodologies, both within the university they are registered with and across CLAHRC EoE.
The Norwegian Knowledge Centre for the Health Services, produces and disseminates evidence-based research about the effects of interventions and measures the quality of health services. The aim is to contribute to well-informed decisions so that health service users receive the best possible health care. The Knowledge Centre has approximately 200 employees and is located in downtown Oslo, Norway.
The Centre values diversity and non-native Norwegians are encouraged to apply.
Are you interested in developing a unit that works with evidence-based practice within the field of child welfare, education, integration, social housing initiatives, work and other welfare services?
There are 4-5 vacant positions as researcher / senior researcher in the social welfare unit. Individuals hired will especially contribute to the production of systematic reviews, in collaboration with information specialists and methods experts. High productivity is expected. Languages: Norwegian (preferred but not a requirement) & English (required).
2-year post-doctoral fellowship position
School of Physical and Occupational Therapy, Faculty of Medicine, McGill
DEADLINE 15 May
Under the supervision of Dr. André Bussières and Dr. Aliki Thomas, the post-doctoral fellow will conduct research in the area of knowledge translation (KT) and higher education (HE) in rehabilitation. Funding is available for the first year. The successful candidate will be expected to apply for competitive post-doctoral funding to support the second year of the fellowship. Applicants with a background in rehabilitation (e.g. chiropractic, occupational therapy, physical therapy) or other relevant health discipline are invited to apply. Applicants should have a strong interest in KT, evidence-based rehabilitation practices (EBRH), higher education and curriculum design to support EBRH and KT. The successful candidate will have a strong record of academic achievement during their doctoral studies, and evidence of scholarly outputs including peer reviewed publications and conference presentations. The post-doctoral fellow will work independently within a larger research team, oversee the daily activities of the lab and work with junior trainees (MSc and PhD students).
Translations Support Officer
DEADLINE 10 March
In order to support our Translations Co-ordinator in delivering our Translation strategy, this exciting new position has been created for a Translations Support Officer to join Cochrane’s Central Executive team. The main tasks of this role will be to develop and maintain learning and support programmes and resources for Cochrane translation teams; and to develop and facilitate communication and dissemination activities of Cochrane translation teams.