June 22, 2015


Abstracts
Grants & Awards
Publications
Courses
News
Resources
Opportunities

Announcements

Latest TREC newsletter is available

Learn more about TREC findings and the people involved.

Dementia Friends Launched in Canada

Dementia Friends Canada will engage Canadians in understanding what it means to live with dementia and how better to support those affected within the community. It will improve awareness and understanding about dementia, which is essential in overcoming stereotypes and reducing the stigma attached to the disease.

CIHI: Performance of 1,000 Canadian long-term care facilities now publicly available

Your Health System, a groundbreaking web tool created by the Canadian Institute for Health Information (CIHI) on how health systems across the country compare with one another, has released 9 new performance indicators from the long-term care (LTC) sector, which includes more than 1,000 nursing homes and other LTC facilities.

New Report on Women and Dementia
Women and Dementia: A global research review
Alzheimer’s Disease International, 2015

Dementia disproportionately affects women throughout the world and countries need to develop health and social care policies based on evidence of need within each country, according to the new “Women and Dementia: A Global Research Review” report from Alzheimer’s Disease International. In 2014, women accounted for 62 percent of people over age 80 around the globe. Population aging is particularly rapid in Africa, Latin America, the Caribbean and Asia and the prevalence of dementia is increasing. ADI estimates the by 2050, 71% of the 135 million people with dementia will live in low and middle income countries and the “vast majority of these people will be cared for at home, most likely by a female relative,” says the report, which outlines various socioeconomic and domestic challenges facing women living in low and middle income countries and suggests that women around the world are must less likely to access help and support than their male counterparts.

Abstracts

CALL FOR ABSTRACTS:
2015 Qualitative Health Research (QHR) Conference
19-20 October, Toronto ON
DEADLINE 23 June

Through discussion, debate and dissemination we will address the challenges and opportunities for making Qualitative Health Research a driving force towards the preferred future of healthcare. Dr. Carole Estabrooks is one of the keynotes.

CALL FOR SESSIONS:
Walk with Me 2016: Call for Sessions!
10-11 March Edmonton AB
DEADLINE 15 September

There are many exciting initiatives and projects underway in Canada that are shifting the culture of aging in significant and positive ways. Building on the success of last year’s conference, Walk with Me 2016 invites submissions for a wide range of engaging sessions that will accelerate and give profile to this social movement.

CALL FOR ABSTRACTS:
​5th Annual Symposium on Communicating Complex Information (SCCI)
21-23 February 2016
East Carolina University, Greenville NC
DEADLINE 15 October

Building on the success of the previous four conferences,the Symposium on Communicating Complex Information (SCCI) explores how complex information changes how we communicate, and how those changes affect information design, information architecture, user experience, and usability. It seeks to examine how design and content choices influence behavior as people interact with complex
information and how we can best design complex information systems. SCCI fosters an integrated approach to the design of complex information by bringing together members from a range of research and practitioner communities.

CALL FOR ABSTRACTS:
International Federation on Ageing 13th Global Conference on Ageing, Disasters in an Ageing World.
21-23 June 2016 Brisbane Australia
DEADLINE 5 November

The Program Committee invites authors to submit abstracts for oral, poster, symposium and workshop presentations for the IFA 13th Global Conference on Ageing, Disasters in an Ageing World. The building blocks of this conference include accurate and insightful risk reduction, readiness to provide effective responses in diverse environmental and population situations, with dedicated time and resources toward a journey of full recovery. Together the building blocks give rise to individual and community resilience – sometimes against all odds, yet reflecting the power of the human spirit. This global conference provides a vibrant opportunity for stakeholders including content experts, decision and policy makers, service providers and practitioners, consumers, advocates, and academics to come together to present and debate on age related issues, policies and practices as it is related to disasters and older people more generally.
Abstracts submitted should correspond with one or more of the thematic tracks below:
-Disasters and Older People
-Age Friendly Cities/Communities
-Care and Support for Older People (Community and Residential)
-Elder Abuse, Law and Rights
-Income Protection and Security

CALL FOR ABSTRACTS:
Nursing Home Research International Working Group
2-3 December Toulouse France
DEADLINE 30 June

The conference aims to go forward and raise further awareness on the need to promote research in nursing homes. The event will highlight last findings and best practices on the following topics: Alzheimer’s disease, polypharmacy, functional decline and physical activity, management of hypertension, pain, diabetes and nutrition, loneliness and depression, behavior disorders and agressivity, palliative care and end-of-life, assessment and quality improvement, care organization and transitional care, gerontechnology and new technologies. Abstracts accepted for presentation at the Nursing Home Research International Working Group will be published in a special supplement of the Journal of Nutrition Health and Aging – JNHA for the event.

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Grants & Awards

Canadian Critical Care Trials Group Research Fellowship Award 2015
DEADLINE 31 July 2015

The Fellowship Award program provides support for highly qualified candidates in the areas of critical care that are relevant to the CCCTG at the post-PhD degree or the post-health professional degree stages to add to their experience by engaging in health research in Canada.

Covenant Health: Network of Excellence in Seniors’ Health and Wellness Innovation Fund Call for Proposals
DEADLINE 8 September

In keeping with the Network’s purpose and mandate, the Network has established a fund with a focus on projects and initiatives that enable high-impact change in the seniors’ health and wellness system. The 2015 Innovation Fund is now open.

TVN Call for large-scale, transformative research projects
Webinar about this call 30 June 10:00-11:00

Technology Evaluation in the Elderly Network (TVN) invites researchers and their teams to submit proposals for large-scale, patient-centred, multi-year transformative research projects that have the potential to radically improve systems of care for frail elderly Canadians.

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Publications

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

KT

Factors influencing evidence-based practice for community nurses. Canada-flat-icon
Non UofA Access
Baird LM, Miller T.
British journal of community nursing 2015 May;20(5):233-242

Factors influencing the development of evidence-based nursing practice (EBNP) were examined in Prince Edward Island, Canada. An adapted electronic questionnaire was distributed to practicing registered nurses and nurse practitioners (n=68). An analysis of variance revealed a significant difference between nurses’ clinical practice setting and the EBNP scale. Significant differences were also found between age and education level when compared with the EBNP subscales where novice nurses were less likely to rely on experience and intuition, and expert nurses with a higher level of education reported being more skilful at synthesising and applying information from research findings into their nursing practice.

Dementia Care Evidence: Contextual Dimensions that Influence Use in Northern Home Care Centres Canada-flat-icon
Non UofA Access
Forbes D, Strain L, Blake C, Peacock S, Harrison W, Woytkiw T, Hawranik P, et al
Online Journal of Rural Nursing and Health Care 2015;15(1):117-149.

To better understand the contextual dimensions of two home care centres in two Canadian northern, rural communities that influence the use of evidence from the perspectives of home care providers (HCPs). Sample: All clinical leaders, managers, and home care providers (n=48 FTE) in the two home care centres were sent an information letter outlining the study’s purpose, expectations, and benefits and invited to participate in focus groups conducted in two home care centres. Fourteen staff participated in the two focus groups. Method: A qualitative interpretive descriptive approach was used. Semi-structured questions were used to guide the audiotape recorded focus groups. Transcripts were coded using Lubrosky’s thematic analysis. Findings: Our findings are described in broad contextual themes (e.g., challenges in using the RAI-HC, availability of resources, relationships in a rural community, leadership, and evaluation) that included both positive and negative contextual dimensions that influenced the use of evidence. Conclusions: Most importantly, reallocated resources are needed in northern home care settings. Challenges in exchanging evidence related to difficult relationships with physicians, clients, and their family caregivers. Leadership and collaboration dimensions were fundamental to establishing a vibrant workplace in which HCPs provided and exchanged evidence-based dementia care.

Enhancing dissemination and implementation research using systems science methods.
Non UofA Access
Burke JG, Lich KH, Neal JW, Meissner HI, Yonas M, Mabry PL.
International Journal of Behavioral Medicine 2015 Jun;22(3):283-291

Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions. PURPOSE: The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity. METHOD: Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method can be used to address D&I challenges. RESULTS: The case studies feature relevant behavioral topical areas: chronic disease prevention, community violence prevention, and educational intervention. To emphasize consistency with D&I priorities, the discussion of the value of each method is framed around the elements of the established Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. CONCLUSION: Systems science methods can help researchers, public health decision makers, and program implementers to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.

Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.
Non UofA Access
Kaplan HC, Sherman SN, Cleveland C, Goldenhar LM, Lannon CM, Bailit JL.
BMJ quality & safety 2015 Jun 8

Antenatal corticosteroids (ANCS) reduce complications of preterm birth; however, not all eligible women receive them. Many hospitals and providers do not have the right processes and conditions to enable ANCS administration with high reliability. The objective of this study was to understand conditions that enable delivery of ANCS with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project. METHODS: We conducted focus groups and semistructured interviews with members of the OPQC project team (n=27) and other care providers (n=70) using a purposeful sample of 6 sites involved in the OPQC ANCS project. Participants including nurses (n=57), attending obstetricians (n=17), physician trainees (n=21) and certified nurse midwives (n=2) were asked to reflect on their experiences and to identify factors contributing to optimal use of ANCS. Focus groups and interviews were transcribed verbatim and were analysed by a multidisciplinary team using an iterative approach that combined inductive and deductive methods to identify and categorise themes. RESULTS: Six major themes supporting reliable implementation of ANCS at these hospitals emerged including: (1) presence of a high reliability culture, (2) processes that emphasise high reliability, (3) timely and efficient administration process, (4) multiple disciplines are involved, (5) evidence of benefit supports ANCS use and (6) benefit is recognised at all levels of the care team. CONCLUSIONS: Our findings identify the key processes and supports needed to ensure delivery of ASCS with high reliability and are reinforced by implementation and reliability science. They are useful for foundation of the successful implementation of other evidence-based practices at high levels of reliability.

International “best practices” in health care: the roles of context and innovation.
Non UofA Access
Goes J, Savage GT, Friedman LH.
Advances in health care management 2015;17:31-35

Explores recent approaches to international best practices and how they relate to context and innovation in health services. DESIGN/METHODOLOGY/APPROACH: Critical review of existing research on best practices and how they created, diffused, and translate in the international setting. FINDINGS: Best practices are widely used and discussed, but processes by which they are developed and diffused across international settings are not well understood. RESEARCH IMPLICATIONS: Further research is needed on innovation and dissemination of best practices internationally. ORIGINALITY/VALUE: This commentary points out directions for future research on innovation and diffusion of best practices, particularly in the international setting.

Variables associated to quality of life among nursing home patients with dementia
Non UofA Access
Mjorud M, Kirkevold M, Rosvik J, Selbaek G, Engedal K.
Aging & mental health 2014;18(8):1013-1021

To study which variables are associated with quality of life (QOL) in persons with dementia (PWD) living in nursing homes (NHs). METHODS: A cross-sectional study included 661 PWD living in NH. To measure QOL the quality of life in late-stage dementia scale (QUALID) was applied. Other scales were: the clinical dementia rating scale (CDR), physical self-maintenance scale (PSMS), and neuropsychiatric inventory questionnaire (NPI-Q). RESULTS: The patients’ mean age was: 86.9 (SD 7.7), 472 (71.4%) were women. Of all, 22.5% had CDR 1, 33.6% had CDR 2, and 43.9% had CDR 3. The mean PSMS score was 18.2 (SD 5.0), 43.1% lived in special care units, 56.9% in regular units. In a linear regression analysis NPI-affective score (β = 0.360, p-value < 0.001), NPI-agitation score (β = 0.268, p-value < 0.001), PSMS total score (β = 0.181, p-value < 0.001), NPI-apathy (β = 0.144, p-value < 0.001), NPI psychosis (β = 0.085, p-value 0.009), CDR sum of boxes score (β = 0.081, p-value 0.026) were significantly associated with QUALID total score (explained variance 44.5%). CONCLUSION: Neuropsychiatric symptoms, apathy, severity of dementia, and impairment in activities in daily living are associated with reduced QOL in NH patients with dementia.

Implementing administrative evidence based practices: lessons from the field in six local health departments across the United States.
Non UofA Access
Duggan K, Aisaka K, Tabak RG, Smith C, Erwin P, Brownson RC.
BMC health services research 2015 Jun 6;15:221-015-0891-3

Administrative evidence based practices (A-EBPs) are agency level structures and activities positively associated with performance measures (e.g., achieving core public health functions, carrying out evidence-based interventions). The objectives of this study were to examine the contextual conditions and explore differences in local health department (LHD) characteristics that influence the implementation of A-EBPs. METHODS: Qualitative case studies were conducted based on data from 35 practitioners in six LHDs across the United States. The sample was chosen using an A-EBP score from our 2012 national survey and was linked to secondary data from the National Public Health Performance Standards Program. Three LHDs that scored high and three LHDs that scored low on both measures were selected as case study sites. The 37-question interview guide explored LHD use of an evidence based decision making process, including A-EBPs and evidence-based programs and policies. Each interview took 30-60 min. Standard qualitative methodology was used for data coding and analysis using NVivo software. RESULTS: As might be expected, high-capacity LHDs were more likely to have strong leadership, partnerships, financial flexibility, workforce development activities, and an organizational culture supportive of evidence based decision making and implementation of A-EBPs. They were also more likely to describe having strong or important relationships with universities and other educational resources, increasing their access to resources and allowing them to more easily share knowledge and expertise. CONCLUSIONS: Differences between high- and low-capacity LHDs in A-EBP domains highlight the importance of investments in these areas and the potential those investments have to contribute to overall efficiency and performance. Further research may identify avenues to enhance resources in these domains to create an organizational culture supportive of A-EBP

The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: Mixed-methods survey and interview study
Non UofA Access
Tunnecliff J, Ilic D, Morgan P, Keating J, Gaida JE, Clearihan L, et al.
Journal of medical Internet research 2015 May 20;17(5):e119

The aim of this study was to explore health researchers’ and clinicians’ current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. METHODS: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. RESULTS: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information. CONCLUSIONS: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice.

Attitudes, Perceptions and Utilization of Evidence-Based Practices in Residential Care
Non UofA Access
James S, Thompson R, Ross J, Sternberg N, Schnur E, Butler L, et al.
Residential Treatment for Children & Youth 2015 06/09; 2015/06

This study reports on results of a national survey conducted in the United States about the attitudes, perceptions and utilization of evidence-based practices (EBPs) in residential care settings. Seventy-five of 118 member agencies (63.6% response rate) of a voluntary national residential care association responded to a web-administered structured survey, which included the Evidence-Based Practices Attitude Scale. Results show overwhelmingly positive attitudes toward EBPs. Concerns were reported mainly with regard to cost and impeding a client-driven practice approach. The study also showed a high degree of utilization of EBPs with over 88% of programs reporting the use of at least one practice they considered to be evidence-based. Altogether 53 different practices were reported although it is unknown at this point whether practices were delivered with fidelity. Behaviorally-based and trauma-focused interventions constituted the most common interventions used by residential care agencies. Practices were subsequently validated against four national clearinghouse sites, indicating that only slightly over half of all reported practices had been evaluated by at least one clearinghouse and rated as having some research evidence for effectiveness. Divergent views about what practices are evidence-based point to the need for continued discussion between the practice and research fields about conceptualizations of evidence.

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework
Non UofA Access
Little EA, Presseau J, Eccles MP.
Implementation science 2015 Jun 17;10(1):90-015-0280-7

Behavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change. There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication. METHODS: A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted. RESULTS: Nine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included “memory, attention and decision processes”, “knowledge”, “environmental context and resources”, “social influences” and “beliefs about consequences”. Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size. CONCLUSIONS: When explicit use of theory to inform interventions is absent, it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF. In osteoporosis management, this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions. This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic reviews of implementation interventions in other implementation contexts.

Identifying priorities in knowledge translation from the perspective of trainees: results from an online survey Canada-flat-icon
Newman K, Van Eerd D, Powell B, Urquhart R, Cornelissen E, Chan V, et al.
Implementation Science 2015;10(1):92

Background: The need to identify priorities to help shape future directions for research and practice increases as the knowledge translation (KT) field advances. Since many KT trainees are developing their research programs, understanding their concerns and KT research and practice priorities is important to supporting the development and advancement of KT as a field. Our purpose was to identify research and practice priorities in the KT field from the perspectives of KT researcher/practitioner trainees.FindingsSurvey response rate was 62 % (44/71). Participants were mostly Canadian graduate students, post-doctoral fellows, residents, and learners from various disciplines; the majority was from Ontario (44 %) and Quebec (20 %). Seven percent (5/71) were from other countries including USA, UK, and Switzerland. Seven main KT priority themes were identified: determining the effectiveness of KT strategies, technology use, increased key stakeholder involvement, context, theory, expand ways of inquiry, and sustainability. Conclusions: Overall, the priorities identified by the trainees correspond with KT literature and with KT experts’ views. The trainees appeared to push the boundaries of current KT literature with respect to creative use of communication technologies research.

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Health Care Administration and Organization

Dementia care in the context of primary care reform: an integrative review. Canada-flat-icon
Non UofA Access
Spenceley SM, Sedgwick N, Keenan J.
Aging & mental health 2015;19(2):107-120

The purpose of this review was to determine the influence of the growing body of evidence about the attributes of high-performing primary care systems on the literature related to the primary care of people living with dementia. METHODS: In this integrative review, we examined a broad range of published and grey literature (2000-2013) about the primary care of dementia, using a systematic approach set up in advance of the literature search. The review was guided by two questions: What are the evident models of primary care for dementia? How do the models line up with the other attributes of high-performing primary care? RESULTS: Three models were noted: carved-out, co-managed, and integrative-hub, all informed by different assumptions about the role of primary care in dementia. The models varied in alignment with the attributes of high-performing primary care, although we found very little attention to accessibility, relational continuity or comprehensiveness of care. CONCLUSIONS: We know what we need to pay attention to in building our primary care system – and no population will put the performance of primary care more to the test over the next two decades than the rapidly growing number of people who will be living with complex chronic conditions like dementia. Recent literature around primary care and dementia shows promise in attending to some of the attributes of high-performing primary care, yet much more work is needed if we are to truly leverage the potential value of primary care in addressing the needs of these complex and numerous future patients.

Nurses’ sensemaking of contradicting logics: An underexplored aspect of organisational work in nursing homes
Non UofA Access
Kristiansen M, Obstfelder A, Lotherington AT.
Scandinavian Journal of Management 2015

Organisational work, understood as the practices by which care services are organised, is often referred to as the glue in healthcare organisations. In response to healthcare reforms, organisational work in Norwegian nursing homes has undergone extensive changes. With increased standardisation and efficiency demands, new managerial logic often stands in stark contrast to traditional professional logic. Although organisational work is essential for all action in care, there is a lack of research on how contradicting logics influence organisational work in nursing homes. In this study, we combine the institutional logic perspective with sensemaking to demonstrate how nurses create new patterns and routines in organisational work. Our analysis indicates that contradicting logics create incongruous events that nurses attempt to clarify through sensemaking. To illustrate nurses’ sensemaking, we rely on new theoretical developments from the institutional logic perspective. The study contributes with a new understanding of nurses’ organisational work in nursing homes. In addition, by combining the institutional logic perspective with sensemaking, the study adds to previous knowledge in the institutional literature by demonstrating how sensemaking enables contradicting logics to co-exist. © 2015 Elsevier Ltd.

“Wish we would have known that!” Communication Breakdown Impedes Person-Centered Care.
Non UofA Access
Kolanowski A, Van Haitsma K, Penrod J, Hill N, Yevchak A.
The Gerontologist 2015 Jun;55 Suppl 1:S50-60

To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored. DESIGN AND METHODS: Participants were 59 staff from two nursing homes. Focus group methodology captured discussions in eight 1-hr sessions. Sessions were audiotaped and transcribed. Data were analyzed using qualitative content analysis to provide a comprehensive summary of real world context of implementing PCC. RESULTS: To deliver PCC staff identified a need for access to psychosocial/medical history of the resident and knowledge of strategies families used for managing BPSD in the past. However, resident information is not routinely shared with all staff and written documentation systems for communicating resident-specific information do not support the time-pressured work pattern of certified nursing assistants (CNAs). Word-of-mouth was considered more reliable and expedient than educational sessions. CNAs described themselves as visual learners who prefer educational programs addressing individual resident emergent behaviors and programs that are scheduled at dedicated times. IMPLICATIONS: To improve PCC the flow of information exchange requires: inclusion of all staff, particularly CNAs; systems of communication that consider the time and resource constraints of nursing homes; development of educational programs for BPSD that are responsive to staff learning styles; administrative investment in nursing leadership to effect these changes; and reimbursement approaches to encourage culture change investments. © The Author 2015.

Resilience and organisational empowerment among long-term care nurses: effects on patient care and absenteeism. Canada-flat-icon
Non UofA Access
Williams J, Hadjistavropoulos T, Ghandehari OO, Malloy DC, Hunter PV, Martin RR.
Journal of nursing management 2015 Jun 3

To study resilience among long-term care (LTC) nurses and its relationship to organisational empowerment, self-reported quality of care, perceptions of resident personhood (i.e. viewing another person as a person, implying respect) and absenteeism. BACKGROUND: Although resilience has been examined among nurses, it has not been studied in LTC nurses where resident rates of dementia are high, and nurses may experience stress affecting care and the way residents are perceived. METHOD: A sample of one hundred and thirty LTC nurses from across North America completed a series of questionnaires. RESULTS: Resilient nurses were more likely to report higher quality of care and to view residents as having higher personhood status (despite deteriorating cognitive function). Resilience was not predictive of absenteeism. Organisational empowerment did not add to the predictive power of resilience. CONCLUSIONS: Resilience is of importance in LTC nursing research and future studies could examine this construct in relation to objectively measured resident outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings suggest that interventions to improve LTC staff resilience would be important to pursue and that consideration should be given to resilience in optimizing the match between potential staff members and LTC positions. © 2015 John Wiley & Sons Ltd.

How Registered Nurses, Licensed Practical Nurses and Resident Aides Spend Time in Nursing Homes: An Observational Study Canada-flat-icon
Non UofA Access
McCloskey R, Donovan C, Stewart C, Donovan A.
International journal of nursing studies

Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. Objectives To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. Methods A multi-center cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data was collected by a research assistant who conducted 368 hours of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. Results Findings indicate staff activities vary across roles, sites and shifts. Licensed Practical Nurses (nursing assistants) have the greatest variation in their role while Registered Nurses have the least amount of variability. In some sites both Registered Nurses and Licensed Practical Nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. Conclusions There may be opportunities for Registered Nurses and Licensed Practical Nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting.

Future Demand For Long-Term Care Workers Will Be Influenced By Demographic And Utilization Changes.
Non UofA Access
Spetz J, Trupin L, Bates T, Coffman JM.
Health affairs (Project Hope) 2015 Jun 1;34(6):936-945

A looming question for policy makers is how growing diversity of the US elderly population and greater use of home and community-based services will affect demand for long-term care workers. We used national surveys to analyze current use and staffing of long-term care, project demand for long-term care services and workers through 2030, and assess how projections varied if we changed assumptions about utilization patterns. If current trends continue, the occupations anticipated to grow the most over the period are counselors and social workers (94 percent), community and social services workers (93 percent), and home health and personal care aides (88 percent). Alternative projections were computed for scenarios that assumed changing racial and ethnic patterns of long-term care use or shifts toward noninstitutional care. For instance, if Hispanics used services at the same rate as non-Hispanic blacks, the projected demand for long-term care workers would be 5 percent higher than if current trends continued. If 20 percent of nursing home care were shifted to home health services, total employment growth would be about 12 percent lower. Demographic and utilization changes would have little effect on projections of robust long-term care employment growth between now and 2030. Policy makers and educators should redouble efforts to create and sustainably fund programs to recruit, train, and retain long-term care workers.

Caring for acutely unwell older residents in residential aged care facilities: Perspectives of staff and general pracitioners.
Non UofA Access
Stokoe A, Hullick C, Higgins I, Hewitt J, Armitage D, O’Dea I.
Australasian journal on ageing 2015 Jun 9

To explore the challenges and facilitators of managing acutely unwell residents in their residential aged care facilities (RACF) and transferring RACF residents to the emergency department of a tertiary referral hospital in Australia. METHODS: This exploratory study used a qualitative descriptive approach incorporating structured focus group interviews with nursing staff from RACFs and General Practitioners (GPs) within the local area. Four focus groups were held with staff from RACFs and one with GPs who visited one or more of the facilities during 2010. The interview data were analysed for themes relating to the study aims. RESULTS: Findings revealed both challenges and facilitators associated with managing acutely unwell older people including, communication, nursing staffing mix and numbers, use of advanced care directives, responsibilities of GPs and awareness of community services. CONCLUSION: From these findings it is possible to make recommendations for alternative ways of practising and/or new models of care. © 2015 AJA Inc.

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Health Care Innovation and Quality Assurance

Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial.
Non UofA Access
Richter C, Berg A, Fleischer S, Kopke S, Balzer K, Fick EM, et al.
Implementation science 2015 Jun 4;10(1):82-015-0268-3

The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions. METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents’ quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study. DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers’ Perception of Quality of Care? A Cross-Sectional Study.
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Zuniga F, Ausserhofer D, Hamers JP, Engberg S, Simon M, Schwendimann R.
Journal of the American Medical Directors Association 2015 May 28

To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. DESIGN: Cross-sectional study. SETTING: National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. PARTICIPANTS: A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. MEASUREMENTS: Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. RESULTS: Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. CONCLUSIONS: Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes. Copyright © 2015 AMDA

The Role of Severe Dementia in Nursing Home Report Cards.
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Konetzka RT, Brauner DJ, Coca Perraillon M, Werner RM.
Medical care research and review 2015 May 27

Health care report cards are intended to improve quality, but there may be considerable heterogeneity in who benefits. In this article, we examine the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. Our results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures. After public reporting was initiated, outcomes for nursing home residents with severe dementia did not consistently improve or worsen. We see no evidence that individuals with severe dementia are being avoided by nursing homes, despite their potential negative impact on quality scores, but we do find an increase in coding of end-stage disease. Additional risk-adjustment, stratification, or additional quality measures may be warranted. © The Author(s) 2015.

Clinical Burden, Quality of Care, Organizational Context: Different Lenses to Optimize Care for Older People
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Wong RY.
Journal of the American Medical Directors Association 2015/06;16(6):444-445.

For many practitioners in geriatrics, the primary mission in caring for frail older people (especially those with dementia) is to optimize their quality of life. This is often achieved, at least in part, by reducing their clinical symptom burden, which is particularly relevant in end-of-life care. Although recent advances have focused on improving the pharmacologic and nonpharmacologic modalities of symptom reduction at the level of an individual patient, we must remember that a system-based approach to improve the quality-of-care provision can have a larger impact on groups of patients, and when such quality improvement results in an organizational or contextual change, the impact can become more sustainable over time.

Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net: a cluster-randomized trial.
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Gold R, Nelson C, Cowburn S, Bunce A, Hollombe C, Davis J, et al.
Implementation science 2015 Jun 10;10(1):83-015-0259-4

Integrated health care delivery systems devote considerable resources to developing quality improvement (QI) interventions. Clinics serving vulnerable populations rarely have the resources for such development but might benefit greatly from implementing approaches shown to be effective in other settings. Little trial-based research has assessed the feasibility and impact of such cross-setting translation and implementation in community health centers (CHCs). We hypothesized that it would be feasible to implement successful QI interventions from integrated care settings in CHCs and would positively impact the CHCs. METHODS: We adapted Kaiser Permanente’s successful intervention, which targets guideline-based cardioprotective prescribing for patients with diabetes mellitus (DM), through an iterative, stakeholder-driven process. We then conducted a cluster-randomized pragmatic trial in 11 CHCs in a staggered process with six “early” CHCs implementing the intervention one year before five “‘late” CHCs. We measured monthly rates of patients with DM currently prescribed angiotensin converting enzyme (ACE)-inhibitors/statins, if clinically indicated. Through segmented regression analysis, we evaluated the intervention’s effects in June 2011-May 2013. Participants included ~6500 adult CHC patients with DM who were indicated for statins/ACE-inhibitors per national guidelines. RESULTS: Implementation of the intervention in the CHCs was feasible, with setting-specific adaptations. One year post-implementation, in the early clinics, there were estimated relative increases in guideline-concordant prescribing of 37.6 % (95 % confidence interval (CI); 29.0-46.2 %) among patients indicated for both ACE-inhibitors and statins and 38.7 % (95 % CI; 23.2-54.2 %) among patients indicated for statins. No such increases were seen in the late (control) clinics in that period. CONCLUSIONS: To our knowledge, this was the first clinical trial testing the translation and implementation of a successful QI initiative from a private, integrated care setting into CHCs. This proved feasible and had significant impact but required considerable adaptation and implementation support. These results suggest the feasibility of adapting diverse strategies developed in integrated care settings for implementation in under-resourced clinics, with important implications for efficiently improving care quality in such settings. CLINICALTRIALS.GOV: NCT02299791 .

An examination of quality of care in Norwegian nursing homes – a change to more activities?
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Kjos BO, Havig AK.
Scandinavian journal of caring sciences 2015 Jun 8

Studies on Norwegian nursing homes have shown that the general care is at a relatively high level, while the level of physical and social activities is relatively low. As a response to these findings, the Norwegian government has stressed the importance of activities in various white papers and circulars and, in recent years, has launched several campaigns specifically aimed at increasing the level of activities. AIM: The aim of the study was to examine the following: (i) how the government has succeeded in increasing the level of physical and social activities in Norwegian nursing homes; (ii) how the level of activities compares to the general care; and (iii) how the level of activities and the general care are influenced by the following facility characteristics: residents’ mobility level, total staffing levels, ratio of RNs, ratio of unlicensed staff and ward size. METHOD: A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. RESULTS: On a scale ranging from 1 to 7, the staff members assess the activity dimension to be 4.31 and the general care dimension to be 5.66. The activity dimension was significantly negatively correlated with the ratio of unlicensed staff, the ratio of Registered Nurses and the residents’ mobility level, while the general care dimension was significantly negatively correlated with the ratio of unlicensed staff. CONCLUSION: The study shows that the level of physical and social activities offered to the residents is relatively low, while the general care level is significantly higher, in line with earlier studies. Consequently, the government has not succeeded with its current policy to increase the level of activities in nursing homes. The relationship between the two quality dimensions and the explanatory variables shows that nursing home quality is a complicated phenomenon. © 2015 Nordic College of Caring Science.

Putting Residents First: Strategies Developed by CNAs to Prevent and Manage Resident-to-Resident Violence in Nursing Homes.
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Snellgrove S, Beck C, Green A, McSweeney JC.
The Gerontologist 2015 Jun;55 Suppl 1:S99-S107

Resident-to-resident violence (RRV) in nursing homes (NHs) is common and threatens the safety and quality of life of both residents and caregivers. The purpose of this portion of a larger qualitative study was to explore strategies developed by certified nurses’ assistants (CNAs) to prevent and manage RRV in NHs. DESIGN AND METHODS: Semistructured interviews were used to collect data. Data were analyzed utilizing content analysis and constant comparison. RESULTS: Analysis revealed one overriding theme, “Putting Residents First” which the CNAs described as a conscious effort to put themselves or a beloved family member in the place of the resident while administering care. Within this theme, there were three related subthemes: (a) Knowing the Residents, (b) Keeping Residents Safe, and (c) Spending Quality Time. IMPLICATIONS: Together, these themes suggest that the formulation of strategies for decreasing and managing RRV was influenced significantly by the ability of the CNAs to empathize with the residents for whom they were caring. The results indicate that in the absence of evidence-based interventions, CNAs have developed their own strategies for the management and prevention of RRV. These strategies may provide a foundation for the development and testing of interventions aimed at preventing and managing RRV in NHs. © The Author 2015.

Safety of Rural Nursing Home-to-Emergency Department Transfers: Improving Communication and Patient Information Sharing Across Settings.
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The “siloed” approach to healthcare delivery contributes to communication challenges and to potential patient harm when patients transfer between settings. This article reports on the evaluation of a demonstration in 10 rural communities to improve the safety of nursing facility (NF) transfers to hospital emergency departments by forming interprofessional teams of hospital, emergency medical service, and NF staff to develop and implement tools and protocols for standardizing critical interfacility communication pathways and information sharing. We worked with each of the 10 teams to document current communication processes and information sharing tools and to design, implement, and evaluate strategies/tools to increase effective communication and sharing of patient information across settings. A mixed methods approach was used to evaluate changes from baseline in documentation of patient information shared across settings during the transfer process. Study findings showed significant improvement in key areas across the three settings, including infection status and baseline mental functioning. Improvement strategies and performance varied across settings; however, accurate and consistent information sharing of advance directives and medication lists remains a challenge. Study results demonstrate that with neutral facilitation and technical support, collaborative interfacility teams can assess and effectively address communication and information sharing problems that threaten patient safety.

Scoping review of physical rehabilitation interventions in long-term care: protocol for tools, models of delivery, outcomes and quality indicators. Canada-flat-icon
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McArthur C, Gibbs J, Papaioannou A, Hirdes J, Milligan J, Berg K, et al.
BMJ open 2015 Jun 8;5(6):e007528-2014-007528

A growing number of medically complex older adults reside in long-term care (LTC) and often require physical rehabilitation (PR). While PR is effective at maintaining or improving a patient’s physical function, the breadth of PR interventions evaluated in LTC, which outcomes or quality indicators (QI) can be used to evaluate PR, and what tools or models can be used to determine eligibility for PR services remain unknown. METHODS AND ANALYSIS: A scoping review will be conducted to address the following research questions: (1) What types of PR have been evaluated for efficacy or effectiveness in LTC? (2) Which outcomes or QIs have been used when evaluating PR interventions in LTC, and how can this inform evaluation of PR using existing QIs in the Canadian context? (3) What tools or models exist or have been validated for decision-making in the allocation of PR resources in LTC? We will conduct a comprehensive literature search in MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Physiotherapy Evidence Database (PEDro) and Occupational Therapy Systematic Evaluation of Evidence database (OTseeker) and a structured grey literature search. Two team members will screen articles and abstract the data. The results will be displayed according to the research question they address. Data abstracted regarding outcomes and QIs will be mapped onto existing, publicly reported QIs used in Ontario, Canada. ETHICS AND DISSEMINATION: The scoping review will synthesise the characteristics of PR interventions described in the literature, the outcomes used to evaluate them and tools to determine eligibility for services. The review will be the first step in formally identifying what outcomes and QIs have been used to evaluate PR in LTC, and will be used to inform a stakeholder consensus process exploring the same question. The scoping review may also identify knowledge gaps. The results will be disseminated via publication and presentation at conferences, in addition to a 1-day stakeholder meeting.

A cross-sectional survey to investigate the quality of care in Tuscan (Italy) nursing homes: the structural, process and outcome indicators of nutritional care.
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Bonaccorsi G, Collini F, Castagnoli M, Di Bari M, Cavallini MC, Zaffarana N, et al.
BMC health services research 2015 Jun 6;15:223-015-0881-5

Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear. Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk. METHODS: A cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors. RESULTS: Out of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians. Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56-0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk. CONCLUSIONS: Of all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs.

Measuring nursing assistants’ knowledge, skills and attitudes in a palliative approach: A literature review.
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Karacsony S, Chang E, Johnson A, Good A, Edenborough M.
Nurse education today 2015 May 21

Nursing assistants are the largest aged care workforce providing care to older people in residential aged care facilities. Although studies have focused on their training and development needs when providing a palliative approach, a valid and reliable instrument to evaluate their knowledge, skills and attitudes is required. AIMS: To examine what instruments have been used to evaluate nursing assistants’ knowledge of, skills in and attitudes towards a palliative approach in residential aged care facilities, critically evaluate development processes, and discuss the strengths and limitations of existing instruments for this population. METHODS: CINAHL, the Cochrane Library, ERIC, MEDLINE, PubMed, Scopus and Web of Science were searched using key words. Selected articles were published in English in the period 2004-2014 and included instruments which evaluated nursing assistants and a palliative approach. RESULTS: Ten studies using seven instruments met the inclusion criteria. One of these instruments measured nursing assistants’ level of comfort in providing end-of-life care. The six remaining instruments measured palliative care knowledge, palliative care practice, self-efficacy, knowledge and attitudes towards people with advanced dementia, beliefs and attitudes to death, dying, palliative and interdisciplinary care across the aged care workforce. CONCLUSION: Seven instruments have been used to evaluate nursing assistants’ knowledge, skills and attitudes in a palliative approach. Instrument design and recommended psychometric processes for development limit specificity and usefulness of these instruments for nursing assistants’ scope of practice. Adhering to recommended psychometric processes will increase the validity and reliability of an instrument tailored to this population and a palliative approach. Copyright © 2015 Elsevier Ltd.

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.
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McAlearney AS, Terris D, Hardacre J, Spurgeon P, Brown C, Baumgart A, et al.
Quality management in health care 2014 Oct-Dec;23(4):254-267

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. METHODS: We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. RESULTS AND CONCLUSIONS: We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Development of the Austrian Nursing Minimum Data Set (NMDS-AT): The Third Delphi Round, a Quantitative Online Survey.
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Ranegger R, Hackl WO, Ammenwerth E.
Studies in health technology and informatics 2015;212:73-80

Very little is known about predictors of response rates to long-term follow-up mail-out surveys, including whether the timing of an incentive affects response rates. We aimed to determine whether the timing of the incentive affects response rates and what baseline demographic and psychological factors predict response rates to a 12 year follow-up survey. STUDY DESIGN AND SETTING: Participants were 450 randomly selected people from the Penrith population, Australia who had previously participated in a mail-out survey 12 years earlier. By random allocation, 150 people received no incentive, 150 received a lottery ticket inducement with the follow-up survey and 150 received a lottery ticket inducement on the return of a completed survey. RESULTS: The overall response rate for the study was 63%. There were no significant differences in terms of response rates between the no incentive (58.8%;95%CI 49.8%,67.3%), incentive with survey (65.1%;95%CI 56.2%,73.3%) and promised incentive (65.3%;95%CI 56.1%,73.7%) groups. Independent predictors of responding to the 12 year survey were being older (OR=1.02, 95%CI 1.01,1.05,P=0.001) and being less neurotic as reported on the first survey 12 years earlier (OR=0.92, 95%CI 0.86,0.98, P=0.010).

The problem with checklists.
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Catchpole K, Russ S.
BMJ quality & safety 2015 Jun 18.

Since the seminal studies by Gawande and colleagues and Pronovost et al,checklists have become the go-to solution for a vast range of patient safety and quality issues in healthcare. Some see them as a quick and obvious solution to a relatively straightforward problem. For others, they illustrate a failure to understand and address the complex challenges in patient safety and quality improvement. Indeed, successes and failures illustrate an underlying difficulty with understanding precisely why checklists work in some cases but not in others.

Managing for quality aged residential care with a migrant workforce
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Ngocha-Chaderopa NE, Boon B.
Journal of Management & Organization 2015;FirstView:1-17

Given the growing demand for aged residential care facilities in Western industrialised economies, the adequate staffing of these facilities is a growing concern. Increasingly migrant care workers are being employed to fill the local labour shortfall. In this paper we present findings of a qualitative study exploring how managers of aged residential care facilities work to ensure consistent delivery of quality care through their migrant care workers. The issues raised by the 16 managers cluster around three themes: communication and language barriers; racism by residents, families and managers; and underemployment of tertiary qualified migrant care workers. In addition to issues of quality care delivery, concerns around migrant employee well-being are seen to be difficult to avoid.

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Research Practice and Methodology

Privacy Preserving Probabilistic Record Linkage (P3RL): a novel method for linking existing health-related data and maintaining participant confidentiality.
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Schmidlin K, Clough-Gorr KM, Spoerri A, SNC study group.
BMC medical research methodology 2015 May 30;15(1):46

Record linkage of existing individual health care data is an efficient way to answer important epidemiological research questions. Reuse of individual health-related data faces several problems: Either a unique personal identifier, like social security number, is not available or non-unique person identifiable information, like names, are privacy protected and cannot be accessed. A solution to protect privacy in probabilistic record linkages is to encrypt these sensitive information. Unfortunately, encrypted hash codes of two names differ completely if the plain names differ only by a single character. Therefore, standard encryption methods cannot be applied. To overcome these challenges, we developed the Privacy Preserving Probabilistic Record Linkage (P3RL) method. METHODS: In this Privacy Preserving Probabilistic Record Linkage method we apply a three-party protocol, with two sites collecting individual data and an independent trusted linkage center as the third partner. Our method consists of three main steps: pre-processing, encryption and probabilistic record linkage. Data pre-processing and encryption are done at the sites by local personnel. To guarantee similar quality and format of variables and identical encryption procedure at each site, the linkage center generates semi-automated pre-processing and encryption templates. To retrieve information (i.e. data structure) for the creation of templates without ever accessing plain person identifiable information, we introduced a novel method of data masking. Sensitive string variables are encrypted using Bloom filters, which enables calculation of similarity coefficients. For date variables, we developed special encryption procedures to handle the most common date errors. The linkage center performs probabilistic record linkage with encrypted person identifiable information and plain non-sensitive variables. RESULTS: In this paper we describe step by step how to link existing health-related data using encryption methods to preserve privacy of persons in the study. CONCLUSION: Privacy Preserving Probabilistic Record linkage expands record linkage facilities in settings where a unique identifier is unavailable and/or regulations restrict access to the non-unique person identifiable information needed to link existing health-related data sets. Automated pre-processing and encryption fully protect sensitive information ensuring participant confidentiality. This method is suitable not just for epidemiological research but also for any setting with similar challenges.

Methodological and Epistemological Considerations in Utilizing Qualitative Inquiry to Develop Interventions. Canada-flat-icon
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Duggleby W, Williams A.
Qualitative health research 2015 Jun 10

The purpose of this article is to discuss methodological and epistemological considerations involved in using qualitative inquiry to develop interventions. These considerations included (a) using diverse methodological approaches and (b) epistemological considerations such as generalization, de-contextualization, and subjective reality. Diverse methodological approaches have the potential to inform different stages of intervention development. Using the development of a psychosocial hope intervention for advanced cancer patients as an example, the authors utilized a thematic study to assess current theories/frameworks and interventions. However, to understand the processes that the intervention needed to target to affect change, grounded theory was used. Epistemological considerations provided a framework to understand and, further, critique the intervention. Using diverse qualitative methodological approaches and examining epistemological considerations were useful in developing an intervention that appears to foster hope in patients with advanced cancer.
© The Author(s) 2015.

Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support
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Proctor E, Luke D, Calhoun A, McMillen C, Brownson R, McCrary S, et al.
Implementation science 2015 Jun 11;10(1):88

Little is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work. METHODS: A multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care. RESULTS: Prompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research. CONCLUSIONS: Implementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence about the value of sustaining interventions over time, identifying correlates of sustainability along with strategies for sustaining evidence-supported interventions, advancing the theoretical base and research designs for sustainability research, and advancing the workforce capacity, research culture, and funding mechanisms for this important work.

The SQUIRE Guidelines: an evaluation from the field, 5 years post release.
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Davies L, Batalden P, Davidoff F, Stevens D, Ogrinc G.
BMJ quality & safety 2015 Jun 18

The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines were published in 2008 to increase the completeness, precision and accuracy of published reports of systematic efforts to improve the quality, value and safety of healthcare. Since that time, the field has expanded. We asked people from the field to evaluate the Guidelines, a novel approach to a first step in revision. METHODS: Evaluative design using focus groups and semi-structured interviews with 29 end users and an advisory group of 18 thinkers in the field. Sampling of end users was purposive to achieve variation in work setting, geographic location, area of expertise, manuscript writing experience, healthcare improvement and research experience. RESULTS: Study participants reported that SQUIRE was useful in planning a healthcare improvement project, but not as helpful during writing because of redundancies, uncertainty about what was important to include and lack of clarity in items. The concept “planning the study of the intervention” (item 10) was hard for many participants to understand. Participants varied in their interpretation of the meaning of item 10b “the concept of the mechanism by which changes were expected to occur”. Participants disagreed about whether iterations of an intervention should be reported. Level of experience in writing, knowledge of the science of improvement and the evolving meaning of some terms in the field are hypothesised as the reasons for these findings. CONCLUSIONS: The original SQUIRE Guidelines help with planning healthcare improvement work, but are perceived as complicated and unclear during writing. Key goals of the revision will be to clarify items where conflict was identified and outline the key components necessary for complete reporting of improvement work.

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Aging

Physical and Psychological Distress Are Related to Dying Peacefully in Residents With Dementia in Long-Term Care Facilities.
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De Roo ML, Albers G, Deliens L, de Vet HC, Francke AL, Van Den Noortgate N, et al.
Journal of pain and symptom management 2015 Apr 4

Although dying peacefully is considered an important outcome of high-quality palliative care, large-scale quantitative research on dying peacefully and the factors associated with a peaceful death is lacking. OBJECTIVES: To gain insight into how many residents with dementia in long-term care facilities die peacefully, according to their relatives, and whether that assessment is correlated with observed physical and psychological distress. METHODS: This was a retrospective cross-sectional study of deceased nursing home residents in a representative sample of long-term care facilities in Flanders, Belgium (2010). Structured post-mortem questionnaires were completed by relatives of the resident, who were asked to what extent they agreed that the resident “appeared to be at peace” during the dying process. Spearman correlation coefficients gave the correlations between physical and psychological distress (as measured using the Symptom Management at the End of Life with Dementia and Comfort Assessment in Dying at the End of Life with Dementia scales) and dying peacefully (as measured using the Quality of Dying in Long Term Care instrument). RESULTS: The sample comprised 92 relatives of deceased residents with dementia. In 54% of cases, relatives indicated that the resident died peacefully. Weak-to-moderate correlations (0.2-0.57) were found between dying peacefully and physical distress in the last week of life. Regarding psychological distress, weak-to-moderate correlations were found for both the last week (0.33-0.44) and last month of life (0.28-0.47). CONCLUSION: Only half of the residents with dementia died peacefully as perceived by their relatives. Relatives’ assessment of whether death was peaceful is related to both physical and psychological distress. Further qualitative research is recommended to gain more in-depth insights into the aspects on which relatives base their judgment of dying peacefully. Copyright © 2015

Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center
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D’Souza MF, Davagnino J, Hastings SN, Sloane R, Kamholz B, Twersky J.
Journal of the American Geriatrics Society 201

Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran’s Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community-dwelling individuals with dementia aged 65 and older who received primary care in the medical center’s outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow-up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home-based

Cognitive Fluctuations as a Challenge for the Assessment of Decision-Making Capacity in Patients With Dementia.
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Trachsel M, Hermann H, Biller-Andorno N.
American Journal of Alzheimer’s Disease and Other Dementias 2014 Jun 18

Decision-making capacity (DMC) is an indispensable prerequisite for medical treatment choices, including consent to treatment, treatment discontinuation, and refusal of treatment. In patients with dementia, DMC is often affected. A particular challenge in assessing DMC are cognitive fluctuations that may lead to a fluctuation in DMC as well. Cognitive fluctuations are a diagnostic core feature of dementia with Lewy bodies and occur in Parkinson’s and Alzheimer’s diseases. In this article, these challenges are discussed and suggestions for assessing the DMC of patients with dementia with cognitive fluctuations are presented.

Activity involvement and quality of life of people at different stages of dementia in long term care facilities.
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Smit D, de Lange J, Willemse B, Twisk J, Pot AM.
Aging & mental health 2015 Jun 2:1-10

Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account. METHOD: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses. RESULTS: Despite resident’s cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small. CONCLUSION: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement.

Systematic review and meta-analysis of the impact of carer stress on subsequent institutionalisation of community-dwelling older people.
Non UofA Access
Donnelly NA, Hickey A, Burns A, Murphy P, Doyle F.
PloS one 2015 Jun 2;10(6):e0128213

In the caregiving literature there is a common assertion that a higher level of carer stress is a critical determinant of premature ending of homecare. However, this contention has not been systematically assessed. We therefore systematically reviewed and meta-analysed the prospective association between various forms of carer stress and subsequent institutionalisation of community-dwelling older people. METHODS: Systematic literature search of prospective studies measuring carer stress at baseline and institutionalisation at follow-up. Given substantial interchangeability in the measurement of carer stress, we included a wide number of exposure measures, namely: carer stress, burden, depression, distress, anxiety, burnout, and strain. Institutionalisation included both acute and long-term care utilisation. The standardised mean difference between stressed and non-stressed carers was the primary measure of effect. We assessed study quality with the Crowe Critical Appraisal Tool (CCAT). Pre-planned sensitivity analysis included examination of estimates according to study size; decade published; study quality according to quartiles of CCAT scores; population; follow-up period; study design and impact of adjusted or unadjusted estimates. RESULTS: The search yielded 6,963 articles. After exclusions, we analysed data from 54 datasets. The meta-analysis found that while carer stress has a significant effect on subsequent institutionalisation of care recipients, the overall effect size was negligible (SMD=0·05, 95% CI=0·04-0·07). Sensitivity analyses found that, the effect size was higher for measurements of stress than for other measures, though still relatively small (SMD=0·23, 95% CI=0·09-0·38). Thus, whether analysing the association between carer stress, burden, distress, or depression with either acute or long-term care, the effect size remains small to negligible. Concurrently, we found estimates reduce over time and were smaller with larger studies and those of higher quality, according to the CCAT scores. CONCLUSION: Despite strong statements to the contrary, it appears that the effect of carer stress on subsequent care recipient institutionalisation is small to negligible. The current findings point to a biased literature, with significant small study effects. The results suggest a need to re-evaluate the degree to which carer stress predicts premature ending of home care. Concurrently, other factors may be more crucial in institutional placement than carer stress and should be investigated.

Factors Related to Rejection of Care and Behaviors Directed towards Others: A Longitudinal Study in Nursing Home Residents with Dementia.
Non UofA Access
Galindo-Garre F, Volicer L, van der Steen JT.
Dementia and geriatric cognitive disorders extra 2015 Apr 10;5(1):123-134

The aim of this study was to analyze factors related to rejection of care and behaviors directed towards others in nursing home residents with dementia. METHODS: The relationship of lack of understanding, depression, psychosis and pain with rejection of care and behaviors directed towards others was explored using four assessments from the Minimum Data Set (MDS) within a period of 15 months on 1,101 residents with dementia in Dutch nursing homes. Presence of depressive symptoms was ascertained using a validated MDS scale, and presence of lack of understanding, rejection of care, psychosis and pain through the individual MDS items. A structural equation modeling approach and latent growth models were used to investigate the longitudinal relationship between changes in rejection of care and physical or verbal behaviors directed towards others, and changes in lack of understanding, pain, depression and psychotic symptoms. RESULTS: Changes in lack of understanding predicted changes in rejection of care, and there was also a relationship between changes in depression and rejection of care. Changes of behaviors directed towards others were related to changes in lack of understanding and depression. Pain and behaviors directed towards others were unrelated, and psychosis was rather stable throughout. A mediation model suggested that the relationship of lack of understanding with behaviors directed towards others was mediated by rejection of care. CONCLUSION: These results indicate that lack of understanding and depression are important factors in development of rejection of care and behaviors directed towards others. The relationship between lack of understanding and behaviors directed towards others is mediated by rejection of care. Improvement in communication between residents and caregivers, and perhaps also effective treatment of depression may prevent or ameliorate these behaviors directed towards others.

Restorative Care’s Effect on Activities of Daily Living Dependency in Long-stay Nursing Home Residents.
Non UofA Access
Talley KM, Wyman JF, Savik K, Kane RL, Mueller C, Zhao H.
The Gerontologist 2015 Jun;55 Suppl 1:S88-98

PURPOSE OF THE STUDY: (a) Identify the prevalence of nursing homes providing Medicare supported restorative care programs and of long stay participants, (b) compare characteristics between restorative care participants and nonparticipants, and (c) assess restorative care’s effect on change in activities of daily living (ADL) dependency. DESIGN AND METHODS: Longitudinal analysis of Minimum Data Set assessments linked to the 2004 National Nursing Home Survey using a sample of 7,735 residents, age ≥ 65 years living in 1,097 nursing homes for at least 6 months. Receipt of any restorative care was used as a time varying predictor to estimate change in ADL dependency over 18 months using linear mixed models. RESULTS: The sample was 75% female, 89% non-Hispanic White, with a mean age of 85±8, and average length of stay of 3.2±3.4 years. Most nursing homes had restorative care programs (67%), but less than one-third of long-stay residents participated. After controlling for resident and nursing home characteristics, the predicted mean ADL dependency score (range 0-28) at baseline was 18 for restorative care participants and 14 for nonparticipants. Over 18 months, ADL dependency increased 1 point for both participants and nonparticipants (p = .12). IMPLICATIONS: A minority of long-stay residents participated in Medicare supported restorative care programs despite their availability and potential benefits. Even though participants had greater vulnerability for deterioration in physical, mental, and functional health than nonparticipants, both groups had similar rates of ADL decline. Future research is needed to determine if providing restorative care to less dependent long-stay residents is effective.

The Impact of Medicaid Payer Status on Hospitalizations in Nursing Homes.
Non UofA Access
Cai S, Miller SC, Nelson DL, Mukamel DB.
Medical care 2015 Jul;53(7):574-581

To examine the association between payer status (Medicaid vs. private-pay) and the risk of hospitalizations among long-term stay nursing home (NH) residents who reside in the same facility. DATA AND STUDY POPULATION: The 2007-2010 National Medicare Claims and the Minimum Data Set were linked. We identified newly admitted NH residents who became long-stayers and then followed them for 180 days. ANALYSES: Three dichotomous outcomes-all-cause, discretionary, and nondiscretionary hospitalizations during the follow-up period-were defined. Linear probability model with facility fixed-effects and robust SEs were used to examine the within-facility difference in hospitalizations between Medicaid and private-pay residents. A set of sensitivity analyses were performed to examine the robustness of the findings. RESULTS: The prevalence of all-cause hospitalization during a 180-day follow-up period was 23.3% among Medicaid residents compared with 21.6% among private-pay residents. After accounting for individual characteristics and facility effects, the probability of any all-cause hospitalization was 1.8-percentage point (P<0.01) higher for Medicaid residents than for private-pay residents within the same facility. We also found that Medicaid residents were more likely to be hospitalized for discretionary conditions (5% increase in the likelihood of discretionary hospitalizations), but not for nondiscretionary conditions. The findings from the sensitivity analyses were consistent with the main analyses. CONCLUSIONS: We observed a higher hospitalization rate among Medicaid NH residents than private-pay residents. The difference is in part driven by the financial incentives NHs have to hospitalize Medicaid residents.

Unplanned Transfer to Emergency Departments for Frail Elderly Residents of Aged Care Facilities: A Review of Patient and Organizational Factors.
Non UofA Access
Dwyer R, Stoelwinder J, Gabbe B, Lowthian J.
Journal of the American Medical Directors Association 2015 Apr 28

With an aging population, a growing number of older adults experience physical or cognitive decline that necessitates admission to residential aged care facilities (RACF). Each year a considerable proportion of these residents has at least 1 emergency transfer to hospital, which may result in a number of adverse outcomes. Rates of transfer from RACF to hospital can vary considerably between different RACFs suggesting the presence of potentially modifiable risk factors for emergency department (ED) transfer. METHODS: A systematic and comprehensive search of the peer-reviewed literature using 4 electronic databases was conducted. Included papers were those reporting on determinants of unplanned transfer to hospital for elderly people (aged 65 years and above) living in RACFs. Studies were assessed for quality and key concepts and themes extracted. RESULTS: There are both individual patient factors and health system factors, which influence rates of transfer to hospital for elderly RACF residents. For individuals, increased risk of ED transfer has been associated with presence of particular comorbidities such as chronic airways disease, congestive cardiac failure, and diabetes; presence of indwelling devices; absence of an advance care plan; and reduced functional ability. For organizations, “for profit” facilities and those with poorer staff to patient ratios also have higher rates of transfer to hospital, compared with those owned by not-for-profit organizations and those with improved registered nurse and medical practitioner staffing. CONCLUSIONS: This review has identified a number of potentially modifiable patient and organizational factors that should reduce the need for burdensome transfer to the ED and improve the quality of both acute care and end-of-life care for this population of frail, elderly individuals. A number of these determinants, including facility staffing, the role of specialist geriatricians, and advance directives, should be further examined, ideally through interventional trials to evaluate their impact on the pre-hospital and emergency management of these patients. Copyright © 2015 AMDA

Mobilizing Action – Family Caregivers in Canada Canada-flat-icon
Canadian Cancer Action Network, Canadian Home Care Association, Canadian Caregiver Coalition
2015

A national action plan for caregivers has been released. Mobilizing Action – Family Caregivers in Canada is an integrated and shared plan to address the physical, psychosocial and financial needs of family caregivers. Over sixty organizations across Canada have built upon this plan. Many health care providers, community organizations, researchers, employers, government members and caregivers have shared their knowledge and experience in the development of this plan.

A Road Less Rocky – Supporting Carers of People with Dementia (UK)
Carers Trust, 2015

This report from the Carers Trust found that carers of people with dementia are not getting the support and advice they often desperately need. It makes recommendations to policy makers and commissioners on how to improve the support for carers of people with dementia.

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Courses

MSc in Implementation and Improvement Science
King’s College London, UK

MSc Implementation and Improvement Science is aimed at those who need to design, evaluate and research robust implementation and improvement science programmes. The course is aimed at those from health, policy, NGO and government sector, including health and social science researchers both in the UK and working in an international context.

Workshop on Writing and Giving Outstanding Presentations
Wilson Centre, Toronto 3-4 March 2016 $1100

Sea turtles can have a lifespan of over one hundred years. That is if they survive the first ten minutes. Turtle hatchlings, in their first moments of life have to make a perilous journey, from their nest on shore, to the safety of the ocean. About one in a thousand make it. In many ways this is how presentations work. An idea that makes it into an audience’s memory can have a very long life. That is, if it survives the first ten minutes.

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News

Muskoka dementia advocates lobby at Queen’s Park Canada-flat-icon

Despite a defeated national dementia strategy, the province of Ontario has committed to an Ontario Dementia Plan.

Use of anti-psychotic drugs for community dwelling seniors rising Canada-flat-icon

The use of anti-psychotic drugs by seniors in their own homes and other community settings in Ontario has jumped by a whopping 26 per cent in only five years, according to new research.

Safer care for new residents at Prince Albert’s Herb Bassett Home Canada-flat-icon

New residents being admitted to the Herb Bassett Home are now able to have their medications available when they arrive thanks to the work done by a Rapid Process Improvement Workshop team.

Modernization project in nursing homes will lead to more resident-centred care in New Brunswick Canada-flat-icon

The provincial government is investing $2.65 million through its Home First Strategy in new technology for nursing homes that will gather data on everything from what residents like to eat and the medications they take, to their spiritual and cultural needs.

More care needed for dementia patients, Manitoba judge rules Canada-flat-icon

A Manitoba judge is calling for secure units in all personal care homes to handle aggressive and violent patients with dementia.

Improving appropriateness of antipsychotic use in long-term care Canada-flat-icon

The problem of inappropriate and over prescribing of antipsychotics has recently been put back in the spotlight by a Health Quality Ontario report that demonstrates a wide variance in prescription rates across LTCHs in Ontario.

Playgrounds For Seniors Improve Fitness, Reduce Isolation

No more sitting around in the park feeding the squirrels. Playgrounds designed for seniors have caught on in Asia and Europe and are beginning to make their way across the Big Pond.

More Seniors, Much Sicker (US)

About 15 percent account for half of medicare spending. Two-thirds of traditional Medicare beneficiaries older than 65 have multiple chronic conditions, according to a USA TODAY analysis of county-level Medicare data. More than 4 million — about 15% — have at least six long-term ailments. Those sickest seniors account for more than 41% of the $324 billion spent on traditional Medicare.

Improving dementia care: CQUINS and Enhanced Services – Professor Alistair Burns (UK)

The uptake of the CQUIN has been excellent with the 90 percent target for each of the three stages of the Find, Assess/Investigate and Refer components of the direct clinical aspects of the scheme. There have also been more aspects of the process to changes in the CQUIN, which has also evolved to include, as far as we can, delirium.

Animation illustrates urgent need to revamp care for frail older people (UK)

The NHS Confederation’s independent Commission on Improving Urgent Care for Older People has launched an animation highlighting the challenges in providing urgent care for older people. The commission aims to find practical solutions for improving acute care for our frail older population.

Report finds both improvements and troubling trends in Alberta nursing home care Canada-flat-icon

A declining proportion of Albertans in nursing homes are physically restrained and prescribed anti-psychotic drugs, according to new quality measures released today.

Nutrition problems at Newfoundland & Labrador long-term care facilities outlined in AG report Canada-flat-icon

A number of issues were found when it comes to nutrition for residents at some long-term care facilities, including a lack of consistent policies and meals that were not in accordance with Canada’s Food Guide.

Massive rise in health lost to dementia, finds global study

The number of people losing a healthy life due to dementia has almost doubled across the globe in one generation, reveals a report in The Lancet. The latest Global Burden of Disease Study found a 92 per cent increase in dementia-related early death and years lived with disability between 1990 and 2013.

Reconsidering care for frail older people Canada-flat-icon

With the number of Canadians over 65 set to double in the next 20 years and the number over 80 set to quadruple over the next 30 years, a growing number of health care planners and geriatricians think “frailty” should be formally adopted as a clinical concept within elder care.

Identifying Best Practices for Continuity of Care in Ontario’s Nursing Workforce Canada-flat-icon

NHSRU-KTEP researchers from the University of Toronto site have performed a qualitative study entitled Identifying Best Practices to Optimize Continuity of Care in Ontario’s Nursing Workforce to explore health care leaders’ perceptions and experiences regarding best practices for improving the achievement of 70% full-time (FT) employment of nurses in Ontario’s hospitals.

Why are nursing homes worse than residential homes? (UK)

The Care Quality Commission says nursing homes provide poorer care than residential homes – and the recruitment and retention of nurses remains an issue.

Reviewer right to reply: dealing with author rebuttals

The scenario is all too familiar. You patiently read through the paper, you make exhaustive notes, you write up a comprehensive review with point-by-point instructions explaining exactly how the manuscript is to be changed and then, lo and behold, the author has the audacity to disagree! Makes you wonder why you bother.

At Home, Many Seniors Are Imprisoned by Their Independence

Article on seniors who are homebound.

Anatomy of a Healthcare Quality Metric

And yet, the question lingers — how exactly do we measure quality? Today quality measurement is rigid, periodic, and manual. Here’s a peek behind the curtain of what we measure today — and what’s possible tomorrow.

More than 700 Manitoba care home staff injured in past 5 years Canada-flat-icon

Staff working in personal care homes (PCH) and group homes in Manitoba have been injured by the people they care for more than 700 times in the past five years, costing the workers compensation program about $500,000 annually.

Health union says long term care patients at risk Canada-flat-icon

Seventy-one per cent of the members who responded in February rated the services provided by health regions as either poor or fair. In a follow up survey conducted recently, 80 per cent of respondents said little has changed to improve between now and the last time members were asked.

Opinion: Hopeful signs emerging in seniors care for Albertans Canada-flat-icon

The many Albertans alarmed at the long and steady decline in the quality of seniors care may finally have cause for hope. The new NDP government has already made a good start by putting one minister, Sarah Hoffman, in charge of both the health and seniors departments. For too long, we have put the medical needs of seniors in a different category from the medical needs of the rest of the population, with dramatically negative results.

Older people wait too long for essential social care, says Age UK

New figures released today (Wednesday 17 June) by Age UK show an escalating social care crisis in England with 2,431,120 bed days lost to the NHS between June 2010 and March 2015.

Researcher says rural N.B. faces future challenge with dementia cases Canada-flat-icon

The number of dementia cases in New Brunswick will rise dramatically over the next 20 years, and rural areas of the province will face a particular challenge, according to a study by a professor at Mount Allison University.

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Resources

The Canadian Clinical Trials Asset Map Canada-flat-icon

Canada is aiming to regain its research edge through a new national database highlighting the country’s resources for clinical trials in the hope it will attract international companies doing research.

Anti-Psychotics in Older Adults Canada-flat-icon
Recorded webinar from brainXchange & Alzheimer Society of Canada

This presentation described anti-psychotic drug therapies and their use in older adults. We also discussed alternative management strategies..

SCIE’s Video Simulation of the Dementia Experience
Social Care Institute for Excellence (SCIE)

In this film we find out what it might feel like to live with dementia. Viewers will experience a little of what it is like to find yourself in a world that seems familiar and yet doesn’t always make sense.

What makes a good abstract?
Wiely

Insights for authors on the structure, style and search engine optimization (SEO) of titles and abstracts for articles and books.

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Opportunities

Editor with expertise in statistical methods
International Journal of Mental Health Nursing (IJMHN)
DEADLINE 30 June 2015

The International Journal of Mental Health Nursing (IJMHN) is currently seeking a new Editor with expertise in statistical methods. The new Editor will assume responsibility for assisting the EIC from July 2016. The term of office will last two years, subject to agreement. The journal uses the electronic peer review management system, ScholarOne.

Translational Chair in Knowledge Translation/Health Outcomes Canada-flat-icon
Alberta Innovates Health Solutions (AIHS), University of Alberta
Open until filled

This is an exciting position ready to be filled by a researcher in the early stages of their career, ideally at the Assistant or Associate Professor level, who will build on the health innovation momentum in Alberta by developing a transformative health outcomes research program. Health Outcomes Research and Knowledge Translation are defined as applied clinical research that generates knowledge to improve clinical decision-making and/or health care delivery to optimize patient outcomes and/or health service efficiency and translates that knowledge to decision makers, care providers, as well as other scientists. Areas of priority include, but are not restricted to, perinatal or child health outcomes in alignment with the recently formed provincial Maternal, Neonatal, Child and Youth Strategic Clinical Network, the Women and Children’s Health Research Institute (WCHRI), and the Faculty of Medicine & Dentistry.

Research Project Manager Canada-flat-icon
Ontario Stroke Network SPOR

The OSN SPOR Research Project Manager (RPM) will assist the OSN Best Practice Leader (BPL) by providing project management and administrative support for the OSN SPOR Demonstration Project initiatives. A major component of this work is building and managing internal and external relationships and providing pro-active assistance and executive support in an effective and efficient manner.

Health Services Implementation Specialist (Military Health)
Engility Corporation, Arlington VA USA

Engility Corporation is seeking a Health Services Implementation Specialist with recent experience in dissemination and implementation research and/or the implementation of evidence –based health service programs or interventions. The candidate must understand the roles of various processes for how interventions are implemented and the context of dissemination factors (setting, population, behaviors, organizational factors and policies) on results.

Endowed Professor, Evidence Based Nursing and Director
Sarah Cole Hirsh Institute for Best Nursing Practice Based on Evidence, Frances Payne Bolton School of Nursing at Case Western Reserve University
Cleveland OH

We are seeking a Director for the Sarah Cole Hirsh Institute for Best Nursing Practices Based on Evidence. The qualified applicant is a nurse leader with a record of scholarship and a commitment to students and to improving health care; holds a DNP or PhD in nursing; has experience in conducting systematic reviews; experience with writing for publication required; experience with editing other’s writing preferred; minimum of 3 years in a supervisory role.

Faculty Position in Dissemination and Implementation Science
Mayo Clinic, Rochester MN USA

Mayo Clinic seeks Health Services Researchers with a Ph.D. in a field relevant to Health Services Research (i.e. public health, decision sciences, psychology, health services research, health systems engineering), or an M.D. with additional training or experience in one or more of these areas for faculty positions within and outside the tenure system. Appointment will be at the Assistant, Associate, or Full Professor level, commensurate with qualifications and experience. Scientific leadership opportunities exist for mid- to senior-level researchers with the appropriate level of demonstrated experience.

Postdoctoral Position in Pediatrics Canada-flat-icon
Alberta Research Centre for Health Evidence (ARCHE), University of Alberta, Edmonton

The Alberta Research Centre for Health Evidence (ARCHE (https://www.ualberta.ca/ARCHE/)), is searching for a post-doctoral fellow to conduct research in the area of knowledge translation and/or implementation science. Under the direction of the ARCHE Director, the Postdoctoral Fellow will take a lead role in creating a “living lab” of research in knowledge translation and/or implementation in the area of child health. The successful applicant will have the opportunity to work with a dynamic team of researchers located across Canada and around the world. He/she will take a lead role in producing high-quality peer-reviewed manuscripts, and, as time and funding permits, he/she will participate in conference presentations and will engage in other forms of dissemination.

Research Associate to coordinate systematic reviews and knowledge synthesis research projects Canada-flat-icon
University of Manitoba’s Centre for Healthcare Innovation
Winnipeg MB
Open until filled

The KS Research Associate will coordinate systematic reviews and similar knowledge synthesis research projects from inception to completion and will serve as a content and methodological expert/consult to clients of the CHI. It is anticipated that the individual will have or will acquire particular expertise in a specific domain of KS (e.g. observational reviews, interventional reviews, scoping reviews, rapid reviews, etc.).

Senior Technical Advisor (Methodology)
National Institute for Health and Care Excellence (NICE)
Manchester/London UK
DEADLINE 6 July

Reporting to the Associate Director (Methodology) within the Centre for Clinical Practice you will join the team responsible for overseeing the development of NICE clinical guidelines. You will be taking on some of the toughest challenges in NHS policy making, within an innovative, evolving organisation that will support your on-going professional development, and play a pivotal role in the Guidelines Programme.

Senior Research Fellow in Health Services Research (Flying Start)
DEADLINE 9 July
University of Bedfordshire – Faculty of Health and Social Sciences – Institute for Health Research
Bedfordshire UK

Fixed-term post (3 years in the first instance with the possibility of renewal); based at their Putteridge Bury Campus. As part of the continued successful collaboration between the Institute for Health Research and the Luton Flying Start Programme, applications are invited for a new Research & Evaluation post – to lead the planning, design and execution of the evaluation of the Flying Start programmes.

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