July 20, 2015


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Lastest TREC Newsletter

Learn about the TREC AGM, our summer students, and our system projects.

TREC receives CIHR Operating Grant
Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM)

Thanks to all our co-applicants and collaborators on this project that will evaluate different strategies to get research findings back to managers in the system in a timely and effective way so that they result in improvements in quality of care. We will be testing various feedback packages to determine the strategy that is most effective at fostering improvements and is also cost-effective. The project will be carried out in nursing homes in Alberta, British Columbia and Manitoba. The information developed will contribute to better care for Canadian seniors who spend their final years in a nursing home.

Come and work with TREC:
Post Doctoral Position Tranlsating Research in Elder Care – Longitudinal Measurement System
Open until filled

Under the direction of the core TREC TMS study team, the successful fellow will play a major role in analysis, interpretation and the production of scientific outputs and stakeholder dissemination and reports. We have an expectation that the successful fellow will engage as a junior team member in many aspects of the TMS project, attend major team meetings, and that they will both publish as a co-author and lead on selected papers. An ambitious publishing record during and subsequent to the two years of the fellowship is one of our key expectations. Selected conference presentations may be an expectation as resources permit. The fellow will also participate actively in grant submissions and have an opportunity to mentor doctoral and master’s students. This is also an opportunity to become involved in and gain experience in a large national team and its international partners who are working in a partnered model of research (i.e., integrated KT model).

New TREC article:
Reliability and Validity of the Alberta Context Tool (ACT) with Professional Nurses: Findings from a Multi-Study Analysis
Squires JE, Hayduk L, Hutchinson AM, Mallick R, Norton PG, Cummings GG, et al.
PloS one 2015 Jun 22;10(6):e0127405

Although organizational context is central to evidence-based practice, underdeveloped measurement hindersitsassessment. The Alberta Context Tool, comprised of 59 items that tap10 modifiable contextual concepts, was developed to address this gap. The purpose of this study to examine the reliability and validity of scores obtained when the Alberta Context Tool is completed by professional nurses across different healthcare settings. Five separate studies (N = 2361 nurses across different care settings) comprised the study sample. Reliability and validity were assessed. Cronbach’s alpha exceeded 0.70 for9/10 Alberta Context Tool concepts. Item-total correlations exceeded acceptable standards for 56/59items. Confirmatory Factor Analysescoordinated acceptably with the Alberta Context Tool’s proposed latent structure. The mean values for each Alberta Context Tool concept increased from low to high levels of research utilization(as hypothesized) further supporting its validity. This study provides robust evidence forreliability and validity of scores obtained with the Alberta Context Tool when administered to professional nurses.

Nova Scotia launches dementia strategy and 3 year plan
Dementia Strategy

The province has launched the Nova Scotia’s first-ever dementia strategy, Towards Understanding. Ensuring access to timely, accurate diagnosis, more public education and awareness, better supports for families and caregivers, and enhancing the health system to provide coordinated dementia care are focus of the strategy. As part of the strategy, the province has outlined a three-year action plan. The strategy, as well as the action plan will remain flexible and responsive throughout, informed by the experience of implementation and ongoing health system planning.

New article by Dr. Greta Cummings
PEDro or Cochrane to Assess the Quality of Clinical Trials? A Meta-Epidemiological Study.
Armijo-Olivo S, da Costa BR, Cummings GG, Ha C, Fuentes J, Saltaji H, et al.
PloS one 2015 Jul 10;10(7):e0132634

There is debate on how the methodological quality of clinical trials should be assessed. We compared trials of physical therapy (PT) judged to be of adequate quality based on summary scores from the Physiotherapy Evidence Database (PEDro) scale with trials judged to be of adequate quality by Cochrane Risk of Bias criteria. DESIGN: Meta-epidemiological study within Cochrane Database of Systematic Reviews. METHODS: Meta-analyses of PT trials were identified in the Cochrane Database of Systematic Reviews. For each trial PeDro and Cochrane assessments were extracted from the PeDro and Cochrane databases. Adequate quality was defined as adequate generation of random sequence, concealment of allocation, and blinding of outcome assessors (Cochrane criteria) or as trials with a PEDro summary score >/=5 or >/=6 points. We combined trials of adequate quality using random-effects meta-analysis. RESULTS: Forty-one Cochrane reviews and 353 PT trials were included. All meta-analyses included trials with PEDro scores >/=5, 37 (90.2%) included trials with PEDro scores >/=6 and only 22 (53.7%) meta-analyses included trials of adequate quality according to the Cochrane criteria. Agreement between PeDro and Cochrane was poor for PeDro scores of >/=5 points (kappa = 0.12; 95% CI 0.07 to 0.16) and slight for >/=6 points (kappa 0.24; 95% CI 0.16-0.32). When combining effect sizes of trials deemed to be of adequate quality according to PEDro or Cochrane criteria, we found that a substantial difference in the combined effect size (>/=0.15) was evident in 9 (22%) out of the 41 meta-analyses for PEDro cutoff >/=5 and 10 (24%) for cutoff >/=6. CONCLUSIONS: The PeDro and Cochrane approaches lead to different sets of trials of adequate quality, and different combined treatment estimates from meta-analyses of these trials. A consistent approach to assessing RoB in trials of physical therapy should be adopted.

New article by Dr. Adrian Wagg
Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations
Non UofA Access
Orme S, Morris V, Gibson W, Wagg A.
Drugs & aging 2015 Jul 14

Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual’s situation should be applied.

New article by Dr. Kim Fraser
A Scoping Review of Research on the Arts, Aging, and Quality of Life.
Non UofA Access
Fraser KD, O’Rourke HM, Wiens H, Lai J, Howell C, Brett-MacLean P.
The Gerontologist 2015 Aug;55(4):719-729

Artistic engagement has been identified as a promising way to improve older adults’ quality of life (QoL) and health. This has resulted in a growing, yet diverse, knowledge base. The purpose of this scoping review was to describe and map the nature and extent of research conducted on the arts, aging, and either QoL or health for well older adults. DESIGN AND METHODS: We followed scoping review procedures. Research librarians developed a comprehensive search strategy to capture published and gray literature across 16 databases. We systematically screened 9,720 titles/abstracts and extracted data. Findings were collated by tabulating frequencies and textual data organized according to themes. RESULTS: 94 articles were included, spanning nine disciplines, and most were published after 2000 (72%). Most of the studies were conducted in the United States (52%). Research teams rarely published more than one study about the arts and QoL/health. The studies used qualitative (49%), quantitative (38%), or mixed methods (10%). The most common art form examined was music (40%). Artistic engagement was usually active (70%) and frequently occurred in groups (56%). Health and QoL were conceptualized and operationalized in many different ways. IMPLICATIONS: There is a need for programs of research (instead of teams conducting only one study), the development and application of conceptual frameworks, and multiple perspectives in order to build knowledge about how the arts contribute to health and QoL for older adults.

Abstracts

CALL FOR ABSTRACTS:
8th Annual Conference on the Science of Dissemination and Implementation
Washington DC 14-15 December
DEADLINE 20 August

The conference seeks novel research or conceptual papers that address any of the topics included within the thematic tracks, with an emphasis on empirical findings for how best to integrate evidence-based interventions within clinical and community settings and/or how to recast the nature or conduct of the research itself to make it more relevant and actionable in those settings.

CALL FOR ABSTRACTS:
The 7th International Conference on Patient- and Family-Centered Care
25-27 July New York, NY
DEADLINE 31 July

IPFCC is proud to announce The 7th International Conference on Patient- and Family-Centered Care—Partnerships in Care, Interprofessional Education, and Research. The conference will showcase innovative programs and approaches dedicated to collaboration among health care professionals, patients, residents in long-term care communities, and families and other care partners. We invite you to submit an abstract.

CALL FOR ABSTRACTS:
Margaret Scott Wright Research & Innovation Day
6 November Edmonton AB
DEADLINE 18 September

Join your clinical, student and Faculty colleagues for the new joint MSW Research & Innovation Day annual research conference, to explore how nurses can work together to mentor each other, strengthen our links, and improve our care, scholarship and practice for our patients.

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Grants & Awards

AIHS Partnership for Research and Innovation in the Health System (PRIHS)
LOI DEADLINE: 24 September
Full Application DEADLINE (by invite only): 31 March

PRIHS will fund the development and implementation of evidence informed solutions to Alberta-specific health system challenges. The goal is to test solutions and use the resulting evidence to scale and spread change throughout the health system. Patient and family involvement in all phases of the research projects is required.

AIHS Community Engagement and Conference Grant
DEADLINE 31 July

This flexible grant is available to community and educational organizations, not-for-profits, and those involved in knowledge exchange in the health research and innovation environment. This grant is designed to cover a broad spectrum of activities, including those that promote collaboration and networking within the academic community and beyond.

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Publications

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

KT

Perceived factors influencing nurses’ use of evidence-informed protocols for remote cancer treatment-related symptom management: A mixed methods study. Canada-flat-icon
Non UofA Access
Stacey D, Carley M, Ballantyne B, Skrutkowski M, Whynot A, Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Team.
European journal of oncology nursing 2015 Jun;19(3):268-277

To assess factors perceived to influence nurses’ use of symptom protocols when providing remote management for oncology patients. METHOD: A mixed methods descriptive study was guided by the Knowledge-to-Action Framework. In 2013, 8 focus groups and 7 interviews were conducted with 49 nurses or patients/family members in three ambulatory oncology programs within different provincial healthcare systems. Role-play with a protocol was used during nurse focus groups/interviews. Nurses who provided remote symptom support received a survey. Data was triangulated using thematic analysis guided by the Ottawa Model of Research Use. RESULTS: Over 90% of nurses provide telephone support during regular hours only. These symptom protocols were being used by 14% of nurses at one program. Nurses rated the protocols positively for content and format (>85%) but 20% indicated too complex. Protocol facilitators were systematic approach, comprehensive, and evidence-based. Protocol barriers were too long, not for symptom clusters, and inadequate space for documenting. To facilitate use, nurses need to enhance their knowledge (73%) and skills (58%), get access to resources, and obtain performance feedback. Nurse barriers included the learning curve, being unaware of protocols, and feeling tied to a script. Organizational barriers were communication challenges with patients, lack of electronic charting, and no clear direction to use them (54%). CONCLUSIONS: Several barriers and facilitators were perceived to influence the use of symptom protocols. Nurses and patients/family members identified similar factors. Interventions are needed to overcome barriers to nurses using the protocols such as education, clear organizational mandate, and integration with documentation.

Collaborative development and implementation of a knowledge brokering program to promote research use in Burkina Faso, West Africa. Canada-flat-icon
Non UofA Access
Dagenais C, Some TD, Boileau-Falardeau M, McSween-Cadieux E, Ridde V.
Global health action 2015 Jan 27;8:26004

Despite efforts expended over recent decades, there is a persistent gap between the production of scientific evidence and its use. This is mainly due to the difficulty of bringing such knowledge to health workers and decision-makers so that it can inform practices and decisions on a timely basis. One strategy for transferring knowledge to potential users, that is, gaining increasing legitimacy, is knowledge brokering (KB), effectiveness of which in certain conditions has been demonstrated through empirical research. However, little is known about how to implement such a strategy, especially in the African context. The KB program presented here is aimed specifically at narrowing the gap by making scientific knowledge available to users with the potential to improve health-related practices and decision making in Burkina Faso. The program involves Canadian and African researchers, a knowledge broker, health practitioners, and policy-makers. This article presents the collaborative development of the KB strategy and the evaluation of its implementation at year 1. The KB strategy was developed in stages, beginning with a scoping study to ensure the most recent studies were considered. Two one-day workshops were then conducted to explore the problem of low research use and to adapt the strategy to the Burkinabè context. Based on these workshops, the KB program was developed and brokers were recruited and trained. Evaluation of the program’s implementation after the first year showed that: 1) the preparatory activities were greatly appreciated by participants, and most considered the content useful for their work; 2) the broker had carried out his role in accordance with the logic model; and 3) this role was seen as important by the participants targeted by the activities and outputs. Participants made suggestions for program improvements in subsequent years, stressing particularly the need to involve decision-makers at the central level.

Nursing unit leaders’ influence on the long-term sustainability of evidence-based practice improvements. Canada-flat-icon
Non UofA Access
Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL.
Journal of nursing management 2015 Jun 17

To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. BACKGROUND: Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. METHODS: A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. RESULTS: Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. CONCLUSIONS: Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. IMPLICATIONS: As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.

Facilitating the implementation of evidence-based practice through contextual support and nursing leadership
Kueny A, Shever LL, Mackin ML, Titler MG.
Journal of Healthcare Leadership 2015 06;7:29

Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. Methods: This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. Results: NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

Translational networks in healthcare? Evidence on the design and initiation of organizational networks for knowledge mobilization.
Non UofA Access
Fitzgerald L, Harvey G.
Social science & medicine (1982) 2015 Aug;138:192-200

International attention has focussed on the variations between research evidence and practice in healthcare. This prompted the creation of formalized translational networks consisting of academic-service partnerships. The English Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are one example of a translational network. Using longitudinal, archival case study data from one CLAHRC over a 3-year period (2008-11), this article explores the relationship between organizational form and the function(s) of a translational network. The article focuses on the research gaps on the effective structures and appropriate governance to support a translational network. Data analysis suggested that the policy of setting up translational networks is insufficient of itself to produce positive translational activity. The data indicate that to leverage the benefits of the whole network, attention must be paid to devising a structure which integrates research production and use and facilitates lateral cross-disciplinary and cross-organizational communication. Equally, appropriate governance arrangements are necessary, particularly in large, multi-stakeholder networks, where shared governance may be questionable. Inappropriate network structure and governance inhibits the potential of the translational network. Finally, the case provides insights into the movement of knowledge within and between network organizations. The data demonstrate that knowledge mobilization extends beyond knowledge translation; knowledge mobilization includes the negotiated utilization of knowledge – a balanced power form of collaboration. Whilst much translational effort is externally focused on the health system, our findings highlight the essential need for the internal negotiation and mobilization of knowledge within academia. Copyright © 2015 Elsevier Ltd

A multifaceted feedback strategy alone does not improve the adherence to organizational guideline-based standards: a cluster randomized trial in intensive care
Non UofA Access
de Vos ML, van der Veer SN, Wouterse B, Graafmans WC, Peek N, de Keizer NF, et al.
Implementation science : IS 2015 Jul 8;10(1):95-015-0285-2

Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards. METHODS: In a cluster randomized controlled study design the intervention ICUs received extensive monthly feedback reports, they received outreach visits and initiated a quality improvement team. The control ICUs received limited quarterly feedback reports only. We collected primary data prospectively within the setting of a Dutch national ICU registry over a 14-month study period. The target indicators were bed occupancy rate (aiming at 80 % or below) and nurse-to-patient ratio (aiming at 0.5 or higher). Data were collected per 8-h nursing shift. Logistic regression analysis was performed. For both study end points, the odds ratios (OR) for improvements at follow-up versus at baseline were calculated separately for control and intervention ICUs. RESULTS: We analyzed data on 67,237 nursing shifts. The bed occupancy rate did not improve in the intervention group compared to baseline (adjusted OR 0.88; 95 % confidence interval (CI), 0.62-1.27) or compared to control group (OR 0.67; 95 % CI 0.39-1.15). The nurse-to-patient ratio did not improve (OR 0.72; 95 % CI 0.41-1.26 compared to baseline and OR 0.65; 95 % CI 0.35-1.19 compared to control group). CONCLUSIONS: A multifaceted feedback intervention did not improve the adherence to guideline-based standards on the organizational issues bed occupancy rate and nurse-to-patient ratio in the ICU. The reasons may be a limited confidence in data quality, the lack of practical tools for improvement, and the relatively short follow-up. TRIAL REGISTRATION: ISRCTN: ISRCTN50542146.

Bringing it home: expanding the local reach of dissemination and implementation training via a university-based workshop.
Non UofA Access
Morrato EH, Rabin B, Proctor J, Cicutto LC, Battaglia CT, Lambert-Kerzner A, et al.
Implementation science 2015 Jul 4;10:94-015-0281-6

Currently, national training programs do not have the capacity to meet the growing demand for dissemination and implementation (D&I) workforce education and development. The Colorado Research in Implementation Science Program (CRISP) developed and delivered an introductory D&I workshop adapted from national programs to extend training reach and foster a local learning community for D&I. METHODS: To gauge interest and assess learning needs, a pre-registration survey was administered. Based on feedback, a 1.5-day workshop was designed. Day 1 introduced D&I frameworks, strategies, and evaluation principles. Local and national D&I experts provided ignite-style talks on key lessons followed by panel discussion. Breakout sessions discussed community engagement and applying for D&I grants. A workbook was developed to enhance the training and provided exercises for application to an individual’s projects. Day 2 offered expert-led mentoring sessions with selected participants who desired advanced instruction. Two follow-up surveys (immediate post-workshop, 6 months) assessed knowledge gained from participation and utilization of workshop content. RESULTS: Ninety-three workshop registrants completed an assessment survey to inform workshop objectives and curriculum design; 43 % were new and 54 % reported a basic understanding of the D&I field. Pre-registrants intended to use the training to “apply for a D&I grant” (73 %); “incorporate D&I into existing projects” (76 %), and for quality improvement (51 %). Sixty-eight individuals attended Day 1; 11 also attended Day 2 mentoring sessions. In the 1-week post-workshop survey (n = 34), 100 % strongly agreed they were satisfied with the training; 97 % strongly agreed the workshop workbook was a valuable resource. All Day 2 participants strongly agreed that working closely with faculty and experts increased their overall confidence. In the 6-month follow-up evaluation (n = 23), evidence of new D&I-related manuscripts and grant proposals was found. Training materials were published online ( http://www.ucdenver.edu/implementation/workshops ) and disseminated via the National Institutes of Health (NIH) Clinical and Translational Science Awards Consortium. To sustain reach, CRISP adapted the materials into an interactive e-book ( http://www.CRISPebooks.org ) and launched a new graduate course. CONCLUSIONS: Local D&I training workshops can extend the reach of national training programs.

Evidence Molded by Contact with Staff Culture and Patient Milieu: an Analysis of the Social Process of Knowledge Utilization in Nursing Homes
Non UofA Access
Øye C, Mekki T, Skaar R, Dahl H, Forland O, Jacobsen F.
Vocations and Learning 2015 07/03:1-16

Knowledge utilization is politically “hot” because it informs decisions on improving the quality of care in nursing homes (NHs). The difficulties encountered in implementing evidence-based knowledge into practice may be explained by contextual factors. Contextual factors are crucial to understanding the process of knowledge utilization; how the evidence’ is implemented and received locally by identifying facilitators, as well as barriers to change. This article is based on an evidence-based education intervention executed by four teams of two facilitators with care staff, which aimed to prevent the use of restraint in nursing home (NH) residents with dementia in 24 NHs in Norway. The study used a mixed method design combining cluster randomized controlled trial (C-RCT), participatory action research (PAR) and ethnography, where the aim was to document and examine the success or failure of the education intervention. The empirical material for this paper is primarily based on a post –intervention ethnographic investigation in three NHs in the sample, to investigate the relationship between an education intervention and staff culture. The ethnographic investigation gave a setting and context-specific plausible explanation of why the educational intervention failed or succeeded. This study has shown that the social process of knowledge utilization is influenced by contextual factors such as staff culture, patient mix and milieu as well as structural conditions. The NH conditions are not stable, but rather moving and constantly changing as a response to variation in the staff culture, the patient mix, the resources available and the nursing homes current situation. Therefore, the evidence in connection with staff culture could be understood as “a ball of clay” molding itself differently when coming in touch with staff culture and their collective and individual experiences. Potential for a successful process of knowledge utilization has to do with timing and organizational readiness, which is difficult to foresee when planning an education intervention.

Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice.
Non UofA Access
Saunders H.
Journal of Clinical Nursing 2015 Jul;24(13-14):2035-2051

To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. BACKGROUND: Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. DESIGN: A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. METHODS: A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. CONCLUSIONS: Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. RELEVANCE TO CLINICAL PRACTICE: A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.

Dissemination of Evidence-Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial
Non UofA Access
Tjia J, Field T, Mazor K, Lemay CA, Kanaan AO, Donovan JL, et al.
Journal of the American Geriatrics Society 2015 Jul 14

To evaluate the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). DESIGN: Three-arm, cluster randomized trial. SETTING: NHs. PARTICIPANTS: NHs in the state of Connecticut. MEASUREMENTS: Evidence-based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders, and 42 NHs were recruited and randomized to one of three toolkit dissemination strategies: mailed toolkit delivery (minimal intensity); mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing (moderate intensity); and in-person toolkit delivery with academic detailing, on-site behavioral management training, and quarterly audit and feedback reports (high intensity). Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS: Toolkit awareness of 30% (7/23) of leadership of low-intensity NHs, 54% (19/35) of moderate-intensity NHs, and 82% (18/22) of high-intensity NHs reflected adoption and implementation of the intervention. Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs. Antipsychotic prescribing levels declined during the study period, but there were no statistically significant differences between study arms or from secular trends. CONCLUSION: RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends. Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents.

The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis Canada-flat-icon
Non UofA Access
Yost J, Ganann R, Thompson D, Aloweni F, Newman K, Hazzan A, et al.
Implementation science 2015 Jul 14;10(1):98-015-0286-1

Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions. METHODS: A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme. RESULTS: Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (-1.7 to 7.1), I (2) = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation. CONCLUSIONS: KT interventions are being implemented and evaluated on nurses’ behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.

Knowledge brokering in public health: Logic analysis of the results of a qualitative evaluation Canada-flat-icon
Non UofA Access
Dagenais C, Laurendeau M, Briand-Lamarche M.
Evaluation and program planning

Empirical data on the processes underlying knowledge brokering (KB) interventions, including their determining factors and effects, remain scarce. Furthermore, these interventions are rarely built on explicit theoretical foundations, making their critical analysis difficult, even a posteriori. For these reasons, it appeared relevant to revisit the results of a qualitative evaluation undertaken in the province of Quebec in parallel with a Canada-wide randomized controlled trial (RCT) evaluating various KB strategies in public health. This paper looks critically at the theoretical foundations of the KB interventions in light of two conceptual models: 1) the dissemination model underlying the KB interventions used in the Canadian trial and 2) a systemic KB model developed later. This critical analysis sheds light on the processes involved in KB interventions and the factors influencing their implementation and effects. The conclusions of the critical analysis are consistent with the systemic model, in which interpersonal contact is an essential condition for effective KB interventions. This analysis may advance knowledge in the field by enhancing our understanding of the role of knowledge brokers as essential mediators in KB processes and outcomes.

Research funders’ roles and perceived responsibilities in relation to the implementation of clinical research results: a multiple case study of Swedish research funders
Non UofA Access
Brantnell A, Baraldi E, van Achterberg T, Winblad U.
Implementation science 2015 Jul 17;10(1):100

Implementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funders in relation to implementation and their views on responsibilities in implementation. FINDINGS: Ten cases were studied and compared using semi-structured interviews. In addition, websites and key documents were reviewed. Eight facilitative roles for research funders in relation to the implementation of clinical research results were identified. Three of them were common for several funders: “Advocacy work,” “Monitoring implementation outcomes,” and “Dissemination of knowledge.” Moreover, the research funders identified six different actors responsible for implementation, five of which belonged to the healthcare setting. Collective and organizational responsibilities were the most common forms of responsibilities among the identified actors responsible for implementation. CONCLUSIONS: The roles commonly identified by the Swedish funders, “Advocacy work,” “Monitoring implementation outcomes,” and “Dissemination of knowledge,” seem feasible facilitative roles in relation to the implementation of clinical research results. However, many actors identified as responsible for implementation together with the fact that collective and organizational responsibilities were the most common forms of responsibilities entail a risk of implementation becoming no one’s responsibility.

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Health Care Administration and Organization

Are environmental characteristics in the municipal eldercare, more closely associated with frequent short sick leave spells among employees than with total sick leave: a cross-sectional study.
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Stapelfeldt CM, Nielsen CV, Andersen NT, Krane L, Fleten N, Borg V, et al.
BMC public health 2013 Jun 13;13:578-2458-13-578

It has been suggested that frequent-, short-term sick leave is associated with work environment factors, whereas long-term sick leave is associated mainly with health factors. However, studies of the hypothesis of an association between a poor working environment and frequent short spells of sick leave are few and results are inconsistent. Therefore, we aimed to explore associations between self-reported psychosocial work factors and workplace-registered frequency and length of sick leave in the eldercare sector. METHODS: Employees from the municipal eldercare in Aarhus (N = 2,534) were included. In 2005, they responded to a work environment questionnaire. Sick leave records from 2005 were dichotomised into total sick leave days (0-14 and above 14 days) and into spell patterns (0-2 short, 3-9 short, and mixed spells and 1-3 long spells). Logistic regression models were used to analyse associations; adjusted for age, gender, occupation, and number of spells or sick leave length. RESULTS: The response rate was 76%; 96% of the respondents were women. Unfavourable mean scores in work pace, demands for hiding emotions, poor quality of leadership and bullying were best indicated by more than 14 sick leave days compared with 0-14 sick leave days. For work pace, the best indicator was a long-term sick leave pattern compared with a non-frequent short-term pattern. A frequent short-term sick leave pattern was a better indicator of emotional demands (1.62; 95% CI: 1.1-2.5) and role conflict (1.50; 95% CI: 1.2-1.9) than a short-term non-frequent pattern.Age (= 40 years) statistically significantly modified the association between the 1-3 long-term sick leave spell pattern and commitment to the workplace compared with the 3-9 frequent short-term pattern. CONCLUSIONS: Total sick leave length and a long-term sick leave spell pattern were just as good or even better indicators of unfavourable work factor scores than a frequent short-term sick leave pattern. Scores in commitment to the workplace and quality of leadership varied with sick leave pattern and age. Thus, different sick leave measures seem to be associated with different work environment factors. Further studies on these associations may inform interventions to improve occupational health care.

The use of information and communication technologies to support working carers of older people – a qualitative secondary analysis.
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Andersson S, Magnusson L, Hanson E.
International journal of older people nursing 2015 Jun 15

Family care support services have mainly focused on older spousal carers of older people and have largely overlooked working carers, whom combine paid work with informal/family care responsibilities. Recently, however, information and communication technology (ICT) systems have been identified as a potentially flexible way of supporting working carers. AIM: The aim of this study was to describe nursing and support staff’s experiences of using ICT for information, e-learning and support of working carers of older people. DESIGN: The study employed a descriptive, qualitative approach conducting a qualitative secondary analysis of two original data sets. In total, seventeen professional staff members from two municipal family carer support units in Sweden that had implemented ICTs were interviewed using a semi-structured interview guide consisting of open-ended questions. METHOD: Two data sets were merged using latent qualitative content analysis. FINDINGS: Secondary analysis produced three subthemes and an overall theme, a virtual road as a carriageway for the support of working carers, consisting of both enabling and hindering aspects in family support. This theme provides access points in both directions and is based on caring instruments that enable nursing staff’s support role. The staff’s sustainability and ability to support is influenced by caring opportunities and barriers. CONCLUSIONS: The findings suggest the ICTs to be flexible structures that provided nursing staff with a means and method to support working carers of older people. To overcome barriers to its use, measures to optimise support for working carers and the older person are needed. IMPLICATIONS FOR PRACTICE: The use of ICTs provides nurses with a means to offer support to working carers of older people and enables carers to be informed, to learn and to share their burdens with others when caring for an older family member. © 2015 John Wiley & Sons Ltd.

Preparing Nursing Homes for the Future of Health Information Exchange
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Alexander GL, Rantz M, Galambos C, Vogelsmeier A, Flesner M, Popejoy L, et al.
Applied clinical informatics 2015 Apr 15;6(2):248-266

Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation. BACKGROUND: NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes. METHOD: To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE. RESULTS: All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) Laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information. CONCLUSION: We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical care.

Hidden Owners, Hidden Profits, and Poor Nursing Home Care: A Case Study
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Harrington C, Ross L, Kang T.
International journal of health services : planning, administration, evaluation 2015 Jul 9

The study examined the ownership transparency, financial accountability, and quality indicators of a regional for-profit nursing home chain in California, using a case study methodology to analyze data on the chain’s ownership and management structure, financial data, staffing levels, deficiencies and complaints, and litigation. Secondary data were obtained from regulatory and cost reports and litigation cases. Qualitative descriptions of ownership and management were presented and quantitative analyses were conducted by comparing financial and quality indicators with other California for-profit chains, for-profit non-chains, and nonprofit nursing home groups in 2011. The chain’s complex, interlocking individual and corporate owners and property companies obscured its ownership structure and financial arrangements. Nursing and support services expenditures were lower than nonprofits and administrative costs were higher than for-profit non-chains. The chain’s nurse staffing was lower than expected staffing levels; its deficiencies and citations were higher than in nonprofits; and a number of lawsuits resulted in bankruptcy. Profits were hidden in the chain’s management fees, lease agreements, interest payments to owners, and purchases from related-party companies. Greater ownership transparency and financial accountability requirements are needed to ensure regulatory oversight and quality of care.

The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels
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Paek SC, Zhang NJ, Wan TT, Unruh LY, Meemon N.
Medical care research and review 2015 Jul 14

This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e., nurse staffing levels that each individual nursing home must retain by its state staffing standards) and analyzed the policy impact. The study findings indicated that state staffing standards for the categories of registered nurse, licensed nurse, or total nurse are positively related to registered nurse, licensed nurse, or total nurse staffing levels, respectively. Nursing homes more actively responded to licensed staffing requirements than total staffing requirements. However, nursing homes did not increase their staffing levels as much as those required by state staffing standards. It is possibly because the quality-oriented inspection allows flexibility in nursing homes’ control of nurse staffing levels.

Influence of Nurse Aide Absenteeism on Nursing Home Quality.
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Castle NG, Ferguson-Rome JC.
The Gerontologist 2015 Aug;55(4):605-615

Deficits in quality end-of-life care for nursing home (NH) residents are well known. Palliative care is promoted as an approach to improve quality. The Palliative Care Survey (PCS) is designed to measure NH staff palliative care knowledge and practice. OBJECTIVES: To comparing palliative care knowledge and practices across NH staff roles using the PCS, and to examine relationships between facility characteristics and PCS scores. METHODS: The PCS was administered to front line NH staff — nursing assistants (CNAs), nurses (LPNs and RNs) and social workers (SWs) — in 51 facilities in 2012. Descriptive statistics were calculated by job role. Linear mixed effects models were used to identify facility and individual factors associated with palliative care practice and knowledge. RESULTS: The analytic sample included 1200 surveys. CNAs had significantly lower practice and knowledge scores compared to LPNs, RNs and SWs (P<0.05). LPNs had significantly lower psychological, end-of-life and total knowledge scores than RNs ({<0.05 for all). While knowledge about physical symptoms was uniformly high, end-of-life knowledge was notably low for all staff. A one-point higher facility star rating was significantly associated with a 0.06 increase in family communication score (P=0.003; 95% CI 0.02-0.09; SE=0.02). Higher penetration of hospice in the NH was associated with higher end-of-life knowledge (P=0.003; parameter estimate = 0.006; 95% CI 0.002-0.010; SE=0.002). Sixty-two percent of respondents stated that, with additional training, they would be interested in being leaders in palliative care. CONCLUSION: Given observed differences in palliative care practice and knowledge scores by staff training, it appears the PCS is a useful tool to assess NH staff. Low end-of-life knowledge scores represent an important target for quality improvement.

Nursing Home Staff Palliative Care Knowledge and Practices: Results of a Large Survey of Front-Line Workers
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Unroe KT, Cagle JG, Lane KA, Callahan CM, Miller SC.
Journal of pain and symptom management 2015 Jul 3

Deficits in quality end-of-life care for nursing home (NH) residents are well known. Palliative care is promoted as an approach to improve quality. The Palliative Care Survey (PCS) is designed to measure NH staff palliative care knowledge and practice. OBJECTIVES: To comparing palliative care knowledge and practices across NH staff roles using the PCS, and to examine relationships between facility characteristics and PCS scores. METHODS: The PCS was administered to front line NH staff — nursing assistants (CNAs), nurses (LPNs and RNs) and social workers (SWs) — in 51 facilities in 2012. Descriptive statistics were calculated by job role. Linear mixed effects models were used to identify facility and individual factors associated with palliative care practice and knowledge. RESULTS: The analytic sample included 1200 surveys. CNAs had significantly lower practice and knowledge scores compared to LPNs, RNs and SWs (P<0.05). LPNs had significantly lower psychological, end-of-life and total knowledge scores than RNs ({<0.05 for all). While knowledge about physical symptoms was uniformly high, end-of-life knowledge was notably low for all staff. A one-point higher facility star rating was significantly associated with a 0.06 increase in family communication score (P=0.003; 95% CI 0.02-0.09; SE=0.02). Higher penetration of hospice in the NH was associated with higher end-of-life knowledge (P=0.003; parameter estimate = 0.006; 95% CI 0.002-0.010; SE=0.002). Sixty-two percent of respondents stated that, with additional training, they would be interested in being leaders in palliative care. CONCLUSION: Given observed differences in palliative care practice and knowledge scores by staff training, it appears the PCS is a useful tool to assess NH staff. Low end-of-life knowledge scores represent an important target for quality improvement.

Reforming Long-Term Care Funding in Alberta, Canada Canada-flat-icon
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Sutherland,R.Trafford Crump, Nadya Repin and Jason M.
Healthcare Quarterly 2015 04/30;18(1):26-31

Like many provinces across Canada, Alberta is facing growing demand for long-term care. Issues with the mixed funding model used to pay long-term care providers had Alberta Health Services concerned that it was not efficiently meeting the demand for long-term care. Consequently, in 2010, Alberta Health Services introduced the patient/care-based funding (PCBF) model. PCBF is similar to activity-based funding in that it directly ties the complexity and care needs of long-term care residents to the payment received by long-term care providers. This review describes PCBF and discusses some of its strengths and weaknesses. In doing so, this review is intended to inform other provinces faced with similar long-term care challenges and contemplating their own funding reforms

Moral Distress in the Care of Persons with Dementia in Residential Care Settings in Southern Alberta Canada-flat-icon
Spenceley S., Hagen B., Hall B., Awasoga O., Witcher C.
2015

The main objective of this two year study was to explore the nature, extent and effects of moral distress among nursing caregivers (registered nurses, licensed practical nurses and health care aides) providing care to persons diagnosed with dementia and living in long term care (LTC) and assisted living (AL) environments. The research was undertaken in Southern Alberta in two phases. Phase one involved interviews with 18 nursing caregivers of persons with dementia, to understand situations that contributed to moral distress, and to inform the development of a survey instrument. Phase two included survey development and piloting (n=68), followed by a survey of a larger sample of nursing caregivers across 30 care facilities (N=389) to better understand the prevalence of moral distress among caregivers in these settings, the situations that trigger it, and its effects.

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Health Care Innovation and Quality Assurance

Evolution and Initial Experience of a Statewide Care Transitions Quality Improvement Collaborative: Preventing Avoidable Readmissions Together.
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Axon RN, Cole L, Moonan A, Foster R, Cawley P, Long L, et al.
Population health management 2015 Jun 23

Increasing scrutiny of hospital readmission rates has spurred a wide variety of quality improvement initiatives. The Preventing Avoidable Readmissions Together (PART) initiative is a statewide quality improvement learning collaborative organized by stakeholder organizations in South Carolina. This descriptive report focused on initial interventions with hospitals. Eligible participants included all acute care hospitals plus home health organizations, nursing facilities, hospices, and other health care organizations. Measures were degree of statewide participation, curricular engagement, adoption of evidence-based improvement strategies, and readmission rate changes. Fifty-nine of 64 (92%) acute care hospitals and 9 of 10 (90%) hospital systems participated in collaborative events. Curricular engagement included: webinars and coaching calls (49/59, 83%), statewide in-person meetings (35/59, 59%), regional in-person meetings (44/59, 75%), and individualized consultations (46/59, 78%). Among 34 (58%) participating hospitals completing a survey at the completion of Year 1, respondents indicated complete implementation of multidisciplinary rounding (58%), post-discharge telephone calls (58%), and teach-back (32%), and implementation in process of high-quality transition records (52%), improved discharge summaries (45%), and timely follow-up appointments (39%). A higher proportion of hospitals had significant decreases (≥10% relative change) in all-cause readmission rates for acute myocardial infarction (55.6% vs. 30.4%, P=0.01), heart failure (54.2% vs. 31.7%, P=0.09), and chronic obstructive pulmonary disease (41.7% vs. 33.3%, P=0.83) between 2011-2013 compared to earlier (2009-2011) trends. Focus on reducing readmissions is driving numerous, sometimes competing, quality improvement initiatives. PART successfully engaged the majority of acute care facilities in one state to harmonize and accelerate adoption of evidence-based care transitions strategies.

The influence of individual and organizational factors on person-centred
dementia care.
Canada-flat-icon
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Hunter PV, Hadjistavropoulos T, Thorpe L, Lix LM, Malloy DC.
Aging & mental health 2015 Jun 22:1-9

Although some individual and organizational contributors to person-centred care or quality of care have been studied, they have rarely been examined together. Our goal was to investigate the association of personal and organizational-environmental characteristics with self-reported person-centred behaviours in long-term residential care settings. METHOD: We asked 109 long-term care staff from two Canadian long-term care homes to complete scales assessing self-reported person-centred care, organizational support for person-centred care, beliefs about personhood in dementia, and burnout. Independent variables included four employee background characteristics (age, gender, occupation, and years of education), beliefs about personhood in dementia, burnout, and three aspects of organizational support for person-centred care (the physical environment of residents, collaboration on care, and support from management). Dependent variables included five aspects of person-centred care: autonomy, personhood, knowing the person, comfort care, and support for relationships .We used multiple linear regression analysis and changes in R2 to test variable associations. RESULTS: Including organizational variables in regression models resulted in statistically significant (p < .05) changes in R2 for each of the five dependent variables. Including personal variables resulted in statistically significant changes in R2 for some dependent variables, but not others. In particular, including employee background characteristics resulted in a statistically significant change in R2 for comfort care, and including beliefs about personhood and burnout resulted in statistically significant changes in R2 for personhood but not for other dependent variables. CONCLUSION: Organizational characteristics are associated with several aspects of person-centred dementia care. Individual characteristics, including gender, beliefs about personhood, and burnout, appear to be more important to some aspects of person-centred dementia care (e.g., respect for personhood and comfort care) than others.

Towards a measurement instrument for determinants of innovations.
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Fleuren MA, Paulussen TG, Van Dommelen P, Van Buuren S.
International journal for quality in health care 2014 Oct;26(5):501-510

To develop a short instrument to measure determinants of innovations that may affect its implementation. DESIGN: We pooled the original data from eight empirical studies of the implementation of evidence-based innovations. The studies used a list of 60 potentially relevant determinants based on a systematic review of empirical studies and a Delphi study among implementation experts. Each study used similar methods to measure both the implementation of the innovation and determinants. Missing values in the final data set were replaced by plausible values using multiple imputation. We assessed which determinants predicted completeness of use of the innovation (% of recommendations applied). In addition, 22 implementation experts were consulted about the results and about implications for designing a short instrument. SETTING: Eight innovations introduced in Preventive Child Health Care or schools in the Netherlands. PARTICIPANTS: Doctors, nurses, doctor’s assistants and teachers; 1977 respondents in total. RESULTS: The initial list of 60 determinants could be reduced to 29. Twenty-one determinants were based on the pooled analysis of the eight studies, seven on the theoretical expectations of the experts consulted and one new determinant was added on the basis of the experts’ practical experience. CONCLUSIONS: The instrument is promising and should be further validated. We invite researchers to use and explore the instrument in multiple settings. The instrument describes how each determinant should preferably be measured (questions and response scales). It can be used both before and after the introduction of an innovation to gain an understanding of the critical change objectives. © The Author 2014.

Nurses’ and personal care assistants’ role in improving the relocation of older people into nursing homes.
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Ellis JM, Rawson H.
Journal of Clinical Nursing 2015 Jul;24(13-14):2005-2013

This article presents findings from a study that explored nurses’ and personal care assistants’ role in improving the relocation of older people into a nursing home. BACKGROUND: Suggestions for improving the relocation process for older people moving into a nursing home have been the outcomes of studies that have interviewed residents and their families. However, the views of nurses and personal care assistants working in nursing homes have not been previously explored. DESIGN: An exploratory, descriptive qualitative research design. METHODS: Individual interviews were conducted with 20 care staff (seven registered nurses, five enrolled nurses and eight personal care assistants) employed at four nursing homes. FINDINGS: Using thematic analysis, two key themes were identified: ‘What it’s like for them’ – highlighted staffs’ awareness of the advantages, disadvantages and meaning of relocation, and focused on staffing and nursing care; other services provided and the environment. The second theme – ‘We can make it better’, revealed suggestions for improving the relocation process, and included spending time with new residents and the importance of a person-centred approach to care. CONCLUSION: Care staff have an important role in improving the relocation process of older people into a nursing home, as well as contributing to the discussion on this important clinical topic. RELEVANCE TO CLINICAL PRACTICE: Challenging care staff to acknowledge the importance of their role in helping older people settle into a nursing home is a key requirement of nursing practice in aged care. Nursing practice guidelines, with a focus on person-centred care, on how to manage the relocation process for an older person and their family are required for this aspect of nursing home care. Education of staff on relocation policies and procedures is essential to ensure that residents and their families are supported through this process. © 2015 John Wiley & Sons Ltd.

Health care provider social network analysis: A systematic review
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Bae SH, Nikolaev A, Seo JY, Castner J.
Nursing outlook 2015 Jun 6

Although considerable progress has been made in understanding networks, their structure, and their development, little has been known about their effectiveness in the health care setting and their contributions to quality of care and patient safety.The purpose of this study was to examine studies using social network analysis (SNA) in the health care workforce and assess factors contributing to social network and their relationships with care processes and patient outcomes. METHODS: We identified all published peer-reviewed SNA articles in CINAHL, PubMed, PsycINFO, JSTOR, Medline (OVID), and Web of Science databases until April 2013. RESULTS: Twenty-nine published articles met the inclusion criteria. Current evidence of the health care workforce’s social networks reveals the nature of social ties are related to personal characteristics, practice setting, and types of patients. Few studies also revealed the social network effects adoption and the use of a health information system, patient outcomes, and coordination. CONCLUSIONS: Current studies on the social ties of health care workforce professionals include several assessments of inefficiencies. The level of technical sophistication in studies tends to be low. Future study using enhanced sophistication in study design, analysis, and patient outcome testing are warranted to fully leverage the potential of SNA in health care studies.

Senior staff perspectives of a quality indicator program in public sector residential aged care services: a qualitative cross-sectional study in Victoria, Australia
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Chadwick LM, MacPhail A, Ibrahim JE, McAuliffe L, Koch S, Wells Y.
Australian Health Review : A Publication of the Australian Hospital Association 2015 Jul 13

The aims of the present study were to describe the views of senior clinical and executive staff employed in public sector residential aged care services (RACS) about the benefits and limitations of using quality indicators (QIs) for improving care, and to identify any barriers or enablers to implementing the QI program.Methods A cross-sectional qualitative study using semistructured interviews and direct observation of key informants involved in the QI program was performed across 20 public sector RACS in Victoria, Australia. Participants included senior clinical, executive and front-line staff at the RACS. The main outcome measures were perceived benefits and the enablers or barriers to the implementation of a QI program.Results Most senior clinical and executive staff respondents reported substantive benefits to using the QIs and the QI program. A limited number of staff believed that the QI program failed to improve the quality of care and that the resource requirements outweighed the benefits of the program, resulting in disaffected staff.Conclusions The QIs and QI program acted as a foundation for improving standards of care when used at the front line or point of care. Senior executive engagement in the QI program was vital to successful implementation.What is known about this topic? QIs measure the structures, processes or outcomes of care and identify issues that need further investigation or improvement. QIs are increasingly being adopted throughout the world. In Australia, the public sector RACS QIs project was implemented in 2006. It is yet to be formally evaluated.What does this paper add? Perceived benefits and limitations of the QI program were identified, together with barriers to successful implementation of the program and recommendations for future improvements. QI data were reported to improve quality culture and assist with identifying clinical areas for improvement. However, the QI program was associated with significantly increased workload and some stakeholders questioned its usefulness. The QI program studied could be improved through better access to education and training for those responsible for data collection and results dissemination to appropriate training and resources; and revision of the QI definitions and reporting methods.What are the implications for clinicians? QI data are useful for identifying opportunities for quality improvement. Despite data limitations, public sector RACS can use data for internal benchmarking, staff education and targeting of quality improvement interventions. At the policy level, revising the QI definitions and simplifying data collection and reporting would improve and strengthen the program. At the clinician and executive level, there is also a strong preference for QI data that allow comparison and benchmarking between facilities.

Resident- and Facility-Level Predictors of Quality of Life in Long-Term Care.
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Shippee TP, Henning-Smith C, Kane RL, Lewis T.
The Gerontologist 2015 Aug;55(4):643-655

Although there is substantial research on quality of care in nursing homes (NH), less is known about what contributes to quality of life (QOL) for NH residents. This study assesses multiple domains of QOL and examines facility- and resident-level correlates for different domains. DESIGN AND METHODS: Data come from (a) self-reported resident interviews using a multidimensional measure of QOL; (b) resident clinical data from the Minimum Data Set; and (c) facility-level characteristics from Minnesota Department of Human Services. We used factor analysis to confirm domains of QOL, and then employed cross-sectional hierarchical linear modeling to identify significant resident- and facility-level predictors of each domain. RESULTS: We examined six unique domains of QOL: environment, personal attention, food, engagement, negative mood, and positive mood. In multilevel models, resident-level characteristics were more reliable correlates of QOL than facility characteristics. Among resident characteristics, gender, age, marital status, activities of daily living, mood disorders, cognitive limitations, and length of stay consistently predicted QOL domains. Among facility characteristics, size, staff hours, quality of care, and percent of residents on Medicaid predicted multiple QOL domains. IMPLICATIONS: Examining separate domains rather than a single summary score makes associations with predictors more accurate. Resident characteristics account for the majority of variability in resident QOL. Helping residents maintain functional abilities, and providing an engaging social environment may be particularly important in improving QOL.

Predictors of Long-Term Care Facility Residents’ Self-Reported Quality of Life With Individual and Facility Characteristics in Canada Canada-flat-icon
Non UofA Access
Kehyayan V, Hirdes JP, Tyas SL, Stolee P.
Journal of aging and health 2015 Jul 6

Identify predictors of long-term care (LTC) facility residents’ self-reported quality of life (QoL). METHOD: QoL of a convenience sample of 928 residents from 48 volunteer LTC facilities across six Canadian provinces was assessed using the inter-Resident Assessment Instrument (interRAI) Self-Report Nursing Home Quality of Life Survey. Multivariate regression models were used to identify predictors. RESULTS: In logistic regression modeling, residents who were religious and socially engaged, had a positive global disposition, or resided in rural, private, or municipal facilities were less likely to report low QoL. Those with post-secondary education and who were dependent on activities of daily living were more likely to report low QoL. These factors, except for religiosity and residence in municipal facilities, were significant in generalized estimating equation (GEE) modeling. DISCUSSION: QoL is significantly associated with select resident and LTC facility characteristics with implications for improving residents’ QoL and LTC facility programming, and guiding future research and social policy development.

Impact of Organizational Stability on Adoption of Quality-Improvement Interventions for Diabetes in Primary Care Settings Canada-flat-icon
Non UofA Access
Wozniak L, Soprovich A, Rees S, Frank L, Johnson ST, Majumdar SR, et al.
Canadian journal of diabetes 2015 Jul 3

Although there have been tremendous advances in diabetes care, including the development of efficacious interventions, there remain considerable challenges in translating these advances into practice. Four primary care networks (PCNs) in Alberta implemented 2 quality-improvement interventions focused on lifestyle and depression as part of the Alberta’s Caring for Diabetes (ABCD) project. METHODS: We used the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework to evaluate adoption of the quality-improvement interventions in the PCN setting. We undertook semistructured interviews with PCN staff (n=24); systematic documentation (e.g. field notes) and formal reflections by the research team (n=4). Content analysis was used to interrogate the data. RESULTS: The Ready? Set? Go! construct summarizes our findings well. We observed that the participating PCNs were in a favourable position to adopt the 2 interventions successfully. We implemented strategies to promote adoption (Ready), and respondents reported prioritization and willingness to initiate the interventions based on positive indicators (Set). Regardless, the interplay of organizational stability, leadership support, existing physician culture and organizational context influenced the overall degree of adoption of the interventions across the PCNs (Go). CONCLUSIONS: Our findings suggest that implementation of quality-improvement interventions into settings similar to the PCNs we studied will have the greatest likelihood of success when there is priority alignment, genuine and sustained leadership support and an innovative organizational culture. However, the stability of organizations may affect the degree to which staff can adopt quality-improvement interventions successfully, so organizational stability should be assessed on an ongoing basis.

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Research Practice and Methodology

Improving recruitment of older people to clinical trials: use of the cohort multiple randomised controlled trial design.
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Clegg A, Relton C, Young J, Witham M.
Age and Ageing 2015 Jul;44(4):547-550

There is widespread evidence of under-recruitment of older people to research studies, notably randomised controlled trials of interventions. Study exclusion criteria, ethical dilemmas, patient preference, risk of bias and challenges for treatment comparisons are particular problems faced by researchers. This article describes how more widespread use of the cohort multiple randomised controlled trial (cmRCT) design in ageing research may help address many of these problems. The original key features of the cmRCT design are a large observational cohort of people with the condition of interest (e.g. frailty) with regular measurement of outcomes for the whole cohort. For each RCT eligible patients are identified and a random selection offered the trial intervention; their outcomes are compared with those eligible patients not offered the intervention. Relevant assents are obtained at baseline to enable future involvement in a range of potential trials. Where possible, the follow-up schedule is aligned with the key time points for assessment in future trials and includes the key baseline descriptors, and primary and secondary outcomes. The cmRCT approach also enables detailed observational and qualitative research for the chosen condition of interest, and might include the establishment of research biobanks to better align basic science, epidemiological, qualitative and clinical trial research. © The Author 2015

Barriers to qualitative dementia research: the elephant in the room.
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Carmody J, Traynor V, Marchetti E.
Qualitative health research 2015 Jul;25(7):1013-1019

As our population is aging, the global prevalence of dementia is rising. Recent extensive reviews of the dementia literature highlight a clear need for additional qualitative research to address the experiences of people with dementia and their carers. To date, the vast majority of published dementia research is quantitative in nature and, perhaps not surprisingly, attracts the bulk of government funding. In contrast, qualitative dementia research is poorly resourced and less frequently published. Although a myriad of factors are responsible for this dichotomy, we propose that inadequate funding represents the “elephant in the room” of dementia research. In this article, we describe and emphasize the need for qualitative dementia research, highlight existing barriers, and outline potential solutions. Examples of barriers are provided and theoretical underpinnings are proposed. © The Author(s) 2014.

Using simplified peer review processes to fund research: a prospective study.
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Herbert DL, Graves N, Clarke P, Barnett AG.
BMJ open 2015 Jul 2;5(7):e008380-2015-008380

To prospectively test two simplified peer review processes, estimate the agreement between the simplified and official processes, and compare the costs of peer review. DESIGN, PARTICIPANTS AND SETTING: A prospective parallel study of Project Grant proposals submitted in 2013 to the National Health and Medical Research Council (NHMRC) of Australia. The official funding outcomes were compared with two simplified processes using proposals in Public Health and Basic Science. The two simplified processes were: panels of 7 reviewers who met face-to-face and reviewed only the nine-page research proposal and track record (simplified panel); and 2 reviewers who independently reviewed only the nine-page research proposal (journal panel). The official process used panels of 12 reviewers who met face-to-face and reviewed longer proposals of around 100 pages. We compared the funding outcomes of 72 proposals that were peer reviewed by the simplified and official processes. MAIN OUTCOME MEASURES: Agreement in funding outcomes; costs of peer review based on reviewers’ time and travel costs. RESULTS: The agreement between the simplified and official panels (72%, 95% CI 61% to 82%), and the journal and official panels (74%, 62% to 83%), was just below the acceptable threshold of 75%. Using the simplified processes would save $A2.1-$A4.9 million per year in peer review costs. CONCLUSIONS: Using shorter applications and simpler peer review processes gave reasonable agreement with the more complex official process. Simplified processes save time and money that could be reallocated to actual research. Funding agencies should consider streamlining their application processes. Published by the BMJ Publishing Group Limited.

Advancing the field of health systems research synthesis
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Langlois EV, Ranson MK, Barnighausen T, Bosch-Capblanch X, Daniels K, El-Jardali F, et al.
Systematic reviews 2015 Jul 10;4:90-015-0080-9

Those planning, managing and working in health systems worldwide routinely need to make decisions regarding strategies to improve health care and promote equity. Systematic reviews of different kinds can be of great help to these decision-makers, providing actionable evidence at every step in the decision-making process. Although there is growing recognition of the importance of systematic reviews to inform both policy decisions and produce guidance for health systems, a number of important methodological and evidence uptake challenges remain and better coordination of existing initiatives is needed. The Alliance for Health Policy and Systems Research, housed within the World Health Organization, convened an Advisory Group on Health Systems Research (HSR) Synthesis to bring together different stakeholders interested in HSR synthesis and its use in decision-making processes. We describe the rationale of the Advisory Group and the six areas of its work and reflects on its role in advancing the field of HSR synthesis. We argue in favour of greater cross-institutional collaborations, as well as capacity strengthening in low- and middle-income countries, to advance the science and practice of health systems research synthesis. We advocate for the integration of quasi-experimental study designs in reviews of effectiveness of health systems intervention and reforms. The Advisory Group also recommends adopting priority-setting approaches for HSR synthesis and increasing the use of findings from systematic reviews in health policy and decision-making.

Using knowledge translation as a framework for the design of a research protocol. Canada-flat-icon
Non UofA Access
Fredericks S, Martorella G, Catallo C.
International journal of nursing practice 2015 May;21 Suppl 2:157-163

Knowledge translation has been defined as the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, resulting in a stronger health-care system. Using KT activities to aid in the adoption of evidence into practice can address current health-care challenges such as increasing organizational practice standards, alleviating the risk for adverse events and meeting practitioner needs for evidence at the bedside. Two general forms of KT have been identified. These being integrated KT and end-of-grant KT. Integrated KT involves the knowledge users in the research team and in the majority of stages of the research process. End-of-grant KT relates to the translation of findings through a well-developed dissemination plan. This paper describes the process of using an integrated knowledge translation approach to design a research protocol that will examine the effectiveness of a web-based patient educational intervention. It begins with a description of integrated knowledge translation, followed by the presentation of a specific case example in which integrated knowledge translation is used to develop a nursing intervention. The major elements of integrated knowledge translation pertain to need for a knowledge user who represents the broad target user group, and who is knowledgeable in the area under investigation and who as authority to enact changes to practice. Use of knowledge users as equal partners within the research team; exploring all feasible opportunities for knowledge exchange; and working with knowledge users to identify all outcomes related to knowledge translation are the other major elements of integrated knowledge translation that are addressed throughout this paper. Furthermore, the relevance of psychosocial or educational interventions to knowledge translation is also discussed as a source of knowledge. In summary, integrated knowledge translation is an important tool for the development of new interventions, as it helps to apply science to practice accurately. It supports the elaboration of the design while enhancing the relevance of the intervention through the validation of feasibility and acceptability with clinicians and patients.

Guidance for conducting systematic scoping reviews.
Non UofA Access
Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB.
International journal of evidence-based healthcare 2015 Jul 1

Reviews of primary research are becoming more common as evidence-based practice gains recognition as the benchmark for care, and the number of, and access to, primary research sources has grown. One of the newer review types is the ‘scoping review’. In general, scoping reviews are commonly used for ‘reconnaissance’ – to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not amenable to a more precise systematic review of the evidence. While scoping reviews may be conducted to determine the value and probable scope of a full systematic review, they may also be undertaken as exercises in and of themselves to summarize and disseminate research findings, to identify research gaps, and to make recommendations for the future research. This article briefly introduces the reader to scoping reviews, how they are different to systematic reviews, and why they might be conducted. The methodology and guidance for the conduct of systematic scoping reviews outlined below was developed by members of the Joanna Briggs Institute and members of five Joanna Briggs Collaborating Centres.

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Aging

What are frailty instruments for? Canada-flat-icon
Non UofA Access
Rockwood K, Theou O, Mitnitski A.
Age and Ageing 2015 Jul;44(4):545-547

Frailty is measured to understand its nature and biology, to aid diagnosis and care planning, to measure outcomes and to stratify risk. Such goals oblige two types of frailty measures – for screening and for assessment – and recognition that not all measures will serve all purposes. When the goal is broad identification of people at risk, a dichotomised approach (frailty is present or absent ) is appropriate. If, however, the degree of risk varies, strategies to test grades of frailty will be required. Frailty measures should be implemented and evaluated in relation to the goal for their use. © The Author 2015

Who has undiagnosed dementia? A cross-sectional analysis of participants of the Aging, Demographics and Memory Study.
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Savva GM, Arthur A.
Age and Ageing 2015 Jul;44(4):642-647

Delays in diagnosing dementia may lead to suboptimal care, yet around half of those with dementia are undiagnosed. Any strategy for case finding should be informed by understanding the characteristics of the undiagnosed population. We used cross-sectional data from a population-based sample with dementia aged 71 years and older in the United States to describe the undiagnosed population and identify factors associated with non-diagnosis. METHODS: the Aging, Demographics and Memory Study (ADAMS) Wave A participants (N = 856) each underwent a detailed neuropsychiatric investigation. Informants were asked whether the participant had ever received a doctor’s diagnosis of dementia. We used multiple logistic regression to identify factors associated with informant report of a prior dementia diagnosis among those with a study diagnosis of dementia. RESULTS: of those with a study diagnosis of dementia (n = 307), a prior diagnosis of dementia was reported by 121 informants (weighted proportion = 42%). Prior diagnosis was associated with greater clinical dementia rating (CDR), from 26% (CDR = 1) to 83% (CDR = 5). In multivariate analysis, those aged 90 years or older were less likely to be diagnosed (P = 0.008), but prior diagnosis was more common among married women (P = 0.038) and those who had spent more than 9 years in full-time education (P = 0.043). CONCLUSIONS: people with dementia who are undiagnosed are older, have fewer years in education, are more likely to be unmarried, male and have less severe dementia than those with a diagnosis. Policymakers and clinicians should be mindful of the variation in diagnosis rates among subgroups of the population with dementia. © The Author 2015.

The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: A systematic review.
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Syed Elias SM, Neville C, Scott T.
Geriatric nursing (New York, N.Y.) 2015 Jun 19

Loneliness, anxiety and depression are common problems for older adults in long-term care. Reminiscence therapy is a non-pharmacological intervention that may be of some benefit. In comparison to individual reminiscence therapy, group reminiscence therapy is a preferred option when dealing with the resource constraints of long-term care. The aim of this paper was to systematically review the literature in order to explore the effectiveness of group reminiscence therapy for older adults with loneliness, anxiety and depression in long-term care. Results indicated that group reminiscence therapy is an effective treatment for depression in older adults, however to date, there is limited research support for its effectiveness to treat loneliness and anxiety. Further research and an improvement in methodological quality, such as using qualitative and mixed methods approaches, is recommended to help establish an evidence base and provide better understanding of the effectiveness of group reminiscence therapy. Copyright © 2015 Elsevier Inc.

Effects of multisensory and motor stimulation on the behavior of people with dementia
Non UofA Access
Sposito G, Barbosa A, Figueiredo D, Yassuda MS, Marques A.
Dementia 2015 June 25

A quasi-experimental study using a pre–posttest design was conducted in four aged care facilities to assess the effects of a person-centred care (PCC) multisensory stimulation (MSS) and motor stimulation (MS) program, implemented by direct care workers, on the behaviors of residents with dementia. Data were collected at baseline and after the intervention through video recordings of morning care routines. Forty-five residents with moderate and severe dementia participated in the study. A total of 266 morning care routines were recorded. The frequency and duration of a list of behaviors were analyzed. The frequency of engagement in task decreased significantly (p = .002) however, its duration increased (p = .039). The duration of gaze directed at direct care workers improved significantly (p = .014) and the frequency of closed eyes decreased (p = .046). There was a significant decrease in the frequency of the expression of sadness. These results support the implementation of PCC–MSS and MS programs as they may stimulate residents’ behaviors.

Pain and Aggression in Nursing Home Residents With Dementia: Minimum Data Set 3.0 Analysis.
Non UofA Access
Ahn H, Garvan C, Lyon D.
Nursing research 2015 Jul-Aug;64(4):256-263

Few studies have examined the potential relationship between pain and aggressive behavioral symptoms in nursing home (NH) residents with dementia as a function of resident communicative status (ability to self-report pain). OBJECTIVES: The objective of this study was to examine the relationship between pain and aggression for residents who self-reported pain and for those whose pain was measured by staff evaluation of pain-related behaviors. METHODS: This is a secondary analysis of the comprehensive data collected from January to March 2012 in the national Minimum Data Set (MDS) 3.0 of NH residents, aged 65 years or older, with dementia (N = 71,227). Pain was measured using the MDS Pain Assessment Interview for residents who could communicate or by staff evaluation using the MDS Pain Behavior Scale for residents who could not communicate. The relationship between pain and aggressive behavioral symptoms was estimated from logistic regression models after controlling for covariates (functional/cognitive impairments, pain medications, comorbidities, and sociodemographic variables). RESULTS: In residents who could not communicate, pain was associated with both verbal and physical aggression (verbal aggression: adjusted odds ratio [AOR] = 1.23, 95% CI [1.17, 1.29]; physical aggression: AOR = 1.20, 95% CI [1.14, 1.26]). In residents who could communicate, pain was associated with verbal aggression only (AOR = 1.12, 95% CI [1.04, 1.18]). DISCUSSION: The relationship between pain and aggressive behavioral symptoms varies according to the communicative status of NH residents and disproportionately affects those who cannot articulate their pain. Strategies for enhancing pain management in these residents are needed to adequately treat pain and reduce aggression.

Gender Differences in Institutional Long-Term Care Transitions.
Non UofA Access
Mudrazija S, Thomeer MB, Angel JL.
Women’s health issues : official publication of the Jacobs Institute of Women’s Health 2015 Jun 27

This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics. METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models. RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements. CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs. Copyright © 2015 Jacobs Institute of Women’s Health.

Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study Canada-flat-icon
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Kosteniuk JG, Morgan DG, O’Connell ME, Kirk A, Crossley M, Teare GF, et al.
BMC geriatrics 2015 Jul 3;15(1):73-015-0075-3

Determining the epidemiology of dementia among the population as a whole in specific jurisdictions – including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria. METHODS: We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescription Drug, and RAI-MDS, i.e., Long-term Care). RESULTS: A total of 3,270 incident cases of dementia (7.28 per 1,000 PAR) and 13,012 prevalent cases (28.16 per 1,000 PAR) were identified during 2012/13. This study found the incidence rate increased by 2.8 to 5.1 times and the prevalence rate increased by 2.6 to 4.6 times every 10 years after 45 years of age. Overall, the age-standardised incidence rate was significantly lower among females than males (7.04 vs. 7.65 per 1,000 PAR) and the age-standardised prevalence rate was significantly higher among females than males (28.92 vs. 26.53 per 1,000 PAR). Over one-quarter (28 %) of all incident cases were admitted to long-term care before a diagnosis was formally recorded in physician or hospital data, and nearly two-thirds of these cases were identified at admission with impairment at the moderate to very severe level or a disease category of Alzheimer’s disease/other dementia. CONCLUSIONS: Linking multiple sources of registry data contributes to our understanding of the epidemiology of dementia across multiple segments of the population, inclusive of individuals residing in long-term care. This information is foundational for public awareness and policy recommendations, health promotion and prevention strategies, appropriate health resource planning, and research priorities.

Identifying Feasible Physical Activity Programs for Long-Term Care Homes in the Ontario Context Canada-flat-icon
Shakeel S, Newhouse I, Malik A, Heckman G.
Canadian Geriatrics Journal 2015;18(2):73-104

Structured exercise programs for frail institutionalized seniors have shown improvement in physical, functional, and psychological health of this population. However, the ‘feasibility’ of implementation of such programs in real settings is seldom discussed. The purpose of this systematic review was to gauge feasibility of exercise and falls prevention programs from the perspective of long-term care homes in Ontario, given the recent changes in funding for publically funded physiotherapy services. Method Six electronic databases were searched by two independent researchers for randomized controlled trials that targeted long-term care residents and included exercise as an independent component of the intervention. Results A total of 39 studies were included in this review. A majority of these interventions were led by physiotherapist(s), carried out three times per week for 30–45 minutes per session. However, a few group-based interventions that were led by long-term care staff, volunteers, or trained non-exercise specialists were identified that also required minimal equipment. Conclusion This systematic review has identified ‘feasible’ physical activity and falls prevention programs that required minimal investment in staff and equipment, and demonstrated positive outcomes. Implementation of such programs represents cost-effective means of providing long-term care residents with meaningful gains in physical, psychological, and social health.

Oral health and dental care of elderly adults dependent on care
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Baumgartner W, Schimmel M, Muller F.
Swiss dental journal 2015;125(4):417-426

The increase in life expectancy in Switzerland is posing new challenges, as more and more people are becoming dependent on care, both at home and in long-term care facilities. The dental profession must deal with patients retaining their own teeth until later in life with an increased incidence and severity of caries and periodontal diseases. The association between general and oral health is becoming important, particularly in older people with medical conditions. Aspiration pneumonia can develop as a result of pathogenic bacteria descending from the oral cavity to the bronchoalveolar system, which presents a frequent, potentially life-threatening danger. By adapting care and treatment concepts, the masticatory ability can be preserved or restored, which in turn helps preventing malnutrition. Other aims include preventing infections as well as maintaining subjective well-being and an attractive dental appearance. Care standards should be defined for the provision of oral-health related dentistry for the vulnerable population of the care-dependent adults. These should be implemented by an interdisciplinary care team composed of nursing personnel, long-term care facility managers, Spitex staff, physicians, dentists as well as dental assistants and hygienists.

From beginning to end: perspectives of the dementia journey in northern Ontario Canada-flat-icon
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Di Gregorio D, Ferguson S, Wiersma E.
Canadian journal on aging 2015 Mar;34(1):100-112

Research on dementia care continues to develop, yet little attention has been given to the dementia experience in rural, northern communities. This study explored the dementia journey through the viewpoints of health service providers, caregivers, community members, and people living with dementia. The findings highlight the complexity of dementia awareness and understanding. Sound awareness and knowledge of dementia itself, the community services available, as well as of the perspectives of individuals living with dementia and care partners specifically in rural, northern Ontario are fundamental to quality care and support of individuals with dementia. Practical service implications and the need for greater developments with respect to the awareness and understanding of dementia in rural, northern communities are discussed.

Daily (In)Activities of Nursing Home Residents in Their Wards: An Observation Study
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Ouden MD, Bleijlevens MH, Meijers JM, Zwakhalen SM, Braun SM, Tan FE, et al.
Journal of the American Medical Directors Association 2015 Jul 6

Research shows that nursing home residents are largely inactive. This inactivity negatively influences physical fitness, and participation in daily activities is known to have a positive influence on physical function and quality of life. Existing research does not provide sufficient insight into the daily activities in which nursing home residents participate. This insight is needed to develop future interventions so as to encourage nursing home residents to participate in daily activities and, thereby, decrease inactivity. The purpose of this study was to obtain insight into daily (in)activities of psychogeriatric and somatic nursing home residents during the day and their body positions during these (in)activities. DESIGN: Cross-sectional observation study. SETTING: Nursing homes in the Netherlands (19 psychogeriatric and 11 somatic wards). PARTICIPANTS: Participants were 723 home residents in 7 nursing homes. MEASUREMENTS: Observations were conducted using a self-developed observation list. Residents were observed in their wards during 5 random observation times between 7:00 am and 11:00 pm, in which the daily activity and position of the resident during this activity were scored. Percentages of activities and positions were calculated for each observation time. RESULTS: In total, 3282 observations (91% of the intended 3615 observations) were conducted. Nursing home residents of both psychogeriatric and somatic wards were mainly observed partaking in inactivities, such as sleeping, doing nothing, and watching TV (range: 45%-77% of the 5 observation times). Furthermore, residents were engaged in activities of daily living (ADLs) (range: 15%-38%) that mainly comprised activities related to mobility (range: 10%-19%) and eating and drinking (range: 2%-17%). Engagement of residents in instrumental ADLs (IADLs) was rarely observed (up to 3%). Residents were largely observed in a lying or sitting position (range: 89%-92%). CONCLUSION: Most of the psychogeriatric and somatic nursing home residents spend their day inactive in a lying or sitting position in the ward. To encourage nursing home residents in daily activities in the wards, interventions are needed that (1) focus on increasing ADLs and IADLs, and (2) encourage standing and walking.

The impact of oral health on the quality of life of nursing home residents
Non UofA Access
Porter J, Ntouva A, Read A, Murdoch M, Ola D, Tsakos G.
Health and quality of life outcomes 2015 Jul 15;13(1):102-015-0300-y

Good oral health in older residents of nursing homes is important for general health and quality of life. Very few studies have assessed how oral symptoms affect residents’ quality of life. OBJECTIVE: To assess the clinical and subjective oral health, including oral health related quality of life (OHRQoL), and the association of oral symptoms with OHRQoL in older people residing in nursing homes in Islington, London. METHOD: Overall, 325 residents from nine nursing homes were clinically examined and 180 residents were interviewed to assess their oral symptoms and their OHRQoL using the OIDP measure. Managers and carers working in the homes were also interviewed. RESULTS: Almost two thirds of the sample were dentate (64.5 %). 61.3 % of dentate and 50.9 % of edentate residents reported problems such as dry mouth, sore cracked lips, broken teeth and toothache and ill-fitting dentures. Oral health impacted considerably upon resident’s OHRQoL; 20.2 % of dentate and 30.9 % of edentate reported at least one oral impact in the past 6 months. Sensitive teeth, toothache, bleeding gums, dry mouth and loose natural teeth among the dentate and loose or ill-fitting dentures among the edentate were strongly associated with higher prevalence of oral impacts even after adjusting for demographic and socio-economic factors, and for the number of teeth (dentate only). CONCLUSION: The burden of oral conditions was considerable. Oral symptoms were very common and were strongly associated with residents’ worse OHRQoL. Health promotion programmes are important to help residents maintain an acceptable level of oral health and function.

Staff-resident interactions in long-term care for people with dementia: the role of meeting psychological needs in achieving residents’ well-being
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Willemse BM, Downs M, Arnold L, Smit D, de Lange J, Pot AM.
Aging & mental health 2015;19(5):444-452

The aim of this study is to explore the extent to which staff-resident interactions address or undermine residents’ psychological needs and how such interactions are associated with residents’ well-being. METHOD: Data on staff-resident interactions and residents’ well-being were collected for 51 residents from nine long-term care settings using dementia care mapping (DCM). DCM yields a count and detailed description of staff-resident interactions that either address (personal enhancers – PEs) or undermine (personal detractions – PDs) residents’ psychological needs, and every 5-minute scores for each resident’s mood and engagement (ME-value). The relationship between PEs and PDs and well-being was analysed by studying residents’ ME-values before and three time frames after a PE or PD occurred. RESULTS: A total of 76 PEs and 33 PDs were observed. The most common PEs were those addressing psychological needs for comfort and occupation. However residents’ well-being increased most often after PEs that addressed residents’ need for identity, attachment and inclusion. The most common PDs were those which undermined the need for comfort, inclusion and occupation. Residents’ well-being decreased most often after PDs that undermined the need for comfort. CONCLUSION: Increasing interactions which address residents’ need for attachment, identity and inclusion and eliminating interactions which undermine residents’ need for comfort may be particularly important in achieving residents’ well-being. In the long run, residents’ well-being could be achieved by staff availing of the opportunities to empower and facilitate residents, thus meeting their needs for occupation. These findings provide directions for training in person-centred care.

Dementia care mapping: effects on residents’ quality of life and challenging behavior in German nursing homes. A quasi-experimental trial
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Dichter MN, Quasdorf T, Schwab CG, Trutschel D, Haastert B, Riesner C, et al.
International psychogeriatrics / IPA 2015 Jul 3:1-18

Person-centered care (PCC) is a widely recognized concept in dementia research and care. Dementia Care Mapping (DCM) is a method for implementing PCC. Prior studies have yielded heterogeneous results regarding the effectiveness of DCM for people with dementia (PwD). We aimed to investigate the effectiveness of DCM with regard to quality of life (QoL) and challenging behavior in PwD in nursing homes (NHs). METHODS: Leben-QD II is an 18-month, three-armed, pragmatic quasi-experimental trial. The sample of PwD was divided into three groups with three living units per group: (A) DCM applied since 2009, (B) DCM newly introduced during the study, and (C) a control intervention based on a regular and standardized QoL rating. The primary outcome was QoL measured with the Quality of Life-Alzheimer’s Disease (QoL-AD) proxy, and the secondary outcomes were QoL (measured with QUALIDEM) and challenging behavior (measured with the Neuropsychiatric Inventory Nursing Home version, NPI-NH). RESULTS: There were no significant differences either between the DCM intervention groups and the control group or between the two DCM intervention groups regarding changes in the primary or secondary outcomes. At baseline, the estimated least square means of the QoL-AD proxy for groups A, B, and C were 32.54 (confidence interval, hereafter CI: 29.36-35.72), 33.62 (CI: 30.55-36.68), and 30.50 (CI: 27.47-33.52), respectively. The DCM groups A (31.32; CI: 28.15-34.48) and B (27.60; CI: 24.51-30.69) exhibited a reduction in QoL values, whereas group C exhibited an increase (32.54; CI: 29.44-35.64) after T2. CONCLUSIONS: DCM exhibited no statistically significant effect in terms of QoL and challenging behavior of PwD in NHs. To increase the likelihood of a positive effect for PwD, it is necessary to ensure successful implementation of the intervention.

Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings
Non UofA Access
Sebba Tosta de Souza DM, Veiga DF, Santos ID, Abla LE, Juliano Y, Ferreira LM.
Journal of wound, ostomy, and continence nursing Jul-Aug;42(4):352-359

The purpose of this study was to measure and compare health-related quality of life in elderly patients with pressure ulcers in different health care settings (home care acute care facility, and long-term care facility [LTCF]). DESIGN: Cross-sectional comparative study. SUBJECTS AND SETTING: One hundred ten elderly patients with (n = 36) and without (n = 74) pressure ulcers living in LTCFs, hospitals, or at home. The research setting included 1 tertiary and 2 community-based hospitals, 10 LTCFs, and 18 community health centers in Brazil. METHODS: The Mini-Mental State Examination, Braden Scale for Predicting Pressure Sore Risk, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to assess cognitive status, pressure ulcer risk, and health-related quality of life, respectively. RESULTS: Compared with those without pressure ulcers, elderly patients with pressure ulcers reported significantly lower (worse) SF-36 scores on physical functioning (P < .001) and role physical (P < .05) in all settings, and on social functioning (P = .045) and role emotional (P = .036) in LTCFs. Subjects in hospitals with pressure ulcers scored significantly higher (better) SF-36 scores on mental health (P = .046) and vitality (P = .009). Hospitalized patients without pressure ulcers had lower SF-36 scores on bodily pain (P = .007) and general health (P = .026) than those living in LTCFs or at home. Patients without pressure ulcers in LTCFs had significantly lower Mini-Mental State Examination scores (lower cognitive status) than those living in other settings (P = .001). CONCLUSIONS: Elderly patients with pressure ulcers who were hospitalized and living at home or in LTCFs reported low scores on physical functioning and role physical, and LTCF residents also reported low scores on social functioning and role emotional. This shows the need for an environment that includes health care professionals prepared to implement strategies for pressure ulcer prevention.

Accreditation and Resident Safety in Ontario Long-Term Care Homes Canada-flat-icon
McDonald SM.
Healthcare Quarterly 2015 04/30;18(1):54-59

To determine if accreditation is associated with better resident safety processes and outcomes in 587 Ontario long-term care (LTC) homes. A second area of interest is whether LTC home characteristics influence pursuit of accreditation. Findings: Out of five safety areas examined, accreditation was only associated with a lower occurrence of falls. Three of four organizational characteristics examined (facility ownership, chain membership and location) were predictors of facility accreditation. Implications: To prevent inequalities in organizations’ ability to pursue accreditation, policymakers may need to consider new initiatives that reduce barriers for LTC homes that lack sufficient resources.

Agitation and Aggression in Long-Term Care Residents with Dementia Canada-flat-icon
The Newfoundland & Labrador Centre for Applied Health Research

This document is organized into lists and descriptions of interventions with the highest level of evidence to interventions that are not supported in the scientific literature at present.

Enhancing the quality of life of older people through better support and care (Australia)
AgeWell June 2015

This report, part of NACA’s Blueprint Series, responds to the Australian Government’s desire to look at further reform and the Aged Care Sector Statement of Principles which was developed to guide future reform. It sets out NACA’s vision, the objectives the organization thinks need to be met to fulfil the vision, and the steps that stakeholders, particularly governments, can take to create a stronger aged care future for all.

Dementia 2015: Aiming higher to transform lives (UK)
Alzheimer’s Society July 2015

Dementia 2015: Aiming higher to transform lives is Alzheimer’s Society’s fourth annual report looking at quality of life for people with dementia in England. It contains the results of our annual survey of people with dementia and their carers, and an assessment of what is currently in place and needs to be done to improve dementia care and support in England over the next five years. It looks at some key resources: our general election manifesto – The dementia promise, the content and ambitions of the Prime Minister’s challenge on dementia 2020 and other recently published data and evidence. Following the calls to action in these publications, Dementia 2015: Aiming higher to transform lives sets out key areas of recommendation, with specific calls for a national action plan across government, health and social care.

The hidden cost of dementia in Wales (UK)
Alzheimer’s Society July 2015

This is an overview of the findings of research commissioned by Alzheimer’s Society and conducted by the Personal Social Services Research Unit (PSSRU), London School of Economics. It follows on from research published in Dementia UK: Update, (Prince et al, 2014). This report aims to provide an accurate understanding of the cost of dementia to society in Wales, and to assist in policy development, influencing, commissioning and service design.

How Can and Should UK Society Adjust to Dementia
Joseph Rowntree Foundation

Our paper sets out to address the following themes:
• the development of conceptual/theoretical thinking – especially looking at the social model of disability – and its relevance to dementia. Attention is paid to social diversity and equity;
• social attitudes and understanding – opportunities and barriers. Here the focus is on disablism and ageism – and the degree to which these overlap;
• the nature and development of services – thinking beyond the usual health and social care boxes – thinking spatially;
• the empowerment and involvement of people living with dementia.

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Events

UofA

Summer Student Poster Presentations
Wednesday 29 July 12:45-14:00

Come and learn more about the students’ projects. The ones I’ve heard about were very interesting.

Non UofA

A pRoject Ethics Community Consensus Initiative (ARECCI) Forum
AIHS Monday 21 September Edmonton AB

This is a one day event for those who are involved in project ethics in the community. Research conducted in Canada must comply with ethics guidelines to protect participants and ensure their safety. All human health research in Alberta, for example, is rigorously reviewed and monitored but what about ethics oversight for non-research projects? Alberta Innovates – Health Solutions offers ARECCI, an initiative that has developed a project ethics framework, easy to use tools and training programs to help support those conducting knowledge-generating projects that are not considered research.
The ARECCI Forum agenda items include:
-Organization’s Recognized Review
-Secondary Use of Data
-ARECCI 2.0
-Second Opinion Reviewer Candidate Capstone Projects

Online

Posterior Cortical Atrophy: Trying to See What They Cannot
The brainXchange & the Alzheimer Society of Canada
Thursday 30 July 10:00-11:00 MT

Posterior cortical atrophy is a rare type of dementia that robs people on how they see the world and interact. This presentation will review the signs, symptoms, causes and strategies of this disorder.

Dissemination and Implementation Research in Health: Translating Science to Practice
Wednesday 22 July 10:30-12:00 MT
Presenters: Ross C. Brownson, PhD, Washington University in St. Louis (WUSTL) and Graham A. Colditz, DrPH, MD, MPH, WUSTL

The AHRQ’s Practice-Based Research Network Resource Center is hosting this webinar. Presenters will discuss their new book, “Dissemination and Implementation Research in Health: Translating Science to Practice” which addresses key challenges in Dissemination and Implementation (D&I) research. Among these, the authors will discuss how to evaluate the evidence base on effective interventions; which strategies will produce the greatest impact; how to design an appropriate study; and how to track a set of essential outcomes.

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Courses

MA Dementia Studies
The School of Nursing and Midwifery, University of Sheffield
Sheffield, UK

This new masters programme has been developed by staff in the School of Nursing and Midwifery and the Departments of Sociological Studies and Human Communication Sciences. The MA programme team is comprised of academics and practitioners active in dementia education, research, and clinical practice.

End of Grant Knowledge Translation (KT)
KT Canada
14 August Halifax NS

This full-day course is designed to provide grant writers with the needed tools to write the KT portion of their grant applications. Course attendees will use their own grants to develop an end of grant KT plan.
Speakers include:
-Kim Barnhardt (Communications and Partnerships Strategist, Canadian Medical Association Journal)
-Jessie McGowan, PhD (Adjunct professor, Dept of Medicine, University of Ottawa; Associate Editor, Journal of Clinical Epidemiology)
-Sharon Straus, MSc, MD (Director and Principal Investigator, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital; Professor, Dept of Medicine, University of Toronto)

The Master of Health Leadership and Policy in Seniors Care
University of British Columbia

The Master of Health Leadership and Policy in Seniors Care will equip you with sector-relevant, cross-disciplinary technical skills to help create the future of seniors health care. The program balances in-depth technical knowledge with the practical, hands-on leadership skills required for graduates to lead and oversee service provision.

Online

Systematic Reviews in Health
University of Portsmouth
1 year full-time distance learning, 2 years part-time distance learning full time: £1,370 part time: £685

This distance learning course is designed for busy health care professionals, such as nurses, doctors, and professionals allied to medicine, who are keen to obtain a postgraduate qualification in a flexible, timely manner through distance learning study. The course materials are available throughout your registration period.

Systematic reviews for policy and practice: diversity, design and debate
EPPI Centre Runs for 15 weeks from 21 September 2015.

Systematic reviews for policy and practice will enable you to plan and appraise systematic reviews. On completion, you will be familiar with a range of different systematic review designs that make use of both qualitative and quantitative data, and you will have a critical appreciation of the relevance of systematic reviews to evidence-informed policy and practice. This online course allows you to choose where and when you study, whilst still receiving tuition from experienced researchers at the EPPI-Centre in London. In the course you will try out and reflect upon various review stages, including formulating a review question, searching and screening, critical appraisal of reports and planning review design and management. Participation includes free access to our specialised systematic review software EPPI-Reviewer.

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News

Millions More Long-Term Care Workers Needed by 2030 (US)

t least 2.5 million more long-term care workers will be needed to look after older Americans by 2030, a new study shows. This demand will remain even if there is a major shift from institutional care to home care, according to the researchers.

New study finds one-third of dementia nurses have unhealthy behaviours because of distress at work Canada-flat-icon

Three-quarters of nurses in southern Alberta who treat residential dementia patients frequently experience distress from being unable to give patients what they need, a new study has found.

CIHI: Supply of nurses in Canada declines for first time in 2 decades Canada-flat-icon

For the first time in 2 decades, more regulated nurses left their profession than entered it, according to a recent report from the Canadian Institute for Health Information (CIHI). Fewer of these professionals — which include registered nurses (RNs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs) — applied for registration, while more chose not to renew their registration due to factors such as retirement, a new career path or a move outside Canada.

The twelve habits of highly productive writers

I started to think about the practices of highly productive writers. What are the personality traits and habits that help people crank out the pages? Here are a few that occur to me.

Many NHS hospital patients complain of ‘lack of dignity’ (UK)

A fifth of people in hospital in England are not always treated with respect and dignity, according to a wide-ranging survey of NHS patients. Analysis of the 2012 poll has found that poor care was more likely to be experienced by those aged over 80.

How to Get the Most Out of a Conference

Conferences are an overwhelming rush of presentations, conversations, and potential meet-ups, and it can be tough to know where to focus your time. How do you figure out which sessions to attend? Should you skip the keynote to meet an important contact? How many coffee dates are too many? And what should you do if you’re an introvert who hates small talk?

COPE “Best Practices” Principles Updated

COPE is just one of a number of organisations that is seeing a large rise in applications for membership from new journals. Although we very much want to encourage and support legitimate new journals, we are also mindful that many new journals are not currently sufficiently transparent about their business practices and authors in particular may be unable to judge the legitimacy of these journals. Together with OASPA, DOAJ, and WAME we have therefore compiled a minimum set of criteria that journals will be assessed against when they apply for membership at one of our organisations. The full criteria can be seen here and we welcome feedback. We encourage authors and anyone else who is unfamiliar with a journal to use these criteria in assessing a journal.

Sampling the Debenham experience – Professor Alistair Burns and Professor John Young (UK)

NHS England’s National Director for Dementia and National Director for the Frail Elderly report on an innovative project in sleepy Suffolk: Debenham is a picturesque village in Suffolk. Since 2009 it has developed a unique approach to the care and support of older people and, specifically, the carers of people with dementia. This is based on a collaborative social movement where the community has taken responsibility for the welfare and support of older people. It grew from conversations between an inspirational group of local people who were committed to improving things for their community united by the common mantra of: “If it is not good enough for my mother, it is not good enough.” http://www.the-debenham-project.org.uk

June Andrews: A Revolution for Dementia Treatment
BBC Podcast

Professor June Andrews, Director, the Dementia Services Development Centre, University of Stirling, argues for a revolution in our approach to dealing with dementia. She outlines immediate low cost changes that would make a dramatic difference to delaying the onset of the illness and caring for people with dementia.

Increasing participation of older people in research: an innovative study design

In this blog, Andy Clegg, Senior Lecturer at Leeds University and Consultant Geriatrician at Bradford Royal Infirmary, expands on a recent Age & Ageing paper, looking at the use of the innovative cohort multiple randomised controlled trial (cmRCT) design to increase participation of older people in research studies

How can I help #saveCochraneCanada?

When we announced Cochrane Canada’s funding challenge at the 2015 Symposium, the response from attendees was clear: You want to help! We are working hard on many fronts, but there is strength in numbers. The offer of assistance is welcome and enthusiastically accepted. Here are our thoughts on what you can do to help us.

Centers for Medicare and Medicaid Services (CMS) launches initiative to reduce avoidable hospitalizations among nursing facility residents (US)

This new effort aims to improve the quality of care for people residing in nursing facilities. CMS will support organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs. The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations. This initiative supports the Partnership for Patients’ goal of reducing hospital readmission rates by 20% by the end of 2013.

Status of Women in the States report shows older women spend more than twice as much as older men on long-term services and supports (US)

The new report “Status of Women in the States” takes a look at older women across the country and by state including demographics, opportunities, health, and employment and earnings. Some of the findings are relevant to ALFA’s data collection on long-term living issues related to workforce development, operational excellence, consumer choice and quality care through its Senior Living 2025 initiative

Antipsychotics overprescribed to Quebec seniors with dementia: report Canada-flat-icon

A new exposé conducted by a Quebec City newspaper suggests Quebec nursing homes are overmedicating seniors with dementia, despite multiple warnings from Health Canada warning against the usage of antipsychotics in this capacity.

Many More Women Than Men Living to 100. But male centenarians have fewer chronic ills than females, British study finds

Although women are four times more likely than men to hit 100, they are more likely to suffer broken bones or develop more than one chronic health problem, such as incontinence or loss of vision or hearing, the British researchers said. Men had fewer chronic ailments.

More Caregivers Are No Spring Chickens Themselves

Gail Schwartz wants to keep her 85-year-old husband out of a nursing home as long as she can, but it isn’t easy.

Development of an electronic Frailty Index (eFI) (UK)

As part of NIHR CLAHRC YH, Andy Clegg and John Young, from the Academic Unit of Elderly Care & Rehabilitation, University of Leeds, are working in collaboration with Chris Bates and John Parry at TPP/ResearchOne to develop and validate an electronic frailty index (eFI) that uses existing electronic health record data to identify and severity grade frailty. The eFI has been developed using the cumulative deficit model of frailty, whereby frailty is defined on the basis of the accumulation of a range of deficits, which are clinical signs (e.g. tremor), symptoms (e.g. breathlessness), diseases (e.g. hypertension) and disabilities. The eFI consists of 36 deficits which have been constructed using around 2,000 primary care clinical codes (Read codes). The eFI calculates a frailty score by dividing the number of deficits present by the total possible. For example, if a patient has 9 out of 36 deficits, the eFI score is 0.25. The score is a robust predictor of those who are at greater risk of adverse outcomes (e.g. care home admission and mortality)

Mid-Summer Check In: How’s Your Summer Writing Coming Along?

Faculty frequently use the summer months to get ahead on their own writing projects. The Writing Campus has a few tips and ideas for maximizing that productivity!

Baltimore hospital opens emergency department for seniors

Moving to better serve its older population, St. Agnes recently became the second Maryland hospital to open a separate emergency department for seniors. It offers an entrance next to the existing one, safer, more comfortable environs and a staff trained in elder care issues.

How to Salvage Your Summer Writing

Writing for Inside Higher Ed, Kerry Ann Rockquemore, Ph.D., president, of the National Center for Faculty Development & Diversity, responds to the tenure track faculty member who fears having lost half the summer and momentum while getting no writing accomplished.

Landmark 69-year study to provide window into dementia

A landmark study that has been following a group of people since their birth in the same week in March 1946 is now turning its focus to the risk factors and early signs of dementia.

NSHRF competition to create Evidence Review Synthesis Centres Canada-flat-icon

The Nova Scotia Health Research Foundation is hosting a national competition for the Public Health Agency of Canada (PHAC) in order to identify two Evidence Review Synthesis Centres (ERSC). The Centres will be expected to produce systematic reviews in order to support the Canadian Task Force on Preventive Health Care (Task Force) guidelines and recommendations.

CIHR Restructuring of Institute Advisory Boards Canada-flat-icon

The new model — comprising fewer boards to enhance collaboration and transversal thinking across Institutes and their stakeholder communities — adheres to Governing Council’s vision of an advisory model that can provide all 13 Institutes with a wider scope of expertise, better identify opportunities for collaboration and enhance coherence across CIHR’s many initiatives, while also complementing other existing CIHR advisory mechanisms.

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Resources

Care of older people in hospital standards
Healthcare Improvement Scotland June 2015

The revised standards support acute episodes of care of older people in hospital. The scope focuses on initial assessment after admission and on more complex journeys of care (rehabilitation, care transitions and discharge planning). The standards have been developed in recognition of the integration of health and social care services.

Dementia-friendly social support – checklist
Uniting AgeWell

Organisations and staff facilitating social support groups for seniors will benefit from a new ‘dementia-friendly checklist’ produced by a collaborative that involved an aged care provider, consumer group and researchers. The resource aims to ensure that social support programs reduce the effects of dementia and increase opportunities for people living with dementia to meaningfully participate. The creators said it can be used by any social support program in any setting.

Writing a literature review: six steps to get you from start to finish

Writing a literature review is often the most daunting part of writing an article, book, thesis, or dissertation. “The literature” seems (and often is) massive. I have found it helpful to be as systematic as possible when completing this gargantuan task. Sonja Foss and William Walters* describe an efficient and effective way of writing a literature review. Their system provides an excellent guide for getting through the massive amounts of literature for any purpose: in a dissertation, an M.A. thesis, or an article or book in any field of study. Below is a summary of the steps they outline as well as a step-by-step method for writing a literature review.

Best Practices Guide for Safely Reducing Anti-Psychotic Drug Use in Residential Care Canada-flat-icon
BC Care Providers Association

This Guide is organized into three parts.
Part 1: An Overview provides facts and figures about dementia, antipsychotic prescription rates, health care consent, and workplace safety.
Part 2: Our Members’ Best Practices describes the successful anti-psychotic drug reduction strategies used by seven BC residential care providers.
Part 3: Resources provides information about other helpful materials, including resources and tips from some other jurisdictions.

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Opportunities

Editor in Chief: Research and Theory for Nursing Practice

Research and Theory for Nursing Practice is seeking a qualified and distinguished editor to review, edit, and select articles for publication in the peer-reviewed journal. Research and Theory for Nursing Practice is published four times a year by Springer Publishing Company. This position is paid and would be for a three-year, renewable term.

TVN Theme Lead for Optimization of Community and Residential Care
DEADLINE 31 August

TVN is seeking a qualified individual to serve in a leadership capacity as Theme Lead for patient-centred research focused on optimizing community and residential care for frail elderly Canadians. While the role of Theme Lead is a volunteer position, TVN will provide administrative support and may financially support research and knowledge translation activities identified by the Theme Lead.

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