October 26, 2015



Congratulations to Dr. Shannon Scott

The Royal Society of Canada has included Shannon in its 2015 cohort of 48 members to the College of New Scholars, Artists and Scientists. Way to go Shannon!!!!!

New article by Dr. Adrian Wagg
Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.
Non UofA Access
K. M. Holtzer-Goor, J. G. Gaultney, P. van Houten, A. S. Wagg, et al.
PLoS One 2015 Oct 1;10(10):e0138225

OBJECTIVE: Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands. METHOD: A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs. RESULTS: With the new care strategy a QALY gain of 0.005 per patient is achieved while saving euro402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved. CONCLUSION: Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

New report from The Health Foundation on Context in Quality Improvement
Context for successful quality improvement (UK)

Building on a series of thought pieces – published by the Health Foundation in Perspectives on context – this best evidence review combines the ideas of receptive and non-receptive contexts for change, with a psychological perspective and the proposition that social context is the key facilitator of quality improvement. The review also considers context at structural levels within the health care system:
-macro – the system level
-meso – the organisation level
-micro – the clinical team level.
Crucially, the review considers how all of these factors combine to impact upon the success and sustainability of quality improvement efforts.

WHO report on ageing and health

Comprehensive public health action on population ageing is urgently needed. This will require fundamental shifts, not just in the things we do, but in how we think about ageing itself. The World report on ageing and health outlines a framework for action to foster Healthy Ageing built around the new concept of functional ability. Making these investments will have valuable social and economic returns, both in terms of health and wellbeing of older people and in enabling their on-going participation in society.


Our Future is Aging
16-17 June Mount Saint Vincent University Halifax NS
DEADLINE 13 November

This scientific peer-reviewed conference will create a forum to bring together critical and applied perspectives that converge on the issue of research on aging. The conference will provide a unique opportunity for established and emerging researchers, scientists, educators, practitioners, artists and policy makers who are interested and engaged in research on aging to come together to learn about, and be inspired by, one another’s work. It offers a forum to explore how research on aging makes a difference in institutions, communities and individuals’ everyday lives; as well as an occasion to discuss existing collaborations in research on aging, and foster new ones.

14th International Conference on Communication, Medicine, and Ethics (COMET)
4-6 July Aalborg, Denmark
DEADLINE 21 December

The COMET conference aims to bring together scholars from different disciplinary backgrounds involving various healthcare specialties and the human and social sciences. A special emphasis is on the dissemination of on-going research in language/discourse/communication studies in relation to healthcare education, patient participation and professional ethics.

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


Knowledge to action for solving complex problems: insights from a review of nine international cases. Canada-flat-icon
Non UofA Access
B. L. Riley, K. L. Robinson, J. Gamble, et al.
Health Promot Chronic Dis Prev Can 2015 May;35(3):47-53

INTRODUCTION: Solving complex problems such as preventing chronic diseases introduces unique challenges for the creation and application of knowledge, or knowledge to action (KTA). KTA approaches that apply principles of systems thinking are thought to hold promise, but practical strategies for their application are not well understood. In this paper we report the results of a scan of systems approaches to KTA with a goal to identify how to optimize their implementation and impact. METHODS: A 5-person advisory group purposefully selected 9 initiatives to achieve diversity on issues addressed and organizational forms. Information on each case was gathered from documents and through telephone interviews with primary contacts within each organization. Following verification of case descriptions, an inductive analysis was conducted within and across cases. RESULTS: The cases revealed 5 guidelines for moving from conceiving KTA systems to implementing them: (1) establish and nurture relationships, (2) co-produce and curate knowledge, (3) create feedback loops, (4) frame as systems interventions rather than projects, and (5) consider variations across time and place. CONCLUSION: Results from the environmental scan are a modest start to translating systems concepts for KTA into practice. Use of the strategies revealed in the scan may improve KTA for solving complex public health problems. The strategies themselves will benefit from the development of a science that aims to understand adaptation and ongoing learning from policy and practice interventions, strengthens enduring relationships, and fills system gaps in addition to evidence gaps. Systems approaches to KTA will also benefit from robust evaluations.; Publisher: Abstract available from the publisher.

Knowledge brokering in public health: A critical analysis of the results of a qualitative evaluation. Canada-flat-icon
Non UofA Access
C. Dagenais, M. C. Laurendeau and M. Briand-Lamarche.
Eval Program Plann 2015 Dec;53:10-17

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.

Building a Unit-Level Mentored Program to Sustain a Culture of Inquiry for Evidence-Based Practice.
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S. T. Breckenridge-Sproat, M. D. Throop, D. Raju, D. A. Murphy, L. A. Loan and P. A. Patrician.
Clin Nurse Spec 2015 Nov-Dec;29(6):329-337

PURPOSE: This study tested the effectiveness of a dynamic educational and mentoring program, facilitated by unit-level mentors, to introduce, promote, and sustain an evidence-based practice (EBP) culture among nurses in a military healthcare setting. BACKGROUND: The need to identify gaps in practice, apply principles of EBP, and advance scientific applications in the pursuit of quality nursing care is as important to military healthcare as it is in the civilian sector. DESCRIPTION: The Advancing Research through Close Collaboration Model guided the intervention and study. Three instruments were used: the Organizational Readiness for System-wide Integration of Evidence-Based Practice, EBP Beliefs, and EBP Implementation scales. The study took place in 3 military hospitals simultaneously undergoing facility and staff integration. Data were collected from staff nurses in the inpatient nursing units before and after a facilitated education and mentoring intervention. OUTCOME: Three hundred sixty nurses (38%) completed baseline, and 325 (31%) completed follow-up surveys. Scores improved on all 3 measures following implementation of the program; however, the differences were statistically significant only for the Organizational Readiness for System-wide Integration of Evidence-Based Practice scale (70.96 vs 77.63, t = -3.95, P < .01). In the paired individual pretest/posttest subsample (n = 56), scores improved significantly on all 3 instruments. CONCLUSIONS: Despite typically high turnover rates of military personnel and restructuring of 3 facilities during the study period, the readiness for, beliefs about, and implementation of EBP improved. This study suggests that a commitment to an EBP culture may diffuse among individuals in an organization, even while experiencing significant change. It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure and workforce composition.

Strategies to implement evidence into practice to improve palliative care: recommendations of a nominal group approach with expert opinion leaders
J. van Riet Paap, K. Vissers, S. Iliffe, et al.
BMC Palliat Care 2015 Sep 29;14:47-015-0044-9

BACKGROUND: In the past decades, many new insights and best practices in palliative care, a relatively new field in health care, have been published. However, this knowledge is often not implemented. The aim of this study therefore was to identify strategies to implement improvement activities identified in a research project within daily palliative care practice. METHODS: A nominal group technique was used with members of the IMPACT consortium, being international researchers and clinicians in cancer care, dementia care and palliative care. Participants identified and prioritized implementation strategies. Data was analyzed qualitatively using inductive coding. RESULTS: Twenty international clinicians and researchers participated in one of two parallel nominal group sessions. The recommended strategies to implement results from a research project were grouped in five common themes: 1. Dissemination of results e.g. by publishing results tailored to relevant audiences, 2. Identification and dissemination of unique selling points, 3. education e.g. by developing e-learning tools and integrating scientific evidence into core curricula, 4. Stimulation of participation of stakeholders, and 5. consideration of consequences e.g. rewarding services for their implementation successes but not services that fail to implement quality improvement activities. DISCUSSION: The added value of this nominal group study lies in the prioritisation by the experts of strategies to influence the implementation of quality improvement activities in palliative care. Efforts to ensure future use of scientific findings should be built into research projects in order to prevent waste of resources.

Knowledge Translation: Where Are the Qualitative Health Researchers? Canada-flat-icon
Non UofA Access
J. L. Bottorff.
Qual Health Res 2015 Nov;25(11):1461-1462.

Along with rapid advances in knowledge have come expectations for speedy translation of research into improvements to health care services, new diagnostic tools and interventions, and innovations in health promotion to improve patient and health system outcomes.

Inside the “Black Box” of a Knowledge Translation Program in Applied Health Research.
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J. Heaton, J. Day and N. Britten.
Qual Health Res 2015 Nov;25(11):1477-1491

In this article, we present the findings of a participatory realistic evaluation of a 5-year program of health care research intended to promote the translation of knowledge into routine clinical practice. The program was one of the nine pilot Collaborations for Leadership in Applied Health Research and Care funded by the English National Institute for Health Research between 2008 and 2013. Our aim was to delineate the mechanisms by which, and circumstances in which, some projects carried out under the program achieved success in knowledge translation while others were frustrated. Using qualitative methods, we examined how closer collaboration between academics and clinicians worked in four purposefully chosen case studies. In a synthesis of the findings, we produced a “black box” model of how knowledge translation was enabled by the activation of nine mechanisms. These are summarized in the form of five simple rules for promoting knowledge translation through collaborations based on principles of coproduction.

Leadership for Knowledge Translation The Case of CLAHRCs
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D. Spyridonidis, J. Hendy and J. Barlow.
Qual Health Res 2015 Nov;25(11):1492-1505

Calls for successful knowledge translation (KT) in health care have multiplied over recent years. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) program is a policy initiative in the United Kingdom aimed at speeding-up the translation of research into health care practice. Using multiple qualitative research methods and drawing on the ongoing processes used by individuals to interpret and contextualize information, we explore how new organizational forms for KT bridge the gap between research and practice. We pay particular attention to the relationship between the organization and practices of KT and leadership. Our empirical data demonstrate how the relationship between leadership and KT shifted over time from a push model where the authoritarian top-down leadership team set outcome measures by which to judge KT performance to one which aimed to distribute leadership capacity across a wide range of stakeholders in health and social care systems. The relationship between the organization and practices of KT and leadership is affected by local contextual influences on policies directed at increasing the uptake of research in clinical practice. Policy makers and service leaders need to recognize that more dispersed type of leadership is needed to accommodate the idiosyncratic nature of collective action.

Exploring the Hidden Barriers in Knowledge Translation: A Case Study Within an Academic Community.
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G. Harvey, R. J. Marshall, Z. Jordan and A. L. Kitson.
Qual Health Res 2015 Nov;25(11):1506-1517

Debates about knowledge translation (KT) typically focus on the research-practice gap, which appears to be premised on the assumption that academics are a homogeneous collective, sharing a common view. We argue that a number of hidden barriers need to be addressed related to the understanding, interpretation, ability, and commitment to translate knowledge within academic communities. We explore this by presenting a qualitative case study in a health sciences faculty. Applying organizational and management theory, we discuss different types of boundaries and the resultant barriers generated, ranging from diversity in understanding and perceptions of KT to varying motivations and incentives to engage in translational activity. We illustrate how we are using the empirical findings to inform the development of a KT strategy that targets the identified barriers. Investing in this internal KT-focused activity is an important step to maximize the potential of future collaborations between producers and users of research in health care.

Translating research knowledge in dementia care organisations.
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H. Alyami, K. Peri, J. Vanderpyl and G. Cheung.
Australas Psychiatry 2015 Oct 12

OBJECTIVE: To evaluate dementia care organisations’ capacity to acquire, assess, adapt and apply dementia research. METHODS: We used the Canadian Health Services Research Foundation’s survey, ‘Is research working for you?’ by inviting the members of the New Zealand National Dementia Cooperative to participate in the online survey. RESULTS: A total of 146 (32%) members responded and indicated that, although the workforce had the skills to engage in research and implement evidence into practice, there was limited organisational support in terms of the time, resources and access to external support. CONCLUSIONS: We propose a number of strategies to improve knowledge translation in dementia care.

Validity and usability of a professional association’s web-based knowledge translation portal: American Physical Therapy Association’s PTNow.org.
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J. E. Deutsch, W. Romney, J. Reynolds and T. J. Manal.
BMC Med Inform Decis Mak 2015 Oct 8;15(1):79-015-0178-y

BACKGROUND: PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site. METHODS: Physical therapist participants used clinical summaries (available in 3 formats–as a full summary with hyperlinks, “quick takes” with hyperlinks, and a portable two-page version) on the PTNow.org site to answer knowledge acquisition and clinical reasoning questions related to four patient scenarios. They also responded to questions about ease of use related to website navigation and about format and completeness of information using a 1-5 Likert scale. Responses were coded to reflect how participants used the site and then were summarized descriptively. Preferences for clinical summary format were analyzed using an analysis of variance (ANOVA) and a Dunnett T3 post hoc analysis. RESULTS: Seventeen participants completed the study. Clinical relevance and completeness ratings by experienced clinicians, which were used as the measure of content validity, ranged from 3.1 to 4.6 on a 5 point scale. Construct validity based on the information on the PTNow.org site was supported for knowledge acquisition questions 66 % of the time and for clinical reasoning questions 40 % of the time. Usability ratings for the full clinical summary were 4.6 (1.2); for the quick takes, 3.5 (.98); and for the portable clinical summary, 4.0 (.45). Participants preferred the full clinical summary over the other two formats (F = 5.908, P = 0.007). One hundred percent of the participants stated that they would recommend the PTNow site to their colleagues. CONCLUSION: Prelimary evidence supported both content validity and construct validity of knowledge acquisition, and partially supported construct validity of clinical reasoning for the clinical summaries on the PTNow.org site. Usability was supported, with users preferring the full clinical summary over the other two formats. Iterative design is ongoing.

Implementing best practice in hospital multidisciplinary nutritional care: an example of using the knowledge-to-action process for a research program. Canada-flat-icon
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C. Laur and H. H. Keller.
J Multidiscip Healthc 2015 Oct 3;8:463-472

BACKGROUND: Prospective use of knowledge translation and implementation science frameworks can increase the likelihood of meaningful improvements in health care practices. An example of this creation and application of knowledge is the series of studies conducted by and with the Canadian Malnutrition Task Force (CMTF). Following a cohort study and synthesis of evidence regarding best practice for identification, treatment, and prevention of malnutrition in hospitals, CMTF created an evidence-informed, consensus-based pathway for nutritional care in hospitals. The purpose of this paper is to detail the steps taken in this research program, through four studies, as an example of the knowledge-to-action (KTA) process. THE KTA PROCESS: The KTA process includes knowledge creation and action cycles. The steps of the action cycle within this program of research are iterative, and up to this point have been informed by three studies, with a fourth underway. The first study identified the magnitude of the malnutrition problem upon admission to hospital and how it is undetected and undertreated (study 1). Knowledge creation resulted in an evidence-based pathway established to address care gaps (study 2) and the development of monitoring tools (study 3). The study was then adapted to local context: focus groups validated face validate the evidence-based pathway; during the final phase, study site implementation teams will continue to adapt the pathway (studies 2 and 4). Barriers to implementation were also assessed; focus groups and interviews were conducted to inform the pathway implementation (studies 1, 2, and 4). In the next step, specific interventions were selected, tailored, and implemented. In the final study in this research program, plan-do-study-act cycles will be used to make changes and to implement the pathway (study 4). To monitor knowledge use and to evaluate outcomes, audits, staff surveys, patient outcomes, etc will be used to record process evaluations (studies 3 and 4). Finally, a sustainability plan will be incorporated into the final study of the program (study 4) to sustain knowledge use. DISCUSSION: Use of frameworks can increase the likelihood of meaningful and sustainable improvements in health care practice. The example of this program of research demonstrates how existing evidence has been used to identify, create, and adapt knowledge, and how multidisciplinary teams have been used to effect changes in the hospital setting. CONCLUSION: Effective implementation is essential in nutritional health care, and this multidisciplinary program of research provides an example of how the KTA process can facilitate implementation and promote sustainability.

Moving knowledge to action: a qualitative study of the Registered Nurses’ Association of Ontario Advanced Clinical Practice Fellowship program. Canada-flat-icon
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W. A. Gifford, B. L. Davies, J. Ploeg, S. Eldred and I. Bajnok.
Nurs Leadersh (Tor Ont) 2013 Mar;26(1):32-57

With funding from the Ontario Ministry of Health and Long-Term Care, the Registered Nurses’ Association of Ontario (RNAO) established the Advanced Clinical Practice Fellowship (ACPF) program in 2000 to improve patient care and outcomes through advanced nursing knowledge and skills. This paper describes the perceptions of ACPF fellows regarding their influence on quality of care and patient outcomes, specifically, the types of practice change activities initiated, successful implementation and influence on outcomes, barriers encountered and strategies used to address them and influence change. METHODS: Thirty telephone interviews were conducted with ACPF fellows after completing their fellowship. Interviews were analyzed using descriptive content analysis. RESULTS: Fifty-one practice change activities were identified. Ratings for successful implementation (1 = not successful, 10 = extremely successful) were 7.2/10; ratings for successful influence on outcomes were 7.4/10. Barriers identified were (a) resistant attitudes, (b) time and workload, (c) lack of administrative support and (d) lack of mentor’s involvement. Strategies proposed were (a) building a knowledge base, (b) negotiation and dialogue and (c) self-reliance and persistence. IMPLICATIONS: The ACPF program is an innovative and highly utilized initiative. While this program supports strategic directions of government and nursing professional groups, further research will validate and expand on the specific ways in which the initiative influences professional development, healthcare delivery and patient outcomes.

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Health Care Administration and Organization

Dancing the two – Step in Ontario’s long – term care sector: Deterrence regulation = consolidation Canada-flat-icon
T. Daly.
Studies in Political Economy 2015;95:29-58

This paper explores shifts in public and private care delivery over time through an analysis of Ontario’s approach to long-term care funding and regulation in relation to other jurisdictions in Canada and abroad. The case of the evolution of Ontario’s long-term care policy-from the 1940s until early 2013-shows how moving from compliance- to deterrence-oriented regulation can support the consolidation of commercial providers’ ownership and increase the likelihood of nonprofit and public providers outsourcing their management.

Nurse practitioner interactions in acute and long-term care: an exploration of the role of knotworking in supporting interprofessional collaboration. Canada-flat-icon
Non UofA Access
C. Hurlock-Chorostecki, M. van Soeren, K. MacMillan, S. Sidani, F. Donald and S. Reeves.
BMC Nurs 2015 Oct 14;14:50-015-0102-x. eCollection 2015

BACKGROUND: Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care. The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care. METHOD: Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of “knotworking” to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts. RESULTS: Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions. CONCLUSIONS: Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed.

Nursing assistants: “He seems to be ill” – a reason for nurses to take action: validation of the Early Detection Scale of Infection (EDIS).
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P. Tingstrom, A. Milberg, N. Rodhe, J. Ernerud, E. Grodzinsky and M. Sund-Levander.
BMC Geriatr 2015 Oct 12;15(1):122-015-0114-0

BACKGROUND: Signs and symptoms of infection in frail elderly are atypical, causing delay in diagnosis and treatment. To improve communication between healthcare staff of signs and symptoms of infection we developed an instrument, using qualitative data from observations by nursing assistants when they suspected infection. The aim of this study was to assess the validity of nursing assistants observations by developing and testing the instrument for early detection of infection in elderly nursing home residents. METHODS: The early detection of infection (EDIS) instrument was based on data from focus interviews with nursing assistants. Over one year the nursing assistants used EDIS to document episodes of suspected early signs and symptoms of infection in 204 nursing home residents. Two physicians classified documented episodes as “no infection”, “possible infection”, and “infection”. The content validity of the 13 items of the EDIS was established to explore the relationships between the items. The construct validity was used to explore the relationship between the items and the presence or absence of infection. The predictive value of the developed model was evaluated by the percentage of correct classifications of the observed cases. Generalized linear model (ordinal multinomial distribution and logit link) was used. RESULTS: Of the 388 events of suspected infection, 20 % were assessed as no infection, 31 % as possible infection and 49 % as infection. Content validity analysis showed that 12/13 of the items correlated significantly with at least one other statement. The range in number of significant inter-correlations was from 0 (“pain”) to 8 (“general signs and symptoms of illness”). The construct validity showed that the items “temperature” , “respiratory symptoms” and “general signs and symptoms of illness” were significantly related to “infection”, and these were also selected in the model-building. These items predicted correct alternative responses in 61 % of the cases. CONCLUSION: The validation of EDIS suggests that the observation of “general signs and symptoms of illness”, made by nursing assistants should be taken seriously in detecting early infection in frail elderly. Also, the statement “He/She is not as usual” should lead to follow-up.

Making Meaningful Improvements to Direct Care Worker Training through Informed Policy: Understanding How Care Setting Structure and Culture Matters.
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M. E. Kemeny and B. Mabry.
Gerontol Geriatr Educ 2015 Oct 9

Well intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from of 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs’ learning and working environment.

Nurse Staffing and Quality of Care of Nursing Home Residents in Korea.
Non UofA Access
J. H. Shin and T. K. Hyun.
J Nurs Scholarsh 2015 Oct 14

PURPOSE: To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. METHODS: This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. FINDINGS: The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. CONCLUSIONS: Study results supported RNs’ unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents’ outcomes in Korea. CLINICAL RELEVANCE: We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately contributes to the stable settlement of the long-term care insurance system for elders.

Electronic Health Records in Long-Term Care: Staff Perspectives.
Non UofA Access
R. Meehan.
J Appl Gerontol 2015 Oct 12

As long-term post-acute care (LTPAC) settings continue to increase their adoption of electronic health records (EHRs), it is important to learn from end users currently working with the technology to identify clinical implications and opportunities to improve systems and surrounding processes. This study utilized one-on-one interviews of direct care nurses (n = 20) in a Midwest United States LTPAC setting to describe patterns of use, and areas to improve. The majority of respondents evaluated the EHR as easy to use, with a positive impact on quality of care, through efficiencies gained in communication with the care team. Staff responses outline desired modifications to the software, including fixes to data fields for more accurate medication administration and accurate reports on bowel protocol follow-up. Recommendations for LTPAC organizations are made regarding improved staff training on the EHR, and modifications to the EHR and related processes to improve quality of care and staff retention.

Influenza vaccination rates and beliefs about vaccination among nursing home employees.
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J. D. Daugherty, S. C. Blake, J. M. Grosholz, S. B. Omer, L. Polivka-West and D. H. Howard.
Am J Infect Control 2015 Feb;43(2):100-106

BACKGROUND: Recent studies have suggested that vaccination of nursing home staff members may reduce the incidence of influenza among nursing home residents. Current national estimates of employee vaccination rates (around 50%) indicate that residents may be at an unnecessarily high risk of contracting influenza. This article reports on the influenza vaccination rates and attitudes toward the vaccine among employees in 37 nursing homes in 3 states. METHODS: Nursing home employees were surveyed at nursing homes in Florida, Georgia, and Wisconsin in 2011-2012. Completed surveys were received from a total of 1,965 employees. RESULTS: Approximately 54% of the employees surveyed received the vaccination during the 2010-2011 and 2011-2012 influenza seasons. Nursing home-level staff vaccination rates varied widely, from 15%-97%. Black and younger employees were less likely to receive the vaccine. Employee vaccination rates in nursing homes that used incentives were 12 percentage points higher than those that did not use incentives (P = .08). CONCLUSION: Low vaccination rates among nursing home workers may put residents at increased risk for influenza-related morbidity and mortality. The Centers for Medicare and Medicaid Services may consider employee vaccination rates as a quality indicator in addition to resident vaccination rates. Our findings support the use of a trial to test the use of incentives to increase employee vaccination rates.

Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study.
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Y. H. Jeon, J. Conway, L. Chenoweth, J. Weise, T. H. Thomas and A. Williams.
J Clin Nurs 2015 Apr;24(7-8):999-1010

AIMS AND OBJECTIVES: To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). BACKGROUND: Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. DESIGN: A Delphi method. METHODS: Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. RESULTS: Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. CONCLUSIONS: The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. RELEVANCE TO CLINICAL PRACTICE: The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals’ and organisations’ performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care.

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Health Care Innovation and Quality Assurance

A framework to guide implementation research for care transitions interventions.
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S. M. Dy, M. Ashok, R. C. Wines and L. Rojas Smith.
J Healthc Qual 2015 Jan-Feb;37(1):41-54

Evaluating implementation of complex interventions to improve care transitions and comparison across studies is challenging due to issues such as variation in methods and lack of reporting key evaluation elements. This article describes a framework for evaluating implementation of hospital to ambulatory care transitions interventions and application to a case study. We searched published and gray literature for relevant frameworks. We adapted the general Consolidated Framework for Implementation Research, adding elements relevant to other complex interventions. We refined these adaptations through structured expert input and application to case studies. Key adaptations included conceptualization around organizations, not just settings, and around patient- and caregiver-centeredness. Although these interventions are often oriented toward institutional outcomes such as readmissions, tailoring interventions to specific patient needs strengthens effectiveness. Coordination and communication are important between organizations and providers and with patients and caregivers. Roles of those involved in the intervention–providers, administrators, and facilitators from different organizations–are also key constructs. Finally, as these interventions often are tailored to specific settings and adapt over time, assessing intervention design–which components are implemented as part of the bundle, how they are actually implemented, and their differential impact on effectiveness–is critical.

Safety of Rural Nursing Home-to-Emergency Department Transfers: Improving Communication and Patient Information Sharing Across Settings.
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J. B. Tupper, C. E. Gray, K. B. Pearson and A. F. Coburn.
J Healthc Qual 2015 Jan-Feb;37(1):55-65

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

Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study
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K. Abrahamson, S. DeCrane, C. Mueller, H. W. Davila and G. Arling.
J Nurs Care Qual 2015 Jul-Sep;30(3):261-268

This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.

Oversight on the borderline: Quality improvement and pragmatic research.
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J. A. Finkelstein, A. L. Brickman, A. Capron, et al.
Clin Trials 2015 Oct;12(5):457-466

Pragmatic research that compares interventions to improve the organization and delivery of health care may overlap, in both goals and methods, with quality improvement activities. When activities have attributes of both research and quality improvement, confusion often arises about what ethical oversight is, or should be, required. For routine quality improvement, in which the delivery of health care is modified in minor ways that create only minimal risks, oversight by local clinical or administrative leaders utilizing institutional policies may be sufficient. However, additional consideration should be given to activities that go beyond routine, local quality improvement to first determine whether such non-routine activities constitute research or quality improvement and, in either case, to ensure that independent oversight will occur. This should promote rigor, transparency, and protection of patients’ and clinicians’ rights, well-being, and privacy in all such activities. Specifically, we recommend that (1) health care organizations should have systematic policies and processes for designating activities as routine quality improvement, non-routine quality improvement, or quality improvement research and determining what oversight each will receive. (2) Health care organizations should have formal and explicit oversight processes for non-routine quality improvement activities that may include input from institutional quality improvement experts, health services researchers, administrators, clinicians, patient representatives, and those experienced in the ethics review of health care activities. (3) Quality improvement research requires review by an institutional review board; for such review to be effective, institutional review boards should develop particular expertise in assessing quality improvement research. (4) Stakeholders should be included in the review of non-routine quality improvement and quality improvement-related research proposals. Only by doing so will we optimally leverage both pragmatic research on health care delivery and local implementation through quality improvement as complementary activities for improving health.

Improving communication when caring for acutely ill patients with dementia.
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C. Kilgore.
Nurs Older People 2015 May;27(4):35-38

People living with dementia have complex needs, which may be compounded when they develop an acute illness. It is vital to recognise any deterioration in a patient and respond appropriately to prevent serious complications and, in some cases, mortality. It is necessary for all healthcare professionals to develop assessment skills that take account of potential communication difficulties. This article reviews the literature on communicating with people with dementia, and considers the main issues involved in managing patients with an acute illness who are already living with dementia. The aim is to ensure that nurses consider how they communicate in these situations and to recognise the benefits that can be gained by healthcare professionals and patients from enhanced communication.

Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents.
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J. Torma, U. Winblad, A. Saletti and T. Cederholm.
J Nutr Health Aging 2015 Jan;19(1):70-76

OBJECTIVES: Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation (EF) and educational outreach visits (EOVs), in order to introduce nutritional guidelines (e.g. screening, food quality and mealtime ambience), into a nursing home (NH) setting and to evaluate the clinical outcomes. DESIGN: A controlled study with baseline and follow-up measurements. SETTING: Four NHs. PARTICIPANTS: A total of 101 NH residents. INTERVENTION: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. MEASUREMENTS: The outcomes were nutritional status (Mini Nutritional Assessment-Short Form, MNA-SF), body mass index (BMI), functional ability (Barthel Index, BI), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life (EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. RESULTS: After a median of 18 months, nutritional parameters (MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group (p=0.008). Multiple linear regression analyses indicated that the intervention group assignment (EF) was independently from other potentially related factors associated with less cognitive decline. CONCLUSION: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.

Exploring factors that contribute to dose administration aid incidents and identifying quality improvement strategies: the views of pharmacy and nursing staff.
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J. F. Gilmartin, J. L. Marriott and S. Y. Hussainy.
Int J Pharm Pract 2014 Dec;22(6):407-414

BACKGROUND: Dose administration aids (DAAs) organise medicines that have been repacked according to the day of the week and time of the day in which they must be taken. In Australia, DAAs are commonly prepared by pharmacy staff for residential aged care facility (RACF) medicine administration. Although the limited available literature indicates that DAA incidents of inaccurate or unsuitable medicine repacking do occur, there is a paucity of qualitative research identifying quality improvement strategies for this service. OBJECTIVES: This study aims to investigate the perceived contributing factors to DAA incidents and strategies for quality improvement in RACFs and pharmacies. METHODS: Health professional perceptions were drawn from three structured focus groups, including six pharmacists, five nurses, a pharmacy technician and a personal care worker. Participants were involved in the preparation, supply or use of DAAs at pharmacies or RACFs that were involved in a previous DAA audit. Transcripts were analysed using thematic analysis. KEY FINDINGS: Four major themes were identified as contributing to DAA incidents, with quality improvement strategies aligned to those same four themes: communication, knowledge and awareness, medicine handling and attitude. Strategies included improving interprofessional communication and addressing the limitations associated with RACF medicine records; targeting medicine knowledge gaps and increasing awareness of DAA incidents; encouraging greater care when preparing and checking DAAs; and fostering a team mentality among members of the aged care team. CONCLUSIONS: Recommendations include using current findings to develop multidisciplinary quality improvement initiatives to prevent DAA incidents and to improve the quality of this pharmacy medicine supply service.

Perceived barriers to infection prevention and control for nursing home certified nursing assistants: A qualitative study
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J. Travers, C. T. Herzig, M. Pogorzelska-Maziarz, et al.
Geriatr Nurs 2015 Sep-Oct;36(5):355-360

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals.

Computer modeling with randomized-controlled trial data informs the development of person-centered aged care homes.
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L. Chenoweth, V. Vickland, J. Stein-Parbury, Y. H. Jeon, P. Kenny and H. Brodaty.
Neurodegener Dis Manag 2015 Oct 19

AIM: To answer questions on the essential components (services, operations and resources) of a person-centered aged care home (iHome) using computer simulation. MATERIALS & METHODS: iHome was developed with AnyLogic software using extant study data obtained from 60 Australian aged care homes, 900+ clients and 700+ aged care staff. Bayesian analysis of simulated trial data will determine the influence of different iHome characteristics on care service quality and client outcomes. Interim results: A person-centered aged care home (socio-cultural context) and care/lifestyle services (interactional environment) can produce positive outcomes for aged care clients (subjective experiences) in the simulated environment. CONCLUSION: Further testing will define essential characteristics of a person-centered care home.

Study protocol for “Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)”: a pragmatic trial comparing implementation strategies.
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R. Gold, C. Hollombe, A. Bunce, et al.
Implement Sci 2015 Oct 16;10(1):144-015-0333-y

BACKGROUND: Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies’ effectiveness in the community health center setting. METHODS/DESIGN: This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics’ ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the “how” and “why” underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in “real-world” practices. DISCUSSION: Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02325531.

Effectiveness of educational nursing home visits on quality of life, functional status and care dependency in older adults with mobility impairments: a randomized controlled trial.
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A. Buss, K. Wolf-Ostermann, T. Dassen, N. Lahmann and S. Strupeit.
J Eval Clin Pract 2015 Oct 13

RATIONALE, AIMS AND OBJECTIVES: Facilitating and maintaining functional status (FS) and quality of life (QoL) and avoiding care dependency (CD) are and will increasingly become major tasks of nursing. Educational nursing home visits may have positive effects on FS and QoL in older adults. The aim of this study was to determine the effectiveness of educational home visits on FS, QoL and CD in older adults with mobility impairments. METHOD: We performed a randomized controlled trial. The study was conducted in the living environments of 123 participants with functional impairments living in Hamburg, Germany. The intervention group received an additional nursing education intervention on mobility and QoL; the control group received care as usual. Data were collected from August 2011 to December 2012 at baseline, 6 months and 12 months of follow-up. The main outcomes were FS (Barthel Index), QoL (WHOQOL-BREF) and CD (Care Dependency Scale). Data were analyzed using descriptive statistics and generalized linear models. RESULTS: In total, 113 participants (57 in the intervention and 56 in the control group) were included in the study. The intervention had no statistical significant effect on FS, QoL and CD. CONCLUSIONS: The intervention did not show the benefits that we assumed. Further studies on the effects of educational nursing interventions should be performed using different concepts and rigorous research methods.

Sustained increase in resident meal time hand hygiene through an interdisciplinary intervention engaging long-term care facility residents and staff.
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M. O’Donnell, T. Harris, T. Horn, et al.
Am J Infect Control 2015 Feb;43(2):162-164

Hand hygiene by patients may prevent acquisition and dissemination of health care-associated pathogens, but limited efforts have been made to engage patients in hand hygiene interventions. In a long-term care facility, we found that residents were aware of the importance of hand hygiene, but barriers, such as inaccessible products or difficult to use products, limited compliance. A dramatic and sustained improvement in meal time hand hygiene was achieved through engagement of staff and residents.

Assessing approaches and barriers to reduce antipsychotic drug use in Florida nursing homes.
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M. L. Ellis, V. Molinari, D. Dobbs, K. Smith and K. Hyer.
Aging Ment Health 2015;19(6):507-516

OBJECTIVES: Antipsychotic medications have been federally regulated since 1987, yet research suggests they continue to be used inappropriately to alleviate behavioral symptoms associated with dementia. In 2012, the Centers of Medicare and Medicaid launched a new initiative to reduce antipsychotic medication in nursing homes by 15% nationally. The aim of this study was to examine qualitative data to explore strategies that have been implemented, to assess which strategies are evidence-based, and to make recommendations to improve upon practices to reduce antipsychotic medication use. METHOD: A convenience sample of 276 nursing home professional staff members were surveyed about these topics using open-ended questions. RESULTS: Theme-based content analysis yielded three main themes. The themes related to changes in practice included the following: (1) increased review of resident behavior and antipsychotic medication regimens; (2) reduction in antipsychotic medications or dosage; and (3) increased use of nonpharmacological interventions. The main themes relevant to needed assistance included the following: (1) education; (2) clinical support; and (3) increased financial resources and reimbursement. DISCUSSION: Overall findings indicate that the majority of facilities are actively responding to the initiative, but challenges remain in education, finding mental health support, and in reimbursement.

Development of the Quality of Australian Nursing Documentation in Aged Care (QANDAC) instrument to assess paper-based and electronic resident records.
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N. Wang, C. Bjorvell, D. Hailey and P. Yu.
Australas J Ageing 2014 Dec;33(4):E18-24

AIM: To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records. METHODS: The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model. RESULTS: The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results. CONCLUSION: The QANDAC instrument may be a useful audit tool for quality improvement and research in aged care documentation.

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Research Practice and Methodology

Analyzing Data Generated Through Deliberative Dialogue: Bringing Knowledge Translation Into Qualitative Analysis. Canada-flat-icon
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K. M. Plamondon, J. L. Bottorff and D. C. Cole.
Qual Health Res 2015 Nov;25(11):1529-1539

Deliberative dialogue (DD) is a knowledge translation strategy that can serve to generate rich data and bridge health research with action. An intriguing alternative to other modes of generating data, the purposeful and evidence-informed conversations characteristic of DD generate data inclusive of collective interpretations. These data are thus dialogic, presenting complex challenges for qualitative analysis. In this article, we discuss the nature of data generated through DD, orienting ourselves toward a theoretically grounded approach to analysis. We offer an integrated framework for analysis, balancing analytical strategies of categorizing and connecting with the use of empathetic and suspicious interpretive lenses. In this framework, data generation and analysis occur in concert, alongside engaging participants and synthesizing evidence. An example of application is provided, demonstrating nuances of the framework. We conclude with reflections on the strengths and limitations of the framework, suggesting how it may be relevant in other qualitative health approaches

Classification and prevalence of spin in abstracts of non-randomized studies evaluating an intervention.
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C. Lazarus, R. Haneef, P. Ravaud and I. Boutron.
BMC Med Res Methodol 2015 Oct 13;15(1):85-015-0079-x

BACKGROUND: Spin represents specific reporting strategies, either intentional or unintentional, to convince the reader that the beneficial effect of the experimental intervention in terms of efficacy and safety is greater than that shown by the results. The objectives of this study were to 1) develop a classification of spin specific to non-randomized studies assessing an intervention and 2) estimate the prevalence of spin in abstracts of reports of such studies. METHODS: In a first step, we developed a specific classification of spin for non-randomized studies by a literature review and pilot study. In a second step, 2 researchers trained in the field of methodology evaluated the prevalence of spin in the abstract of all non-randomized studies assessing an intervention published in the BioMed Central Medical Series journals between January 1, 2011 and December 31, 2013. All disagreements were resolved by consensus. We also determined whether the level of spin in abstract conclusions was high (spin reported without uncertainty or recommendations for further trials), moderate (spin reported with some uncertainty or recommendations for further trials) or low (spin reported with uncertainty and recommendations for further trials). RESULTS: Among the 128 assessed articles assessed, 107 (84 %) had at least one example of spin in their abstract. The most prevalent strategy of spin was the use of causal language, identified in 68 (53 %) abstracts. Other frequent strategies were linguistic spin, inadequate implications for clinical practice, and lack of focus on harm, identified in 33 (26 %), 25 (20 %), and 34 (27 %) abstracts respectively. Abstract conclusions of 61 (48 %) articles featured a high level of spin. CONCLUSION: Abstract of reports of non-randomized studies assessing an intervention frequently includes spin. Efforts to reduce the prevalence of spin in abstract for such studies are needed.

Preferences of Knowledge Users for Two Formats of Summarizing Results from Systematic Reviews: Infographics and Critical Appraisals. Canada-flat-icon
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K. Crick and L. Hartling.
PLoS One 2015 Oct 14;10(10):e0140029

OBJECTIVES: To examine and compare preferences of knowledge users for two different formats of summarizing results from systematic reviews: infographics and critical appraisals. DESIGN: Cross-sectional. SETTING: Annual members’ meeting of a Network of Centres of Excellence in Knowledge Mobilization called TREKK (Translating Emergency Knowledge for Kids). TREKK is a national network of researchers, clinicians, health consumers, and relevant organizations with the goal of mobilizing knowledge to improve emergency care for children. PARTICIPANTS: Members of the TREKK Network attending the annual meeting in October 2013. OUTCOME MEASURES: Overall preference for infographic vs. critical appraisal format. Members’ rating of each format on a 10-point Likert scale for clarity, comprehensibility, and aesthetic appeal. Members’ impressions of the appropriateness of the two formats for their professional role and for other audiences. RESULTS: Among 64 attendees, 58 members provided feedback (91%). Overall, their preferred format was divided with 24/47 (51%) preferring the infographic to the critical appraisal. Preference varied by professional role, with 15/22 (68%) of physicians preferring the critical appraisal and 8/12 (67%) of nurses preferring the infographic. The critical appraisal was rated higher for clarity (mean 7.8 vs. 7.0; p = 0.03), while the infographic was rated higher for aesthetic appeal (mean 7.2 vs. 5.0; p<0.001). There was no difference between formats for comprehensibility (mean 7.6 critical appraisal vs. 7.1 infographic; p = 0.09). Respondents indicated the infographic would be most useful for patients and their caregivers, while the critical appraisal would be most useful for their professional roles. CONCLUSIONS: Infographics are considered more aesthetically appealing for summarizing evidence; however, critical appraisal formats are considered clearer and more comprehensible. Our findings show differences in terms of audience-specific preferences for presentation of research results. This study supports other research indicating that tools for knowledge dissemination and translation need to be targeted to specific end users’ preferences and needs.

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Underlying risk factors for prescribing errors in long-term aged care: a qualitative study.
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A. Tariq, A. Georgiou, M. Raban, M. T. Baysari and J. Westbrook.
BMJ Qual Saf 2015 Oct 14

OBJECTIVES: To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). DESIGN AND SETTING: The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. RESULTS: System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors’ time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. CONCLUSIONS: The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing.

Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: pragmatic trial.
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J. Werner, T. Wosch and C. Gold.
Aging Ment Health 2015 Oct 12:1-9

OBJECTIVES: Several studies have suggested positive effects of music therapy in dementia, but research on age-related depression has been limited and of insufficient quality. The aim of this study was to examine the effect of interactive group music therapy versus recreational group singing on depressive symptoms in elderly nursing home residents. METHOD: Residents of two German nursing homes with sufficient length of stay who were not bedridden were invited to participate in a pragmatic trial. A total of 117 participants, grouped into four clusters (based on their wards), were randomised to interactive group music therapy (n = 62; 20 units of 40 minutes, 2x/week) or recreational group singing (n = 55; 10 units of 90 minutes, 1x/week). The level of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale at baseline (47% with at least mild depression) and follow-up in the 6th and 12th weeks. There was no blinding of assessors. RESULTS: The level of depressive symptoms improved significantly more in those assigned to music therapy (n = 60) than in recreational singing (n = 53), both in 6th week (mean difference 3.0 scores, 95% CI 1.21 to 4.79, p = 0.001) and 12th week (mean difference 4.50 scores, 95% CI 2.51 to 6.50, p < 0.001). CONCLUSION: The results suggest that music therapy decreases depressive symptoms in elderly people in nursing homes more effectively than recreational singing.

The meaningfulness of participating in support groups for informal caregivers of older adults with dementia: a systematic review.
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J. Lauritzen, P. U. Pedersen, E. E. Sorensen and M. B. Bjerrum.
JBI Database System Rev Implement Rep 2015 Jul 17;13(6):373-433

BACKGROUND: Informal caregivers who perform at-home care of older people with dementia might have feelings of a meaningless existence, burden, anxiety, stress and fatigue. Support groups are considered an especially effective and economical way to relieve informal caregivers’ stress and burden, although it is unclear if participating in group meetings produces a meaningful outcome for the informal caregiver. OBJECTIVES: To identify the meaningfulness of participating in support groups for informal caregivers of older adults with dementia living in their own home. INCLUSION CRITERIA: TYPES OF PARTICIPANTS: Informal caregivers of older adults aged 65 years and over with dementia. The informal caregiver was a family member, and care was performed at home. PHENOMENA OF INTEREST: How the informal caregivers perceived the meaningfulness of participating in support groups. The setting was all locations where support groups for informal caregivers were held and studied. Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes: Subjective accounts of the informal caregivers’ perceptions of the meaningfulness associated with participating in support groups. Beliefs, benefits, rewards and attitudes related to a caregiver’s experiences as a participant in support groups and in the role as caregiver. The perception by informal caregivers of participating in support groups as a way to release stress. SEARCH STRATEGY: The search aimed at finding published and unpublished studies in English, German, Danish, Swedish and Norwegian, and was unrestricted by time. Eleven electronic databases and eleven websites were searched. METHODOLOGICAL QUALITY: Methodological quality of the qualitative papers was assessed independently by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA EXTRACTION: Qualitative data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were synthesized using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. RESULTS: A total of 59 findings from five studies were aggregated into five categories. Three synthesized findings were generated based on the meta-aggregation of the categories: 1) emotional benefits of peer-based support; 2) facing the challenges of caregiving; and 3) embracing the future through virtual configuration of group meetings. CONCLUSIONS: The five studies provided useful and credible findings from caregivers’ voices that are not often heard in regard to the meaning of participating in support groups. Peer support is beneficial for caregivers, and it provides a source of positive emotional support and a means of venting negative feeling and gaining help to address issues in the everyday life of caring for older adults with dementia.

The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review.
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J. Apostolo, P. Queiros, M. Rodrigues, I. Castro and D. Cardoso.
JBI Database System Rev Implement Rep 2015 Jul 17;13(6):220-278

BACKGROUND: It is widely acknowledged that mental disorders are common in old age and that depression is one of the most serious threats to the mental health of older adults. The lives of older adults are adversely affected both by major depression and subsyndromal depression. Depression should be approached with both pharmacotherapy and complementary therapies. The disadvantages posed by psychopharmacotherapy may be more prominent among older adults and there is a greater probability of drug interference. Different nonpharmacological interventions have been reported to reduce depressive symptoms in older adults with no adverse side effects. OBJECTIVES: This review aimed to identify and synthesize the best available evidence on the effectiveness of nonpharmacological interventions for older adults with depressive disorders. INCLUSION CRITERIA: TYPES OF PARTICIPANTS: This review considered studies that included older adults: adult patients, aged over 65 years with any type of depressive disorder, regardless of comorbidities and any previous treatments, but excluded those with manic or psychotic episodes/symptoms. Patients receiving pharmacological treatment for depression or other illnesses were included. Types of intervention(s)/phenomena of interest: This review considered studies that used nonpharmacological interventions for older adults with depressive disorders. Types of studies: This review considered any experimental study design, including randomized controlled trials, non-randomized controlled trials, or other quasi-experimental studies, including before and after studies. Types of outcomes: This review considered studies that included the following outcome measures: depressive symptomatology. The secondary outcomes were the level of autonomy in activities of daily living, cognitive function, health-related quality of life and wellbeing. SEARCH STRATEGY: An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 2000 to March 2012 of major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included in the review. METHODOLOGICAL QUALITY: Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Two independent reviewers assessed 23 studies. There was general agreement among the reviewers to include six of the studies in this review. DATA EXTRACTION: Data were extracted using the Joanna Briggs Institute data extraction form for experimental studies and included participant characteristics, intervention characteristics and methods of the study. DATA SYNTHESIS: The impact of interventions on depression outcomes was described in a narrative format for each specific intervention. Data from two studies were pooled in a meta-analysis. RESULTS: Twenty-three studies met the inclusion criteria. Of those, 17 studies were excluded after assessment of their methodological quality. The remaining six original articles, which included 520 participants, were included in this review. Five were randomized clinical trials and one was a quasi-experimental study. The interventions included in this systematic review were: cognitive behavior therapy, competitive memory training, reminiscence group therapy, problem-adaptation therapy, and problem-solving therapy in home care. Evidence suggests that all of these interventions reduce depressive symptoms. Data from two studies reporting the effectiveness of problem-solving therapy in home care were pooled in a meta-analysis.

Potentially inappropriate prescribing (PIP) in long-term care (LTC) patients: validation of the 2014 STOPP-START and 2012 Beers criteria in a LTC population-a protocol for a cross-sectional comparison of clinical and health administrative data. Canada-flat-icon
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L. M. Bjerre, R. Halil, C. Catley, et al.
BMJ Open 2015 Oct 9;5(10):e009715-2015-009715

INTRODUCTION: Potentially inappropriate prescribing (PIP) is frequent and problematic in older patients. Identifying PIP is necessary to improve prescribing quality; ideally, this should be performed at the population level. Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) and Beers criteria were developed to identify PIP in clinical settings and are useful at the individual patient level; however, they are time-consuming and costly to apply. Only a subset of these criteria is applicable to routinely collected population-level health administrative data (HAD) because the clinical information necessary to implement these tools is often missing from databases. The performance of subsets of STOPP/START and Beers criteria in HAD compared with clinical data from the same patients is unknown; furthermore, the performance of the updated 2014 STOPP-START and 2012 Beers criteria compared with one another is also unknown. METHODS AND ANALYSIS: A cross-sectional study of linked HAD and clinical data will be conducted to validate the subsets of STOPP/START and Beers criteria applicable to HAD by comparing their performance when applied to clinical and HAD for the same patients. Eligible patients will be 66 years and over and recently admitted to 1 of 6 long-term care facilities in Ottawa, Ontario. The target sample size is 275, but may be less if statistical significance can be achieved sooner. Medication, diagnostic and clinical data will be collected by a consultant pharmacist. The main outcome measure is the proportion of PIP missed by the subset of STOPP/START and Beers criteria applied to HAD when compared with clinical data. ETHICS AND DISSEMINATION: The study was approved by the Ottawa Health Services Network Research Ethics Board, the Bruyere Continuing Care Research Ethics Board and the ethics board of the City of Ottawa Long Term Care Homes. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders. TRIAL REGISTRATION NUMBER: NCT02523482.

Methods for managing residents with dysphagia.
Non UofA Access
J. Rudakiewicz.
Nurs Older People 2015 May;27(4):29-33

Nurses working in nursing homes will care for residents who have dysphagia, or difficulty swallowing, on a regular basis. Clear, evidence-based guidelines are necessary for all staff to be able to meet the needs of these residents safely and efficiently. A multidisciplinary approach is important to ensure accurate assessment, devise appropriate care and achieve specific goals. Equipment such as valved beakers, rimmed plates and non-slip mats will help maintain safety during mealtimes. Prescription items, such as fluid thickeners and anticholinergic medication, help to manage the condition and provide comfort during mealtimes and in between. Robust education and training should be in place for all nursing and care staff who care for residents with the condition.

Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents–a Danish follow-up study.
Non UofA Access
A. M. Beck.
J Nutr Health Aging 2015 Jan;19(1):96-101

OBJECTIVE: The objective of this follow-up study is to assess the association between different potentially modifiable nutritional risk factors; weight loss after six and 12 months and mortality. DESIGN, SETTING: A one year follow-up project among Danish nursing home residents. PARTICIPANTS: A total of 441 nursing home resident living in 11 nursing homes. MEASUREMENTS: Odds ratio was calculated and used to assess the strength of association between different potentially modifiable nutritional risk factors and nutritional status of the participants. The difference in mortality between those who died versus survivors was assessed by means of Fishers Exact Test. RESULTS: Almost half experienced a loss of weight during the follow-up period. The nutritional risk factors significantly or borderline significantly associated with weight loss were; eating dependency, leaves 25% or more of food uneaten at most meals, chewing and swallowing problems. The prevalence of eating dependency; leaves 25% or more of food uneaten at most meals; swallowing problems and enteral nutrition were higher among those who died than among survivors. CONCLUSION: A high percentage of old nursing home residents suffer from weight loss and this is associated with several potentially modifiable nutritional risk factors. Increased combined efforts from all levels of care and wider ranged multidisciplinary nutritional support need to be implemented. Regular routines for assessing weight loss and the potentially modifiable nutritional risk factors cannot be stressed enough.

Nutritional Care Needs in Elderly Residents of Long-Term Care Institutions: Potential Implications for Policies.
Non UofA Access
A. Pezzana, E. Cereda, P. Avagnina, et al.
J Nutr Health Aging 2015;19(9):947-954

OBJECTIVES: To collect information on actual nutritional intervention requirements in long-term care institutions and on the role of institutional factors in nutritional care. DESIGN: A cross-sectional analysis of baseline data (collected between September 2011 and September 2013) within the context of a multicenter prospective cohort study. SETTING: Nineteen long-term care institutions. PARTICIPANTS: Thirteen hundred and ninety-four resident elderly (age >/=60 years). MEASUREMENTS: The prevalence of nutritional derangements (MNA-Short Form) and the need to introduce nutritional interventions on the residents. RESULTS: Prevalence of malnutrition and risk of malnutrition were 35.2% [95%CI, 32.8-37.8] and 52.6% [95%CI, 50.0-55.2], respectively. Malnutrition was more frequent upon admission and in larger institutions (>/=50 beds). Overall, 50% of the residents requiring an individualized nutritional care plan (any type) were not receiving it. Oral diet, the use of fluid thickeners and oral nutritional supplements had to be introduced in 306 (22.5%), 201 (15%) and 175 (13%) residents, respectively. The need to implement the oral diet was mainly due to inadequacy of texture according to chewing and swallowing capabilities. In gender and age-adjusted multivariable logistic regression models, nutritional interventions were associated with worse nutritional status (P/=50 beds) were more likely to require improvement in nutrition care. CONCLUSIONS: In long-term care elderly residents nutritional derangements are very common, underdiagnosed and undertreated. Nutritional screening should be part of routine care. However, also the systematic involvement of a nutritional care specialist appears to be an urgent need, particularly in larger institutions where the standards of care are likely to be lower.

Preparedness for End of Life-a Survey of Jerusalem District Nursing Homes.
Non UofA Access
A. Shaulov, M. Frankel, A. Rubinow, Y. Maaravi and M. Brezis.
J Am Geriatr Soc 2015 Oct;63(10):2114-2119

OBJECTIVES: To evaluate the quality of end-of-life (EOL) care in nursing homes. DESIGN: Survey and semistructured interviews. SETTING: Jerusalem district nursing homes. PARTICIPANTS: Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207). MEASUREMENTS: Qualitative analysis of semistructured interviews and statistical analysis of questionnaires. RESULTS: Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family’s preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents. CONCLUSION: Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement.

The impact of fall risk assessment on nurse fears, patient falls, and functional ability in long-term care. Canada-flat-icon
Non UofA Access
T. Dever Fitzgerald, T. Hadjistavropoulos, J. Williams, et al.
Disabil Rehabil 2015 Oct 16:1-12

PURPOSE: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. METHODS: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. RESULTS: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. CONCLUSION: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. Implications for Rehabilitation Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient’s ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

Exercise programs for people with dementia. Canada-flat-icon
Non UofA Access
D. Forbes, S. C. Forbes, C. M. Blake, E. J. Thiessen and S. Forbes.
Cochrane Database Syst Rev 2015 Apr 15;4:CD006489

BACKGROUND: This is an update of our previous 2013 review. Several recent trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings. OBJECTIVES: Primary objectiveDo exercise programs for older people with dementia improve their cognition, activities of daily living (ADLs), neuropsychiatric symptoms, depression, and mortality? Secondary objectivesDo exercise programs for older people with dementia have an indirect impact on family caregivers’ burden, quality of life, and mortality?Do exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers? SEARCH METHODS: We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group’s Specialised Register, on 4 September 2011, on 13 August 2012, and again on 3 October 2013. SELECTION CRITERIA: In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to exercise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, neuropsychiatric symptoms, depression, and mortality. Secondary outcomes related to the family caregiver(s) and included caregiver burden, quality of life, mortality, and use of healthcare services. DATA COLLECTION AND ANALYSIS: Independently, at least two authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted data. We analysed data for summary effects. We calculated mean differences or standardized mean difference (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and type, frequency, and duration of exercise program. We also evaluated adverse events. MAIN RESULTS: Seventeen trials with 1067 participants met the inclusion criteria. However, the required data from three included trials and some of the data from a fourth trial were not published and not made available. The included trials were highly heterogeneous in terms of subtype and severity of participants’ dementia, and type, duration, and frequency of exercise. Only two trials included participants living at home.Our meta-analysis revealed that there was no clear evidence of benefit from exercise on cognitive functioning. The estimated standardized mean difference between exercise and control groups was 0.43 (95% CI -0.05 to 0.92, P value 0.08; 9 studies, 409 participants). There was very substantial heterogeneity in this analysis (I(2) value 80%), most of which we were unable to explain, and we rated the quality of this evidence as very low. We found a benefit of exercise programs on the ability of people with dementia to perform ADLs in six trials with 289 participants. The estimated standardized mean difference between exercise and control groups was 0.68 (95% CI 0.08 to 1.27, P value 0.02). However, again we observed considerable unexplained heterogeneity (I(2) value 77%) in this meta-analysis, and we rated the quality of this evidence as very low. This means that there is a need for caution in interpreting these findings.In further analyses, in one trial we found that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program. The mean difference between exercise and control groups was -15.30 (95% CI -24.73 to -5.87; 1 trial, 40 participants; P value 0.001). There was no apparent risk of bias in this study. In addition, there was no clear evidence of benefit from exercise on neuropsychiatric symptoms (MD -0.60, 95% CI -4.22 to 3.02; 1 trial, 110 participants; P value .0.75), or depression (SMD 0.14, 95% CI -0.07 to 0.36; 5 trials, 341 participants; P value 0.16). We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the appropriate data were not reported, or we did not retrieve trials that examined these outcomes. AUTHORS’ CONCLUSIONS: There is promising evidence that exercise programs may improve the ability to perform ADLs in people with dementia, although some caution is advised in interpreting these findings. The review revealed no evidence of benefit from exercise on cognition, neuropsychiatric symptoms, or depression. There was little or no evidence regarding the remaining outcomes of interest (i.e., mortality, caregiver burden, caregiver quality of life, caregiver mortality, and use of healthcare services).

Quality of life ratings in dementia care–a cross-sectional study to identify factors associated with proxy-ratings.
Non UofA Access
J. Graske, S. Meyer and K. Wolf-Ostermann.
Health Qual Life Outcomes 2014 Dec 12;12:177-014-0177-1

OBJECTIVE: Quality of life (QoL) is one major outcome parameter in the care for people with dementia (PwD); however, their assessment is lacking a gold standard. The purpose of this study was to evaluate potential factors associated with nurse-rated quality of life of PwD in nursing homes in Berlin, Germany. METHOD: An explorative cross-sectional study was performed in five nursing homes to evaluate QoL. Nurses rated the QoL for all residents with dementia by completing two different standardised assessments (ADRQL, QUALIDEM). Potential associated factors were evaluated concerning resident and nurse related factors. A fixed-effects models of analysis of co-variance (ANCOVA) was used to analyse effects of assumed associated factors of the major outcome parameters ADRQL and QUALIDEM. Associated factors were severity of dementia (GDS), challenging behaviour (CMAI), and other characteristics. Regarding the nurses, burnout (MBI), satisfaction with life (SWLS), attitude (ADQ) and empathy toward residents (JSPE), as well as circumstances of the ratings and days worked in advance of the ratings were assessed. RESULTS: In total, 133 PwD and 88 nurses were included. Overall, the ratings show moderate to high QoL in every subscale independent of the instrument used. Assumed confounders relevantly influenced 14 out of 17 ratings. Predominantly, residents’ challenging behaviour, nurses’ burnout and satisfaction with life as well as the circumstances of the ratings are significant and clinically relevant associated factors. CONCLUSION: Assessing QoL of PwD is acknowledged as a central component of health care and health care research. In later stages of dementia, proxy-reported information obtained from quality of life questionnaires is and will continue to be essential in this research. However, methodological issues that underline this research – matters of measurement and instrument validity – must receive more attention. Associated factors in proxy-ratings have to be routinely assessed in order to get more valid and comparable estimates.

Intimacy and sexuality of nursing home residents with dementia: a systematic review.
Non UofA Access
T. S. Roelofs, K. G. Luijkx and P. J. Embregts.
Int Psychogeriatr 2015 Mar;27(3):367-384

BACKGROUND: Considering people with dementia, increasing cognitive, physical, and environmental impairments can impede the capacity to express and experience intimacy and sexuality. When a move to a residential (nursing) home becomes inevitable, increasing dependency can influence this even more. The aim of the review is to provide a structured overview of all elements of intimacy across the full spectrum of intimacy and sexuality in people with dementia, living in specialist residential care. METHODS: A systematic search and review were conducted. Research published between 1990 and 2013 was identified in the electronic databases: Pubmed, PsychInfo, and Medline. Inclusion and exclusion criteria were predefined. Selected studies were assessed on quality, using the Mixed METHODS Appraisal Tool. RESULTS: Twelve of the 215 initially retrieved unique research publications were selected. A varied range of studies were found; these studies differed in design, research quality, searched population, and research theme. Different themes emerged: intimate and sexual behavior, knowledge and attitudes, capacity to consent and care culture, and staff training and guidelines. CONCLUSIONS: Although results were found in a wide range of intimate and sexual behavior, knowledge, attitudes and needs of others, and descriptions of culture in residential and nursing homes, the perspective of residents was lacking in literature. Also a “protective” care paradigm was found throughout. Future research is needed to highlight resident perspective and develop training opportunities and guidelines for care staff.

Quality of life in older people with dementia: a multilevel study of individual attributes and residential care center characteristics.
Non UofA Access
S. Marventano, M. E. Prieto-Flores, B. Sanz-Barbero, et al.
Geriatr Gerontol Int 2015 Jan;15(1):104-110

AIM: To analyze how the characteristics of institutionalized older people with dementia and residential care centers are associated with the individual’s quality of life (QoL). METHODS: Data were collected from a survey carried out on 525 elderly people aged 60 years or older in 14 nursing care homes across Spain. Multilevel linear analysis to assess the differences in QoL level between centers and individuals was carried out. RESULTS: The characteristics of the individuals that were associated with a higher QoL were functional independence, health status and gathering with family, friends or neighbors. In contrast, higher levels of dementia, depression and the length of institutionalization had a negative effect on QoL. In relation to the residential care center characteristics, the availability of geriatricians was associated with higher QoL, compared with those centers with no geriatricians on staff. In addition, public centers (public ownership and publicly-funded residents) were also associated with higher QoL than private/mixed centers. The multilevel analysis showed that the 16.4% of the differences in QoL was related to residence factors. CONCLUSION: These results reflect the importance of the functional, social, mental and residential dimensions in the QoL of older adults with dementia. Actions devoted to improving these key dimensions would contribute to promote the well-being of this vulnerable population.

Quality of life by proxy and mortality in institutionalized older adults with dementia.
Non UofA Access
A. E. Gonzalez-Velez, M. J. Forjaz, C. Giraldez-Garcia, S. Martin-Garcia, P. Martinez-Martin and Spanish Research Group on Quality of Life and Ageing.
Geriatr Gerontol Int 2015 Jan;15(1):38-44

AIM: This study aimed at analyzing the effect of quality of life (QoL) on mortality in older adults with dementia living in long-term care facilities. METHODS: A prospective observational cohort study was carried out on 412 residents aged older than 60 years, diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Besides assessment of QoL (EQ-5D index by proxy) and perceived health status (EQ-VAS), baseline measurements included severity of dementia (Clinical Dementia Rating Scale [CDR]), comorbidity (number of self-reported chronic conditions), disability evaluation (Barthel Index), cognitive state (Mini Examen Cognoscitivo, a validated and modified Spanish version of the Mini-Mental State Examination) and depression (Cornell Depression Scale for Dementia). Sociodemographic and clinical variables were analyzed as potential effect modifiers and confounders in the relationship between QoL and mortality using a multivariate logistic regression analysis. RESULTS: After an 18-month follow up, 138 residents had died. Adjusting for CDR and Barthel Index, the odds of mortality were multiplied by 0.25 (95% CI 0.09-0.70) and 0.79 (95% CI 0.26-2.42) for every unit of change in the EQ-5D index in the residents with Cornell score /= 6, respectively. CONCLUSION: The present study suggests that the effect of QoL on mortality in institutionalized adults with dementia should take into account the presence or absence of depression. In addition, residents with a greater disability and more advanced dementia should be a target for interventions in rehabilitation care.

A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents.
Non UofA Access
A. Foebel, A. Ballokova, N. I. Wellens, et al.
BMC Geriatr 2015 Oct 19;15(1):128-015-0127-8

BACKGROUND: Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents. METHODS: This longitudinal, retrospective study used data from the interRAI – Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003-2011 by trained nurses. Residents with complete admission and 3-6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC. RESULTS: New AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use. CONCLUSIONS: Social factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.

Models of Dementia Assessment and Diagnosis: Indicative Cost Review (UK)
NHS England

This report identifies and reviews in detail three models of dementia assessment and diagnosis currently being used in dementia care in England. It presents indicative costs for each model, benefits for patients and carers, key messages and considerations about developing the service, giving insight to how a local Clinical Commissioning Group might approach a review of their local services with an aim to making improvements.

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Non UofA

Save the Date
KT Canada Annual Scientific Meeting 2016

KT Canada is pleased to announce that the next KT Canada Annual Scientific Meeting will take place on Monday, June 13th and Tuesday, June 14th 2016.

Save the Date
CIHR Summer Program in Aging
9-13 May

The CIHR Institute of Aging is collaborating with TVN on this innovative training event, “Late Life Issues: Recognizing Frailty and Improving Care”. This unique, interactive training program will run from May 9-13, 2016 and will be held in either Kingston or Toronto, Ontario (TBD). Graduate students and postdoctoral fellows interested in learning about research related to the area of frailty and/or late life issues are encouraged to apply. Trainees will have the opportunity to participate in advanced training that crosses disciplines and brings together trainees, researchers, and members of the public and private sector from across Canada and abroad.


brainXchange webinar: Dementia-Friendly Doorway Design – Interventions & Innovations
Wednesday 28 October 10:00-11:00 MT

An overview of dementia-friendly doorway design for partners in dementia care, including health care providers, facilities, adult day programs, carers, persons living with dementia, etc. Special guests include Karen & Brian Romeril from Creative Art Co. who will share with you examples of creative doorway solutions currently being implemented in our communities.

brainXchange webinar: A Discussion of the Northern Cultural Assessment of Memory (N-CAM)
Thursday 29 Octover 10:00-11:00 MT

Cognitive screens for Indigenous seniors must address the cultural bias of existing assessment protocols, and be developed in consultation with front-line health care workers and health managers who work with Indigenous seniors, including partners from Northern and remote settings. Clinical researchers and graduate students at the University of Saskatchewan’s Rural and Remote Memory Clinic developed the Northern Cultural Assessment of Memory (N-CAM; Crossley et al., 2011; 2012) in partnership with Keewatin Yatthé Regional Health Authority (KYRHA) Home Care Service staff and managers, in consultation with Indigenous seniors and health care staff from the Saskatoon Community Clinic, and with support from the Indigenous Peoples Health Research Centre (IPHRC) and Northern Medical Services.

Save the Date:
brainXchange webinar: Rarer Forms of Dementia Part II
12 November 10:00-11:00

Presenter: Dr David Tang-Wei

Save the Date:
brainXchange webinar: Driving and Dementia
26 November 10:00-11:00

Presenter: Dr Isabelle Gélinas

Save the Date:
brainXchange webinar:
Diogenese syndrome and safety (hoarding)
3 December 10:00-11:00

Presenter: Dr Misiaszek

KT Canada Seminar Series: The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions
Thursday 12 November 10:00-11:00

Learning Objectives:
-Design an effective intervention
-Make a behavioural diagnosis using COM-B
-Link diagnosis to intervention functions and policies
-Link to specific behaviour change techniques

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Health of Ontario’s health system mixed, report finds Canada-flat-icon

A report from Health Quality Ontario shows progress on improving the health system has stalled in some areas.

Ontario families feel toll of caring for ailing, elderly relatives: study Canada-flat-icon

The strain of caring for the sick and the elderly is increasingly being felt by family and friends, says a new Ontario report that finds one-third of informal caregivers are in distress – a number that has doubled in the space of just four years.

Memory Care Centre recreates past for dementia patients Canada-flat-icon

Ontario retirement home intentionally blurs lines between today and yesterday.

Use of restraints in Ontario’s long-term care homes
has been cut in half in just four years

Long-term care homes showed either improvement or relative stability on three key measures of care, including restraint usage, falls, and new or worsening pressure ulcers.

London trust looks to school leavers to fill HCA vacancies (UK)

An apprenticeship scheme to attract school leavers into healthcare assistant roles is being developed by a London trust to try and create earlier routes into nursing and help bring down its vacancy rate.

L’Isle-Verte tragedy prompts Quebec to change certification standards for seniors’ homes Canada-flat-icon

Government to allow cheaper criminal checks, ensure seniors don’t lose access for economic reasons.

Death rates higher in for-profit nursing homes, report says Canada-flat-icon

There are also more hospitalizations, research shows.

Most Ottawa LGBT Seniors Would do Everything They Could to Avoid Going into a Care Facility Canada-flat-icon

The Ottawa Senior Pride Network (OSPN) and Ipsos conducted a survey to identify housing options for Ottawa area LGBT Seniors, understand their role in retirement and housing planning and understand any unique challenges faced by LGBT Seniors.

Nursing Homes’ Residents Face Health Risks From Antibiotics’ Misuse (US)

Antibiotics are prescribed incorrectly to ailing nursing home residents up to 75 percent of the time, the nation’s public health watchdog says.

Film about Dementia Village by UofA graduate student seeks to push policy Canada-flat-icon

An ALES graduate student hopes to convince government policymakers there are merits to a controversial style of housing for people with dementia, with a film she created as her thesis project.

Inspiring culture change through language in long term care Canada-flat-icon

Words are powerful. Just a few of them can hurt or heal; make someone’s day or ruin it altogether. The power of language is why Saskatoon Health Region’s Seniors’ Health and Continuing Care team is trying to change the language used to refer to long-term care homes, those who live in long term care homes and those who access home care or other community services.

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Getting it right every time: Fundamentals of nursing care at the end of life (UK)
Royal College of Nursing (RCN)

This resource has been developed for you by the Royal College of Nursing (RCN) and is designed to offer you support in your delivery of appropriate end of life care alongside your existing training. This resource is for you if you are a registered nurse, student nurse, health care assistant (HCA) or assistant practitioner working in any setting or specialism. The aim is to give you an understanding of your role when it comes to meeting the needs of people with life limiting illnesses. You can work through this resource at your own pace either all at once, or by one of the “bite sized” pieces of learning whenever it is convenient for you.

Learning resource for social work with adults who have dementia
Department of Health, UK

The guidance document is designed to be used by social workers at all levels, from front line practitioners to senior social workers, social work supervisors and managers, to support them to deliver the best outcomes for the people with whom they work.

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SCALS studentship: DPHIL Studentship Linked to the SCALS Research Programme on Assisted Living
Green Templeton College, University of Oxford, Oxford UK
DEADLINE 8 January

The SCALS grant includes a four-year DPhil studentship based at Oxford and supervised by Prof Trish Greenhalgh (a medical doctor who is also trained in sociology) and Dr Sara Shaw (a social scientist specialising in the study of health policy and organisational change). The research student will be linked to Green Templeton College at the University of Oxford.

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