Frailty Management Practices for Older Adults in Primary Care Clinics: A Cross-Sectional Study

Objective: To describe practices used to diagnose and manage frailty in primary care clinics, prior to the implementation of the Canadian Foundation for Healthcare Improvement Initiative. Methods: This is a cross-sectional study of the current frailty management practices in a convenience sample of five primary care clinics in Ottawa, Canada. Data was collected using a survey and qualitative content analysis of the survey data was performed. Results: None of the clinics had established a systematic frailty screening or management program. Primary care providers reported informally using select screening tools, clinical instinct, and case findings in their day-to-day practice to identify patients with frailty and refer them to community resources. Frailty identification and management varied across the clinics and across providers within the same clinic. Conclusion: Our findings indicate that primary care providers recognize the need to identify and manage frailty in their clinical practice. In the absence of guidelines or training, providers are developing their own strategies to address frailty

A concept analysis of the patient experience

Patient experience, an essential indicator of quality patient care, is of increasing importance to hospitals that want to improve and maintain strong patient experience metrics to remain competitive in the business of healthcare. The aim of this study was to clarify the concept of the patient experience by identifying its existing definitions, methods of measurement, and underlying themes and attributes, to differentiate it from similar concepts and propose an operational and theoretical definition to guide valid and reliable development of future assessment tools. Walker and Avant’s eight-step methodology served as the framework for this concept analysis. A literature search, using seven databases and one search engine, was conducted of existing literature published any time up until September 2021. The search identified 19,447 references of which 436 articles and organizational websites were included. Twenty attributes (n= 20) were found to define the patient experience: (1) communication; (2) respect for patients; (3) information and education; (4) patient-centered care; (5) comfort and pain; (6) discharge from hospital; (7) hospital environment; (8) professionalism and trust; (9) clinical care and staff competency; (10) access to care; (11) global ratings (12) medication; (13) transitions and continuity; (14) emotional dimension; (15) outcomes; (16) hospital processes; (17) safety and security; (18) interdisciplinary team; (19) social dimension; and, (20) patient dependent features. The proposed definition of the patient experience is: “Patient experience is the combination of external and internal hospital processes, patient-centered attributes, patient-staff and staff-staff interactions during all episodes of care.” Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

L’expérience des familles qui accompagnent un aîné à l’urgence : un examen de la portée

Introduction : Les aînés sont souvent accompagnés d’un membre de leur famille à l’urgence et considèrent leur présence comme étant importante. Les familles plaident pour leurs besoins et contribuent à la continuité des soins. Toutefois, elles se sentent souvent exclues des soins. Afin d’améliorer la qualité et la sécurité des soins offerts aux aînés, il est nécessaire de considérer l’expérience des familles qui accompagnent un aîné à l’urgence. Objectif : Présenter les résultats d’un examen de la portée ayant pour but de synthétiser la littérature scientifique traitant de l’expérience des familles qui accompagnent un aîné à l’urgence. Méthodes : Examen de la portée réalisé selon Arksey et O’Malley (2005). Six bases de données ont été ciblées et 19 articles scientifiques ont été retenus. Une description de la littérature recensée et une analyse de contenu inductive ont été réalisées. Résultats : La majorité des articles (89 %) ont été publiés depuis 2010, proviennent de la discipline des sciences infirmières (63 %) et ont un devis de recherche qualitatif (79 %). Le Canada (26 %) et l’Australie (26 %) sont meneurs en termes de pays d’origine des études. L’analyse de contenu a permis de cibler trois principales catégories relatives à l’expérience des familles qui accompagnent un aîné à l’urgence : 1) parcours menant à l’urgence; 2) être à l’urgence et 3) recevoir son congé de l’urgence. Discussion et conclusion : L’expérience des familles d’aînés à l’urgence est multifactorielle et s’inscrit dans une trajectoire de soins et de services de santé.Introduction : Les aînés sont souvent accompagnés d’un membre de leur famille à l’urgence et considèrent leur présence comme étant importante. Les familles plaident pour leurs besoins et contribuent à la continuité des soins. Toutefois, elles se sentent souvent exclues des soins. Afin d’améliorer la qualité et la sécurité des soins offerts aux aînés, il est nécessaire de considérer l’expérience des familles qui accompagnent un aîné à l’urgence. Objectif : Présenter les résultats d’un examen de la portée ayant pour but de synthétiser la littérature scientifique traitant de l’expérience des familles qui accompagnent un aîné à l’urgence. Méthodes : Examen de la portée réalisé selon Arksey et O’Malley (2005). Six bases de données ont été ciblées et 19 articles scientifiques ont été retenus. Une description de la littérature recensée et une analyse de contenu inductive ont été réalisées. Résultats : La majorité des articles (89 %) ont été publiés depuis 2010, proviennent de la discipline des sciences infirmières (63 %) et ont un devis de recherche qualitatif (79 %). Le Canada (26 %) et l’Australie (26 %) sont meneurs en termes de pays d’origine des études. L’analyse de contenu a permis de cibler trois principales catégories relatives à l’expérience des familles qui accompagnent un aîné à l’urgence : 1) parcours menant à l’urgence; 2) être à l’urgence et 3) recevoir son congé de l’urgence. Discussion et conclusion : L’expérience des familles d’aînés à l’urgence est multifactorielle et s’inscrit dans une trajectoire de soins et de services de santé

Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit

The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data

Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality

AbstractMeasuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today’s health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance

Effectiveness of person- and family-centered care transition interventions: a systematic review protocol

Abstract Background Care transitions from the hospital to home are critical to the sustainability of our health care system. Ineffective care transitions can be caused by high incidences of post-discharge adverse events, by poor communication with patients, and/or by inadequate information transfer between providers from the hospital to home. Any one of these can lead to fragmented care, high readmission rates, increased visits to the emergency department, and ultimately poor patient outcomes. Despite the ongoing improvement efforts of health care organizations, the efficacy of person- and family-centered care transition interventions on the quality of care and on the patient experience are not known. The aim of this systematic review is to critically analyze the body of evidence regarding the effectiveness of person- and family-centered care transition interventions on the quality of care, and the experience of patients. Methods We will conduct a systematic review using the Cochrane Handbook’s guidelines and will adhere to a standardized reporting format: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy will be conducted in the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and the Cochrane Consumers and Communication Group. Following a two-step screening process, data including the full reference, objectives, target population, description of the intervention and control intervention, outcome measures, design, length of post-intervention follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed. Discussion This systematic review will summarize and present the evidence base for person- and family-centered care transition interventions. This review will also inform further research and will lay the groundwork for more empirical studies on person- and family-centered care transitions. Specifically, the results of this systematic review may inform the development of measures to monitor safe and effective person- and family-centered transitions from the hospital to home. These results may also be important for policy makers, decision-makers, clinicians, and patients/families who are involved in navigating the health care system. Systematic review registration PROSPERO CRD4201706799

Effect of isoflurane on the auditory steady-state response and on consciousness in human volunteers.

BACKGROUND: The auditory steady state response (ASSR) is a sustained electrical response of the brain to auditory stimuli delivered at fast rates (30-50 responses/s). The aim of this study was to evaluate the effect of 0.26-0.50% isoflurane on the ASSR and on consciousness, defined as responsiveness to verbal commands. METHODS: Ten volunteers (21-31 yr) participated. Isoflurane was administered at three stable, end-tidal concentrations: 0.26%, 0.38%, and 0.50%. The ASSR in response to 18,000 stimuli (500-Hz tonebursts, 10 ms, 82-dB, the right ear, 35-45 bursts/s) was recorded from the vertex with reference to the right mastoid. Recordings were made during baseline, at each isoflurane concentration, and during recovery. RESULTS: The mean (SD) ASSR amplitudes were 0.32 (0.23) microV during baseline, 0.24 (0.17) microV during 0.26% isoflurane, 0.09 (0.05) microV during 0.38% isoflurane, 0.04 (0.03) microV during 0.50% isoflurane, and 0.29 (0.33) microV during recovery. The amplitude during baseline and recovery was larger than during 0.38% and 0.50% isoflurane (P < 0.001). The amplitude at 0.26% was larger than at the other concentrations (P < 0.025). The logarithm of the ASSR amplitude was related linearly to the concentration of isoflurane (r = 0.85; P < 0.0001). The prediction probability (Pk) for loss of consciousness was 0.95 for both ASSR and measured isoflurane concentration. An ASSR amplitude < 0.07 microV was always associated with unconsciousness. CONCLUSIONS: The ASSR is attenuated in a concentration-dependent manner by isoflurane. Suppression of consciousness and maximal attenuation of ASSR occur in the same isoflurane concentration range. Profound attenuation of ASSR appears to reflect unconsciousness, defined as unresponsiveness to verbal commands

What is the impact of sensory practices on the quality of life of long-term care residents? A mixed-methods systematic review protocol

Abstract Background With age, the acuity of the five senses (i.e., hearing, sight, taste, smell, touch) is reduced. These types of sensory changes can affect day-to-day activities, making it more difficult for individuals to communicate and to interact with the world around them. The five senses allow us to receive information from the environment in the form of sound, light, smell, taste, and touch. As an older person’s senses decline, they need more stimulation to be aware of these sensations. In long-term care settings, appropriate sensory practices are needed to address the diminishing senses of older adults. The objective of this mixed-methods systematic review is to examine the relationship between the sensory practices and the quality of life of residents living in long-term care settings and to develop an aggregated synthesis of mixed-methods studies to derive recommendations for policy, practice, and research. Methods We will conduct a mixed-methods systematic review in accordance with the Cochrane Handbook. A search strategy has been developed with an expert health sciences librarian and peer reviewed using Peer Review for Electronic Search Strategies (PRESS). Seven databases: MEDLINE (Ovid), PubMed (non-MEDLINE—Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), and Cochrane Central Register of Controlled Trials (CENTRAL) will be searched for studies that meet the inclusion criteria. Two reviewers will independently screen the results of the literature search using a two-step process. Eligible studies will undergo a quality assessment and data extraction. Disagreements will be resolved through consultation with a third reviewer. We will assess the quality of individual studies using the Mixed Methods Appraisal Tool (MMAT). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be used to summarize the strength of the quantitative evidence, and the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool to assess confidence in the qualitative syntheses. Discussion This systematic review will summarize evidence-based knowledge for sensory practices, identify gaps in the literature, and inform an audit program for assessing the presence of sensory practices in the long-term care setting. The results will be relevant to policy makers, decision-makers, clinicians, and residents/families in long-term care settings. Systematic review registration PROSPERO registration # CRD42017032330

Use of participatory visual narrative methods to explore older adults’ experiences of managing multiple chronic conditions during care transitions

Abstract Background Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care. However, there are gaps in evidence on the most effective approaches for fully engaging patients/clients and families in their transitional care. The purpose of this study was to engage older adults with multiple chronic conditions and their family members in the detailed exploration of their experiences during transitions across health care settings and identify potential areas for future interventions. Methods This was a qualitative study using participatory visual narrative methods informed by a socio-ecological perspective. Narrated photo walkabouts were conducted with older adults and family members (n = 4 older adults alone, n = 3 family members alone, and n = 2 older adult/family member together) between February and September 2016. The data analysis of the transcripts consisted of an iterative process until consensus on the coding and analysis was reached. Results A common emerging theme was that older adults and their family members identified the importance of active involvement in managing their own care transitions. Other themes included positive experiences during care transitions; accessing community services and resources; as well as challenges with follow-up care. Participants also felt a lack of meaningful engagement during discharge planning, and they also identified the presence of systemic barriers in care transitions. Conclusion The results contribute to our understanding that person- and family-centered care transitions should focus on the need for active involvement of older adults and their families in managing care transitions. Based on the results, three areas for improvement specific to older adults managing chronic conditions during care transitions emerged: strengthening support for person- and family-centered care, engaging older adults and families in their care transitions, and providing better support and resources