The mission of the Chronicity Areas of Excellence (AoE) is to advance and disseminate knowledge and to influence public policy related to living well with chronic health concerns.
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  1. Orchestrating Care: Nursing practice with hospitalized older adults [Download]

    Title: Orchestrating Care: Nursing practice with hospitalized older adults
    Creator: DAHLKE, S
    Description: Background: The increased incidence of health challenges with aging means that nurses are increasingly caring for older adults, often in hospital settings. Research about the complexity of nursing practice with this population remains limited. Objective: To seek an explanation of nursing practice with hospitalized older adults. Methods: Design. A grounded theory study guided by symbolic interactionism was used to explore nursing practice with hospitalized older adults from a nursing perspective. Glaserian grounded theory methods were used to develop a mid-range theory after analysis of 375 hours of participant observation, 35 interviews with 24 participants, and review of selected documents. Results: The theory of Orchestrating Care was developed to explain how nurses are continuously trying to manage their work environments by understanding the status of the patients on their unit, mobilizing the assistance of others, and stretching available resources to resolve their problem of providing their older patients with what they perceived as “good care” while sustaining themselves as “good” nurses. They described their practice environments as hard and under-resourced. Orchestrating care is comprised of two subprocesses - building synergy and minimizing strain. These two processes both facilitated and constrained each other and nurses’ abilities to orchestrate care. Conclusions: Although system issues presented serious constraints to nursing practice, the ways in which nurses were making meaning of their work environment both aided them in managing their challenges and served to constrain their agency.
    Date Created: 2017
  2. A qualitative study to explore patient and staff perceptions of intradialytic exercise [Download]

    Title: A qualitative study to explore patient and staff perceptions of intradialytic exercise
    Creator: Thompson, Stephanie
    Description: Background and objectives Randomized, controlled trials show that regular exercise is beneficial for patients on hemodialysis. Intradialytic exercise may have additional benefits, such as amelioration of treatment-related symptoms. However, the factors that influence the implementation of intradialytic exercise are largely unknown. Design, setting, participants, & measurements Individual semistructured interviews were conducted with a purposive sample of patients on hemodialysis who had participated in a pilot randomized, controlled trial on intradialytic exercise and dialysis staff that worked in the unit during the trial. The trial took place from July to December of 2014 and enrolled 31 patients. Interviews were conducted from April to December of 2014. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group codes into common themes, first individually and then, across staff and patient interviews. Results Twenty-five patients and 11 staff were interviewed. Three themes common to both groups emerged: support, norms (expected practices) within the dialysis unit, and the role of the dialysis nurse. The support of the kinesiologist enhanced patients’ confidence and sense of capability and was a key component of implementation. However, the practice of initiating exercise at the start of the shift was a barrier to staff participation. Staff focused on the technical aspects of their role in intradialytic exercise, whereas patients viewed encouragement and assistance with intradialytic exercise as the staff’s role. An additional theme of no time (for staff to participate in intradialytic exercise) was influenced by its low priority in their workflow and the demands of the unit. The staff’s emphasis on patients setting up their own equipment and enhanced social interaction among participants were additional themes that conveyed the unintended consequences of the intervention. Conclusions The kinesiologist-patient interactions and staff readiness for intradialytic exercise were important factors in the implementation of intradialytic exercise. Understanding how unit workflow and the personal values of staff can influence implementation may improve the design of intradialytic exercise interventions.
    Subjects: Quality of life, Exercise, Sensation, Dialysis, Perception, Humans, End-stage renal disease, Randomized Controlled Trials as Topic, Qualitative research, Hemodialysis
    Date Created: 2016
  3. Simultaneous temporal trends in dementia incidence and prevalence, 2005–2013: A population-based retrospective cohort study in Saskatchewan, Canada [Download]

    Title: Simultaneous temporal trends in dementia incidence and prevalence, 2005–2013: A population-based retrospective cohort study in Saskatchewan, Canada
    Creator: Kosteniuk, J. G.
    Description: Background: Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification. Methods: Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care). Results: Between 2005/2006 and 2012/2013, the 12-month age-standardized incidence rate of dementia declined significantly by 11.07% and the 12-month age-standardized prevalence increased significantly by 30.54%. The number of incident cases decreased from 3,389 to 3,270 and the number of prevalent cases increased from 8,795 to 13,012. Incidence rate reductions were observed in every database of identification. Conclusions: We observed a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/2006 to 2012/2013. These trends indicate that the average survival time of dementia is lengthening. Continued observation of these time trends is warranted given the short study period.
    Subjects: Dementia, Diagnosis, Epidemiology, Physician, Hospital, Long-Term Care, Prescription Drug, Administrative Data
    Date Created: 2015/11/25
  4. A Pan Canadian Practice Guideline for Screening, Assessment, and Management of Cancer-Related Fatigue in Adults (Version 2) [Download]

    Title: A Pan Canadian Practice Guideline for Screening, Assessment, and Management of Cancer-Related Fatigue in Adults (Version 2)
    Creator: Howell, Doris
    Description: Background Cancer-related fatigue (CRF) is a prevalent problem in cancer and has a side effect of treatment that often worsens during cancer treatment and can persist as a long-term problem for many patients including those in palliative care and cancer survivor populations. Reported prevalence rates for fatigue range from 59% to 100%. CRF is reported as the most distressing side effect of cancer and treatment and causes greater interference with daily life than any other symptom. CRF also impacts on personal, social, work roles and it can have a profound negative impact on overall quality of life (QoL). Because its etiology is not well understood, it is frequently unrecognized and is difficult to manage in clinical practice. Scope and Purpose of this Review The scope of this 2015-Version 2 of CRF guideline is focused on the provision of clinical practice recommendations for members of oncology interdisciplinary team (e.g. primary care physicians, oncologists, nurses, physiotherapist, occupational therapists, rehabilitation specialists), who screen, assess, and manage CRF in their daily clinical practice. Additionally, the recommendations may also help patients and families learn about the most effective strategies for managing CRF. The recommendations apply to those with CRF across the cancer trajectory, from cancer treatment to post-treatment survivorship and palliative or end-of-life care. The guidelines focused on the adult cancer population with fatigue due to cancer and/or cancer treatment. Intended Users The intended users of this guideline are the primary oncology interdisciplinary team, and community practitioners such as family physicians and palliative care teams. The recommendations are intended to also be relevant to specialists in fatigue including psychology and psychiatry, and other members of the allied health care team (occupational therapists, rehabilitation specialists, physiotherapists) who provide counselling to patients in the management of cancer-related fatigue. Patients and their families may also find this guideline useful for understanding the current recommendations and evidence for management for cancer and/or treatment related fatigue. Questions 1. What are the current guideline recommendations for routine screening and assessment of CRF in adults? 2. What is the efficacy of interventions (pharmacological, non‐pharmacological, and/or combinations) for reducing CRF in adults?
    Subjects: cancer, adapted guideline, Fatigue, assessment, screening, supportive care
    Date Created: 2015
  5. Adapting to the physical changes of aging with COPD [Download]

    Title: Adapting to the physical changes of aging with COPD
    Creator: Low, Gail
    Description: The prevalence of Chronic Obstructive Pulmonary Disease is growing, and people are living with this disease well into older age. Little is known about how people with Chronic Obstructive Pulmonary Disease adapt to aging, particularly the physical changes of aging. According to the Identity Process Theory, people are inclined to attribute age-related changes in physical functioning to a transitory state of health, but not their physical health or appearance. Attributing one’s physical functioning to aging itself makes people believe that they are physically “old” and enhances negative affect. We tested the Identity Process Theory using secondary physical functioning and physical health data collected from 87 pulmonary rehabilitation program participants with Chronic Obstructive Pulmonary Disease (age range = 47 - 82 years of age). Transient health states were participants’ 6-Minute Walk Distance and perceived breathlessness during a time-limited exercise test using the Borg Rating of Perceived Exertion Scale. Participants’ age-related changes in physical functioning were attributed to walk distances and their physical health to the physical changes of aging (X2 = 18.55, df = 10, p = 0.05; GFI = 0.95; RMSEA = 0.10). These attribution patterns were replicated in the Borg Rating of Perceived Exertion model (X2 = 13.34, df = 10, p = 0.21; GFI = 0.96; RMSEA = 0.06). The attributing of age-related changes in physical functioning to either transient health state circumvented their propensity for negative affect. Our findings are discussed in relation to maintaining physical functioning and general physical health promotion among Pulmonary Rehabilitation Program participants with Chronic Obstructive Pulmonary Disease.
    Subjects: Pulmonary Rehabilitation, COPD, Mental Health, Aging, Physical Identity
    Date Created: 2015
  6. Place of death of people living with parkinson's disease: A population-level study in 11 countries [Download]

    Title: Place of death of people living with parkinson's disease: A population-level study in 11 countries
    Creator: Moens, Katrien
    Description: Background Most people prefer to receive end-of-life care in familiar surroundings rather than in hospital. This study examines variation in place of death for people dying from Parkinson’s disease (PD) across 11 European and non-European countries. Methods Using death certificate data of 2008 for Belgium, France, Italy, Hungary, Czech Republic, New Zealand, USA, Canada, Mexico, South Korea and Spain for all deaths with PD as an underlying cause (ICD-10 code: G20) cross-national differences in place of death were examined. Associations between place of death and patient socio-demographic and regional characteristics were evaluated using multivariable binary logistic regression analyses. Results The proportion of deaths in hospital ranged from 17% in the USA to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%) and South Korea; nursing home in New Zealand (71%), Belgium (52%), USA (50%), Canada (48%) and Czech Republic (44%); home in Mexico (73%), Italy (51%) and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, USA, Canada), those younger than 80 years (Belgium, France, Italy, USA, Mexico), and those living in areas with a higher provision of hospital beds (Italy, USA). Conclusions In several countries a substantial proportion of deaths from PD occurs in hospitals, although this may not be the most optimal place of terminal care and death. The wide variation between countries in the proportion of deaths from PD occurring in hospital indicates a potential for many countries to reduce these proportions.
    Subjects: Cross-national comparison, Place of death, Palliative care, Risk factors, Parkinson’s disease
    Date Created: 2015
  7. Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: A retrospective cohort study [Download]

    Title: Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: A retrospective cohort study
    Creator: Kosteniuk, Julie G.
    Description: Background Determining the epidemiology of dementia among the population as a whole in specific jurisdictions – including the long-term care population–is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria. Methods We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescription Drug, and RAI-MDS, i.e., Long-term Care). Results A total of 3,270 incident cases of dementia (7.28 per 1,000 PAR) and 13,012 prevalent cases (28.16 per 1,000 PAR) were identified during 2012/13. This study found the incidence rate increased by 2.8 to 5.1 times and the prevalence rate increased by 2.6 to 4.6 times every 10 years after 45 years of age. Overall, the age-standardised incidence rate was significantly lower among females than males (7.04 vs. 7.65 per 1,000 PAR) and the age-standardised prevalence rate was significantly higher among females than males (28.92 vs. 26.53 per 1,000 PAR). Over one-quarter (28 %) of all incident cases were admitted to long-term care before a diagnosis was formally recorded in physician or hospital data, and nearly two-thirds of these cases were identified at admission with impairment at the moderate to very severe level or a disease category of Alzheimer’s disease/other dementia. Conclusions Linking multiple sources of registry data contributes to our understanding of the epidemiology of dementia across multiple segments of the population, inclusive of individuals residing in long-term care. This information is foundational for public awareness and policy recommendations, health promotion and prevention strategies, appropriate health resource planning, and research priorities.
    Subjects: Long-term care, Prescription drug, Dementia, Primary care, Hospital, Alzheimer’s disease, Prevalence, Diagnosis, Incidence, Epidemiology
    Date Created: 2015
  8. Relocation of remote dwellers living with hemodialysis: A time trade-off survey [Download]

    Title: Relocation of remote dwellers living with hemodialysis: A time trade-off survey
    Creator: Tonelli, Marcello
    Description: Background There has been little research exploring the experience of dialysis therapy for people living in remote communities. Remote residence location has previously been associated with excess mortality in hemodialysis (HD) patients, suggesting that relocation to a referral center might improve outcomes. It is unknown whether patients view this approach as acceptable. Methods We studied 121 remote-dwelling chronic HD patients using the time trade-off method applied to hypothetical scenarios. Results Participants indicated that they would trade a median of 6 years of life in their current location (including current social supports) (95% CI 2.25–7) for 10 years of life in a referral center without any of their existing social supports (meaning they would be willing to forgo 4 years of life to remain in their current residence location). When current social supports were assumed to continue in both locations, people were only willing to forego a median of 2 years of life (95% CI 1–4) to remain in their current location. Older participants were much less willing to accept relocation than younger participants; the median time trade-off associated with relocation and without social supports was 2 years for participants aged <50 years, 3 years for those aged 50–69.9 years and 9 years for those aged ≥70 years. Conclusions Hemodialysis patients currently living remotely were willing to forgo much of their remaining life expectancy rather than relocate—especially among older participants. These findings suggest that decisions about relocation should be accompanied by discussion of anticipated changes in quality of life and life expectancy.
    Subjects: Health care services, Hemodialysis, Remote dwellers, End-stage renal disease
    Date Created: 2015
  9. Dementia care evidence: Contextual dimensions that influence use in northern home care centres [Download]

    Title: Dementia care evidence: Contextual dimensions that influence use in northern home care centres
    Creator: Forbes, Dorothy
    Description: Living and working in isolated northern communities pose challenges in using evidence to inform dementia care. Purpose : To better understand the contextual dimensions of two home care centres in two Canadian northern, rural communities that influence the use of evidence from the perspectives of home care providers (HCPs). Sample: All clinical leaders, managers, and home care providers (n=48 FTE) in the two home care centres were sent an information letter outlining the study’s purpose, expectations, and benefits and invited to participate in focus groups conducted in two home care centres. Fourteen staff participated in the two focus groups. Method: A qualitative interpretive descriptive approach was used. Semi-structured questions were used to guide the audiotape recorded focus groups. Transcripts were coded using Lubrosky’s thematic analysis. Findings: Our findings are described in broad contextual themes (e.g., challenges in using the RAI-HC, availability of resources, relationships in a rural community, leadership, and evaluation) that included both positive and negative contextual dimensions that influenced the use of evidence. Conclusions: Most importantly, reallocated resources are needed in northern home care settings. Challenges in exchanging evidence related to difficult relationships with physicians, clients, and their family caregivers. Leadership and collaboration dimensions were fundamental to establishing a vibrant workplace in which HCPs provided and exchanged evidence-based dementia care.
    Subjects: home care contextual dimensions, knowledge exchange, evidence-based dementia care, northern home care
    Date Created: 2015
  10. A meta-study of qualitative research examining determinants of children’s independent active free play [Download]

    Title: A meta-study of qualitative research examining determinants of children’s independent active free play
    Creator: Lee, Homan
    Description: Purpose To produce a meta-study by completing a systematic review of qualitative research examining determinants of independent active free play in children. Method Following systematic electronic and manual searches and application of inclusion/exclusion criteria, 46 studies were retained and subjected to meta-method, meta-theory, and meta-data analyses, followed by a final meta-synthesis. Results Identified determinants of independent active free play were child characteristics (age, competence, and gender), parental restrictions (safety concerns and surveillance), neighborhood and physical environment (fewer children to play with, differences in preferences for play spaces between parents and children, accessibility and proximity, and maintenance), societal changes (reduced sense of community, good parenting ideal, changing roles of parents, privatization of playtime and play spaces), and policy issues (need to give children voice). An ecological model depicting these factors, and the relationships therein, was created. Conclusions This comprehensive meta-study helps establish a knowledge base for children’s independent active free play research by synthesizing a previously fragmented set of studies. Parents’ perceived safety concerns are the primary barrier to children’s active free play. These safety concerns are moderated by child-level factors (age, competence, gender) and broader social issues. Interventions should focus on community-level solutions that include children’s perspectives. From a methods perspective, the reviewed studies used a range of data collection techniques, but methodological details were often inadequately reported. The theoretical sophistication of research in this area could be improved. To this end, the synthesis reported in this study provides a framework for guiding future research.
    Subjects: Meta-synthesis, Parents, Safety, Theory
    Date Created: 2015