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Molitor V, Busse TS, Giehl C, Lauer R, Otte IC, Vollmar HC, Thürmann P, Holle B, Palm R. Educational interventions aimed at improving knowledge of delirium among nursing home staff-a realist review. BMC Geriatr 2024; 24:633. [PMID: 39054433 PMCID: PMC11274774 DOI: 10.1186/s12877-024-05213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Delirium is a neuropathological syndrome that is characterised by fluctuating impairments in attention, cognitive performance, and consciousness. Since delirium represents a medical emergency, it can be associated with adverse clinical and economic outcomes. Although nursing home residents face a high risk of developing delirium, health care professionals in this field appear to have limited knowledge of delirium despite the critical role they play in the prevention, diagnosis, and treatment of delirium in nursing homes. OBJECTIVE The purpose of this realist review is to develop an initial programme theory with the goal of understanding how, why, and under what circumstances educational interventions can improve the delirium-specific knowledge of health care professionals in nursing homes. METHODS This realist review was conducted in accordance with the RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines and includes the following steps: (1) search strategy and literature review; (2) study selection and assessment; (3) data extraction; (4) data synthesis; and (5) development of an initial programme theory. It also included stakeholder discussions with health care professionals recruited from nursing home care, which focused on their experiences with delirium. RESULTS From a set of 1703 initially identified publications, ten publications were included in this realist review. Based on these publications, context-mechanism-outcome configurations were developed; these configurations pertained to (1) management support, (2) cognitive impairments among residents, (3) familiarity with residents, (4) participatory intervention development, (5) practical application, (6) case scenarios, (7) support from experts and (8) relevance of communication. CONCLUSIONS Educational interventions aimed at improving the delirium-specific knowledge of health care professionals should feature methodological diversity if they are to enhance health care professionals' interest in delirium and highlight the fundamental contributions they make to the prevention, diagnosis, and treatment of delirium. Educational interventions should also take into account the multidimensional contextual factors that can have massive impacts on the relevant mode of action as well as the responses of health care professionals in nursing homes. The identification of delirium in residents is a fundamental responsibility for nursing home staff. TRIAL REGISTRATION This review has been registered at Open Science Framework https://doi.org/10.17605/OSF.IO/6ZKM3.
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Affiliation(s)
- Vincent Molitor
- Faculty of Health, School of Nursing Science, Witten Herdecke University, Witten, Germany.
- School VI -School of Medicine and Health Sciences, Carl von Ossietzky Universität, Oldenburg, Germany.
| | - Theresa Sophie Busse
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Chantal Giehl
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Romy Lauer
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Ina Carola Otte
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Petra Thürmann
- Faculty of Health, School of Medicine, Chair of Clinical Pharmacology, Witten Herdecke University, Witten, Germany
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Bernhard Holle
- Faculty of Health, School of Nursing Science, Witten Herdecke University, Witten, Germany
- German Center for, Deutsches Zentrum fur Neurodegenerative Erkrankungen (DZNE) Standort Witten, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Science, Witten Herdecke University, Witten, Germany
- School VI -School of Medicine and Health Sciences, Carl von Ossietzky Universität, Oldenburg, Germany
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Zipfel N, Horreh B, Hulshof CTJ, de Boer AGEM, van der Burg-Vermeulen SJ. The relationship between the living lab approach and successful implementation of healthcare innovations: an integrative review. BMJ Open 2022; 12:e058630. [PMID: 35768105 PMCID: PMC9240880 DOI: 10.1136/bmjopen-2021-058630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The concept of living labs as a research method to enhance participation of end-users in the development and implementation process of an innovation, gained increasing attention over the past decade. A living lab can be characterised by five key components: user-centric, cocreation, real-life context, test innovation and open innovation. The purpose of this integrative literature review was to summarise the literature on the relationship between the living lab approach and successful implementation of healthcare innovations. METHODS An integrative literature review searching PubMed, EMBASE, PsycINFO and Cinahl databases between January 2000 and December 2019. Studies were included when a living lab approach was used to implement innovations in healthcare and implementation outcomes were reported. Included studies evaluated at least one of the following implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration or sustainability. Quality was assessed based on a tool developed by Hawker et al. RESULTS Of the 1173 retrieved articles, 30 studies were included of which 11 of high quality. Most studies involved a combination of patients/public (N=23) and providers (N=17) as key stakeholders in the living lab approach. Living lab components were mostly applied in the development phase of innovations (N=21). The majority of studies reported on achievement of acceptability (N=22) and feasibility (N=17) in terms of implementation outcomes. A broader spectrum of implementation outcomes was only evaluated in one study. We found that in particular six success factors were mentioned for the added-value of using living lab components for healthcare innovations: leadership, involvement, timing, openness, organisational support and ownership. CONCLUSIONS The living lab approach showed to contribute to successful implementation outcomes. This integrative review suggests that using a living lab approach fosters collaboration and participation in the development and implementation of new healthcare innovations. PROSPERO REGISTRATION NUMBER CRD42020166895.
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Affiliation(s)
- Nina Zipfel
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bedra Horreh
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sylvia J van der Burg-Vermeulen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Wilchesky M, Ballard SA, Voyer P, McCusker J, Lungu O, Champoux N, Vu TTM, Cole MG, Monette J, Ciampi A, Belzile E, Carmichael PH, McConnell T. The PREvention Program for Alzheimer's RElated Delirium (PREPARED) cluster randomized trial: a study protocol. BMC Geriatr 2021; 21:645. [PMID: 34784897 PMCID: PMC8594158 DOI: 10.1186/s12877-021-02558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Delirium is a significant cause of morbidity and mortality among older people admitted to both acute and long-term care facilities (LTCFs). Multicomponent interventions have been shown to reduce delirium incidence in the acute care setting (30-73%) by acting on modifiable risk factors. Little work, however, has focused on using this approach to reduce delirium incidence in LTCFs. METHODS The objective is to assess the effectiveness of the multicomponent PREPARED Trial intervention in reducing the following primary outcomes: incidence, severity, duration, and frequency of delirium episodes in cognitively impaired residents. This 4-year, parallel-design, cluster randomized study will involve nursing staff and residents in 45-50 LTCFs in Montreal, Canada. Participating public and private LTCFs (clusters) that provide 24-h nursing care will be assigned to either the PREPARED Trial intervention or the control (usual care) arm of the study using a covariate constrained randomization procedure. Approximately 400-600 LTC residents aged 65 and older with dementia and/or cognitive impairment will be enrolled in the study and followed for 18 weeks. Residents must be at risk of delirium, delirium-free at baseline and have resided at the facility for at least 2 weeks. Residents who are unable to communicate verbally, have a history of specific psychiatric conditions, or are receiving end-of-life care will be excluded. The PREPARED Trial intervention consists of four main components: a decision tree, an instruction manual, a training package, and a toolkit. Primary study outcomes will be assessed weekly. Functional autonomy and cognitive levels will be assessed at the beginning and end of follow-up, while information pertaining to modifiable delirium risk factors, medical consultations, and facility transfers will be collected retrospectively for the duration of the follow-up period. Primary outcomes will be reported at the level of intervention assignment. All researchers analyzing the data will be blinded to group allocation. DISCUSSION This large-scale intervention study will contribute significantly to the development of evidence-based clinical guidelines for delirium prevention in this frail elderly population, as it will be the first to evaluate the efficacy of a multicomponent delirium prevention program translated into LTC clinical practice on a large scale. TRIAL REGISTRATION NCT03718156 , ClinicalTrials.gov .
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Affiliation(s)
- Machelle Wilchesky
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada.
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada.
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Stephanie A Ballard
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 3645, Québec, QC, G1V 0A6, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Ovidiu Lungu
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Functional Neuroimaging Unit, Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Queen Mary Rd, Montreal, QC, H3W 1W5, Canada
- Department of Psychiatry, Université de Montréal, Pavillon Roger-Gaudry, Faculté de Medicine, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Nathalie Champoux
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - T T Minh Vu
- Centre de recherche du CHUM, 91000, rue Saint-Denis, Montréal, QC, H2X 0A9, Canada
| | - Martin G Cole
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Ted McConnell
- Division of General Internal Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
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McCormick L, Godfrey CM, Muscedere J, Hendrikx S. Integrated knowledge translation strategies in the acute care of older people: a scoping review protocol. ACTA ACUST UNITED AC 2018; 14:103-107. [PMID: 27755322 DOI: 10.11124/jbisrir-2016-003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the evidence on the use of integrated knowledge translation (iKT) strategies in acute care. This information will assist in the identification of the strategies used to engage stakeholders, such as patients and decision makers, in the research process and how their involvement has influenced the implementation or integration of research into practice. The extent to which these iKT activities have occurred in the context of care of the elderly, intensively ill patient will be examined. The question that will guide this review is: What iKT strategies have been used within the acute care environment for the care of an older person, specifically: (a) where have these strategies been used, and (b) how have iKT strategies been implemented?
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Affiliation(s)
- Loretta McCormick
- 1Western University, London, Ontario, Canada 2The Queen's Collaboration for Healthcare Quality: a Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada 3Critical Care Program Kingston General Hospital, Department of Medicine Queen's University, Kingston, Ontario, Canada 4Allyn and Betty Taylor Library Western University, London, Ontario, Canada
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McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. Six-month outcomes of co-occurring delirium, depression, and dementia in long-term care. J Am Geriatr Soc 2014; 62:2296-302. [PMID: 25482152 DOI: 10.1111/jgs.13159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the 6-month outcomes of co-occurring delirium (full syndrome and subsyndromal symptoms), depression, and dementia in a long-term care (LTC) population. DESIGN Observational, prospective cohort study with 6-month follow-up conducted from 2005 to 2009. SETTING Seven LTC facilities in the province of Quebec, Canada. PARTICIPANTS Newly admitted and long-term residents recruited consecutively from lists of residents aged 65 and older admitted for LTC, with stratification into groups with and without severe cognitive impairment. The study sample comprised 274 residents with complete data at baseline on delirium, dementia, and depression. MEASUREMENTS Outcomes were 6-month mortality, functional decline (10-point decline from baseline on 100-point Barthel scale), and cognitive decline (3-point decline on 30-point Mini-Mental State Examination). Predictors included delirium (full syndrome or subsyndromal symptoms, using the Confusion Assessment Method), depression (Cornell Scale for Depression in Dementia), and dementia (chart diagnosis). RESULTS The baseline prevalences of delirium, subsyndromal symptoms of delirium (SSD), depression, and dementia were 11%, 44%, 19%, and 66%, respectively. By 6 months, 10% of 274 had died, 19% of 233 had experienced functional decline, and 17% of 246 had experienced cognitive decline. An analysis using multivariable generalized linear models found the following significant interaction effects (P < .15): between depression and dementia for mortality, between delirium and depression for functional decline, and between SSD and dementia for cognitive decline. CONCLUSION Co-occurrence of delirium, SSD, depression, and dementia in LTC residents appears to affect some 6-month outcomes. Because of limited statistical power, it was not possible to draw conclusions about the effects of the co-occurrence of some syndromes on poorer outcomes.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
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