Amanda Ross-White

Frequent emergency department use by individuals seeking mental healthcare: a systematic search and review.

OBJECTIVE The aim of this study was to compare research on individuals who frequently use the ED for mental health complaints including parameters used to identify the population, as well as socio-demographic, clinical, and service use factors. METHODS Systematic search and review of Medline, Cinahl, PsycInfo, and HealthStar (1980 to 2011). Double-data extraction ensured accuracy. Descriptive statistics were reported. RESULTS Thirteen studies were included. Median sample size was 100. Parameters varied across studies. Profile: young, unemployed males living in transient accommodations, diagnosis of a psychotic disorder, self-referral to the ED for symptoms/unmet needs, and discharge to community resources. CONCLUSIONS Consistently used, meaningful definitions/parameters are needed.

Brief review: Adoption of electronic medical records to enhance acute pain management

AbstractPurpose The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists’ experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada.SourceWe first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management.Principal findingsThe key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution’s process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow.ConclusionsUse of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.RésuméObjectifL’objectif de cet article est d’examiner les réticences des médecins à l’adoption du dossier médical informatisé (DMI) ainsi que l’expérience des anesthésiologistes avec les DMI utilisés au service de prise en charge de la douleur aiguë de deux centres tertiaires canadiens.SourceNous passons tout d’abord en revue la littérature récente afin de déterminer si les réticences des médecins à l’adoption évoluent étant donné la croissance exponentielle des technologies de l’information et l’évolution de l’environnement des soins de santé. Par la suite, nous rapportons l’expérience institutionnelle de deux centres universitaires des sciences de la santé et les défis qu’ils ont rencontrés au cours des dix dernières années en matière de mise au point et de mise en œuvre d’un système de dossier médical informatisé pour la prise en charge de la douleur aiguë.Constatations principalesLes principaux obstacles à l’adoption du DMI que nous avons identifiés sont liés à des contraintes financières, technologiques et de temps. Ces obstacles sont identiques à ceux rapportés dans une revue méthodique réalisée avant 2009 et demeurent d’importants facteurs rendant difficiles la mise en œuvre d’un tel système. Nous avons rencontré ces difficultés pendant le processus d’adoption de DMI spécifiques à la prise en charge de la douleur aiguë dans notre institution. En outre, nos résultats soulignent l’importance de la participation des médecins dans les étapes de mise au point et de mise en œuvre du DMI afin d’intégrer leurs commentaires et de garantir que le système de DMI s’intègre dans leur flux de travail.ConclusionL’utilisation du DMI deviendra inévitablement la norme de soins; toutefois, de nombreux obstacles persistent et freinent sa mise en œuvre et son adoption. Ces défis à la mise en œuvre peuvent être résolus en utilisant une stratégie institutionnelle de changement qui tient compte de ces obstacles et fournit les ressources nécessaires à la mise en œuvre. En adoptant le DMI, la communication, la prise en charge des patients, la recherche et la sécurité des patients seront toutes améliorées.

Safety in home care: a mapping review of the international literature

Aim This integrative study on safety in home care provides a synopsis of evidence in the Canadian and international literature. The objectives of this study were to: (i) develop/test a comprehensive search strategy to locate the literature on harmful incidents (previously called adverse events (AEs)) in the home care environment to track emerging evidence; (ii) determine what has been documented about AEs in the home care setting; and (iii) catalogue definitions of safety in home care by analysis of reported/published definitions. Methods The review was characterised by a process of mapping and categorising existing literature in practice, health services and policy literature. Methods included a thorough search strategy determined by time/scope constraints, quality assessment of study sets relevant to design and graphic/tabular representation of the synthesis. This multi-step, iterative process used an explicit search and retrieval strategy based on Cochrane and Joanna Briggs Institute methodologies. A modified Problem, Intervention, Comparison, Outcome template was used to design the search. To facilitate concept clarification, key definitions relevant to patient safety and AEs in home care were catalogued. Results Multiple runs on searches were performed for sensitivity and specificity using the Peer Review of Electronic Search Strategies methodology developed by the Canadian Agency for Drugs and Technologies in Health and additional other approaches. Ninety-two research studies published from 1993 to 2010 and representing 14 countries (the majority North American) met the inclusion criteria (i.e. addressing AEs within the context of home care). Studies varied in scope from one home healthcare agency/site to nationwide investigations that involved more than five million participants. Quantitative research methods included experimental, descriptive and retrospective designs. Qualitative research methods included focus groups, interviews and consensus workshops. The nature of AEs was categorised as types of patient injury/harm related to an AE, caregiver instigated injury/harm and organisational/services/staff injury/harm. Conclusions There is an emerging evidence base about safety in home care. A predominant theme was the lack of conceptual clarity with the terms patient safety and AEs in the home care environment. An important finding was that innovative strategies/tools appear in the grey or peer-review literature as quality initiatives with/without evaluation elements. Traditionally, we do not concentrate heavily on the grey literature, but to advance the field, it may be necessary to place more emphasis on this source. A glaring limitation was the paucity of research on the occurrence of AEs and a lack of quality of research that documents prevalence estimates/incidence rates. Interventional research to evaluate risk reduction strategies was very limited and will advance only when tracking and documentation of various AEs improves.

Prevalence of chronic pain and related risk factors in military veterans: a systematic review protocol

Background Chronic pain is of major concern to global health and one of the top reasons for a patient to seek physician care. The prevalence of chronic pain in the civilian population has been well documented, as has chronic pain with certain injuries commonly seen in veterans; however little is known about the burden of chronic pain in the general population of veterans. Objectives The objective of this review is to summarize the evidence on the prevalence of chronic pain and related risk factors in military veterans. Inclusion criteria Types of participants International studies that included military veterans. Focus of the review Studies that evaluated the prevalence of and/or related risk factors associated with chronic pain in the general military veteran population. Types of studies Analytical and descriptive epidemiological studies including prospective and retrospective cohort studies, and cross sectional studies. Search strategy The search strategy targeted both published and unpublished studies. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search in MEDLINE, CINAHL, Embase, PsycINFO and Web of Science included all identified keywords and index terms. Reference lists were hand searched. Inclusion criteria were English language studies published between 1996 and 2013. The search for unpublished studies included: Dissertations and theses, MedNar, Centers for Disease Control and Prevention (CDC). All identified studies were assessed for relevance based on information provided in the title, abstract and subject terms. Full papers were retrieved for studies that satisfied the inclusion criteria, or if there was uncertainty regarding relevance. Studies identified from reference list searches of included studies were assessed for relevance based on the title. Data collection Two independent reviewers extracted data from the selected papers using the standardized data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI). Data synthesis Meta‐analysis was not possible due to methodological and statistical heterogeneity of the studies. Hence study findings are presented in narrative form. Results A total of 4829 citations were located by the search strategy. Of this set, 1218 were duplicates, 3536 were off‐topic and 73 did not meet inclusion criteria. Twelve studies were included in this systematic review. The prevalence of pain ranged from 25% to 72%. The prevalence of moderate to severe chronic pain of at least three months duration was 27.4%. Factors associated with chronic pain included sex, being married, lower levels of education, smoking, emotional distress, rank, type of service and being younger. Conclusions There is a significant burden of chronic pain in veterans, and it appears to be higher than in civilian populations. However, the current evidence is limited by the paucity of available studies and the variability in study design and pain measurement. Implications for research The findings of this review may be useful for clinician and policy decisions to improve the care of veterans and to target veterans with a high burden of chronic pain.

Utilisation of theoretical models and frameworks in the process of evidence synthesis.

Background A systematic review is a comprehensive enquiry or study of secondary data sources. There is a research question, an a priori articulation of methods and a set of procedures to focus the investigation. Despite these rigorous structures to guide the review, synthesising evidence is a challenging, resource intense and time consuming process. Large volumes of information complicate not only the search functions, but also the conceptualisation of the evidence needed to create the concise and integrated results. Use of a theoretical model or framework could serve as an essential element in effectively focusing the review and designing the methods to respond to the knowledge question. Objective This scoping review sought to confirm the value of models or frameworks used by authors working within traditional methodologies for evidence synthesis. Inclusion criteria Types of participants The focus of this review was on the context of health care. Types of intervention(s)/phenomena of interest All studies that discussed models or frameworks used specifically to address the process of synthesis were included. Types of studies Discussion, scholarship or methodology papers and reviews were included. Types of outcome All theoretical models or frameworks were described, with specific attention to the purpose of the framework for each study, and the contribution of the framework to the process of synthesis. Search strategy The search strategy aimed to find both published and unpublished studies. A three‐step search strategy was utilised. The databases for published material included CINAHL; Medline; EMBASE; PsycINFO; AMED; Cochrane; Biomed Central; Scirus; and Mednar. Databases for unpublished material included Dissertation Abstracts; Sociological Abstracts; Conference proceedings. Methodological quality The review was a focused scoping review to locate and describe the contribution of theoretical models or frameworks to the process of synthesis. The methodological quality of the discussion papers was therefore not assessed. Data collection Data was extracted from the discussion papers using an adaptation of the standardised data extraction tool from the Joanna Briggs Institute Data Extraction for Narrative, Expert opinion & text (JBI‐NOTARI). Data synthesis Results were discussed in narrative form. The use of frameworks in each step of the synthesis process was discussed. Results Eight studies (nine papers) formed the final set included in this review. The studies targeted the following issues: Child protection; end‐of‐life care; predictors of adolescent sexual behaviour and intention; primary care career choice; prognosis of acute whiplash; reluctance to care; use of Information Technology; young childs post‐divorce adjustment. Frameworks were used in four of the seven steps of synthesis, and integration of the data indicated that the use of frameworks in the process of evidence synthesis was valuable and had many advantages. Conclusion This review illustrates that the addition of structure and guidance provided by a framework can serve to benefit the process of integration. Studies in this review indicated that the use of frameworks helped to inform the association between variables, guide the search strategy, structure and clarify the outcomes, identify knowledge gaps and indicate areas for future research. Used in this manner, frameworks could provide a valuable foundation for the process of synthesis. Implications for practice Evidence from systematic reviews informs practice. The incorporation of a theoretical model or framework helps to guide the process of synthesis and clarify the outcomes. This added transparency will facilitate the assimilation of the evidence by the target audience. Implications for research Systematic reviews are the highest level of evidence available at this time. The use of theoretical models or frameworks in the review process strengthens the rigor and transparency of the integrative method. Further research into the contribution of theoretical models or conceptual frameworks to the process of synthesis may be valuable.

Towards a conceptual consensus of continuity in mental healthcare: focused literature search and theory analysis

AIM While continuity of care is an important component in the provision of mental health services, a universally accepted definition is missing. There is a need to identify areas of consensus and discrepancy in continuity theory and provide a foundation for advancing measurement capabilities. The purpose of this study was to systematically identify and examine scholarship on continuity in mental healthcare. METHODS Using a focused literature review modelled on the Joanna Briggs Methodology for systematic reviews, MEDLINE, CINAHL, Embase, PsycINFO and Health STAR were searched from 1950 to 2011 for articles on the theoretical nature of continuity in mental healthcare. Included conceptualisations were subject to a theory analysis to critically examine similarities and differences. Next, a content analysis on the extracted data was used to identify a global understanding and set of theoretically defined concepts for the whole. Finally, the identified global concepts were compared with the original documents and to items identified on existing quantitative measurement tools to assess areas of consensus and discrepancy. RESULTS Seven documents describing the conceptualisation of continuity in mental healthcare were identified. From these, a deductive theoretical summary is proposed and theoretical consensus exists to support nine global concepts of continuity in mental healthcare. These global concepts include Longitudinality, Input & Individuality, Comprehensiveness, Flexible Consistency, Stability & Relationship, Accessibility, Information & Sharing, Realities, and Responsibility/Accountability. The original theories proposed by Dr Bachrach and colleagues and Dr Joyce and colleagues, as well as the ACSS-MH measurement tool, provide the best coverage of the proposed concepts. CONCLUSIONS Consensus exists across conceptualisations of continuity in mental healthcare, yet it is obscured by inconsistent use of language. Existing tools capture many of the associated concepts and elements, but none do so entirely. Further tool development and psychometric testing is needed. This study provides the foundational work required to advance research priorities in this area.

Quantifying Cognitive Dysfunction Across the Spectrum of End Stage Kidney Disease - A Systematic Review and Meta-Analysis: Cognitive Dysfunction Across the Spectrum of End Stage Kidney Disease

Cognitive dysfunction is reportedly highly prevalent among chronic kidney disease (CKD) patients. A variety of screening tools and neuropsychiatric batteries are used to quantify the magnitude and nature of this dysfunction. Our objective is to summarize the neurocognitive testing used, and determine what degree cognitive dysfunction is reported in CKD patients. All study designs published in English that contained participants who were either pre‐dialysis patients, haemodialysis (HD) or peritoneal dialysis (PD) patients or renal transplant recipients were considered. Reported comparative non‐CKD control data was also collected. All study designs were included. The search period encompassed articles from 1980 to May 2018. This review is registered with PROSPERO (CRD42018096568). Of the 1711 articles screened, 148 articles were relevant and used in the meta‐analysis. Commonly used assessments were The Mini–Mental State Examination (MMSE), The Modified Mini–Mental State Examination, the Trails Making Tests (TMT) forms A and B and components of the Wechsler Adult Intelligence Scale: Digit Span and Digit Symbol. Means for all assessments were adjusted using a random effects model to account for the differences in variance. Adjusted mean MMSE scores were significantly lower for both pre‐dialysis (26.08, n = 17 073) and HD (26.31, n = 3314) patients when compared to non‐CKD controls (28.21, n = 5226). PD (58.01 s, n = 859) and HD (56.04 s, n = 2344) patients also took significantly longer to complete the Trails Making Task A than non‐CKD controls (37.62 s, n = 4809). Patients with CKD, especially pre‐dialysis and those requiring dialysis, are likely to exhibit impairments in cognition that can be identified with specific screening neuropsychological assessments.

Patient Safety Culture in Rural Hospitals: A Systematic Review

in hospitals have had patient safety on their healthcare agenda. 1 Researchers and policy makers in governments, healthcare accreditation bodies and newly formed agencies started researching and developing strategies and guidelines to facilitate this new initiative called patient safety. Some of the literature has focused on different aspect of Patient safety. This systematic review protocol will be to review patient safety culture in rural hospitals

ebrary Reader and Medical Texts

Abstract ebrary has been serving libraries with electronic content since 1999. Libraries can purchase individual titles or a pre-selected package, as well as use ebrary to distribute their own proprietary content, making it a useful option as a corporate knowledge management tool. This review will provide more information about ebrarys proprietary reader software as well as some of the content available through its clinical and life sciences package.