Helen Tam-Tham

Dementia case management and risk of long-term care placement: a systematic review and meta-analysis

The objective of our study is to evaluate the effectiveness of dementia case management compared with usual care on reducing long‐term care placement, hospitalization, and emergency department visits for adult patients with dementia. We also sought to evaluate the effectiveness of this intervention on delaying time to long‐term care placement and hospitalization.

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology–Hemodialysis (SONG-HD) Consensus Workshop

Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes.

Predictors of long-term care placement in persons with dementia: a systematic review and meta-analysis

The main objective of this study was to summarize the effects of various individual, caregiver, and system‐related factors on the risk of long‐term care (LTC) placement for persons with dementia.

Determining the research priorities for patients with chronic kidney disease not on dialysis

Background The importance of engaging key stakeholders, and patients in particular, in determining research priorities has been recognized. We sought to identify the top 10 research priorities for patients with non-dialysis chronic kidney disease (CKD), their caregivers, and the clinicians and policy-makers involved in their care. Methods We used the four-step James Lind Alliance process to establish the top 10 research priorities. A national survey of patients with non-dialysis CKD (estimated glomerular filtration rate <45 mL/min/1.73 m 2 ), their caregivers, and the clinicians and policy-makers involved in their care was conducted to identify research uncertainties. A Steering Group of patients, caregivers, clinicians and researchers combined and reduced these uncertainties to 30 through a series of iterations. Finally, a workshop with participants from across Canada (12 patients, 6 caregivers, 3 physicians, 2 nurses, 1 pharmacist and 1 policy-maker) was held to determine the top 10 research priorities, using a nominal group technique. Results Overall, 439 individuals responded to the survey and identified 1811 uncertainties, from which the steering group determined the top 30 uncertainties to be considered at the workshop. The top 10 research uncertainties prioritized at the workshop included questions about treatments to prevent progression of kidney disease (including diet) and to treat symptoms of CKD, provider- and patient-targeted strategies for managing CKD, the impact of lifestyle on disease progression, harmful effects of medications on disease progression, optimal strategies for treatment of cardiovascular disease in CKD and for early identification of kidney disease, and strategies for equitable access to care for patients with CKD. Conclusions We identified the top 10 research priorities for patients with CKD that can be used to guide researchers, as well as inform funders of health-care research.

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

There is general agreement that frailty is a state of heightened vulnerability to stressors arising from impairments in multiple systems leading to declines in homeostatic reserve and resiliency, but unresolved issues persist about its detection, underlying pathophysiology, and relationship with aging, disability, and multimorbidity. A particularly challenging area is the relationship between frailty and hospitalization. Based on the deliberations of a 2014 Canadian expert consultation meeting and a scoping review of the relevant literature between 2005 and 2015, this discussion paper presents a review of the current state of knowledge on frailty in the acute care setting, including its prevalence and ability to both predict the occurrence and outcomes of hospitalization. The examination of the available evidence highlighted a number of specific clinical and research topics requiring additional study. We conclude with a series of consensus recommendations regarding future research priorities in this important area.

Does the Evidence Support Conservative Management as an Alternative to Dialysis for Older Patients with Advanced Kidney Disease

There is ongoing debate whether older adult patients with stage 5 CKD gain survival advantage when treated with dialysis compared with conservative management. Comprehensive conservative management that is chosen or medically advised ([1][1]) focuses on optimizing quality of life and is recommended

A Population-Based Analysis of Quality Indicators in CKD

BACKGROUND AND OBJECTIVES Awareness of CKD remains low in comparison with other chronic diseases, such as diabetes, leading to low use of preventive medications and appropriate testing. The objective of this study was to evaluate the quality of care provided to people with and at risk of CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a population-based analysis of all Albertans with eGFR=15-59 ml/min per 1.73 m2 between April 1, 2011 and March 31, 2012 as well as patients with diabetes (as of March 31, 2012). We assessed multiple quality indicators in people with eGFR=15-59 ml/min per 1.73 m2, including appropriate risk stratification with albuminuria testing and preventive medication use and screened people with diabetes using urine albumin-to-creatinine ratio and serum creatinine measurements. RESULTS Among 96,480 adults with eGFR=15-59 ml/min per 1.73 m2, we found that 17.0% of those without diabetes were appropriately risk stratified with a measure of albuminuria compared with 64.2% of those with diabetes (P<0.001). Of those with eGFR=15-59 ml/min per 1.73 m2 and moderate or severe albuminuria, 63.2% of those without diabetes received an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker compared with 82.1% in those with diabetes (P<0.001). Statin use was also significantly lower in patients with eGFR=15-59 ml/min per 1.73 m2 without diabetes (39.2%) compared with those with diabetes (64.6%; P<0.001). Among 235,649 adults with diabetes, only 41.8% received a urine albumin-to-creatinine ratio and 73.2% received a serum creatinine measurement over 1 year. CONCLUSIONS We identified large gaps in care, especially in those with CKD but no diabetes. The largest gap was in the prescription of guideline-concordant medication in those with CKD as well as appropriate screening for albuminuria in those with diabetes. Our work illustrates the importance of measuring health system performance as the first step in a quality improvement process to improve care and outcomes in CKD.

A randomized controlled trial comparing in-person and wiki-inspired nominal group techniques for engaging stakeholders in chronic kidney disease research prioritization.

BackgroundFew studies have evaluated stakeholder engagement in chronic kidney disease (CKD) research prioritization. In this two-arm, parallel group randomized controlled trial, we sought to compare an in-person nominal group technique (NGT) approach with an online wiki-inspired alternative to determining the top 10 CKD research priorities, and to evaluate stakeholder engagement and satisfaction with each process.MethodsEligible participants included adults ≥18 years with access to a computer and Internet, high health literacy, and from one of the following stakeholder groups: patients with CKD not on dialysis, their caregivers, health care providers who care for patients with CKD, or CKD-related health policymakers. Fifty-six participants were randomized to a wiki-inspired modified NGT that occurred over 3 weeks vs. a 1-day in-person NGT workshop, informed by James Lind Alliance methodology, to determine the top 10 CKD-related research priorities. The primary outcome was the pairwise agreement between the two groups’ final top 10 ranked priorities, evaluated using Spearman’s correlation coefficient. Secondary outcomes included participant engagement and satisfaction and wiki tool usability.ResultsSpearman’s rho for correlation between the two lists was 0.139 (95 % confidence interval −0.543 to 0.703, p = 0.71), suggesting low correlation between the top 10 lists across the two groups. Both groups ranked the same item as the top research priority, with 5 of the top 10 priorities ranked by the wiki group within the top 10 for the in-person group. In comparison to the in-person group, participants from the wiki group were less likely to report: satisfaction with the format (73.7 vs.100 %, p = 0.011); ability to express their views (57.9 vs 96.0 %, p = 0.0003); and perception that they contributed meaningfully to the process (68.4 vs 84.0 %, p = 0.004).ConclusionsA CKD research prioritization approach using an online wiki-like tool identified low correlation in rankings compared with an in-person approach, with less satisfaction and perceptions of active engagement. Modifications to the wiki-inspired tool are required before it can be considered a potential alternative to an in-person workshop for engaging patients in determining research priorities.Trial registration(ISRCTN18248625)

User-driven conversations about dialysis through Facebook: A qualitative thematic analysis.

As one of the most popular social networking sites in the world, Facebook has strong potential to enable peer support and the user‐driven sharing of health information. We carried out a qualitative thematic analysis of the wall posts of a public Facebook group focused on dialysis to identify some of the major themes discussed.

Primary care physicians’ perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study

BackgroundGuideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care.ObjectivesOur objectives are to (1) interview primary care physicians to determine their perspectives of conservative care for older adults with stage 5 CKD and (2) survey primary care physicians to determine the prevalence of key barriers and facilitators to provision of conservative care for older adults with stage 5 CKD.DesignA sequential exploratory mixed methods design was adopted for this study. The first phase of the study will involve fundamental qualitative description and the second phase will be a cross-sectional population-based survey.SettingThe research is conducted in Alberta, Canada.ParticipantsThe participants are primary care physicians with experience in providing care for older adults with stage 5 CKD not planning on initiating dialysis.MethodsThe first objective will be achieved by undertaking interviews with primary care physicians from southern Alberta. Participants will be selected purposively to include physicians with a range of characteristics (e.g., age, gender, and location of clinical practice). Interviews will be recorded, transcribed verbatim, and analyzed using conventional content analysis to generate themes. The second objective will be achieved by undertaking a population-based survey of primary care physicians in Alberta. The questionnaire will be developed based on the findings from the qualitative interviews and pilot tested for face and content validity. Physicians will be provided multiple options to complete the questionnaire including mail, fax, and online methods. Descriptive statistics and associations between demographic factors and barriers and facilitators to care will be analyzed using regression models.LimitationsA potential limitation of this mixed methods study is its cross-sectional nature.ConclusionsThis work will inform development of clinical resources and tools for care of older adults with stage 5 CKD, to address barriers and enable facilitators to community-based conservative care.ABRÉGÉMise en contexteLes comités pour l’établissement de lignes directrices ont relevé la nécessité pour la recherche de faciliter la mise en place d’un traitement conservateur chez les adultes âgés atteints d’insuffisance rénale chronique (IRC) de stade 5, des patients présentant une incidence élevée de comorbidité et d’altération de la fonction rénale. Des méthodes qualitatives et quantitatives seront utilisées pour assurer une compréhension détaillée des obstacles aux soins de première ligne et en contrepartie, des éléments qui les facilitent.Objectifs de l’étudeCette étude vise deux objectifs principaux :1) Interroger les médecins qui prodiguent des soins primaires afin de connaître leur point de vue sur l’administration d’un traitement conservateur chez les patients âgés atteints d’IRC de stade 5.2) Sonder ces mêmes médecins pour établir la prévalence tant des obstacles à fournir des traitements conservateurs que des éléments la facilitant chez les patients âgés atteints d’IRC de stade 5.Cadre et type d’étudeIl s’agit d’un modèle d’étude exploratoire à méthodes mixtes qui sera effectuée de façon séquentielle. Une première phase impliquera une description qualitative fondamentale tandis qu’une deuxième consistera en une enquête transversale menée dans la population. Les deux phases de l’étude se tiendront en Alberta, au Canada.ParticipantsUn groupe de médecins prodiguant des soins primaires à des patients âgés atteints d’IRC de stade 5, mais n’envisageant pas de commencer des traitements d’hémodialyse.MéthodologieLe premier objectif sera atteint en menant une enquête auprès des médecins du sud de l’Alberta prodiguant des soins de première ligne. Les participants seront sélectionnés avec l’intention d’inclure des praticiens représentant un éventail de caractéristiques (âge, genre, lieu de pratique). Les entrevues seront enregistrées puis transcrites intégralement, et l’information recueillie sera traitée en utilisant une approche conventionnelle d’analyse du contenu pour en tirer les thématiques. Le second objectif sera également réalisé en procédant à une enquête dans la population de médecins prodiguant des soins de première ligne en Alberta. Le questionnaire sera mis au point suivant les résultats obtenus lors des entretiens qualificatifs et testés lors d’essais-pilotes visant à établir leur validité apparente et de contenu. Les praticiens disposeront de plusieurs moyens pour retourner le questionnaire une fois complété soit par la poste, par fax ou par d’autres méthodes en ligne. Les données statistiques descriptives ainsi que les associations établies entre les facteurs démographiques et les obstacles et facilitateurs de soins seront analysées à l’aide de modèles de régression.Limites de l’étudeNous prévoyons une éventuelle limite à cette étude par méthodes mixtes compte tenu de sa nature transversale.ConclusionsÀ terme, ces travaux orienteront le développement de ressources cliniques et d’outils pour la prise en charge des patients âgés atteints d’IRC de stade 5. Ils contribueront également à rendre possible l’établissement de programmes de traitements conservateurs communautaires et à éliminer les obstacles rencontrés.