Rating Methodological Quality: Toward Improved Assessment and Investigation

Assessing methodological quality is considered essential in deciding what investigations to include in research syntheses and in detecting potential sources of bias in meta-analytic results. Quality assessment is also useful in characterizing the strengths and limitations of the research in an area of study. Although numerous instruments to measure research quality have been developed, they have lacked empirically-supported components. In addition, different summary quality scales have yielded different findings when they were used to weight treatment effect estimates for the same body of research. Suggestions for developing improved quality instruments include: distinguishing distinct domains of quality, such as internal validity, external validity, the completeness of the study report, and adherence to ethical practices; focusing on individual aspects, rather than domains of quality; and focusing on empirically-verified criteria. Other ways to facilitate the constructive use of quality assessment are to improve and standardize the reporting of research investigations, so that the quality of studies can be more equitably and thoroughly compared, and to identify optimal methods for incorporating study quality ratings into meta-analyses.     

Mutual Aid: A Contribution to Best-Practice Social Work

This keynote speech, delivered in French and translated to English with minor adjustments for publication, presents some of the author's ideas about mutual-aid practice as best-practice social work. The author discusses the etiology and centrality of mutual aid in social work with groups, presents five characteristics of mutual-aid practice that reflect best-practice social work and identifies four key characteristics—joy in sharing, faith, courage, and curiosity—of mutual-aid practitioners. Similarities between mutual-aid practice and evidence-based group work, practice evaluation and participatory-action research are discussed as well. The author presents group work as inherently evidence based and challenges the idea that subjective measures alone may not be valid in reaching this determination.     

Psychosocial Care in Nursing Homes in the Era of the MDS 3.0: Perspectives of the Experts

Meeting psychosocial needs of nursing home residents is increasingly regarded as a critical component of care, and the nationally-mandated nursing home care screening instrument— the Minimum Data Set (MDS) 3.0—was modified and implemented in 2010 to promote better assessment of psychosocial needs and health. Recognizing the importance of psychosocial well-being among nursing home residents, and the promise of MDS 3.0 for improving psychosocial care, this article reports recommendations derived from a conference of stakeholders representing diverse disciplines and organizations regarding next steps following MDS 3.0 screening. Results relate to seven areas of psychosocial care and address cross-cutting recommendations to improve psychosocial care.     

Discharge Planning

Discharge planning services have become very important to older adults who are subject to shortened hospital stays due to the prospective payment form of reimbursement based on diagnostic related groups (DRGs). A study of older adults discharged from three acute care hospitals in New York City shows a direct association between patients' satisfaction with their discharge plan and the number of services arranged by discharge planners. Patients told, "your DRGs are up" as the reason for their discharge, needed the greatest amount of help with activities of daily living. Implications for social workers offering discharge planning services are addressed.     

Depression,Hopelessness, and Suicidal Ideation Among the Elderly

Abstract

This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one's own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and depression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment.     

The Cycle of Bias in Health Research: A Framework and Toolbox for Critical Appraisal Training

Recognizing bias in health research is crucial for evidence-based decision making. We worked with eight community groups to develop materials for nine modular, individualized critical appraisal workshops we conducted with 102 consumers (four workshops), 43 healthcare providers (three workshops), and 33 journalists (two workshops) in California. We presented workshops using a “cycle of bias” framework, and developed a toolbox of presentations, problem-based small group sessions, and skill-building materials to improve participants' ability to evaluate research for financial and other conflicts of interest, bias, validity, and applicability. Participant feedback indicated that the adaptability of the toolbox and our focus on bias were critical elements in the success of our workshops.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

循证护理在冠心病介入治疗后患者中的应用价值

目的：探讨循证护理在冠状动脉性心脏病介入治疗（ PCI）后患者中的应用价值。方法选取2013年1月～2014年3月期间行PCI治疗的冠心病患者100例,分为观察组与对照组,各50例,对照组采用常规护理,观察组采用循证护理。观察两组患者术后血管并发症和不良反应的发生情况,以及PCI前后生存质量差异和汉密尔顿焦虑量表（ HAMA）评分差异。结果观察组血管并发症及不良反应总发生率为12．00％,对照组总发生率为30．00％,两组比较差异显著（ P＜0．05）。两组术前生存质量及HAMA评分无显著差异（P＞0．05）,出院时及3个月后均较前次有显著改善（P＜0．05或P＜0．01）,观察组显著优于对照组（ P＜0．01）。结论循证护理可显著减少冠心病介入治疗后患者的血管并发症及不良反应,改善生存质量。     

老年肺腺癌患者应用EGFR-TKIs治疗的观察及护理

目的探讨我科应用EGFR-TKIs分子靶向药物厄洛替尼和吉非替尼治疗老年肺腺癌不良反应的观察及护理。方法对26例EGFR基因突变阳性的老年肺腺癌患者,根据医嘱给予厄洛替尼或吉非替尼口服治疗并观察记录其用药后的不良反应。结果在26例老年患者中疾病控制率为73.1%。主要不良反应以皮疹最为多见,其次是腹泻,经医护人员精心处理后症状缓解,继续顺利治疗。结论口服分子靶向药物如厄洛替尼和吉非替尼治疗肺腺癌疗效确切,特别对于老年患者,耐受性良好。护理人员提前做好用药指导,通过精心的护理,可以提高患者用药的依从性,有效地改善患者的生存质量。     

糖尿病足的中西医护理新进展

糖尿病足是糖尿病患者的常见慢性并发症之一,其发病率呈现逐年增高的趋势,一旦患上糖尿病足将给患者造成身心上的极大痛苦,甚至导致截肢,严重影响患者的生活质量。但采取积极有效的预防和护理措施可以有效预防发生、阻止糖尿病足的进展,现将近几年糖尿病足的中西医护理新进展综述如下。