Aim
To develop a consensus‐based instrument MELIA to assess the medication literacy of older home care patients to ultimately optimize medication safety.
Design
This study was part of the project ...‘Study of Medication Safety in Home Care’ (doMESTIC), which took place from 2016 to 2020 in Switzerland. The development process for the medication literacy assessment instrument encompassed six steps.
Method
First, a scoping literature search was conducted in the Pubmed, CINAHL, EMBASE and Cochrane Library databases as 2) a basis for the development of assessment items. This was followed by 3) a cognitive interview with home care patients and 4) the first round of a Delphi process. Then, 5) a focus group interview with home care experts was conducted before 6) the second Delphi round. The project took place between August 2020 and June 2021. With these different steps, perspectives of both patients and various home care and medication safety experts were included in the development of the assessment instrument.
Results
A detailed instrument consisting of 20 items as well as a 7‐item short version were developed. The short version is intended for efficient preliminary screening to identify patients at high risk for medication management‐related problems.
Conclusion
Medication literacy in patients 65 years and older receiving professional home care is a key issue in preventing medication errors. A targeted assessment, starting with an efficient short version of MELIA, allows for prioritization of patients for interventions to optimize medication safety while ensuring their independence as much as possible.
Impact
Systematic assessment of patients' medication literacy helps to provide them with targeted and individual support in their medication management to avoid medication errors and increase patient safety. The development of MELIA is a first step in providing an assessment instrument specifically for the home care setting.
Patient or public contribution
Patient participation was an integral part of the instrument development. The initial 23 items were optimized based on cognitive interviews with four home care patients. The next steps of the instrument development were based on feedback of health care professionals—encompassing advance practice nurses, regular nurses, pharmacists and general practitioners—during a two‐step Delphi process as well as a focus group discussion.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
identifying drug-related hospital admissions (DRAs) in older people is difficult. A standardised chart review procedure has recently been developed. It includes an adjudication team (physician and ...pharmacist) screening using 26 triggers and then performing causality assessment to determine whether an adverse drug event (ADE) occurred (secondary to an adverse drug reaction, overuse, misuse or underuse) and whether the ADE contributed to hospital admission (DRA).
to assess the performance of those triggers in detecting DRA.
retrospective study using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) trial.
four European medical centres.
multimorbid (≥ 3 chronic medical conditions) older (≥ 70 years) inpatients with polypharmacy (≥ 5 chronic medications) were enrolled in the OPERAM trial (N = 2,008) and followed for 12 months. We included patients with ≥1 adjudicated hospitalisation during the follow-up.
the positive predictive value (PPV; number of DRAs identified by trigger/number of triggers) was calculated for each trigger and for the tool as a whole.
of 1,235 hospitalisations adjudicated for 832 patients, 716 (58%) had at least one trigger; an ADE was identified in 673 (54%) and 518 (42%) were adjudicated as DRAs. The overall PPV of the trigger tool for detecting DRAs was 0.66 0.62-0.69.
this tool performs well for identifying DRAs in older people. Based on our results, a revised version of the tool was proposed but will require external validation before it can be incorporated into research and clinical practice.
In many classrooms, teachers have started to incorporate graphic novels in classroom instruction. However, research has suggested that some readers may have limited understanding of how to read ...graphic novels, which can create challenges for teachers using the medium. Drawing from a larger study, this article highlights two cases, an expert graphic novel and an expert traditional print text reader, to illustrate how the expanded four resources model may be used as a framework to guide novice graphic novel readers as they engage with graphic text. The article provides next steps for educators as they begin their journey with graphic novels.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NMLJ, NUK, OILJ, PNG, SBCE, SBMB, UL, UM, UPUK
4.
First Impressions Matter Jimenez, Laura M.; Meyer, Carla K.
Journal of literacy research,
12/2016, Volume:
48, Issue:
4
Journal Article
Peer reviewed
Graphic novels in the K-12 classroom are most often used to motivate marginalized readers because of the lower text load and assumption of easy reading. This assumption has thus far been unexplored ...by reading research. This qualitative multiple-case study utilized think-aloud protocols in a new attention-mapping activity to better understand how expert readers use intentional attention shifts to make meaning in graphic novels. Four expert graphic novel readers, and four expert print-dominant readers, between ages 16 and 20 were asked to trace their attention across the opening pages of five graphic novels and to predict what the story was about. Utilizing digital video recordings as the primary data source, analysis included creating a visual representation of each reader’s attention patterns, time used, as well as the complexity and accuracy of his or her predicted stories. Findings indicate that the expert graphic novel readers initially attended to visual elements to gain an understanding of genre, character, and possible plot points. Only after attending to the illustrations did they decode the written text, and finally synthesized the two. The expert print-dominant readers predominantly attended to written text effectively but did not use illustrations to support or extend their understanding or meaning making in the text. This study complicates current assumptions about the ease of reading graphic novels by observing expert-print dominant readers and expert graphic novel readers negotiate written text and illustrations.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The growing popularity of graphic novels for younger readers is hard to miss. This article provides specific ways to think about, recognize, and teach with multimodal texts that leverage student ...interest. In this English language arts unit, we taught a sixth‐grade class how to read and comprehend the complex design elements common to the graphic novel form. The class used both student‐selected graphic novels made available to them by the researchers and a whole‐class graphic novel, One Dead Spy by Nathan Hale. Teaching students how to effectively comprehend graphic novels is much like teaching anything: By identifying the content and strategies that need to be taught, we then identified the corresponding teaching strategies needed. This article reports on the content and strategies, specific ways to help students come to a greater understanding of the text in hand, and graphic novels as a literary form.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NMLJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Homecare client services are often distributed across several interdependent healthcare providers, making proper care coordination essential. However, as studies exploring care ...coordination in the homecare setting are scarce, serious knowledge gaps exist regarding how various factors influence coordination in this care sector. To fill such gaps, this study’s central aim was to explore how external factors (i.e., financial and regulatory mechanisms) and homecare agency characteristics (i.e., work environment, workforce, and client characteristics) are related to care coordination in homecare. Methods This analysis was part of a national multicentre, cross-sectional study in the Swiss homecare setting that included a stratified random sample of 88 Swiss homecare agencies. Data were collected between January and September 2021 through agency and employee questionnaires. Using our newly developed care coordination framework, COORA, we modelled our variables to assess the relevant components of care coordination on the structural, process, and outcome levels. We conducted both descriptive and multilevel regression analyses—with the latter adjusting for dependencies within agencies—to explore which key factors are associated with coordination. Results The final sample size consisted of 1450 employees of 71 homecare agencies. We found that one explicit coordination mechanism (“communication and information exchange” (beta = 0.10, p <.001)) and four implicit coordination mechanisms—“knowledge of the health system” (beta = -0.07, p <.01), “role clarity” (beta = 0.07, p <.001), “mutual respect and trust” (beta = 0.07, p <.001), and “accountability, predictability, common perspective” (beta = 0.19, p <.001)—were significantly positively associated with employee-perceived coordination. We also found that the effects of agency characteristics and external factors were mediated through coordination processes. Conclusion Implicit coordination mechanisms, which enable and enhance team communication, require closer examination. While developing strategies to strengthen implicit mechanisms, the involvement of the entire care team is vital to create structures (i.e., explicit mechanisms) that enable communication and information exchange. Appropriate coordination processes seem to mitigate the association between staffing and coordination. This suggests that they support coordination even when workload and overtime are higher.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
While drug-related problems (DRPs) in the inpatient setting are well known, the scope of these problems in home care has not been critically evaluated.
Aim of the Review
Our primary ...objective was to evaluate the incidence and demographics of DRPs in home care. Our specific aims were to characterize the rate of potentially inappropriate medications (PIMs), medication errors (MEs) and adverse drug events (ADEs) and to identify risk factors which contribute to DRPs in the home care setting.
Methods
Pubmed, Embase and CiNAHL databases were systematically searched from January 2000 to December 2016 for all publications which quantitatively characterized DRPs in the home care setting.
Results
The most commonly reported DRPs characterized in studies were PIMs (n = 16), MEs (n = 4) and the ME-subcategory medication-related discrepancies (n = 7). The frequency of PIMs ranged from 19.8 to 48.4%; up to 26% PIMs were considered severe. Polypharmacy (≥ 9 drugs) and increasing age were the most common risk factors for DRPs. Insufficient interdisciplinary teamwork and inconsistent performance of medication reviews were also risks factors for DRPs. Patients and/or caregivers were responsible for 42.3% of DRPs.
Discussion
Compared with acute inpatient care, DRPs are more frequently reported in home care. The rate of DRPs varies depending upon the reference used to define the problem.
Conclusion
Transfer of complete medical records and the use of an interdisciplinary team have the potential to reduce DRPs, including MEs, specifically when integrating a pharmacist providing regular medication review. Importantly, patients and informal caregivers must be significant partners with this interdisciplinary team.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop ...a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs).
Design
Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously.
Setting
Hospital and community healthcare in the French-speaking part of Switzerland.
Participants
The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge.
Results
Quantitative results from older adults’ profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices.
Conclusion
By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders’ perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
This study explores the possibilities for learning content that might accompany the use of an historically accurate graphic novel as part of a language arts instructional unit. During a 6-day unit, ...16 sixth grade students engaged in graphic novels in ways that support comprehension, both in the context of a graphic novel text set and a specific novel, One Dead Spy. Through qualitative and quantitative analysis, we evaluated student learning of content related to the topic of the American Revolution. Results indicate that engaging students in instruction around the novel built the background knowledge on the topic, as well as increasing their understanding of the topic as measured by a free-recall assessment. In addition, the unit posttest indicated significant learning around conceptual ideas.
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