kaasalainen s, dolovich l, papaioannou a, holbrook a, lau e, ploeg j, levine m, cosby j & emily a (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 407–418 
The process of medication management for older adults with dementia Aim.  The purpose of this study was to explore the personal experiences related to medication management of community‐dwelling older adults diagnosed with dementia, their informal caregivers, as well as healthcare professionals who assist them. Background.  Older adults who have dementia face many challenges in managing their medications while living in the community. Medication regimens used to treat a variety of conditions in older adults with dementia are usually overseen and coordinated by healthcare professionals such as community nurses, physicians and pharmacists, but often, more supports are needed. However, little research has been conducted to study the barriers and facilitators to medication adherence in this unique population. Methods.  Using a grounded theory approach, 57 interviews were completed (10 nurses, 10 pharmacists, 6 physicians, 20 caregivers and 11 patients) in southern Ontario, Canada, in 2007. Findings.  The findings indicate that the processes of medication management differ according to the level of dementia. A number of corresponding facilitators and barriers to medication management were identified. Medication management in early stage dementia is characterised by patients’ desire to maintain independence, denial of issues or disease, and a refusal to take medications owing to feeling angry. In late‐stage dementia, older adults often refuse medications owing to delusional or suspicious thinking, which results in caregivers assuming responsibility for managing their medications. Conclusions.  Older adults with dementia, their informal caregivers and the healthcare professionals who assist them are faced with the challenges of declining cognitive function and memory while trying to manage medications at home. However, a number of adherence strategies appear to be helpful and should be considered. Relevance to clinical practice.  Healthcare professionals struggle with helping older adults who have dementia manage medications safely and therapeutically, often with little resources to draw from. Future work is needed to design, implement and evaluate supportive networks and interventions with the goal of helping older adults with dementia manage their medications better while living in the community.

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Evidence suggests that insulin is under-prescribed in older people. Some reasons for this include physician's concerns about potential side-effects or patients' resistance to insulin. In general, however, little is known about how GPs make decisions related to insulin prescribing in older people. AimTo explore the process and rationale for prescribing decisions of GPs when treating older patients with type 2 diabetes. Design of studyQualitative individual interviews using a grounded theory approach. SettingPrimary care. MethodA thematic analysis was conducted to identify themes that reflected factors that influence the prescribing of insulin. ResultsTwenty-one GPs in active practice in Ontario completed interviews. Seven factors influencing the prescribing of insulin for older patients were identified: GPs' beliefs about older people; GPs' beliefs about diabetes and its management; gauging the intensity of therapy required; need for preparation for insulin therapy; presence of support from informal or formal healthcare provider; frustration with management complexity; and GPs' experience with insulin administration. Although GPs indicated that they would prescribe insulin allowing for the above factors, there was a mismatch in intended approach to prescribing and self-reported prescribing. ConclusionGPs' rationale for prescribing (or not prescribing) insulin is mediated by both practitioner-related and patient-related factors. GPs intended and actual prescribing varied depending on their assessment of each patient's situation. In order to improve prescribing for increasing numbers of older people with type 2 diabetes, more education for GPs, specialist support, and use of allied health professionals is needed. Keywordsinsulin; primary health care; qualitative research; type 2 diabetes mellitus.

Attributing causality to SAE's is a complex process. Clinical trial researchers apply a logical system of reasoning, but feel that the current method of assigning causality could be improved. Based on these findings, future research involving the development of a new causality assessment tool specifically for use in early phase oncology clinical trials may be useful.

A hybrid method based on cognitive interviewing and consensus panels was developed to pretest a questionnaire for caregivers of persons with Alzheimer disease (AD). The objective of the questionnaire was to elicit caregivers' attitudes and opinions on the use of medications to treat the disease. Thirty-one caregivers were divided into five pretest groups, within which each participant was asked to comment on questionnaire wording and design. The comments from participants in the first three groups were used to revise the questionnaire, and the revised version was given to participants in the remaining two groups. Overall, 81% (118/146) of the participants' comments were implemented. The number of comments made in the last two groups decreased relative to the number of comments made in the first three groups. The hybrid method enhanced the user-friendliness of the questionnaire and can serve as an alternative to common ad hoc pretest approaches that have little basis in theory.

BackgroundNumerous health policy makers/researchers are concerned about the limitations of research being applied to support informed decision/policy making and the implementation of practical solutions. The aim of the Chaguo Letu project (which means our choice in Swahili) was to determine how local decision makers could apply a multimethod approach to make strategic decisions to effectively implement a Cervical Self-Sampling Program in Kenya.MethodsA multimethod approach, involving participatory action research, scenario based planning, and phenomenology, was applied in conjunction with two tools to identify relevant factors (negative or positive) that could impact Cervical Self-Sampling Program implementation. A total of 107 stakeholders participated in interviews, focus groups, workshops, and informal interactions. Content analysis, an affinity exercise, and impact analysis were used to analyze data and develop robust strategic directions and supporting implementation strategies.ResultsA total of 57 factors thought to impact the implementation of the Cervical Self-Sampling Program were identified and grouped into 13 thematic categories. These themes were instrumental in developing 10 strategic directions and 22 implementation strategies deemed necessary to implement a technically viable, politically supported, affordable, logistically feasible, socially acceptable, and transformative Program.ConclusionsThis study made three conclusions: 1) there is political will and a desire to improve cervical screening across Kenya, but in a period of dynamic change resources are constrained; 2) implementing the Program in urban/rural settings is logistically feasible, but the majority of Kenyan women could not afford screening without some form of a subsidy, and 3) self-sampling is perceived to be much more socially acceptable than the current Pap screening process. The Chaguo Letu study went beyond the traditional strategy development process of determining “what” needs to do done by describing in detail “how” the Program should be implemented to be relevant and accessible to all Kenyan women at risk of cervical cancer. This work could potentially facilitate communities of practice and knowledge sharing when addressing other types of health decisions in other low resource settings beyond Kenya.

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