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Purpose: This article examines factors within the long-term-care work environment that impact the effectiveness of continuing education. Design & Methods: In Study 1, focus group interviews were conducted with staff and management from urban and rural long-term-care facilities in southwestern Ontario to identify their perceptions of the workplace factors that affect transfer of learning into practice. Thirty-five people were interviewed across six focus groups. In Study 2, a Delphi technique was used to refine our list of factors. Consensus was achieved in two survey rounds involving 30 and 27 participants, respectively. Results: Management support was identified as the most important factor impacting the effectiveness of continuing education. Other factors included resources (staff, funding, space) and the need for ongoing expert support. Implications: Organizational support is necessary for continuing education programs to be effective and ongoing expert support is needed to enable and reinforce learning.

Urinary incontinence is common in the elderly. The epidemiology of fecal and double (urinary and fecal) incontinence is less known. The Canadian Study of Health and Aging (CSHA) is a national study of elderly living in the community at baseline (n = 8,949) and interviewed in 1991-1992, 1996, and 2001. Using data from the CSHA, we report the prevalence of urinary, fecal, and double incontinence in each wave and the cumulative incidence between waves and investigate the predictors of urinary and fecal incontinence. Urinary incontinence increased rapidly in old age, being almost twice as high in women as in men. Fecal and double incontinence were less common, but also increased rapidly with age. In women, parity showed a positive relationship with (prevalent) urinary incontinence. In men, diabetes was a risk factor for urinary and fecal incontinence. We conclude that urinary, fecal, and double incontinence increase rapidly with age and that inquiry about incontinence should be part of routine medical and nursing assessment of all elderly.

In response to Canada's pressing need for effective evidence-based policy, services, and practices specific to seniors, national leaders representing all concerned stakeholders designed and implemented a National Consensus Process to promote spread, exchange, choice, and uptake of research evidence on social and health issues associated with an aging population. This article presents the innovative methods and evaluation of this three-year project, illuminating for all constituencies the challenges and opportunities associated with promoting seniors' independence through collaborative knowledge transfer efforts. A total of 198 organizations and 65 individuals were surveyed at baseline, throughout the intervention, immediately post-intervention, and one year post-intervention. Knowledge from 783 studies was spread to 63,387 people, 90 per cent of whom reported knowledge exchange. Over 50 per cent of stakeholders reported using the research evidence, although processes for facilitating knowledge choice did not achieve consensus. Significant knowledge uptake occurred in two of the four research theme areas. (Contains 8 tables.)

Presents letters to the editor on a number of medical topics as of November 27, 2001. Cost of maintaining adequate antidote supplies; Personalized medications; Thoughts on clear clinical practice guidelines; Use of probiotics as medical therapies.

Presents the conclusions from the Canadian Consensus Conference on Dementia. Objective; Methods; Diagnosis and natural history of dementia; Assessment of dementia; Genetics of dementia; Prevention; Ethical issues in dementia; Cultural issues; Depression and dementia; Management of behavioral disturbances; Pharmacologic therapy; Recommendations; Validation; Discussion.

Background: This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee., Methods: The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada., Results: A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada., Interpretation: This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition.

ABSTRACTOBJECTIVETo ascertain which physician and practice characteristics are associated with self-reported provision of preventive care as recommended by the Canadian Task Force on Preventive Health Care.DESIGNCross-sectional analysis of data from a decennial survey.SETTINGSouthwestern Ontario.PARTICIPANTSA total of 731 family physicians in various practice settings.MAIN OUTCOME MEASURESNumber of patients to whom these physicians provided the recommended preventive services based on physicians' responses to various scenarios presented in the survey. The responses were scored, and the median score was used to dichotomize physicians into high- and low-scoring groups.RESULTSClose to two-thirds of the physicians (61%) were in the high-scoring group. Female family physicians, graduates of Canadian medical schools, and physicians whose practices were organized into family health teams, family health groups, family health networks, community health centres, or health services organizations were more likely to be in the high-scoring group. Physicians practising solo and international medical graduates were more likely to be in the low-scoring group.CONCLUSIONReorganizing delivery of primary care into group practice models might improve provision of preventive services. Licensing requirements for international medical graduates should ensure that these physicians are adequately trained to provide preventive services as recommended in the Canadian context. More research is needed before our results can be generalized beyond southwestern Ontario.

Objective: To determine the effectiveness of preventive primary care outreach interventions aimed at older people. Knowing whether such interventions are effective could help busy family physicians make choices about which preventive care services to provide., Data Sources: We searched MEDLINE, CINAHL, AgeLine, Cochrane Controlled Trials Register, and EMBASE databases and reviewed the reference lists of retrieved articles., Study Selection: We included studies of preventive primary care interventions aimed at patients 65 years and older if the studies were randomized controlled trials and if any of the following outcomes was reported: mortality, living in the community, admission to acute care hospitals, and admission to long-term care. We defined preventive primary care outreach as proactive, provider-initiated care, which can be provided by nurses, physicians, other professionals, or volunteers, that is in addition to usual care and is provided in primary care settings. Such care can be provided through home visits, office visits, telephone contacts, or a combination of these methods., Synthesis: We assessed the quality of studies and extracted descriptive information on study populations, interventions, and outcomes for 19 trials involving 14,911 patients. Summary odds ratios were estimated for each outcome using a random effects model., Conclusion: This review showed that studies of preventive primary care outreach interventions aimed at older people were associated with a 17% reduction of mortality and a 23% increased likelihood of continuing to live in the community.