OPTIMIZING ANTIPSYCHOTIC USE IN RESIDENTIAL CARE: THE ROLE OF ORGANIZATIONAL READINESS FOR CHANGE
Bibliographic record
Abstract
Persons with dementia (PwD) experience challenging neuropsychiatric symptoms (NPS) as their illness progresses. Antipsychotic drugs (APD) have been regularly used in residential care to manage this issue despite the risk of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to continued inappropriate APD use when managing NPS in PwD. Culture of care consists of sets of norms, beliefs, and cognitive frames which inform clinical practice and care delivery. The study also considers organizational readiness for change in examining the implementation of alternate non-pharmaceutical practices to address the issue of NPS. Findings were obtained from three Canadian residential care facilities that worked on reducing inappropriate use of APD. Data came from interviews with 16 licenced practical nurses, 12 nurses, 17 health care assistants, 3 activity leaders, 3 directors of care, 10 physicians, and 14 family members. We found that care providers varied in their perceived capacity to implement novel care strategies and in the support received for innovative thinking and action. We also identified variations in how care providers informally share information on alternate strategies to manage NPS and in the contextual factors facilitating such communication. Finally, we found differences in how family members’ input was meaningfully integrated into care planning. Overall, the study shows how culture of care reflects entrenched responses to NPS but also evolves to support challenges to the decision to prescribe APD, non-pharmaceutical approaches to care, and the meaningful involvement of family members in care planning.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".