A comparison of intimate partner and other sexual assault survivors' use of different types of specialized hospital-based violence services.

BACKGROUND: Little is known about the health service utilization of women sexually assaulted by their intimate partners, as compared with those sexually assaulted by other perpetrators. To address this gap, we describe the use of acute care services post-victimization, as well as a broad range of survivor and assault characteristics, across women assaulted by current or former intimate partners, other known assailants, and strangers. METHODS: Information was gathered from individuals presenting to 30 hospital-based sexual assault and domestic violence treatment centres using a standardized data collection form. We examined the data from 619 women 16 years of age or older who were sexually assaulted by one assailant. RESULTS: Women sexually assaulted by a current or former intimate partner were less likely than those assaulted by another known assailant or a stranger to have been administered emergency contraception (p < 0.001) or prophylaxis for sexually transmitted infections (p < 0.001), and counselled for potential use of HIV post-exposure prophylaxis (p < 0.001). However, these women were more likely than those in the other two groups to have had their injuries documented with photographs (p < 0.001), have undergone a risk assessment (p = 0.008), and/or have engaged in safety planning (p < 0.001). CONCLUSIONS: Women sexually assaulted by current or former intimate partners utilized services offered by sexual assault and domestic violence treatment centres differently than those assaulted by other known assailants and strangers. This may reflect their different health, forensic, and social needs, as well as the importance of offering care tailored to their particular circumstances.

PERCEIVED FEASIBILITY OF ESTABLISHING DEDICATED ELDER ABUSE PROGRAMS OF CARE AT HOSPITAL-BASED SEXUAL ASSAULT/DOMESTIC VIOLENCE TREATMENT CENTETR.

BACKGROUND: Elder abuse is an increasingly important issue that must be addressed in a systematic and coordinated way. OBJECTIVE: Our objective was to evaluate the perceived feasibility of establishing an elder abuse care program at hospital-based sexual assault and domestic violence treatment centers in Ontario, Canada. METHOD: In July 2012, a questionnaire focused on elder abuse care was distributed to all of Ontario's Sexual Assault/Domestic Violence Treatment Centre (SA/DVTC) Program Coordinators/Managers. RESULTS: We found that the majority of Program Coordinators/ Managers favored expansion of their program mandates to include an elder abuse care program. However, these respondents viewed collaboration with a large network of well trained professionals and available services in the community that address elder abuse as integral to responding in a coordinated manner. DISCUSSION: The expansion of health services to address the needs of abused older adults in a comprehensive and integrated manner should be considered as an important next step for hospital-based violence care programs worldwide.

A tutorial on sensitivity analyses in clinical trials: the what, why, when and how.

BACKGROUND: Sensitivity analyses play a crucial role in assessing the robustness of the findings or conclusions based on primary analyses of data in clinical trials. They are a critical way to assess the impact, effect or influence of key assumptions or variations--such as different methods of analysis, definitions of outcomes, protocol deviations, missing data, and outliers--on the overall conclusions of a study.The current paper is the second in a series of tutorial-type manuscripts intended to discuss and clarify aspects related to key methodological issues in the design and analysis of clinical trials. DISCUSSION: In this paper we will provide a detailed exploration of the key aspects of sensitivity analyses including: 1) what sensitivity analyses are, why they are needed, and how often they are used in practice; 2) the different types of sensitivity analyses that one can do, with examples from the literature; 3) some frequently asked questions about sensitivity analyses; and 4) some suggestions on how to report the results of sensitivity analyses in clinical trials. SUMMARY: When reporting on a clinical trial, we recommend including planned or posthoc sensitivity analyses, the corresponding rationale and results along with the discussion of the consequences of these analyses on the overall findings of the study.

Exploring Receipt of HIV PEP Counseling Among Women Sexually Assaulted by an Intimate Partner.

Among 136 women sexually assaulted by a current or former male intimate partner presenting to hospital-based violence treatment centers, 58 (42.6%) received HIV post-exposure prophylaxis (HIV PEP) counseling by a specially trained sexual assault nurse. We identified factors that were associated with receipt of HIV PEP counseling. Those who received counseling were more likely to have been younger than 25 years of age, single, a student, vaginally penetrated, and have received various other services (e.g., STI prophylaxis). They were less likely to have been unemployed. Hospital-based violence treatment centers need to be aware that not all women sexually assaulted by an intimate partner will have the same risk of acquisition of HIV and care needs.

Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study.

OBJECTIVES: To pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults. METHODS: Pilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training. RESULTS: There were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p<0.0001), documentation, legislative, and legal issues (p<0.0001); interview with the older adult, caregiver, and other relevant contacts (p<0.0001); assessment (p=0.0018); medical and forensic examination (p<0.0001); case summary, discharge plan, and follow-up care (p<0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials. CONCLUSIONS: The Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.

A comparison of Indigenous and non-Indigenous survivors of sexual assault and their receipt of and satisfaction with specialized health care services.

In Canada, Indigenous women are more likely than non-Indigenous women to be survivors of sexual assault and experience sexual assaults that are more serious in terms of physical injury and other health-related consequences. Despite their related needs for care and support, there is a paucity of research to date that has examined their uptake of specialized acute health services post sexual assault. To address this gap, we explored the presentation, sociodemographic, assailant, assault, and service use characteristics of Indigenous women, as compared to non-Indigenous adult and adolescent women aged 12 and older presenting to 30 of 35 hospital-based sexual assault treatment centres in Ontario from 2009 to 2011, using bivariate analyses. Of the 948 women in our sample, 116 (12%) identified as being Indigenous. Indigenous survivors differed significantly from non-Indigenous survivors on many presentation, sociodemographic, and assault characteristics. For example, they were more likely to present to a hospital within 24 hours of being assaulted and a treatment centre serving a primarily rural population. They tended to be younger, were more likely to be living in an institutional setting, report community or group affiliations and government or community services as sources of social support, and be assaulted by a parent, guardian, or other relative. In terms of receipt of services, they were more likely to have undergone safety planning and to be referred to child protection or community agencies. They reported high levels of satisfaction with the services received, however, were less likely than non-Indigenous survivors to rate the overall care provided as excellent or good. On the whole, the results of our study suggest that Indigenous women value acute hospital-based sexual assault services. However, they experience sexual assaults in contexts different from non-Indigenous survivors. It is important for health care providers to be attuned to this so that they can appropriately respond to their unique needs.

An Examination of Victim, Assailant, and Assault Characteristics among Cases Classified as Predatory Drug-Facilitated Sexual Assault.

INTRODUCTION: Drug-facilitated sexual assault (DFSA) can be characterized as predatory, where the survivor is covertly or forcibly administered an incapacitating or disinhibiting drug. The purpose of our study was to determine what factors, if any, are associated with cases classified as predatory DFSA. METHODS: Cases were classified on toxicological testing as predatory where there was an unexpected drug(s) found and non-predatory where a drug(s) found had been voluntarily consumed or no drugs at all were found in collected urine samples. RESULTS: One hundred eighty-four suspected intentional drugging cases were seen at one of seven participating hospital-based sexual assault treatment centers. Urine specimens were analyzed from 178 of these cases, of which 48.9% were classified as predatory. In a logistic regression model, the odds of having experienced a predatory DFSA were lower if the survivor was a student or assaulted by a single assailant, but higher if the survivor self-reported mental health problems in the previous 6 months or that the mode of suspected drugging was a recreational drug or non-alcoholic drink (versus an alcoholic drink). CONCLUSIONS: These differences in survivor, assailant, and assault characteristics between cases classified as predatory and non-predatory DFSAs may have important implications for intervention and prevention.

Nonoffending Guardian Assessment of Hospital-Based Sexual Abuse/Assault Services for Children.

In circumstances in which child sexual abuse/assault is suspected, pediatric guidelines recommend referral to services such as multidisciplinary hospital-based violence treatment centers, for specialized medical treatment, forensic documentation, and counseling. As little is known about how such services are perceived, the objective of this case report was to measure the satisfaction of nonoffending guardians of child sexual abuse/assault victims who presented for care at Ontario's hospital-based sexual assault treatment centers. Of the 1,136 individuals who reported sexual abuse/assault and were enrolled in a province-wide service evaluation, 58 were 11 years old and younger. Thirty-three guardians completed a survey. Ratings of care were overwhelmingly positive, with 97% of respondents indicating that they would recommend these services. Nonetheless, it is important to evaluate these pediatric sexual assault services frequently to ensure ongoing optimal, family-centered care.

Development of skills-based competencies for forensic nurse examiners providing elder abuse care.

OBJECTIVE: As a critical step in advancing a comprehensive response to elder abuse built on existing forensic nursing-led hospital-based programmes, we developed a list of skills-based competencies for use in an Elder Abuse Nurse Examiner curriculum. PARTICIPANTS AND SETTING: Programme leaders of 30 hospital-based forensic nursing-led sexual assault and domestic violence treatment centres. PRIMARY AND SECONDARY OUTCOME MEASURES: 149 verbatim recommendations for components of an elder abuse response were identified from a systematic scoping review. In 2 online Delphi consensus survey rounds, these components of care were evaluated by an expert panel for their overall importance to the elder abuse intervention under development and for their appropriateness to the scope of practice of an elder abuse nurse examiner. The components retained after evaluation were translated into skills-based competencies using Bloom's Taxonomy of Learning and, using the Nominal Group Technique, were subsequently reviewed and revised by a subset of members of the expert panel in a consensus meeting. RESULTS: Of the 148 recommendations evaluated, 119 were rated as important and achieved consensus or high level of agreement. Of these, 101 were determined to be within the scope of practice of an Elder Abuse Nurse Examiner and were translated into skills-based competencies. Following review and revision by meeting experts, 47 final competencies were organised by content into 5 metacompetencies: documentation, legal and legislative issues; interview with older adult, caregiver and other relevant contacts; assessment; medical and forensic examination; and case summary, discharge plan and follow-up care. CONCLUSIONS: We determined the skills-based competencies of importance to training forensic nurse examiners to respond to elder abuse in the context of a hospital-based intervention. These findings may have implications for violence and abuse treatment programmes with a forensic nursing component that are considering the provision of a dedicated response to the abuse of older women and men.

Determining Possible Professionals and Respective Roles and Responsibilities for a Model Comprehensive Elder Abuse Intervention: A Delphi Consensus Survey.

OBJECTIVE: We have undertaken a multi-phase, multi-method program of research to develop, implement, and evaluate a comprehensive hospital-based nurse examiner elder abuse intervention that addresses the complex functional, social, forensic, and medical needs of older women and men. In this study, we determined the importance of possible participating professionals and respective roles and responsibilities within the intervention. METHODS: Using a modified Delphi methodology, recommended professionals and their associated roles and responsibilities were generated from a systematic scoping review of relevant scholarly and grey literatures. These items were reviewed, new items added for review, and rated/re-rated for their importance to the intervention on a 5-point Likert scale by an expert panel during a one day in-person meeting. Items that did not achieve consensus were subsequently re-rated in an online survey. ANALYSIS: Those items that achieved a mean Likert rating of 4+ (rated important to very important), and an interquartile range<1 in the first or second round, and/or for which 80% of ratings were 4+ in the second round were retained for the model elder abuse intervention. RESULTS: Twenty-two of 31 recommended professionals and 192 of 229 recommended roles and responsibilities rated were retained for our model elder abuse intervention. Retained professionals were: public guardian and trustee (mean rating = 4.88), geriatrician (4.87), police officer (4.87), GEM (geriatric emergency management) nurse (4.80), GEM social worker (4.78), community health worker (4.76), social worker/counsellor (4.74), family physician in community (4.71), paramedic (4.65), financial worker (4.59), lawyer (4.59), pharmacist (4.59), emergency physician (4.57), geriatric psychiatrist (4.33), occupational therapist (4.29), family physician in hospital (4.28), Crown prosecutor (4.24), neuropsychologist (4.24), bioethicist (4.18), caregiver advocate (4.18), victim support worker (4.18), and respite care worker (4.12). CONCLUSION: A large and diverse group of multidisciplinary, intersectoral collaborators was deemed necessary to address the complex needs of abused older adults, each having important roles and responsibilities to fulfill within a model comprehensive elder abuse intervention.

Development of a comprehensive hospital-based elder abuse intervention: an initial systematic scoping review.

INTRODUCTION: Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review. OBJECTIVES: Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation. METHODS: The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1) addressed a response (e.g., an intervention) to elder abuse, 2) contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3) were available in English. ANALYSIS: The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics. RESULTS: 649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser; ASSESSMENT: physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations. DISCUSSION: To address the lack of evidence to support the recommendations extracted in this review, in a future study, a group of experts will formally evaluate each recommendation for its inclusion in a comprehensive hospital-based response.

A systematic scoping review of adherence to reporting guidelines in health care literature.

BACKGROUND: Reporting guidelines have been available for the past 17 years since the inception of the Consolidated Standards of Reporting Trials statement in 1996. These guidelines were developed to improve the quality of reporting of studies in medical literature. Despite the widespread availability of these guidelines, the quality of reporting of medical literature remained suboptimal. In this study, we assess the current adherence practice to reporting guidelines; determine key factors associated with better adherence to these guidelines; and provide recommendations to enhance adherence to reporting guidelines for future studies. METHODS: We undertook a systematic scoping review of systematic reviews of adherence to reporting guidelines across different clinical areas and study designs. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Medline) from January 1996 to September 2012. Studies were included if they addressed adherence to one of the following guidelines: Consolidated Standards of Reporting Trials (CONSORT), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Quality of Reporting of Meta-analysis (QUOROM), Transparent Reporting of Evaluations with Nonrandomized Designs (TREND), Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). A protocol for this study was devised. A literature search, data extraction, and quality assessment were performed independently by two authors in duplicate. This study reporting follows the PRISMA guidelines. RESULTS: Our search retrieved 5159 titles, of which 50 were eligible. Overall, 86.0% of studies reported suboptimal levels of adherence to reporting guidelines. Factors associated with better adherence included journal impact factor and endorsement of guidelines, publication date, funding source, multisite studies, pharmacological interventions and larger studies. CONCLUSION: Reporting guidelines in the clinical literature are important to improve the standards of reporting of clinical studies; however, adherence to these guidelines remains suboptimal. Action is therefore needed to enhance the adherence to these standards. Strategies to enhance adherence include journal editorial policies endorsing these guidelines.