Local Opinion Leaders Research Articles

Ethical Dilemmas and Their Impact on Accountability in Local Governments: A Study of the Greater Kigezi Sub-Region in Uganda

This study examines the impact of ethical dilemmas on accountability in local governments within the Greater Kigezi sub-region of Uganda comprising of Kabale, Kanungu, Kisoro, Rubanda and Rukiga local governments and therefore, sufficient enough to represent and enable generalization of findings to other local governments in the country. Over the past few decades, public sector reforms have sought to enhance transparency, efficiency, and service delivery. Despite these efforts, Uganda continues to face challenges in maintaining strong accountability systems, particularly at the local government level. Ethical dilemmas—stemming from conflicts of interest, political pressure, resource constraints, and cultural norms—undermine accountability and transparency, leading to corruption and diminished public trust. The study investigates these dynamics by exploring how ethical challenges affect governance in local governments through the aid of questionnaires and interviews with stakeholders drawn from the local governments and opinion leaders who represent the voices of the grassroots. Focusing on the Greater Kigezi sub-region, the research highlights widespread governance issues such as nepotism, political interference, and weak institutional oversight. Findings reveal that ethical dilemmas hinder public sector performance by compromising decision-making and oversight processes. To address these challenges, the study suggests enhancing ethical training, strengthening oversight institutions, fostering civic engagement, and developing clearer policies on ethics and accountability. By implementing these policy reforms, stakeholders can create more transparent and accountable local governance systems that better serve community needs

Identifying Barriers and Implementation Strategies to Inform TBI Screening Adoption in Behavioral Healthcare Settings.

Identify barriers to the adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral healthcare organizations and match these barriers to implementation strategies to inform future implementation efforts. Twenty behavioral health providers. Qualitative study involving individual, semi-structured interviews regarding barriers to adopting the OSU TBI-ID. Data were thematically analyzed around constructs from the Consolidated Framework for Implementation Research (CFIR). Results were matched to strategies using the Expert Recommendations for Implementing Change (CFIR/ERIC) matching tool. Ten barriers were identified across 4 CFIR domains. Inner-Setting barriers were inadequate leadership engagement, priorities, resources, and organizational incentives. Individual-Characteristics barriers were insufficient knowledge about the connection between TBI and behavioral health and how to conduct the OSU TBI-ID with fidelity, low self-efficacy to conduct screening, and inadequate motivation and buy-in to conduct screening. Outer-Setting barriers were lack of state-level mandates and inadequate incentives to conduct screenings. The Process domain barrier was an insufficient engagement of key personnel. Strategy recommendations include: identify and prepare champions; alter incentive and allowance structures; inform local opinion leaders; build a coalition; access new funding; conduct local consensus discussions; involve executive boards; capture/share local knowledge; conduct educational meetings; assess for readiness and identify determinants; identify early adopters; fund and contract for the clinical innovation; create a learning collaborative; and conduct a local needs assessment. This is the first study to examine barriers to adopting the OSU TBI-ID in real-world practice settings. Our results suggest that multilevel implementation strategies addressing mechanisms of change are necessary at the provider, organizational, and systems levels to overcome the complex barriers affecting TBI screening adoption and implementation. Future research is needed to test these strategies and their mechanisms of action on the adoption, implementation, and sustainment of TBI screening, as well as their effect on client-level outcomes.

Barriers and facilitators to evidence-based perioperative hypothermia management for orthopaedic patients: Asystematic review.

To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients. Systematic review. Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database. Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies. Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders. This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery. Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery. Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Due to the study design, no patient or public consultation took place.

Capitalizing on Implementation Science to Advance Antimicrobial Stewardship and Health Equity in Treating Pediatric UTI’s

Background: Pediatric urinary tract infections represent the most common pediatric infection with increasing gram-negative antibiotic resistance. Overutilization of antimicrobials including third generation cephalosporins are known drivers of this resistance. Antimicrobial stewardship (AS) efforts have recently shown that antibiotic selection may be influenced by patient race. Implementation science (IS) can provide frameworks and strategies to improve antimicrobial utilization and equity. Methods: This was a pre/post study of 2 geographically different children’s hospitals general pediatric floors assessing the impact of a set of implementation strategies developed to improve provider knowledge of best practice antimicrobials (based on local susceptibilities for treatment of UTI’s) and influence uptake of best practice prescribing. IS strategies included provider education, local clinical champion and opinion leader involvement, leadership involvement, local policy changes, and stakeholder co-design of decision support tools (a clinical pathway, a specific ITI antibiogram, and a dynamic order set). No education was provided regarding racial differences in prescribing habits. Outcomes were measured utilizing a portion of the RE-AIM Framework of assessing adoption of “Right” antibiotic, order set adoption, and equitable reach (racial differences in prescribing). Results: Hospital A and B had a first-generation cephalosporin prescription rate of 29.7% (n=441) and 20.6% (n-557) pre implementation and 44.6% (n=84) and 47.5% (n=118) post (p < 0 .001). Both hospitals also saw a significant reduction in third-generation cephalosporins. In Hospital A, APRN’s were more likely to prescribe a first generation cephalosporin (52.4%) than a DO (42.1%) or MD (26.4%) pre-implementation (p=0.004). In Hospital B, APRN’s were less likely to prescribe first generation cephalosporins (5.4%) than a DO (28.9%) or MD (19.4%) pre-implementation (p=0.004). No statistical significance was seen post implementation for antimicrobial selection by provider type for either hospital. Based on race, both hospitals had Black and Other patients receiving more first-generation cephalosporins while white patients were more likely to receive third-generation cephalosporins (p=0.033) pre implementation. No statistical significance was seen post implementation for antimicrobial selection based on race. No improvement was seen in order set utilization. Conclusion: With order set utilization not improving with implementation of new dynamic order set, other strategies such as education, clinical champion and opinion leader involvement, and provision of a local UTI antibiogram were likely contributors to the improvement in best antimicrobial for treatment of UTI’s. Further mixed method research is warranted to improve understanding of the relative performance of our strategies, especially the lack of provider adoption of the novel dynamic order set.Disclosure: Jessica Snowden: Advisory board - Pfizer

Evaluation of Community Involvement and Development in an Orthopedic Hospital.

Improving healthcare requires appropriate community involvement supported by appropriate partner engagement methods. This research aims to develop a complex tool for evaluating the social responsibility of health facilities regarding community involvement and development. We developed areas of a new reference framework for the sustainability of healthcare organizations, which includes the area of community involvement and expansion. It is made up of nine indicators. These were designed using the most representative activities reported by hospitals around the world. Their testing was conducted in an orthopedic emergency hospital. The designed indicators are community engagement actions; the interventions' content adapted to the community; partnership and networking; the involvement of volunteers and training networks; the involvement and participation of professional associations; community-involved local opinion leaders; satisfaction with partnerships; initiatives together with the community; and educational visits. The testing and validation of health practices of the indicators highlighted their adequacy with the proposed purpose of the research and the promotion of sustainable development. We have also verified their compatibility with the requirements of national hospital accreditation legislation and the European framework for quality assurance in hospitals.

Cultural renewal in Kisújszállás: A path to sustainability of a Hungarian small town?

The aim of this study is to analyse the social, demographic (and wealth) problems and sustainability issues of a small town in the Hungarian lowlands (Great Plain), Kisújszállás, in the 21st century, and to present the town’s search for a place, especially its attempt to respond and renew itself based on culture. In identifying “lowland” and “Cumanian” characteristics, in addition to (and beyond) the geographical environment and the (still) strongly linked economy, the focus was primarily on the local (for decades declining and ageing) society. In the course of the research, we observed a particular mentality and identity that today increasingly bears the hallmarks of disharmony in the small town society of the lowlands and the region of Greater Cumania. In examining the resilience of the town, we found that while Kisújszállás has the right anchors, it is not enough to think in terms of point capabilities; we should plan for the future in processes. The town sees culture as a key breakout point and a possible response to the pressing socio-economic sustainability challenges. Respondents to our questionnaire survey of local opinion leaders were most concerned about the low level of cultural demand among locals, but also felt that PR and marketing activities related to culture were not satisfactory. In the case of municipal management, under-financing, a lack of decentralization, and networking were highlighted, while in the case of the economy, the lack of industrial parks and incubators and a low level of innovative local entrepreneurial mentality were highlighted. It can be seen that the town is facing the multifaceted problems of a shrinking, ageing society. The situation assessment underlines the social need for change in a (suffering) municipality stuck in an “old lowland” agricultural structure. In the case of Kisújszállás, renewal and identity building based on culture can be seen as a horizontal concept supporting existing development alternatives.

Evidence-Based Storytelling for a Strategic Roadmap to Promote Cancer Prevention via Adolescent HPV Vaccination in Northern New England.

Vaccination rates for the human papillomavirus (HPV) among rural youth in northern New England lag those of more urbanized areas. Reasons include a lack of available medical offices, time constraints, perceptions of vaccines and HPV, and, to a smaller degree, delays caused by the COVID-19 pandemic. We have a responsibility to increase vaccinations in these communities. To do so, vaccination experts recommend addressing the three C's of vaccination hesitation: confidence, complacency, and convenience. With this framework as our foundation, in this article we detail a plan to address these important elements, and we add several more C's: clinics, communication, collaboration, community, capacity, and commitment to the list as we discuss the essential pieces-human, infrastructural, and perceptual-needed to create and promote successful, community-supported, school-based HPV vaccination clinics to serve youths aged nine to 18. We then integrate research and storytelling science into an innovative Persuasion Playbook, a guide for local opinion leaders to use in creating evidence-based, pro-vaccine messages on the community level to promote the clinics via evidence-based, pro-vaccination messages.

Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care.

There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81days). Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.

Research on the Application of Enterprise Brand Advertising Localization in All-media Era

This paper discusses the strategy of enterprise brand to realize advertising localization in the era of all media. Advertising localization means that enterprises customize advertising content in different geographical and cultural backgrounds to better attract and influence local consumers. Specific measures are proposed to address this challenge, including language and cultural adaptation, the use of symbols and images, and the cooperation of local partners and opinion leaders. In addition, through data analysis and adjustment, enterprises can evaluate the effectiveness of advertising in real time and adjust their strategies in time. Through the combined application of these strategies, companies are able to localize their advertising in the all-media era and build stronger connections with local consumers.

"Scaling out" evidence-informed antenatal care to support healthy pregnancy weight gain: a context assessment using the Consolidated Framework for Implementation Research.

Excess gestational weight gain is a challenge within antenatal care. Low-intensity interventions that offer opportunities for individualization, such as pregnancy weight-gain charts (PWGCs) combined with brief advice, have been a promising strategy but scaling out such interventions requires planning. The aim of this study was to examine current practices and conduct a context assessment using the Consolidated Framework for Implementation Research (CFIR) to guide implementation of PWGCs and brief intervention advice to support healthy pregnancy weight gain in two hospitals that provide antenatal care. Retrospective chart audits and surveys of staff and women were used to understand current practice as well as barriers and enablers to implementing change according to the domains and constructs reported in the CFIR. Forty-eight percent (site A) and 46% (site B) of pregnant women who were audited ( n = 180, site A; n = 176, site B) gained weight above recommendations. Most women were unable to accurately report their recommended weight gain for pregnancy (93% site A, 94% site B). Although more than 50% of women reported discussions about weight gain during pregnancy, advice about physical activity and healthy eating (in the context of helping women to achieve healthy gestational weight gain) was low. Mapping barriers and enablers to the CFIR helped guide the selection of implementation strategies, including audit and feedback, informing local opinion leaders, obtaining consensus, identifying champions, and building a coalition. Scaling out of interventions can be enhanced by undertaking a detailed context assessment guided by implementation frameworks.

Professional medical education approaches: mobilizing evidence for clinicians.

Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.

A framework for drivers fostering social-ecological restoration within forest landscape based on people’s participation. A systematic literature review

Degradation exacerbates food and water insecurity, economic hardship, biodiversity loss, and the devastating effects of climate change. Given that ecosystem restoration is a global challenge, the United Nations declared 2021 to 2030 as the Decade of Ecosystem Restoration.Many ecological restoration projects overlook social perspectives, resulting in unsuccessful restoration outcomes within Forest Landscape Restoration (FLR). Against this background, we review social-ecological restoration frameworks and summarize seven key balanced drivers that could help enhance the adoption of ecosystem restoration in a dynamic social context. The drivers relate to including the most affected communities, privileging local knowledge and practices, empowering local representatives and opinion leaders, ensuring social and environmental justice and equity, targeting deep leverage points, aligning restoration practices with local needs and aspirations, and connecting neighboring communities.We argue that ecosystem restoration will be most effective if approached from a social-ecological perspective. In developing countries, establishing social groups that share savings and credit structures within neighboring households can be a sustainable approach. With increasing global initiatives, taking a social-ecological perspective on ecosystem restoration as a social-ecological restoration approach offers new opportunities for both research and practice. Social-ecological restoration is a key strategy that can support the achievement of sustainable development goals (SDGs) and deliver net positive gains environmentally, socially, and economically. Further studies should focus on two new cross-cutting aspects: the ecological and social effects of restoration at small to large scales and social ecological restoration and peace building within a restorative landscape.

Meaningful coproduction with clinicians: establishing a practice-based research network with physiotherapists in regional Australia

BackgroundThe disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at coproducing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe (i) clinicians’ motivations behind, and enablers to, participating in a network, (ii) the process of network establishment and (iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research coproduction.MethodsWe describe the methods and outcomes of the three steps we used to establish the network. Step 1 involved consultation with local opinion leaders and a formative evaluation to understand clinicians’ motivations behind, and enablers to, participating in a network. Step 2 involved establishment activities to generate a founding membership group and codesign a governance model. Step 3 involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritizing research areas.ResultsThrough formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists’ involvement in the network. Establishment activities led to a founding membership group (n = 29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 [70%] are private practice clinicians). Our problem-mapping and prioritization process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes.ConclusionsClinicians are motivated to break down traditional siloed research generation and collaborate with researchers to solve a wide array of issues with the delivery of care. Practice-based research networks have promise for both researchers and clinicians in the common goal of improving patient outcomes.

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study.

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks. Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care. One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders. This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.

The Attitude of the Public Concerning Coercive Measures in Psychiatric Patients

To examine the attitude of the general public in Basel concerning the use of coercive measures while dealing with psychiatric patients. The common population indirectly governs the use of coercive measures in psychiatry by its stigmatization of people with psychiatric illnesses, and its attitude towards treatment in psychiatry and by local opinion leaders and reactions of social networks. The answers of 1,112 persons from a representative population survey were evaluated. Participants were mailed case vignettes and questionnaires, and asked if they considered involuntary admission, coercive medication, and/or seclusion as acceptable measures in dealing with psychiatric patients. When symptoms of a psychotic disorder were present, 31.5% approved of at least one coercive measure, with 22% approval in the case of a borderline personality disorder, and 20.7% in the case of alcohol dependency. However, the overall rejection of coercive measures by the general public in Basel was high. The differential approval of the examined coercive measures depending on psychiatric symptoms was in line with professional medical and ethical guidelines. Public attitudes have an indirect influence on the local use of coercive measures and should be included in the specialist psychiatric discourse.

Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act method.

It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40mg diazepam equivalents) to post (14.61mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.

Raising the HPV Vaccination Rate in Rural Northern New England Using Local Opinion Leaders.

The human papillomavirus is associated with a range of cancers. A vaccine introduced in 2006 has dramatically decreased the incidence of these cancers, but Americans still experience over 47,000 new cases of HPV-related cancers each year. The situation is worse in rural areas, where vaccination rates lag the national average, making HPV a significant health disparity issue. This article lays out an evidence-based HPV vaccine-promotion strategy that will serve as part of a campaign to improve health equity in rural northern New England in a process that is repeatable and sustainable. The campaign includes the following elements: partnerships with state departments of health and trusted community opinion leaders, evidence-based storytelling, local social media, traditional media, and school-based pop-up vaccination clinics. Borrowing from marketing and social marketing frameworks and guided by public health perspectives, we begin with psychographic and geodemographic information about our target audience, followed by a discussion about relevant models, frameworks, and research related to persuasive storytelling. We conclude with the outline of a guidebook to foster the creation of persuasive stories as part of a sustainable, replicable HPV vaccination campaign.

Questões-chave no manejo do câncer de colo do útero: recomendações por consenso de um painel de especialistas brasileiros

OBJECTIVE: We report the results of a panel of Brazilian experts and provide recommendations for the management of these patients. MATERIAL AND METHODS: The panel convened composed by 28 local opinion leaders, addressed 59 multiple-choice questions taking into account the published scientific literature and their own clinical experience. The level of agreement among panel members was qualified as (1) consensus, when at least 75% of the voting panel members; (2) majority vote (50%-74.9%); or (3) less than majority vote. RESULTS: There was at least majority vote for eight of 10 questions on staging and follow-up; for 14 of 23 questions on the treatment of early-stage disease; for 12 of 14 questions related to the treatment of locally-advanced disease; and for seven of the 12 questions related to the treatment of recurrent/metastatic disease. Conclusion: The current recommendations may help practitioners from Brazil and other countries to improve the care they provide to patients.

Use of the knowledge to action model improved physical therapist adherence to a common clinical practice guideline across multiple settings: a multisite case series

BackgroundWhen a new guideline is published there is a need to understand how its recommendations can best be implemented in real-world practice. Yet, guidelines are often published with little to no roadmap for organizations to follow to promote adherence to their recommendations. The purpose of this study was to evaluate the impact of using a common process model to implement a single clinical practice guideline across multiple physical therapy clinical settings.MethodsFive organizationally distinct sites with physical therapy services for patients with peripheral vestibular hypofunction participated. The Knowledge to Action model served as the foundation for implementation of a newly published guideline. Site leaders conducted preliminary gap surveys and face-to-face meetings to guide physical therapist stakeholders’ identification of target-behaviors for improved guideline adherence. A 6-month multimodal implementation intervention included local opinion leaders, audit and feedback, fatigue-resistant reminders, and communities of practice. Therapist adherence to target-behaviors for the 6 months before and after the intervention was the primary outcome for behavior change.ResultsTherapist participants at all sites indicated readiness for change and commitment to the project. Four sites with more experienced therapists selected similar target behaviors while the fifth, with more inexperienced therapists, identified different goals. Adherence to target behaviors was mixed. Among four sites with similar target behaviors, three had multiple areas of statistically significantly improved adherence and one site had limited improvement. Success was most common with behaviors related to documentation and offering patients low technology resources to support home exercise. A fifth site showed a trend toward improved therapist self-efficacy and therapist behavior change in one provider location.ConclusionsThe Knowledge to Action model provided a common process model for sites with diverse structures and needs to implement a guideline in practice. Multimodal, active interventions, with a focus on auditing adherence to therapist-selected target behaviors, feedback in collaborative monthly meetings, fatigue-resistant reminders, and developing communities of practice was associated with long-term improvement in adherence. Local rather than external opinion leaders, therapist availability for community building meetings, and rate of provider turnover likely impacted success in this model.Trial registrationThis study does not report the results of a health care intervention on human participants.

Patient mobilisation in the intensive care unit and evaluation of a multifaceted intervention including Facebook groups: A quasi-experimental study

AimsTo describe prevalence and time to mobilisation in intensive care unit patients defined as a minimum sitting in an upright position in bed, and evaluate the impact of a multifaceted quality improvement campaign on likelihood of patients being mobilised. Research methodology/designQuality improvement project using a quasi-experimental study design, comparing patient cohorts before (Before) and after (Intervention) a campaign including educational sessions, audit and feedback of intensive care unit quality indicators via closed Facebook-groups and e-mail and local opinion leaders. Secondary analysis of mobilisation data from adult intensive care patient stays extracted from electronical medical charts. Likelihood of being mobilised was analysed with Multivariate Cox-regression model and reported as Sub-hazard Ratio (SHR). SettingFour intensive care units in a university hospital. Main outcome measuresPrevalence and time to first documented mobilisation, defined as at least “sitting in bed” during the intensive care unit stay. ResultsOverall, 929 patients were analysed, of whom 710 (76 %) were mobilised; 73 % (356/ 489) in Before vs 81 % (354/ 440) in Intervention (p = 0.007). Median time to mobilisation was 69.9 (IQR: 30.0, 149.8) hours; 71.7 (33.9, 157.9) in Before and 66.0 (27.1, 140.3) in Intervention (p = 0.104). Higher SAPS II-scores were associated with lower likelihood (SHR 0.98, 95 % CI 0.97–0.99), whereas admissions due to gastroenterological failure (SHR 2.1, 95 % CI 1.4–3.0), neurological failure (SHR 1.5, 95 % CI 1.0–2.2) and other causes (intoxication, postoperative care, haematological-, and kidney failure) (SHR 1.7, 95 % CI 1.13–2.6) were associated with higher likelihood of mobilisation vs respiratory failure. ConclusionA quality improvement campaign including use of Facebook groups is feasible and may improve mobilisation in intensive care unit patients. Most patients were mobilised within 72 hours following intensive care unit admission, and SAPS II scores and causes for intensive care unit admission were both associated with likelihood of being mobilised.