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Abstract Background Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by programme fidelity) and care providers’ perceptions of implementation factors during an implementation process and to investigate whether these perceptions are affected by systematic implementation support. Methods Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Programme fidelity and care providers’ perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups at baseline, 6-, 12- and 18-months. Associations and group differences were tested by means of descriptive statistics (mean, standard deviation and confidence interval) and linear mixed effect analysis. Results Including 33 mental health centres or wards, we found care providers’ perceptions of a set of implementation factors to be associated with fidelity but not at baseline. After 18 months of implementation effort, fidelity and care providers’ perceptions were strongly correlated (B (95% CI) = .7 (.2, 1.1), p = .004). Care providers perceived implementation factors more positively when implementation support was provided than when it was not (t (140) = 2.22, p = .028). Conclusions Implementation support can facilitate positive perceptions among care providers, which is associated with higher programme fidelity. To improve implementation success, we should pay more attention to how care providers constantly perceive implementation factors during all phases of the implementation effort. Further research is needed to investigate the validity of our findings in other settings and to improve our understanding of ongoing decision-making among care providers, i.e., the mechanisms of sustaining the high fidelity of recommended practices. Trial registration ClinicalTrials.gov Identifier: NCT03271242 (registration date: 05.09.2017).

The caesium radioisotopes 134Cs, 135Cs, and 137Cs are highly problematic medium-lived species produced during nuclear fission, due to their high radioactivity and environmental mobility. While many ion exchange materials can readily isolate Cs+ ions from neutral or basic aqueous solutions, only ammonium phosphomolybdate (AMP) functions effectively in acidic conditions, removing caesium even down to trace levels. Composites of AMP in a porous polymeric support such as polyacrylonitrile (PAN) can be used to selectively remove Cs+ ions from acidic aqueous decontamination liquors as well as other liquid wastes, and are promising for the isolation of Cs+ isotopes in spent fuel reprocessing. While both AMP and PAN have demonstrable acid stability, and PAN has known resistance to gamma radiation, AMP-PAN composites have received only a limited analysis of their physiochemical and ion exchange performance following irradiation. In this publication, we explore the effect of high levels of gamma irradiation on the ion exchange properties of AMP and AMP-PAN as a Cs+-selective adsorbent under spent fuel dissolver liquor concentrations and acidity. We demonstrate no significant reduction in performance with respect to uptake kinetics or capacity upon irradiation, abiding by the same absorption mechanism observed in the established literature.

Objective Medication documentation is a critical aspect of quality patient care. The current study examined whether electronic medical records provide medication documentation that is more complete and faster to retrieve than traditional paper records. Method This study involves a comparison of archived paper medical records to recent electronic medical records through chart review. A convenient sample of three large community mental health centers in Indiana was used. Medical charts for 180 patients with schizophrenia were rated on a checklist composed of 16 items that was adapted from a national project. Documentation that existed before implementation of the electronic medical record system was compared with that after implementation at each of the three centers. The main outcome measures were completeness and retrieval time of medication documentation. Results Electronic medical records provided medication documentation that was more complete and faster to retrieve than paper records across all centers and within each center. On average, electronic medical records were 40% more complete and 20% faster to retrieve. Conclusion Electronic records have potential to improve medication management for patients in mental health centers over traditional records. However, medication documentation for patients diagnosed with schizophrenia was found to be deficient in many areas, regardless of documentation format. [ABSTRACT FROM AUTHOR]