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Rationale, aims and objectives There is an international imperative to implement research into clinical practice to improve health care. Understanding the dynamics of change requires knowledge from theoretical and empirical studies. This paper presents a novel approach to testing a new meta theoretical framework: the Consolidated Framework for Implementation Research. Method The utility of the Framework was evaluated using a post hoc, deductive analysis of 11 narrative accounts of innovation in health care services and practice from England, collected in 2010. A matrix, comprising the five domains and 39 constructs of the Framework was developed to examine the coherence of the terminology, to compare results across contexts and to identify new theoretical developments. Results The Framework captured the complexity of implementation across 11 diverse examples, offering theoretically informed, comprehensive coverage. The Framework drew attention to relevant points in individual cases together with patterns across cases; for example, all were internally developed innovations that brought direct or indirect patient advantage. In 10 cases, the change was led by clinicians. Most initiatives had been maintained for several years and there was evidence of spread in six examples. Areas for further development within the Framework include sustainability and patient/public engagement in implementation. Conclusion Our analysis suggests that this conceptual framework has the potential to offer useful insights, whether as part of a situational analysis or by developing context-specific propositions for hypothesis testing. Such studies are vital now that innovation is being promoted as core business for health care. [ABSTRACT FROM AUTHOR]

This article discusses the implementation of evidence-based library and information practice. Factors are discussed including intervention complexity, facilitation strategies and participant responsiveness, which may be responsible for variations in the effectiveness of the same program in different areas. Also discussed is the differences that evidence-based library and information practices can have in areas as close as Edmonton and Newcastle, England and as far away as Edmonton, Canada to New Castle, Australia.

Identifies some overarching themes raised by the concept of evidence-based librarianship which was presented during the Evidence Based Librarianship Conference held in England. Implication of the concept on continuing education of practicing librarians; Provision of Library and Information Service Abstracts; Nature and quality of research in health librarianship.

Focuses on the role of health information professionals in medical practice in England. Indication of the decision-making scenario; Familiarity on appraisal skills, resources and techniques; Knowledge on research methods and designs.

Introduction: Prolonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate the evidence base for 10 urgent and emergency care high-impact initiatives identified by the National Health Service (NHS) England., Methods: A two-stage approach was employed. First, a comprehensive search for reviews (2018-2023) was conducted across PubMed, Epistemonikos and Google Scholar. Additionally, full-text searches using Google Scholar were performed for studies related to the key outcomes. In the absence of sufficient review-level evidence, relevant available primary research studies were identified through targeted MEDLINE and HMIC searches. Relevant reviews and studies were mapped to the 10 high-impact initiatives. Reviewers worked in pairs or singly to identify studies, extract, tabulate and summarise data., Results: The search yielded 20 771 citations, with 48 reviews meeting the inclusion criteria across 10 sections. In the absence of substantive review-level evidence for the key outcomes, primary research studies were also sought for seven of the 10 initiatives. Evidence for interventions improving ambulance response times was generally scarce. ED wait times were commonly studied using ED length of stay, with some evidence that same day emergency care, acute frailty units, care transfer hubs and some in-patient flow interventions might reduce direct and indirect measures of wait times. Proximal evidence existed for initiatives such as urgent community response, virtual hospitals/hospital at home and inpatient flow interventions (involving flow coordinators), which did not typically evaluate the NHS England outcomes of interest., Conclusions: Effective interventions were often only identifiable as components within the NHS England 10 high-impact initiative groupings. The evidence base remains limited, with substantial heterogeneity in urgent and emergency care initiatives, metrics and reporting across different studies and settings. Future research should focus on well-defined interventions while remaining sensitive to local context., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances., Aim: The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work., Objectives: The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes., Design: This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory., Main Outcome: The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care., Data Sources: Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts., Review Methods: A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working., Results: Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve., Strengths and Limitations: Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity., Conclusions: Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion., Future Work: Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research., Study Registration: The study is registered as PROSPERO CRD42019141680., Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.

Objectives: In England, the NHS111 service provides assessment and triage by telephone for urgent health problems. A digital version of this service has recently been introduced. We aimed to systematically review the evidence on digital and online symptom checkers and similar services., Design: Systematic review., Data Sources: We searched Medline, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium, Web of Science and ACM Digital Library up to April 2018, supplemented by phrase searches for known symptom checkers and citation searching of key studies., Eligibility Criteria: Studies of any design that evaluated a digital or online symptom checker or health assessment service for people seeking advice about an urgent health problem., Data Extraction and Synthesis: Data extraction and quality assessment (using the Cochrane Collaboration version of QUADAS for diagnostic accuracy studies and the National Heart, Lung and Blood Institute tool for observational studies) were done by one reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies structured around pre-defined research questions and key outcomes., Results: We included 29 publications (27 studies). Evidence on patient safety was weak. Diagnostic accuracy varied between different systems but was generally low. Algorithm-based triage tended to be more risk averse than that of health professionals. There was very limited evidence on patients' compliance with online triage advice. Study participants generally expressed high levels of satisfaction, although in mainly uncontrolled studies. Younger and more highly educated people were more likely to use these services., Conclusions: The English 'digital 111' service has been implemented against a background of uncertainty around the likely impact on important outcomes. The health system may need to respond to short-term changes and/or shifts in demand. The popularity of online and digital services with younger and more educated people has implications for health equity., Prospero Registration Number: CRD42018093564., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Background: Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or 'making it happen', participatory adaptation or 'help it happen', and facilitated evolution or 'let it happen'., Methods: This case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored., Discussion: Researching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability.

Alkylnaphthalenes (AN) are relatively water-soluble hydrocarbons which, following spillages of crude oils, have been widely reported in contaminated marine organisms such as mussels. In the present report we show, by tandem-gas chromatography-time-of-flight-mass spectrometry (GC × GC-ToF-MS), that the range of AN in contaminated wild mussels from the UK extends beyond the previously GC resolved isomers to those with at least seven substituent carbon atoms. Since surprisingly little information on AN toxicity to such marine organisms has been reported we synthesized two C(8) AN and measured the toxicity of C(2-8) AN to mussels (clearance rate assay). C(2-3) AN were appreciably toxic (concentration for 50% clearance rate inhibition, 48 h IC(50) 1.4-2.6 μmol g(-1) dry weight tissue), but several C(4), (6) and C(8) AN, including branched isomers expected to be resistant to biodegradation and more accumulative, were relatively nontoxic (48 h IC(50) > 10 μmol g(-1)) and longer term exposure (8d) failed to elicit a greater toxic response. The accumulation profiles of AN in laboratory mussels exposed to oil were similar to those of the wild mussels. Moreover, laboratory oil-exposed mussels depurated toxic C(2-3) AN within 5 days in clean water and clearance rates recovered. The latter might imply that, in contrast with branched alkyl benzenes tested previously, AN are of less toxic concern, but such a straightforward conclusion cannot necessarily be drawn; a synthetic branched C(8) AN persisted following depuration and was as toxic to mussels as a C(3) AN (IC(50) 1.3 μmol g(-1)). This indicates that the structures of AN are also important.

Purpose: To develop and evaluate a programme of information skills training for social-care practitioners and health-care librarians., Setting: Two one-day training courses run separately for 13 social-care practitioners and 10 health-care librarians in the Trent geographic region within Northern England., Methodology: Qualitative and quantitative feedback collected through questionnaires supplemented by participant observation., Results: While generally feedback was favourable, the courses were overly ambitious. More training sessions of shorter duration would offer participants opportunities to practise and use the skills they have acquired. Social-care practitioners responded more positively to skills associated with appraising qualitative research than with randomised controlled trials. Librarians appreciated the opportunity to learn about unfamiliar social-care resources. Both practitioners and health-care librarians reported that they acquired skills to support evidence-based social care as a result of the training intervention., Discussion/conclusion: Involvement of a multi-disciplinary team and support from a social-care information provider maximized the impact of this experimental training intervention.

Recent years have seen tremendous growth in knowledge management projects within the NHS. Project staff must acquire rapidly a wide range of task-related skills. Conventional training courses may be inappropriately timed or unavailable to project staff. Action learning provides a group-based means of meeting skills deficits associated with project management and delivery. This paper describes an action learning set for project staff on five knowledge management projects within Trent Region. A brief evaluation aimed to identify most and least useful and most and least enjoyable features of the action learning set. Comments on the facilitation and the content of the action learning sessions are analysed. Action learning is feasible in meeting the training needs of project staff. It may also provide a means of meeting the shared learning needs of communities of practice within a virtual environment. Knowledge management does not merely involve management and delivery within innovative projects but also requires exploiting shared learning across projects.