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Objective To identify the core components of successful early warning systems for detecting and initiating action in response to clinical deterioration in paediatric inpatients. Methods A hermeneutic systematic literature review informed by translational mobilisation theory and normalisation process theory was used to synthesise 82 studies of paediatric and adult early warning systems and interventions to support the detection of clinical deterioration and escalation of care. This method, which is designed to develop understanding, enabled the development of a propositional model of an optimal afferent component early warning system. Results Detecting deterioration and initiating action in response to clinical deterioration in paediatric inpatients involves several challenges, and the potential failure points in early warning systems are well documented. Track and trigger tools (TTT) are commonly used and have value in supporting key mechanisms of action but depend on certain preconditions for successful integration into practice. Several supplementary interventions have been proposed to improve the effectiveness of early warning systems but there is limited evidence to recommend their wider use, due to the weight and quality of the evidence; the extent to which systems are conditioned by the local clinical context; and the need to attend to system component relationships, which do not work in isolation. While it was not possible to make empirical recommendations for practice, the review methodology generated theoretical inferences about the core components of an optimal system for early warning systems. These are presented as a propositional model conceptualised as three subsystems: detection, planning and action. Conclusions There is a growing consensus of the need to think beyond TTTs in improving action to detect and respond to clinical deterioration. Clinical teams wishing to improve early warning systems can use the model to consider systematically the constellation of factors necessary to support detection, planning and action and consider how these arrangements can be implemented in their local context. PROSPERO registration number CRD42015015326.

Background and Purpose: We studied the development and delivery of a 14-week complex physical activity intervention for people with Huntington disease, where detailed information about the intervention was fully embedded in the trial design process.\ud \ud Methods: Intervention Development: The intervention was developed through a series of focus groups. The findings from the focus groups informed the development of a logic model for the physical activity intervention that was broadly consistent with the framework of self-determination theory. Intervention Delivery: Key components underpinning the delivery of the intervention were implemented including a defined coach training program and intervention fidelity assessment methods. Training of coaches (physical therapists, occupational therapists, research nurses, and exercise trainers) was delivered via group and 1:1 training sessions using a detailed coach's manual, and with ongoing support via video calls, and e-mail communication as needed. Detailed documentation was provided to determine costs of intervention development and coach training.\ud \ud Results: Intervention delivery coaches at 8 sites across the United Kingdom participated in the face-to-face training. Self-report checklists completed by each of the coaches indicated that all components of the intervention were delivered in accordance with the protocol. Mean (standard deviation) intervention fidelity scores (n = 15), as measured using a purpose-developed rating scale, was 11 (2.4) (out of 16 possible points). Coaches' perceptions of intervention fidelity were similarly high. The total cost of developing the intervention and providing training was [pounds]30,773 ($47,042 USD).\ud \ud Discussion and Conclusions: An important consideration in promoting translation of clinical research into practice is the ability to convey the detailed components of how the intervention was delivered to facilitate replication if the results are favorable. This report presents an illustrative example of a physical activity intervention, including the development and the training required to deliver it. This approach has the potential to facilitate reproducibility, evidence synthesis, and implementation in clinical practice.

A significant number of young children in the United Kingdom experience dental caries, often resulting in a diminished quality of life. Brushing children’s teeth twice a day with fluoride toothpaste significantly reduces their risk of caries, but not all parents adhere to these guidelines. Previous behaviour change interventions in oral health have been largely unsuccessful and criticised for a narrow focus on education with no wider theoretical underpinnings. However, little is known about the factors that influence parents’ decisions about when and how often to brush their child’s teeth at home.\ud The aim of the current project was to understand the wider social, environmental and cognitive factors that influence parents’ decisions about brushing children’s teeth, to inform future advice and interventions.\ud Three studies were conducted, focused on parents of children aged between 3-6 years old, resident in deprived communities in Wales. In-depth interviews (n=15) suggested that parents only took brushing guidelines seriously if they believed other parents did so, that toothbrushing patterns were influenced by the home environment and day-to-day routines, and that parents often saw toothbrushing as having largely short-term benefits. These themes informed the development of a questionnaire survey (n=297), which showed that parents’ perceptions of the norm for brushing were significantly associated with how often they brushed their own child’s teeth. Parents tended to brush their child’s teeth more often when brushing was automatic or ‘habitual’ and saw different benefits in brushing a child’s teeth in the morning and evening. Finally, an experimental study (n=121) showed that parents’ judgements about what constitutes a healthy number of times to brush a child’s teeth were relative rather than absolute, and predicted by Range-Frequency Theory.\ud The findings have implications for re-considering oral health advice offered to parents, and suggest novel theoretical frameworks for developing future behaviour change interventions.