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Background Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs. Methods Participants were 12 mental health service team leaders and their staff ( n  = 100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and a focus group with LOCI trainees. Results Quantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes. Conclusions The LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP.

Background Evidence-based guidelines for management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available; however, clinical practice remains inconsistent with these guidelines. A targeted, theory-informed implementation intervention (Neurotrauma Evidence Translation (NET) intervention) was designed to increase the uptake of three clinical practice recommendations regarding the management of patients who present to Australian EDs with mild head injuries. The intervention involved local stakeholder meetings, identification and training of nursing and medical local opinion leaders, train-the-trainer workshops and standardised education materials and interactive workshops delivered by the opinion leaders to others within their EDs during a 3 month period. This paper reports on the effects of this intervention. Methods EDs (clusters) were allocated to receive either access to a clinical practice guideline (control) or the implementation intervention, using minimisation, a method that allocates clusters to groups using an algorithm to minimise differences in predefined factors between the groups. We measured clinical practice outcomes at the patient level using chart audit. The primary outcome was appropriate screening for post-traumatic amnesia (PTA) using a validated tool until a perfect score was achieved (indicating absence of acute cognitive impairment) before the patient was discharged home. Secondary outcomes included appropriate CT scanning and the provision of written patient information upon discharge. Patient health outcomes (anxiety, primary outcome: Hospital Anxiety and Depression Scale) were also assessed using follow-up telephone interviews. Outcomes were assessed by independent auditors and interviewers, blinded to group allocation. Results Fourteen EDs were allocated to the intervention and 17 to the control condition; 1943 patients were included in the chart audit. At 2 months follow-up, patients attending intervention EDs ( n  = 893) compared with control EDs ( n  = 1050) were more likely to have been appropriately assessed for PTA (adjusted odds ratio (OR) 20.1, 95%CI 6.8 to 59.3; adjusted absolute risk difference (ARD) 14%, 95%CI 8 to 19). The odds of compliance with recommendations for CT scanning and provision of written patient discharge information were small (OR 1.2, 95%CI 0.8 to 1.6; ARD 3.2, 95%CI − 3.7 to 10 and OR 1.2, 95%CI 0.8 to 1.8; ARD 3.1, 95%CI − 3.0 to 9.3 respectively). A total of 343 patients at ten interventions and 14 control sites participated in follow-up interviews at 4.3 to 10.7 months post-ED presentation. The intervention had a small effect on anxiety levels (adjusted mean difference − 0.52, 95%CI − 1.34 to 0.30; scale 0–21, with higher scores indicating greater anxiety). Conclusions Our intervention was effective in improving the uptake of the PTA recommendation; however, it did not appreciably increase the uptake of the other two practice recommendations. Improved screening for PTA may be clinically important as it leads to appropriate periods of observation prior to safe discharge. The estimated intervention effect on anxiety was of limited clinical significance. We were not able to compare characteristics of EDs who declined trial participation with those of participating sites, which may limit the generalizability of the results. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12612001286831), date registered 12 December 2012.

Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. Methods. We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers. Conclusions. IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements.

Purpose Previous studies estimate translation of research evidence into practice takes 17 years. However, this estimate is not specific to cancer control evidence-based practices (EBPs), nor do these studies evaluate variation in the translational process. We examined the translational pathway of cancer control EBPs. Methods We selected five cancer control EBPs where data on uptake were readily available. Years from landmark publication to clinical guideline issuance to implementation, defined as 50% uptake, were measured. The translational pathway for each EBP was mapped and an average total time across EBPs was calculated. Results Five cancer control EBPs were included: mammography, clinicians’ advice to quit smoking, colorectal cancer screening, HPV co-testing, and HPV vaccination. Time from publication to implementation ranged from 13 to 21 years, averaging 15 years. Time from publication to guideline issuance ranged from 3 to 17 years, and from guideline issuance to implementation, − 4 to 12 years. Clinician’s advice to quit smoking, HPV co-testing, and HPV vaccination were most rapidly implemented; colorectal cancer screening and mammography were slowest to implement. Conclusion The average time to implementation was 15 years for the five EBPs we evaluated, a marginal improvement from prior findings. Although newer EBPs such as HPV vaccination and HPV co-testing were faster to implement than other EBPs, continued efforts in implementation science to speed research to practice are needed.

To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings. Secondary analysis of qualitative data. Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis. Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products. By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs.

Introduction:Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival.Methods:All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method.Results:The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P = 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P = 0.26).Conclusions:Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias.

The autism intervention literature focuses heavily on the concept of evidence-based practice, with less consideration of the acceptability, feasibility, and contextual alignment of interventions in practice. A survey of 130 special educators was conducted to quantify this “social validity” of evidence-based practices and analyze its relationship with knowledge level and frequency of use. Results indicate that knowledge, use, and social validity are tightly-connected and rank the highest for modeling, reinforcement, prompting, and visual supports. Regression analysis suggests that greater knowledge, higher perceived social validity, and a caseload including more students with autism predicts more frequent use of a practice. The results support the vital role that social validity plays in teachers’ implementation, with implications for both research and practice.

Background . Despite the emphasis on the importance of implementing evidence‐based practices, nurses did not adopt this approach as a standard. For those who have attempted to implement evidence‐based practice in health care settings, the behaviour is rarely simple or straightforward. Therefore, exploring the mechanism that motivates nurses’ evidence‐based practice behaviour is essential to promote this practice. Aims . The aim of this study was to investigate the effect of the organizational climate for evidence‐based practice on evidence‐based practice behaviour among nurses through the mediating role of evidence‐based practice competence, work control, and the intention to implement evidence‐based practice. Methods . This study consisted of a cross‐sectional design and convenience sampling to recruit 641 nurses employed in 6 hospitals in China. Five self‐report instruments were used to collect the data. A structural equation model was adopted to verify the research hypotheses. IBM SPSS 26.0 and AMOS 24.0 were used for statistical analysis of the data. Results . The organizational climate for evidence‐based practice was significantly and positively related to the nurses’ evidence‐based practice behaviour ( p < 0.01). Direct effects accounted for 45.93% of the total effect. Evidence‐based practice competence, work control, and the intention to implement evidence‐based practice partially mediated the association between the organizational climate and evidence‐based practice behaviour. The indirect effect accounted for 54.07% of the total effect. Conclusion . The organizational climate for evidence‐based practice is critical for predicting and enhancing evidence‐based practice behaviour. Evidence‐based practice competence, work control, and the intention to implement evidence‐based practice are intervening mechanisms that explain how the organizational climate promotes evidence‐based practice behaviour. Implications for Nursing Management . Nursing managers should be aware of the interaction of individual and organizational factors that influence evidence‐based practice behaviours among nurses. Administrators should improve the organizational climate by providing nurses with cultural and team support, mentoring, training projects, resource provisions, and more autonomy and authority at work, which are beneficial to the nurses’ evidence‐based practice competence, work control, and intentions to adopt evidence‐based practices.

Background Evidence-based practice use refers to the integration of current, reliable, and relevant evidence into healthcare decision-making. This includes findings from studies, professional experiences, and updated guidelines aimed at minimizing biases and enhancing clinical decisions based on comprehensive research. Objective This study aimed to evaluate the use of evidence-based practices and identify associated factors among nurses working in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia, in 2024. Methods This institution-based cross-sectional study assessed evidence-based practice use among emergency department nurses. A lottery method of simple random sampling was used to select 233 participants from 542 nurses registered in the nurse manager office. Only 233 nurses were invited to participate in the study, and only 225 responded, resulting in a non-response rate of 3.4% (equivalent to 8 nurses). Data were collected using a self-administered questionnaire that was adapted and modified, comprising six sections with 59 items. Binary logistic regression was used to explore the associations between dependent and independent variables. Variables with a P value of less than 0.05 were deemed significantly associated with the utilization of evidence-based practices. Results Among the 225 nurses who participated in the study, 101 nurses (44.9%, 95% CI: 39.0–52.0%) demonstrated good use of evidence-based practice. The analysis revealed several factors associated with the use of evidence-based practice. Female nurses had an adjusted odds ratio (AOR) of 1.4 (95% CI: 1.201–3.923) for evidence-based practice use compared with male nurses. Nurses with a Master’s degree (AOR = 6.786, 95% CI: 1.141–40.352) and coordinator nurses (AOR = 13.191, 95% CI: 1.843–94.414) were also more likely to utilize evidence-based practices than staff nurses. Additionally, nurses with good knowledge of evidence-based practices had an AOR of 3.801 (95% CI: 1.700–8.498), and those who believed that relevant literature was unavailable had an AOR of 3.316 (95% CI: 1.334–8.246). Conclusion This study identified important factors affecting the use of evidence-based practice among nurses. Female nurses, those with advanced degrees, and nurse coordinators are more likely to engage in this practice. Good knowledge of evidence-based methods enhances their utilization, whereas beliefs about limited access to relevant literature can hinder such utilization. These findings suggest that improving education and access to research resources could boost patient care outcomes. Additionally, nursing leaders and administrators can help overcome barriers by providing training, allowing time off for EBP activities, and adjusting work schedules accordingly.