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Background Belgian primary care is facing significant challenges due to increasing healthcare demands and an overall decline in the workforce. Most general practitioners (GPs) work solo or in mono-disciplinary practices, leading to suboptimal outcomes in areas such as preventive care and health promotion. In response, the Ministry of Health introduced a “New-Deal” for GPs, which includes additional funding to support innovative practice organisation models. A think tank of GP representatives was established to guide the initiative, with input from practising GPs gathered for further insight. This study aims to identify the professionals needed to support GPs in daily practice, define their roles, and explore the conditions necessary for integrating them into the GP-centred model of care. Methods Eleven focus groups were conducted with 122 GPs, ensuring geographical and linguistic diversity across Belgium. Participants were selected through purposive sampling to ensure a diverse range of organisational models across the country. A structured focus group guide was designed, incorporating three scenarios to examine tasks commonly encountered in GP practices. Data analysis was conducted using a codebook developed through an inductive approach. Results GPs expressed a preference for relatively small-scale teams, generally consisting of nurses and receptionists. The role of a practice assistant was more ambiguously defined, positioned between clinical and administrative responsibilities. Key tools for effective team integration included co-location, well-defined protocols, a shared electronic health record, care coordination, and unified logistical management, all of which are critical to fostering multidisciplinary collaboration. Conclusions This study explores Belgian GPs' preferences for integrating healthcare professionals into their practices, with team composition adjusted to workload and patient needs. However, the traditional autonomy of practice design may hinder change. Future research is needed to refine financial models and integration tools for collaborative care.

Through a large number of literature studies and field survey, from the perspective of small farmers' integration into agricultural modernization, this paper innovatively divided the current integration mode of national agricultural organizations into five main types: leading enterprises, leading new agricultural business entities, cooperative financial institutions, embedded scientific research institutes, and financial poverty alleviation and assistance. It found that Ningxia region can gradually carry out horizontal integration and extension in the process of promoting the vertical integration and extension of agricultural industry value chain, and try to explore the possibility of new integration mode such as “modern agricultural cloud service public platform + leading enterprises + farmers” in Ningxia, in order to bridge the gaps in agricultural organization policies through the pilot, because the village plans to plan the development of the industry, adapt to the local conditions to strengthen the village collective economy, and continuously improve the degree of farmers' organization.

Context: This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal \"three circles\" model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines. Methods: The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline. Findings: Common challenges across disciplines include (1) how \"evidence\" should be defined and comparatively weighted; (2) how and when the patient's and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the \"expert\"; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise. Conclusions: A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner's expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed.

Background Previous studies have shown that collaboration between primary care and mental health services can enhance accessibility and improve outcomes for patients seen in general practitioners’ (GPs’) office. There is, however, a lack of empirical evidence regarding the benefits of collaborative care in Norway. This study, part of a larger research project, examined the adaptation and implementation of a successful Canadian collaborative care model developed in Hamilton, Ontario, in three Norwegian GP practices located in different boroughs of Oslo, Norway’s largest city. Aims To evaluate the required adaptations, implementation, challenges, and sustainability of the Hamilton model within the Norwegian context. Methods The overarching study was a cluster-randomised trial testing the adapted model in three urban GP practices over an 18-month period, with three additional GP practices from the same boroughs serving as control groups. Each intervention site included a half-time clinical psychologist from the local community mental health centre and a psychiatrist who visited for two hours each week. The project also aimed to extend collaboration to other health and community services within each borough. This paper evaluates the implementation of the project’s intervention arm, using inductive thematic analysis of documents from all of the project’s phases and following recommendations for the process evaluation of complex interventions. Results The model’s core component—collaboration between GPs and mental health specialists—was successfully implemented. Participating GPs appreciated the convenient access to mental health specialists to assist with managing mental health problems, although they faced challenges in finding time for collaboration. However, health policy restrictions on providing financial support for co-located collaborative care rendered the model unsustainable beyond the trial period and impeded its expansion to further GP practices. Conclusions The model was successfully implemented and viewed by participants as an improvement in healthcare delivery. For such a model to be sustained, however, adjustments must be made to align it with available resources, and reimbursements are needed for collaborative activities in GP practices. It also requires a recognition by funders and planners of the benefits of co-locating mental health specialists within GP practices.

This paper aims to shift the unit of analysis in the study of organisational knowledge from individuals and their actions to practices and their relationships. It introduces the concept of \"site\" to help advance an understanding of the relationship between practice and knowing. The notion of site supports the intuition that knowing is both sustained in practice and manifests itself through practice. It also evokes the idea of knowledge as being rooted in an extended pattern of interconnected activities that only when taken in its living and pulsating entirety constitutes the site of knowing. In this paper, I review the different ways to conceptualise the relationships between knowing and practice, and I show how the idea of site adds to the existing body of work. Building on the results of a longitudinal study in the field of telemedicine, I then offer suggestions on aspects of practice where knowing manifests itself, and I use the concepts of \"translation by contact\" and \"at distance\" to explain how dispersed knowings are woven together and the power effect that can derive from these. I conclude by reflecting on the implications of this radical view and the direction for future research.

Animal experiments remain essential to understand the fundamental mechanisms underpinning malignancy and to discover improved methods to prevent, diagnose and treat cancer. Excellent standards of animal care are fully consistent with the conduct of high quality cancer research. Here we provide updated guidelines on the welfare and use of animals in cancer research. All experiments should incorporate the 3Rs: replacement, reduction and refinement. Focusing on animal welfare, we present recommendations on all aspects of cancer research, including: study design, statistics and pilot studies; choice of tumour models (e.g., genetically engineered, orthotopic and metastatic); therapy (including drugs and radiation); imaging (covering techniques, anaesthesia and restraint); humane endpoints (including tumour burden and site); and publication of best practice.

Background Existing guidance for developing public health interventions does not provide information for researchers about how to work with intervention providers to co-produce and prototype the content and delivery of new interventions prior to evaluation. The ASSIST + Frank study aimed to adapt an existing effective peer-led smoking prevention intervention (ASSIST), integrating new content from the UK drug education resource Talk to Frank ( www.talktofrank.com ) to co-produce two new school-based peer-led drug prevention interventions. A three-stage framework was tested to adapt and develop intervention content and delivery methods in collaboration with key stakeholders to facilitate implementation. Methods The three stages of the framework were: 1) Evidence review and stakeholder consultation; 2) Co-production; 3) Prototyping. During stage 1, six focus groups, 12 consultations, five interviews, and nine observations of intervention delivery were conducted with key stakeholders (e.g. Public Health Wales [PHW] ASSIST delivery team, teachers, school students, health professionals). During stage 2, an intervention development group consisting of members of the research team and the PHW ASSIST delivery team was established to adapt existing, and co-produce new, intervention activities. In stage 3, intervention training and content were iteratively prototyped using process data on fidelity and acceptability to key stakeholders. Stages 2 and 3 took the form of an action-research process involving a series of face-to-face meetings, email exchanges, observations, and training sessions. Results Utilising the three-stage framework, we co-produced and tested intervention content and delivery methods for the two interventions over a period of 18 months involving external partners. New and adapted intervention activities, as well as refinements in content, the format of delivery, timing and sequencing of activities, and training manuals resulted from this process. The involvement of intervention delivery staff, participants and teachers shaped the content and format of the interventions, as well as supporting rapid prototyping in context at the final stage. Conclusions This three-stage framework extends current guidance on intervention development by providing step-by-step instructions for co-producing and prototyping an intervention’s content and delivery processes prior to piloting and formal evaluation. This framework enhances existing guidance and could be transferred to co-produce and prototype other public health interventions. Trial registration ISRCTN14415936 , registered retrospectively on 05 November 2014.

The concept of the medical home has existed since the 1960s, but has recently become a focus for discussion and innovation in the health care system. The most prominent definitions of the medical home are those presented by the Patient-Centered Primary Care Collaborative, the National Committee for Quality Assurance, and the Commonwealth Fund. These definitions share: adoption of health information technology and decision support systems, modification of clinical practice patterns, and ensuring continuity of care. Each of these components is a complex undertaking, and there is scant evidence to guide assessment of diverse strategies for achieving their integration into a medical home. Without a shared vocabulary and common definitions, policy-makers seeking to encourage the development of medical homes, providers seeking to improve patient care, and payers seeking to develop appropriate systems of reimbursement will face challenges in evaluating and disseminating the medical home model.

Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. Methods We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. Results Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. Conclusions Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.