***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial ( SCORE-IT ) was a cluster r and omized controlled trial that evaluated two knowledge translation ( KT ) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function , postural control , and mobility . Twenty rehabilitation centers across Canada were r and omly assigned to either the facilitated or passive KT intervention . The objective of the current study was to underst and the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses , occupational therapists and physical therapists , and clinical managers following completion of the trial . Methods A qualitative descriptive approach involving focus groups was used . Thematic analysis was used to underst and the factors influencing the implementation of the recommended treatments and KT interventions . The Clinical Practice Guidelines Framework for Improvement guided the analysis . Results Thirty-three participants were interviewed from 11 of the 20 study sites ( 6 sites from the facilitated KT arm and 5 sites from the passive KT arm ) . The following factors influencing the implementation of the recommended treatments and KT interventions emerged : facilitation , agreement with the intervention – practical , familiarity with the recommended treatments , and environmental factors , including time and re sources . Each of these themes includes the sub-themes of facilitator and /or barrier . Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations . Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial . Conclusions This is one of the first studies to examine the factors influencing the implementation of stroke recommendations and associated KT interventions within the context of a trial . Findings highlight the important role of self-selected facilitators to implementation efforts . Future research should seek to better underst and the specific characteristics of facilitators that are associated with successful implementation and clinical outcomes , especially within the context of stroke rehabilitation Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community setting s. Methods A naturalistic study with a prospect i ve , before and after design documented the implementation of six newly developed nursing best practice guidelines ( asthma , breastfeeding , delirium-dementia-depression ( DDD ) , foot complications in diabetes , smoking cessation and venous leg ulcers ) . Eleven health care organisations were selected for a one-year project . At each site , clinical re source nurses ( CRNs ) worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities ( i.e. education sessions , policy review ) . Process and patient outcomes were assessed by chart audit ( n = 681 pre-implementation , 592 post-implementation ) . Outcomes were also assessed for four of six topics by in-hospital/home interviews ( n = 261 pre-implementation , 232 post-implementation ) and follow-up telephone interviews ( n = 152 pre , 121 post ) . Interviews were conducted with 83/95 ( 87 % ) CRN 's , nurses and administrators to describe recommendations selected , strategies used and participants ' perceived facilitators and barriers to guideline implementation . Results While statistically significant improvements in 5 % to 83 % of indicators were observed in each organization , more than 80 % of indicators for breastfeeding , DDD and smoking cessation did not change . Statistically significant improvements were found in > 50 % of indicators for asthma ( 52 % ) , diabetes foot care ( 83 % ) and venous leg ulcers ( 60 % ) . Organizations with > 50 % improvements reported two unique implementation strategies which included h and s-on skill practice sessions for nurses and the development of new patient education material s. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack of time , workload pressure and staff resistance . Conclusion Implementation of nursing best practice guidelines can result in improved practice and patient outcomes across diverse setting s yet many indicators remained unchanged . Mobilization of the nursing workforce to actively implement guidelines and to monitor the delivery of their care is important so that patients may learn about and receive recommended healthcare Background Hypertension and diabetes , key risk factors for cardiovascular disease , are significant health problems globally . As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000 , clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011 . This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting . Methods A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level , as well as to gain insight into how practitioners view the usability and practicality of the guidelines . Ten family health centres were r and omly chosen from a list of all the family health centres ( n = 136 ) located in Ulaanbaatar City . In each centre , a focus group discussion with nurses ( n = 20 ) and individual interviews with practice doctors ( n = 10 ) and practice managers ( n = 10 ) were conducted . Data was analysed using a thematic approach utilising the Theoretical Domains Framework . Results The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice . They also reported having attended guideline training sessions which were focused on practice skill development . The majority of participants expressed satisfaction with the wide range of re sources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines . The re sources , supplied from 2011 onwards , included screening devices , equipment for blood tests , medications and educational material s. Other enablers were the participants ’ commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines . Primary care providers reported a number of challenges in implementing the guidelines , including frustration caused by increased workload and long waiting times , time constraints , difficulties with conflicting tasks and low patient health literacy . Conclusions This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low re source primary care setting s. It also offers some key lessons that might be carefully considered when other evidence -based clinical guidelines are to be put into effect in low re source setting s and elsewhere Background The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful underst and ings of how interventions work . In this paper , we provide an explanation of implementation processes from one of the first national implementation research r and omized controlled trials with embedded process evaluation conducted within acute care , and a proposed extension to the Promoting Action on Research Implementation in Health Services ( PARIHS ) framework . Methods The PARIHS framework was prospect ively applied to guide decisions about intervention design , data collection , and analysis processes in a trial focussed on reducing peri-operative fasting times . In order to capture a holistic picture of implementation processes , the same data were collected across 19 participating hospitals irrespective of allocation to intervention . This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention . Data were analysed using content analysis within , and then across data sets . Results A robust and uncontested evidence base was a necessary , but not sufficient condition for practice change , in that individual staff and patient responses such as caution influenced decision making . The implementation context was challenging , in which individuals and teams were bounded by professional issues , communication challenges , power and a lack of clarity for the authority and responsibility for practice change . Progress was made in sites where processes were aligned with existing initiatives . Additionally , facilitators reported engaging in many intervention implementation activities , some of which result in practice changes , but not significant improvements to outcomes . Conclusions This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework . Consistent with the underlying tenant of PARIHS , a multi-faceted and dynamic story of implementation was evident . However , the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework . We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals , evidence , and context to promote evidence -informed practice . This proposal will enhance the potential of the PARIHS framework for explanation , and ensure theoretical development both informs and responds to the evidence base for implementation . Trial registration IS RCT N18046709 - Peri-operative Implementation Study Evaluation ( PoISE ) Background In healthcare and allied healthcare setting s , leadership that supports effective implementation of evidence d-based practice s ( EBPs ) is a critical concern . However , there are no empirically vali date d measures to assess implementation leadership . This paper describes the development , factor structure , and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership : the Implementation Leadership Scale ( ILS ) . Methods Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California , USA . Initial item development was supported as part of a two United States National Institutes of Health ( NIH ) studies focused on developing implementation leadership training and implementation measure development . Clinician work group/team-level data were r and omly assigned to be utilized for an exploratory factor analysis ( n = 229 ; k = 46 teams ) or for a confirmatory factor analysis ( n = 230 ; k = 47 teams ) . The confirmatory factor analysis controlled for the multilevel , nested data structure . Reliability and validity analyses were then conducted with the full sample . Results The exploratory factor analysis result ed in a 12-item scale with four subscales representing proactive leadership , knowledgeable leadership , supportive leadership , and perseverant leadership . Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor . The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity . Conclusions The ILS is a brief and efficient measure of unit level leadership for EBP implementation . The availability of the ILS will allow research ers to assess strategic leadership for implementation in order to advance underst and ing of leadership as a predictor of organizational context for implementation . The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation Background : Many hospitals are unable to consistently implement evidence -based practice s. For example , implementation of the central line bundle ( CLB ) , known to prevent catheter-related bloodstream infections ( CRBSIs ) , is often challenging . This problem is broadly characterized as “ change implementation failure . ” Purpose : The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations . However , gaps remain in underst and ing the mechanisms by which top-down communications enable practice change at the unit level . Addressing these gaps could help identify evidence -based management strategies for successful practice change at the unit level . Our study sought to address this gap . Methods : A prospect i ve study was conducted in two intensive care units within an academic health center . Both units had low baseline adherence to CLB and higher-than-expected CRBSIs .  Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units . Simultaneously , the study examined ( a ) the content and frequency of communication related to CLB through weekly “ communication logs ” completed by unit physicians , nurses , and managers and ( b ) unit outcomes , that is , CLB adherence rates through weekly chart review s. Findings : Both units experienced substantially improved outcomes , including increased adherence to CLB and statistically significant ( sustained ) declines in both CRBSIs and catheter days ( i.e. , central line use ) . Concurrently , both units indicated a statistically significant increase in “ proactive ” communications — that is , communications intended to reduce infection risk — between physicians and nurses over time . Further analysis revealed that , during the early phase of the study , “ champions ” emerged within each unit to initiate process improvements . Practice Implication s : The study helps identify evidence -based management strategies for successful practice change at the unit level . For example , it underscores the importance of ( a ) screening each unit for change champions and ( b ) enabling champions to emerge from within the unit to foster change implementation BACKGROUND Decreasing the use of continuous electronic fetal monitoring and increasing professional labor support for low-risk pregnancies are recommended by the Society of Obstetricians and Gynecologists of Canada . This study explored factors influencing the successful ( and unsuccessful ) introduction of an evidence -based fetal health surveillance guideline . METHODS This qualitative case study was conducted at two tertiary and one community hospital . Data were collected in 14 clinician focus groups ( 51 nurses ) , followed by 8 interviews with nurse administrators and educators . Analysis of verbatim transcripts and unit records included coding and categorizing data to form profiles that were compared across hospitals . RESULTS Implementation of the guideline recommendations in the hospital setting s was affected by many different factors originating in the practice environment , with the potential adopters , and related to the characteristics of the guideline . The influences of these diverse factors interacted sometimes to magnify or counteract each other 's effect . The physical setting , adopter concerns , and the medicolegal issues surrounding the guideline played critical roles in uptake . In addition , changes preceding the introduction of the recommendations , the institution 's agenda , and nursing and medical leadership influenced the uptake of guideline recommendations . The number and experience of nurses in each setting and availability of equipment also affected guideline acceptance and use . CONCLUSIONS When implementing best practice , it is important to identify organizational barriers to the change that will need managing by the appropriate level of administration in the organization . Careful tailoring of implementation interventions to the barriers originating with the potential adopters is also necessary . Be prepared for unanticipated effects Background : Despite three decades of empirical investigation into research utilization and a renewed emphasis on evidence - 
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Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented , relation-oriented and task-oriented behaviours .
The most commonly described behavior was support for the change , which involved demonstrating conceptual and operational commitment to research -based practice s. Conclusions This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action .
Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care .