OBJECTIVE: In 2018, Best Practice Guidelines (BPGs) were published for preventing wrong-level surgery in pediatric spinal deformity, but successful implementation has not been established. The purpose of this study was to evaluate BPG compliance 5 years after publication. We hypothesized higher compliance among BPG authors and among surgeons with more experience, higher caseload, and awareness of the BPGs.
METHODS: We queried North American and European surgeons, authors and nonauthors, and members of pediatric spinal study groups on adherence to BPGs using an anonymous survey consisting of 18 Likert scale questions. Respondents provided years in practice, yearly caseload, and guideline awareness. Mean compliance scores (MCS) were developed by correlating Likert responses with MCS scores (\"None of the time\" = no compliance = MCS 0, \"Sometimes\" = weak to moderate = MCS 1, \"Most of the time\" = high = MCS 2, and \"All the time\" = perfect = MCS 3).
RESULTS: Of the 134 respondents, 81.5% reported high or perfect compliance. Average MCS for all guidelines was 2.4 ± 0.4. North American and European surgeons showed no compliance differences (2.4 vs. 2.3, p = 0.07). Authors and nonauthors showed significantly different compliance scores (2.8 vs 2.4, p < 0.001), as did surgeons with and without knowledge of the BPGs (2.5 vs 2.2, p < 0.001). BPG awareness and compliance showed a moderate positive correlation (r = 0.48, p < 0.001), with non-significant associations between compliance and both years in practice (r = 0.41, p = 0.64) and yearly caseload (r = 0.02, p = 0.87).
CONCLUSIONS: Surgeons reported high or perfect compliance 81.5% of the time with BPGs for preventing wrong-level surgery. Authorship and BPG awareness showed increased compliance. Location, study group membership, years in practice, and yearly caseload did not affect compliance.
METHODS: Level V-expert opinion.

OBJECTIVE: To examine the level of adherence to best-practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs.
METHODS: A retrospective observational study was conducted in 2023.
METHODS: A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best-practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post-operative assessment, patient and interprofessional teams\' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best-practice guidelines.
RESULTS: Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best-practice guidelines of the cohort.
CONCLUSIONS: This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations.
CONCLUSIONS: Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care.
UNASSIGNED: This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines.
UNASSIGNED: No patient or public contribution.

BACKGROUND: MCGR lengthening has become an important innovation in treating patients with EOS. An alternative to traditional growing instrumentation, a single surgical procedure is necessary for insertion of the construct, followed by non-invasive lengthening in the outpatient setting. With every new technology emanates a new complication to troubleshoot. Failure to lengthen in the MCGR is a significant cause of revision surgery. Currently, no consensus exists on how to define a MCGR lengthening failure, what steps are necessary after a failure to lengthen, and what factors determine these next steps. The primary goal of this study was to establish a consensus on how to define and navigate a MCGR that fails to lengthen.
METHODS: A series of 3 surveys were distributed to 49 early onset scoliosis surgeons with 37 responses between December 2021 and April 2022. Consensus was defined as at least 70% agreement.
RESULTS: 37 of 49 surgeons (75%) responded to the first survey, and all 37 surgeons responded to the following two surveys (100%). Consensus statements were reached on 25% of questions (3/12) from survey 1, 40% of questions (4/10) on survey 2, and 100% of questions (5/5) on survey 3. The questions that reached consensus are detailed in Table 1. Consensus steps to navigate a rod that fails to lengthen 1 mm (97%) in the office include retrying during the same visit (78%), changing technique in the office (88%), and not adjusting the interval between lengthening appointments (78%). Table 1 Items that reached consensus from each survey (12 total) Survey Question Response, Consensus Percentage 1 If a rod does not lengthen, do you try again in that office visit?​ Yes, 78% 1 All modes of XR are equivalent when determining failure to lengthen? Yes, 70% 1 If you are unsuccessful at lengthening, you should change the lengthening interval? No, 78% 2 Re-lengthening a rod following a failure to lengthen one should change their technique? Yes, 88% Reposition patient, 100% Alternate rods, 90% No traction in OR, 92.6% 2 Is a MCGR non-operational following 3 consecutive visits where the rod failed lengthening? Yes, 100% 2 Considerations when determining next steps with a non-operational rod? Skeletal Age, 100% Curve Progression, 97% Curve Stiffness, 93.8% Family Convenience, 83% Chronologic Age, 77% Time from Last Lengthening, 70% 2 Can an APP follow your protocol for a rod that has failed to lengthen? Yes, 81% 3 Are you comfortable using either clunk or stall to describe the phenomena of the internal clutch failing within the actuator when lengthening? Yes, 97.3% 3 Clunk/stall try again before an adjustment? Yes, 81% 3 Define failure to lengthen? Less than 1 mm length achieved, 97% 3 After two failure to lengthen events do you discuss next surgical steps?​ Yes, 97% 3 Once a rod had been classified as non-operational (no longer lengthening despite interventions) do you consider the underlying diagnosis when making next step decisions? Yes, 97% CONCLUSION: Best clinical practice guidelines using a Delphi method established a consensus on defining failure to lengthen in a MCGR (less than 1 mm), appropriate responses to failure to lengthen (re-attempt to lengthen and re-position patient) and a definition for a non-functional MCGR (failure to lengthen 3 consecutive times). This consensus will help standardize research on this important problem.
METHODS: V-expert opinion.

Diabetes-related foot disease is a serious and common complication for people with diabetes mellitus. The gold standard care for a person with diabetes-related foot disease is the involvement of a multidisciplinary foot team engaged in evidence-based care. To date, there are seven International Working Group on the Diabetic Foot (IWGDF) guidelines published to assist healthcare providers in managing diabetes-related foot disease around the world. This review discusses the acute management of diabetes-related foot infection with insights from experts of various specialities (internal medicine, infectious disease, vascular surgery, radiology) with a discussion on the implementation of IWGDF guidelines in real life practice and the challenges that healthcare providers may face.

Best Practice Guidelines (BPGs) were published one decade ago to decrease surgical site infection (SSI) in pediatric spinal deformity. Successful implementation has not been established. This study evaluated surgeon compliance with items on the BPG. We hypothesized that BPG authors and surgeons with more experience, higher caseload, and awareness of the BPG would have higher compliance.
We queried North American and European surgeons, authors and non-authors, and members of various spine study groups on adherence to BPGs using an anonymous survey. Mean compliance scores (MCSs) were developed by correlating Likert responses with MCSs (\"None of the time\" = no compliance = MCS 0, \"Sometimes\" = weak to moderate = MCS 1, \"Most of the time\" = high = MCS 2, \"All the time\" = perfect = MCS 3).
Of the 142 respondents, 73.7% reported high or perfect compliance. Average compliance scores for all guidelines was 2.2 ± 0.4. There were significantly different compliance scores between North American and European surgeons (2.3 vs 1.8, p < 0.001), authors and non-authors (2.5 vs. 2.2, p = 0.023), and surgeons with and without knowledge of the BPGs (2.3 vs. 1.8, p < 0.001). There was a weak correlation between BPG awareness and compliance (r = 0.34, p < 0.001) and no correlation between years in practice (r = 0.0, p = 0.37) or yearly caseload (r = 0.2, p = 0.78) with compliance.
Compliance among our cohort of surgeons surveyed was high. North American surgeons, authors of the BPGs and those aware of the guidelines had increased compliance. Participation in a spine study group, years in practice, and yearly caseload were not associated with compliance.
Level V-expert opinion.

UNASSIGNED: To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use of guideline-based practices and how to ensure their ongoing use. The aim of this study was to identify the determinants and knowledge translation interventions (KTIs) influencing ongoing use of selected recommendations of an institutional pain policy and protocol over time from an organizational perspective and 10 years post implementation on two units within an acute care setting.
UNASSIGNED: We conducted a mixed methods case study guided by the Dynamic Sustainability Framework of an EBP 10 years post implementation. We examined protocol sustainability at the nursing department and unit levels of a multi-site tertiary center in Canada. Data sources included document review (n = 29), chart audits (n = 200), and semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level.
UNASSIGNED: We identified 32 sustainability determinants and 29 KTIs influencing ongoing use of an EBP in acute care. Three determinants and eight KTIs had a continuous influence in all three time periods: implementation phase (0-2 yrs), sustained phase (>2-10 yrs.), and at the 10-year mark. Implementation of KTIs evolved with the level of application (e.g., department vs. unit) to fit the EBP within the context highlighting the need to focus on determinants influencing ongoing use. Sustainability was associated with continual efforts of monitoring and providing timely feedback regarding adherence to recommendations. KTIs used to embed recommendations into routine practices/processes positively influenced high adherence rates. Use of a participatory approach for implementation and sustainment and linking KTIs designed to incrementally address low adherence rates facilitated sustainment.
UNASSIGNED: This research provides insight into the relationship between implementation and sustainability determinants and related KTIs during implementation and sustained use phases. Unique determinants identified by department and unit nurses reflect their different perspectives toward the innovation based on their respective roles and responsibilities. KTIs fostered changed behaviors and facilitated EBP sustainment in acute care. Findings confirm the concept of sustainability is a dynamic \"ongoing process.\"

OBJECTIVE: To evaluate the effect of a guidelines-based best practice alerts (BPA) in the electronic health record (EHR) on adherence to American Urological Association (AUA) vesicoureteral reflux (VUR) guidelines.
METHODS: Retrospective cohort study of patients aged 0-17 years old with primary VUR with an initial urology clinic visit the year before or year after BPA implementation was done. Primary outcomes include obtaining vital signs, urinalysis, and ultrasound at initial and 1-year follow-up visit.
RESULTS: We identified 123 patients with initial visits during the study period, 58 of whom returned for 1-year follow-up visits. Patients seen post-BPA were more likely to have height measured at initial visit than those seen pre-BPA (47.3% vs. 11.8%, p < 0.001). The majority of patients were screened with weight (98.3%) and ultrasound (87.9%) at 1-year follow-up both before and after BPA implementation. Neither blood pressure measurements (59.1% vs. 55.6%, p > 0.5) nor urinalysis orders (23.8% vs. 19.4%, p > 0.05) significantly increased post-BPA.
CONCLUSIONS: The use of an EHR-based BPA increased the likelihood of obtaining height measurements by clinic intake staff but did not significantly affect provider adherence to other practice guideline recommendations. Our findings suggest that BPA implementation alone is not sufficient to impact provider uptake of VUR guideline recommendations.

OBJECTIVE: To summarize recommendations from available evidence-based guidelines that enhance, address or guide antiretroviral therapy adherence among adult persons living with human immunodeficiency virus.
METHODS: An integrative literature review approach.
METHODS: Guidelines were accessed through Google from the databases of the Canadian Medical Association InfoBase clinical practice database, National Guidelines Clearinghouse, Writer\'s Guidelines database, the National Institute for Health and Clinical Excellence, UNICEF and WHO. Databases such as PubMed, Google Scholar, EBSCOhost (CINAHL, ERIC, Academic search complete, E-journals, Psych Info and MEDLINE), EMERALD INSIGHT, JSTOR, SCIENCE DIRECT and FINDPLUS were also searched, followed by a citation search. Data sources were searched between 1996 and January 2022.
METHODS: The five steps of the integrative literature review process, as described by Whittemore and Knafl, were used. These steps are as follows: step one; problem identification, step two; literature search, step three; data evaluation; step four: data analysis and the final step was data presentation.
RESULTS: Sixteen guidelines related to antiretroviral therapy adherence were included for data extraction and synthesis. The findings revealed two themes as follows: theme 1: monitoring antiretroviral therapy adherence and theme 2: interventions to promote antiretroviral therapy adherence related to education and counselling, adherence tools, health service delivery and antiretroviral strategies.
CONCLUSIONS: Antiretroviral therapy adherence in adult persons requires both interventions as well as monitoring. The various contributing factors relating to antiretroviral therapy adherence should be further explored.
CONCLUSIONS: Evidence from the included guidelines can assist nurses in promoting a person\'s adherence to antiretroviral treatment, which could improve their health and well-being.

OBJECTIVE: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people.
METHODS: Review of evidence since 2010 using a systematic and consensus approach is performed.
RESULTS: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines.
CONCLUSIONS: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.

Best practice guidelines (BPGs) exist for operating theatre (OT), but strategies to implement them are lacking. To address the gap, an integrative review was undertaken to identify strategies which can be used to implement BPGs in OT. This article aimed to summarise the best existing literature in order to identify and describe strategies for the implementation of BPGs in OT. An extensive search was undertaken to include relevant literature from February 2005 to March 2020 using the following databases: CINAHL, Medline, Biomed Central, Academic Search Complete and Health Source: Nursing/Academic Edition (EBSCOhost) and the Cochrane library. This integrative literature review followed the methodology proposed by Whittemore and Knafl, namely: (1) identification of the research problem, (2) search of the literature, (3) evaluation of the data, (4) analysis of the data and (5) presentation of the results. On completion of the critical appraisal, 15 (n = 15) articles met the inclusion criteria and relevant data were synthesised. The review identified six strategies facilitating implementation of BPGs in OT, namely, communication, education materials and mass media, academic detailing, opinion leaders, audit and feedback, and teamwork and collaboration. The review validated strategies for the implementation of BPGs in OT. Implementation of BPGs is essential to both provide and improve patient care and to benefit health outcomes. This review is expected to contribute to the provision of strategies to implement BPGs in OT.