Implementation science in adolescent healthcare research: an integrative review.

BACKGROUND: Multiple theories, models and frameworks have been developed to assist implementation of evidence-based practice. However, to date there has been no review of implementation literature specific to adolescent healthcare. This integrative review therefore aimed to determine what implementation science theories, models and frameworks have been applied, what elements of these frameworks have been identified as influential in promoting the implementation and sustainability of service intervention, and to what extent, in what capacity and at what time points has the contribution of adolescent consumer perspectives on evidence implementation been considered.  METHODS: An integrative design was used and reported based on a modified form of the PRISMA (2020) checklist. Seven databases were searched for English language primary research which included any implementation science theory, model or framework developed for/with adolescents or applied in relation to adolescent healthcare services within the past 10 years. Content and thematic analysis were applied with the Consolidated Framework for Implementation Research (CFIR) used to frame analysis of the barriers and facilitators to effective implementation of evidence-informed interventions within youth health settings. RESULTS: From 8717 citations, 13 papers reporting 12 studies were retained. Nine different implementation science theories, frameworks or approaches were applied; six of 12 studies used the CFIR, solely or with other models. All CFIR domains were represented as facilitators and barriers for implementation in included studies. However, there was little or no inclusion of adolescents in the development or review of these initiatives. Only three mentioned youth input, occurring in the pre-implementation or implementation stages. CONCLUSIONS: The few studies found for this review highlight the internationally under-developed nature of this topic. Flagging the importance of the unique characteristics of this particular age group, and of the interventions and strategies to target it, the minimal input of adolescent consumers is cause for concern. Further research is clearly needed and must ensure that youth consumers are engaged from the start and consistently throughout; that their voice is prioritised and not tokenistic; that their contribution is taken seriously. Only then will age-appropriate evidence implementation enable innovations in youth health services to achieve the evidence-based outcomes they offer. TRIAL REGISTRATION: PROSPERO 2020 CRD42020201142 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201142

Abnormal Glucose Tolerance in Cystic Fibrosis and the Role of Low Glycaemic Index Diets

Abnormal glucose metabolism states have increased in prevalence in cystic fibrosis (CF). Hypoglycaemia without glucose lowering therapies is a novel complication, with no unifying definition or hypothesis for its aetiology. Thus optimal management strategies for discomforting symptoms remain unclear. Furthermore, there is little evidence for what might prevent progression of impaired glucose tolerance in CF and modifiable factors such as dietary intake in abnormal glucose tolerance may be useful. Five studies were conducted in this thesis: 1) a systematic review of hypoglycaemia in CF in the absence of glucose lowering therapies; 2) a review of an adult CF clinic describing the prevalence of hypoglycaemia on an oral glucose tolerance test (OGTT) and in free-living situations; 3) an extended OGTT study exploring hormonal responses to and the prevalence of post-prandial hypoglycaemia; 4) a study utilising a semi-structured questionnaire and continuous glucose monitoring (CGM) to report on the prevalence of hypoglycaemia in free-living states; 5) a study describing diet quality and the relationship between dietary intake, including dietary glycaemic index (GI) and glucose load (GL), and glucose dysmetabolism using CGM. The systematic review found hypoglycaemia in the absence of glucose lowering therapies occurred during OGTT and CGM. Hypoglycaemia was confirmed on OGTTs and a sub-group of participants reported symptoms suggestive of hypoglycaemia in free-living states. The prevalence of hypoglycaemia may be unmasked by extension of the OGTT out to 3 hours. Abnormal insulin release appears to have a role in its aetiology. The semi-structured questionnaire and CGM confirmed episodes of hypoglycaemia in free-living situations. A detailed food record and formal dietary analysis provided some support for a correlation between dietary GI, GL and glycaemic response variables on CGM. These studies provide empirical support for randomised controlled trials of dietary intervention in CF related glucose dysmetabolism