A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing

Abstract Background Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications) was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers. Methods Two phase mixed methods design is proposed (ISRCTN 12345678). Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers) will evaluate differences in outcomes between two implementation strategies. Primary outcome: Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations. Intervention: In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a) printed materials, b) one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c) three post-workshop teleconferences. Discussion This study will provide vital information on which leadership strategies are well received to facilitate and support guideline implementation. The anticipated outcomes will provide information to assist with effective management of foot ulcers for people with diabetes. By tracking clinical outcomes associated with guideline implementation, health care administrators will be better informed to influence organizational and policy decision-making to support evidence-based quality care. Findings will be useful to inform the design of future multi-centered trials on various clinical topics to enhance knowledge translation for positive outcomes. Trial Registration Current Control Trials ISRCTN0691089

Rapid turnover in site occupancy of a pond-breeding frog demonstrates the need for landscape-level management

Habitat loss and habitat isolation have contributed to declines in the green and golden bell frog (Litoria aurea) over much of its former range in south-eastern Australia. Understanding the parameters critical for the persistence of extant populations is required to halt further declines. We assessed waterbody occupancy in a local network of potential L. aurea breeding habitats on Kooragang Island, Australia, by conducting surveys over two years (2000 and 2001) at 30 waterbodies, and using site-occupancy models. The probability that a waterbody was used by L. aurea in 2000 increased with increasing waterbody area, and decreasing distance to the nearest waterbody where L. aurea was detected and where reproductive recruitment was observed. Large waterbodies where high numbers of L. aurea were detected in 2000 were more likely to be used in 2001. The probability that a waterbody used in 2000 was not used in 2001 (i.e., turnover) decreased with increasing waterbody area and increasing numbers of L. aurea detected at the site in 2000. Our results demonstrate the potential for frog abundance, immigration, and recruitment to reduce local turnover. We recommend that conservation strategies for extant populations of L. aurea protect mosaics of wetland habitat and maintain connectivity among waterbodies

Changes in forest area along stream networks in an agricultural catchment of the Great Barrier Reef Lagoon

Scenes from the series of multispectral sensors on the Landsat satellites were used to map recent changes (between 1972 and 2004) in forest cover within and adjacent to stream networks of an intensively farmed region of the southern Great Barrier Reef catchment (Australia). Unsupervised ISODATA classifications of Tasseled-Cap transformed data (at 57 m ground resolution) mapped forest and cleared areas within 150 m of Pisoneer catchment waterways with 72.2% overall accuracy (K = 0.469), when adjusted for the size of each class. Although the user's accuracy was higher for the forest class (82.1 ± 8.4% at α = 0.05), large errors of commission (34.2 ± 8.3%) substantially affected map accuracy for the cleared class. The main reasons for misclassification include: (1) failure to discriminate narrowly vegetated riparian strips; (2) misregistration of scenes; and (3) spectral similarity of ground cover. Error matrix probabilities were used to adjust the mapped area of classes, resulting in a decline of forest cover by 12.3% and increase of clearing by 18.5% (22.4 km change; 95% confidence interval: 14.3-29.6 km ) between 1972 and 2004. Despite the mapping errors, Landsat data were able to identify broad patterns of land cover change that were verified from aerial photography. Most of the forest losses occurred in open forest to woodland habitat dominated by Eucalyptus, Corymbia, and Lophostemon species, which were largely replaced by sugarcane cropping. Melaleuca communities were similarly affected, though they have a much smaller distribution in the catchment