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

Genetic and physiological studies on potassium and nitrogen uptake and utilization in wheat

Experiments were undertaken to examine the extent of variation for potassium and nitrogen uptake and utilization in wheat and also to address some issues of relevance to the improvement of these traits. These issues included the inheritance of these traits and the difficulties that could arise due to (1) the methodology that is used to measure ion fluxes and utilization, (2) ontogenetic variation in the expression of these traits, and (3) the growth stage at which nutrient utilization is evaluated. To compare varieties developed during different periods in the history of wheat breeding, the varieties were assigned to five groups on the basis of height and origin. Nutrient fluxes were measured either as average net fluxes or short-term net fluxes. Nutrient utilization was expressed as shoot fresh weight per plant, efficiency ratio or utilization efficiency. Substantial variation was observed for all traits except potassium and nitrogen efficiency ratios. Although short-term net potassium fluxes were negatively correlated with root potassium concentration, some of the differences in flux were not associated with differences in root potassium concentration. These differences must therefore be heritable. Due to the complexity of the regulation of nitrate uptake, genotypic differences in short-term net nitrate flux were not examined in relation to root nitrate concentration. Therefore, some of the variation in nitrate flux could be due to differences in root nitrate concentration or some other factor(s) which regulates nitrate uptake. Significant differences between groups were also observed. The tall varieties had the highest potassium and nitrate fluxes but were not significantly different from the triple dwarfs. The double dwarfs were the poorest performers for both nutrient uptake and utilization. In general, the tall traditional varieties were more vigorous and hence showed the highest shoot weight per plant and utilization efficiencies. These findings are examined in relation to the contention that plant breeding under high fertility conditions may have resulted in a decline in the ability of plants to acquire and utilize mineral nutrients. The inheritance of short-term net potassium flux, shoot weight per plant, potassium efficiency ratio and potassium utilization efficiency was studied in four crosses. Complex modes of inheritance were observed for all the traits. For one of the crosses significant reciprocal effects were observed for shoot weight per plant, efficiency ratio and utilization efficiency. Narrow sense heritabilities for the two traits most likely to be selected for, namely short-term net potassium flux and shoot weight per plant, indicated that selection for these traits should be carried out amongst families rather than amongst single plants. Diallel analysis for nitrate uptake and utilization indicated that both additive and dominance gene effects are important in the determination of these traits. The effect of developmental changes in potassium uptake and utilization on varietal comparisons and genetic studies was investigated by comparing the performance of six varieties at different stages of growth over a five-week period. The rankings of the varieties for short-term net potassium flux and shoot weight per plant were found to be fairly consistent. Correlations between average net fluxes for different time periods as well between short-term and average net fluxes were poor. These findings indicate that selection for differences in uptake should be based on fluxes obtained from solutions identical in concentration to the growth solution rather than on perturbation fluxes obtained by depletion of a solution much more concentrated than the growth solution. All measures of potassium utilization based on vegetative growth were poorly correlated with performance at the adult stage. Significant negative rank correlations between shoot fresh weight per plant and grain weight per plant were obtained most likely due to differences in harvest index. This finding casts some doubt on the usefulness of vegetative measures of nutrient utilization as indicators of nutrient-use efficiency for a crop in which the economic product consists of grain.Science, Faculty ofBotany, Department ofGraduat

Biotechnology and Sustainable Crop Production in Zimbabwe

This case study of Zimbabwe has examined developments in biotechnology against the background of a welldeveloped national agricultural research, plant breeding and seeds system. It has then assessed the constraints to biotechnology research, technology development and diffusion in the light of the resources available and the technology transfer mechanisms in place for different groups of farmers. The study concludes that, in the case of Zimbabwe's large-scale commercial farmers, the transfer of biotechnology applications will be determined essentially by their economic advantage over techniques currently in use. In the case of the small-scale and communal areas farmers, it is unlikely that biotechnology innovations — particularly when delivered as seed — would be adopted unless special policy measures to address the problems of seeds supply, are taken ... Cette étude de cas examine les progrès des biotechnologies au Zimbabwe, pays dans lequel la recherche agronomique, la sélection végétale et la production de semences améliorées sont bien développées. Les obstacles à la recherche en biotechnologie, au progrès technique et à sa diffusion sont évalués, notamment du point de vue des ressources disponibles et des mécanismes de transfert technologique vers les diverses catégories d'agriculteurs. Dans le cas des grandes exploitations agricoles du Zimbabwe qui commercialisent leur production, les applications des biotechnologies seront adoptées principalement si leur avantage comparatif économique est supérieur à celui des techniques actuellement utilisées. En revanche, il est peu probable que les innovations des biotechnologies (notamment sous forme de semences) soient adoptées par les petits paysans et les exploitants de terres communautaires, si des mesures spécifiques ne sont pas prises pour résoudre les problèmes d'approvisionnement ...

Understanding Education Graduate Students’ Experience with Publication

Graduate students are expected to participate in the publication process; however, graduate programs often do not provide formal training for students to engage in this scholarly work. Engaging in the publication process could be overwhelming for students if neither proper training nor mentorship is provided. Concerningly, there are few studies examining how to engage graduate students in the publication process, leading to limited directions for graduate programs to better mentor their students to publish. In consideration of these gaps, a peer-reviewed journal, operated by and for graduate students in education, undertook a research study to survey graduate students’ experience with publication. The participants were education graduate students from a Canadian university. They completed an online survey and indicated barriers they faced that prevented them from publishing and what helped them to engage in the publication process. The authors conducted a preliminary summative content analysis on the participants’ responses, which revealed that not knowing how and where to begin the publication process was one of the common barriers to publishing, while the presence of a mentor facilitated engagement in publishing