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The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings.

Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey.

The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system.

The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue.

Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues.

Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

The purpose of this paper is to evaluate the efficacy of good lives model (GLM) interventions on the recidivism outcomes of convicted offenders.

The review adhered to preferred reporting items for systematic reviews and meta-analysis and Cochrane guidelines. Digital databases were searched and articles reporting outcomes of the GLM amongst convicted offenders and outcomes including recidivism data and pre-post measures of dynamic risk were included in a narrative synthesis.

Of 1,791 articles screened, only six studies met the criteria for review. Key findings were: in half the reviewed studies, GLM did not increase recidivism risk; in half the reviewed studies, only when the correct treatment dosage was applied that some evidence of risk reduction was found; there was limited support for GLM increasing or sustaining motivation for resistance from reoffending. Research for the review was limited and support for the GLM in reducing recidivism rates was not established.

In this 2021 review, the authors examined the efficacy of the GLM in reducing recidivism. This addresses a gap in the literature. The authors found that there is insufficient evidence to suggest that the GLM can reduce recidivism. This has implications for practitioners who wish to deliver evidence-based practices in prison/community settings. There is currently not enough peer-reviewed evidence to unequivocally confirm the efficacy of the GLM. The authors recommended additional quality programme outcome research be carried out.

To the best of the authors’ knowledge, this study is the first to assess quantitative and qualitative studies on the efficacy of the GLM and provides foundations for future research.

Patients with extended hospital admissions had no recreation facilities in the ward. They were often confined to spaces around their beds, using the ward corridor for rehabilitation. The purpose of this paper is to outline a quality improvement (QI) intervention-provision of a recreational space for long-stay patients.

An exploratory quantitative pre-, post-test design was utilised, and executed in three phases: patients, visitors and staff survey to explore recreation and comfort needs and preferences; store room refurbishment; and patient, visitor and staff satisfaction with the recreation room.

Overall, 77 questionnaires were completed (n=49 staff; n=28 patient/visitor). Almost two-thirds (64.7 per cent; n=11) of patients had a stay greater than six weeks. Insufficient private space and concerns about disturbing other patients were identified as barriers to taking part in activities. Consequently, a store room was refurbished as a recreation room (9.0 m × 6.0 m) and furnished in three distinct areas. Following refurbishment, over 90 per cent (n=24) of respondents agreed that there was a suitable space where patients could “go and chat” and spend time with family and visitors or speak to the healthcare team.

The physical environment in acute hospitals is seldom prioritised. Needs-based QI projects can improve patient hospital experiences.

This case study highlights how nursing staff can be informed by patients’ and families’ needs and preferences, and initiate QI projects that improve patient hospital experiences.

A postal survey to determine UK medical directors’ (n = 491) attitudes on the importance of effectiveness information; their own access, awareness and use of a variety of sources for information on effectiveness, their own use of and views on the perceived usefulness of the Cochrane Library; their attitudes towards their own role in the local application of clinical governance. Respondents reported high levels of awareness and access to a number of sources of clinical/cost effectiveness information. Respondents regularly referred to paper‐based publications more than electronic databases (only 10 per cent regularly referring to the Cochrane Library). Respondents felt that the Cochrane Library could be improved by increasing the number and range of topics and clinical areas covered, and by improving access and availability.

INTRODUCTION Computers and new information technologies have beyond question brought tremendous advancement in information storage and retrieval. In recent years, the traditional card catalog has given way first to the COM (computer output on microform) catalog, then to the online catalog. Now, many libraries are shifting to the new capability in order to provide better and faster services to their patrons.

Recent evidence indicates an increasing incidence of occupational violence (OV) towards paramedics. Body-worn cameras (BWC) have been posited as an intervention that may deter perpetrators, leading to a growing number of ambulance services introducing BWCs at a considerable financial cost. This study aims to investigate the impact of BWC on the incidence of OV towards paramedics.

A systematic review was conducted according to the JBI methodology. EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane reviews, Cochrane Central Register of Controlled Trials, JBI systematic reviews, TROVE and Google Scholar were searched to identify primary research studies reporting on BWCs as an intervention against an outcome of OV incidence. Primary research papers, publicly-accessible government reports, peer-reviewed and grey literature, if published in English, were eligible.

The search identified 152 documents, of which 125 were assessed following the removal of duplicates. Following abstract screening then full-text review, there were no studies available to include in the review.

The introduction of interventions should be supported by evidence and an analysis of associated health economics. There is a need for ambulance services that have implemented BWC initiatives to make evaluation data available publicly for transparent review to inform decision-making elsewhere in the profession.

To the best of the authors’ knowledge, these findings represent the first investigation of BWCs as a strategy to reduce the incidence of OV towards paramedics. They highlight the need to apply research frameworks rigorously and transparently to OV reduction initiatives to ensure paramedics are protected by evidence-based strategies.

What causes the downward trend of real interest rates in major developed economies since the 1980s? What are the challenges of the near-zero interest and inflation rates for monetary policy? What can the policymakers learn from the latest developments in the monetary and interest rate theory? This paper aims to answer these questions by reviewing both basic principles of interest rate determination and recent academic and policy debates.

The paper critically reviews the explanations for the downward trend of real interest rates in recent decades and monetary policy options in a near-zero interest rate environment.

The decline of real interest rates is likely an outcome of multiple technological, social and economic factors including diminished productivity growth, changing demographics, elevated tail-risk concerns, time-varying convenience yields of safe assets, increased global demand for safe assets, rising wealth and income inequality, falling relative price of capital, accommodative monetary policies, and changes in industry structure that alter the investment and saving behaviors of the corporate sector. The near-zero interest rate limits the space of central banks' response to economic crises. It also challenges some conventional wisdoms of monetary theory and sparks radically new ideas about monetary policy.

This survey differs from the existing work by taking a broader view of both economics and finance literature. It critically assesses the economic forces driving the global decline of real interest rates through the lens of basic principles and empirical evidence and discusses the merits and limitations of each proposed explanation. The study emphasizes the importance of a better understanding of economic forces driving diverging trends of corporate investment and saving behaviors. It also discusses the implications of the neo-Fisherism and the fiscal theory of price level for monetary policy in a low interest rate environment.

Food fortification with common kitchen ingredients has been suggested to improve nutritional intake. The purpose of this paper was to systematically review the efficacy of food fortification on calorie and protein intake among older adults.

A systematic search was conducted using Boolean search logic and seven research databases to identify interventions using fortified foods to increase calorie and protein intake among older adults. Ten studies published in English since 1996 were eligible for inclusion. Study quality was evaluated using an adapted Modified Jadad Questionnaire.

Food fortification was associated with increased calorie intake in eight studies, increased protein intake in five studies, and increased body weight in three studies. However, studies were limited by lack of rigor in methodology and small sample sizes.

Food fortification may improve calorie and protein intake, but results are limited by study weaknesses. Additionally, it is unclear whether improved intake results in improved clinical outcomes.

This study examines the collaborative value practices of cause-based social entrepreneurship alliances. We investigate key drivers of value creation in such alliances.

The study utilizes a longitudinal case study design approach involving four northern Italian businesses for investigating the cause-based social alliances.

The study findings suggest that cause-based alliance differ from other business relationships due to social mission of the alliance and orientation of partners to a specific social cause. However, over time involved firm may pursue commercial interests.

The study utilizes a qualitative case study approach to examine the issues. This may have implications on generalizability of study findings. Further, the sample is limited to small firms, which limit its relevance for large firms.

Managers can utilize the study findings to guide the organizing process of a successful cause-based alliance and can implement it with positive outcomes for their firm.

This is one of the first study on the emerging phenomenon of cause-based social alliance. It contributes to the literature on social entrepreneurship. It informs and guides practitioners about motivations and drivers of such alliances.