In addition, we purposefully aimed to include a mix of teaching status and ICU types as these factors can influence nutrition practice. Participating ICUs were recruited through an international ICU network for quality improvement. www.selleckchem.com/products/lapatinib.html Of the 179 ICUs, 14 sites met the inclusion Inhibitors,Modulators,Libraries criteria. An invite to participate in the PERFECTIS study was sent to all 14 eligible ICUs, and of these, 7 accepted. Three of these ICUs were geographically separate units in 1 hospital, but because of common infrastructure and staffing they developed and implemented one tailored action plan for all 3 units. Reasons for non participation included the contact person no longer working in the ICU, lack of infrastructure to support research, inadequate time to dedicate to the study, and competing research studies.

Characteristics of participating ICUs are shown in Table 2, reflecting a range of sizes, closed and open structures, teaching and non teaching institutions and 2 health care systems. An interdisciplinary local guideline implementation team consisting of the ICU dietitian, attending physician, Inhibitors,Modulators,Libraries and Inhibitors,Modulators,Libraries a nurse was formed at each site. Team members self identified as local nutrition opinion leaders. The local teams were responsible for study coordination, data collection, and implementing the tailored intervention. Intervention The overall design of the intervention was informed by Graham et als Knowledge to Action model which describes the necessary steps for implementation of knowledge.

The barriers assessment was guided by our previously Inhibitors,Modulators,Libraries developed framework for understanding barriers to critical care nutrition guideline recommendations, and the approach to addressing identified barriers was informed by the Barriers Identification and Mitigation Tool developed by Gurses et al. In addition, in designing the intervention we were cognizant of the feedback from participants of a previous cluster RCT evaluating nutrition guideline implementation conducted by our research group and existing literature on tailoring interventions to overcome barriers. The components of Inhibitors,Modulators,Libraries the intervention are described in Table 3. Several of the change strategies were common across participating sites. The main component of the intervention was the development and implementation of an Action Plan tailored to local barriers. These plans aimed to address both individual and organizational barriers amenable to change rather than non modifiable barriers.

The development and implementation of these site specific tailored Action Plans have been described elsewhere and are summarized in Figure 1 Study Schema. In brief, following an audit of nutrition practices to identify guideline practice gaps at each site and the distribution of the barriers to feeding Regorafenib structure critically ill patients questionnaire to all full and part time ICU physicians, managers, dietitian and nurses.