24 Chapter 2 strategies or using a combination of strategies from different EPOC categories was assessed using the Mann-Whitney U test. For comparable groups of similar guidelines with similar outcomes (at least 3 studies), the median relative change was assessed and related to the use of EPOC category implementation strategies alone or to the use of a combination of strategies from different EPOC categories. Results Study selection The initial search strategy and the cross-reference check yielded a total of 17058 records. After 8539 duplicates were removed, 8519 abstracts were assessed for eligibility. Twohundred-and-five full-text records remained and were assessed for eligibility, after which eventually 54 records, regarding 53 unique studies, were included for the synthesis' (Figure 1 Flow diagram for identification, screening and eligibility according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol). Study characteristics Study design, setting and guideline topic The 54 papers described 53 unique implementation studies on 21 guideline topics. Fifteen had a controlled before-after, randomized controlled trial or cluster randomized controlled trial design; 38 studies (71.7%) had a before-after design. Most studies were conducted in western countries (USA n=10, Netherlands n=9, Australia n=8). Half of the studies were performed in a single centre (n=27, 50.9%). Most of the guidelines regarded skin care (n=9) and infection prevention (n=7). Two studies addressed the implementation of a combination of several guidelines, respectively six [24] and three [25, 26]. The most studied setting was a hospital (n=34, 64.2%), followed by a nursing home (n=11), general practice (n=5), home care (n=2), and inpatient rehabilitation centre (n=1). Table 1 Study characteristics broken down by guideline topic shows the study characteristics of the included studies, Supplement 2 provides a more detailed description of the included studies.
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