ArticleImplementation science : IS2015
The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis.
Article in Implementation science : IS, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 27 citations in OpenAlex.
- A pragmatic cluster randomised controlled trial of a tailored intervention to improve the initial management of suspected encephalitis.PloS one · 2018Trial
- Implementation science promotes clinical practice of guidelines: a scoping review.BMC health services research · 2025Article
- Article
- Identifying barriers and enablers to rigorous conduct and reporting of preclinical laboratory studies.PLoS biology · 2023Article
- Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study.BMC health services research · 2022Article
- Evaluation of implementation of risk management guidelines for carriers of pathogenic variants in mismatch repair genes: a nationwide audit of familial cancer clinics.Familial cancer · 2020Article
- Instant Gratification as a Method to Promote Physician Practice Guideline Adherence: A Systematic Review.Cureus · 2020Review
- A 9-month retrospective evaluation of the aetiology and management of patients presenting with encephalitis/meningoencephalitis at a South London hospital.Epidemiology and infection · 2020Article
- Neuropsychological and psychiatric outcomes in encephalitis: A multi-centre case-control study.PloS one · 2020Article
- Article
- Using behaviour change and implementation science to address low referral rates in oncology.BMC health services research · 2018Article
- A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems.Implementation science : IS · 2017Article
- Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals.Implementation science : IS · 2017Article
- A qualitative study to understand guideline-discordant use of imaging to stage incident prostate cancer.Implementation science : IS · 2016Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundCentral nervous system infections can have devastating clinical outcomes if not diagnosed and treated promptly. There is a documented gap between recommended and actual practice and a limited understanding of its causes. We identified and explored the reasons for this gap, focusing on points in the patient pathway most amenable to change and the development of a tailored intervention strategy to improve diagnosis and treatment.
methodsUsing theoretically-informed semi-structured interviews, we explored barriers and enablers to diagnosing and managing patients with suspected encephalitis, specifically performing lumbar punctures and initiating antiviral therapy within 6 h. We purposively sampled hospitals and hospital staff in the UK. We audio recorded and transcribed all interviews prior to a framework analysis. We mapped identified barriers and enablers to the patient pathway. We matched behaviour change techniques targeting clinicians to the most salient barriers and enablers and embedded them within an intervention package.
resultsWe interviewed 43 staff in six hospitals. Clinical staff expressed uncertainty when and how to perform lumbar punctures and highlighted practical difficulties in undertaking them within busy clinical settings. Once treatment need was triggered, clinicians generally felt able to take appropriate therapeutic action, albeit within organisational and resource constraints. Matched behaviour change techniques largely targeted antecedents of treatment. These included decision support to prompt recognition, highlighting the consequences of missed diagnoses for clinicians and patients, and practical support for lumbar punctures. We subsequently devised an evidence-informed package comprising 'core' interventions and, to allow for local flexibility, 'optional' interventions.
conclusionsWe identified several points in the patient pathway where practice could improve, the most critical being around clinical suspicion and initial investigation. Interventions targeting professional beliefs and behaviours whilst optimising their clinical environment were amongst the most promising approaches to improve the care of suspected encephalitis.
trial registrationRandomised trial registered with Controlled Trials ISRCTN06886935 .
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.