The new elements which are applied in the intervention group include a tailored safety advice for the parent, an implementation intention filled in by the parent and the discussion of this advice and implementation intention by the CHC professional with the parents using the techniques of motivational interviewing.
Evaluations of recent crises show large variation in the implementation of crisis advice and thus in the quality of outbreak response.
Electronic evidence-based clinical advice has led to increased clinician adherence to clinical practice guidelines in other healthcare professions, and the development and implementation of electronic advice in chiropractic practice could result in similar changes in clinical behaviour [ 52- 54].
A study examining the causes of differences in the implementation of crisis advice showed that among others, the various categories of professionals involved in outbreak control lacked clearly defined measures to monitor the execution of 'key actions' [ 9].
However, while expert opinion espouses the need to apply the "best available evidence" to guide clinical decisions [ 6], the practical implementation of such advice is not often carried through [ 17- 19].
Their advice on modifications had helped her to return to work, but again, implementation of their advice largely rested with the manager, and advised restricted lifting with no apparent indication of when this arrangement should change: 'It's like I had to refer myself to OH - and that's the only time I've got anywhere.
We thank Bo Samuelsson, MD, PhD, Professor, for constructive advice and implementation of this project.
This justifies the implementation of practical dietary advice based on the study findings.
We also thank the medical personnel of the Ugandan Ministry of Health and the MSF field team for their support and technical advice in the implementation of this study.
There is not much evidence from this study of the systematic implementation of healthy lifestyle advice and management of specific risk factors needed to reduce the risk of an initial stroke and the risk of a subsequent stroke.
