Patients with a contraindication to EN were excluded from the analysis. Days without EN or days with parenteral nutrition were included and counted as 0% adequacy. Days following permanent progression to exclusive oral intake were excluded from the calculation of total and enteral nutrition adequacy. To account for the confounding Enzalutamide prostate cancer effect of duration of nutrition Inhibitors,Modulators,Libraries exposure, the Inhibitors,Modulators,Libraries prescribed calories received by each patient was adjusted for evaluable nutrition days. Statistical analyses were completed using SAS v9. 1. 3. All tests were two sided with statistical significance considered as a P value 0. 05. Institutional ethics approval was obtained, and the need for informed patient and staff consent was waived by the Health Sciences Research Ethics Board at Queens University, Kingston, ON and the 5 participating hospitals.

Results All 5 participating ICUs successfully completed data collection at baseline and follow up, and developed and implemented Inhibitors,Modulators,Libraries a tailored action plan. Table 1 outlines our assessment of feasibility as determined by our a priori evaluation criteria. We determined that we were able to engage ICU staff to participate in the study, and that they were competent at prioritizing barriers and developing a tailored action plan. All sites created a local guideline implementation team. However, at site 4 the team was not multidisciplinary being composed of 2 dietitians. Overall, the number of team members at each site ranged from 2 to 10 individuals. On average 37 barrier questionnaires were completed by ICU staff at each site for a mean response rate of 46%.

Two sites did not achieve a minimum of 35 responses or an overall response rate of 50% at Site 2 and 29 73 at Site 4, respectively. Inhibitors,Modulators,Libraries Table 4 presents the primary and secondary analyses of compliance with the action plans. Across the 5 sites the developed action plans consisted of either 7 or 8 action items, each site identified 1 item that was non modifiable with a progress rank of 0, with the exception of site 2 that identified 2 such items. The median progress rank was 4 indicating implementation 100% complete. For the secondary evaluation, omitting non modifiable barriers, the ability of sites to successfully implement their action items varied from achieving a 4 or 5 progress rank for 1 of the 6 action items at Site 3, to 6 out of 7 action items at Sites 1 and 5.

However, at the time of follow up data collection, several sites had partially implemented action items and Inhibitors,Modulators,Libraries their efforts to complete implementation PS-341 were ongoing. The questionnaire evaluating the implementation of the action plans was completed by 82 nurses. Eighty percent of respondents knew all members of the local guideline implementation team, and 59% had discussed nutrition with these members on a daily or weekly basis.