IntroductionSuccessful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated.MethodsDescriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample.ResultsWe obtained 831 completed questionnaires, an average response rate of 39% (range: 22–77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach’s alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89).ConclusionsThe NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0591-x) contains supplementary material, which is available to authorized users.

We describe detection in the United Kingdom (UK) of the drug-resistant Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate azithromycin resistance. Two female patients developed infection following contact with UK-resident men from the same sexual network linked to travel to Ibiza, Spain. One case failed treatment with ceftriaxone, and azithromycin and gentamicin, before successful treatment with ertapenem. Both isolates had indistinguishable whole-genome sequences. Urgent action is essential to contain this drug-resistant strain.

Research IntroductionOccupational therapy as a profession is experiencing an increasing need to demonstrate its contribution and perceived effectiveness across practice settings by examining clients ' and carers' views (Bannigan et al 2008). Alongside client perspectives, the commissioning consortia need to be convinced that occupational therapy services are valued, otherwise the profession is at risk of losing its funding to outside providers. In the United Kingdom (UK) this situation is becoming critical as health care moves towards Payment by Results and Cluster/Pathway-based commissioning (Department of Health [DH] 2010a, DH 2010b). Identifying existing practice and the effectiveness of occupational therapy in mental health is therefore crucial.This research article presents the first qualitative research synthesis (QRS) undertaken to identify the types of interventions used by occupational therapists internationally, from the perspective of clients, carers, and occupational therapists, respectively. Detail is included on how the synthesis process was conducted. The main findings are discussed in relation to four themed areas and recommendations for practice, policy, and the commissioning of occupational therapy services are suggested.A qualitative research synthesis examining the effectiveness of interventions used by occupational therapists in mental health Key words:Qualitative research, synthesis, effectiveness. Introduction:To date, a range of qualitative studies have been undertaken in intervention effectiveness, but none has synthesized such studies within the occupational therapy mental health literature. This research article presents a qualitative research synthesis that identifies those interventions used by occupational therapists, internationally, which are viewed as effective from both clients' and carers' perspectives.Method: Qualitative research synthesis was used to analyse, synthesize, and interpret results from qualitative studies. Twenty-two studies, collectively capturing client, carer, and occupational therapists' perspectives, were synthesized by the research team.Findings: The findings identified four themes, which indicated that the occupational therapist needs to exhibit professional artistry, facilitate occupational engagement, pace occupation to support the achievement of client goals and new horizons; and also recognized the importance of inclusion that promotes client participation and a sense of belonging in a range of socio-cultural contexts.Conclusion: The use of occupational interventions that provide space for healing, self-rediscovery, identity formation, and community participation, were valued more than short, psychological-based interventions focused on case management and the assessment of mental stability, which were seen as superficial in scope. Occupational therapists need to demonstrate an authentic therapeutic relationship that is built upon care, trust, and respect, in order for interventions to have impact.

This paper introduces the 'Guidelines for Occupational Therapists working with people with Huntington's disease' which is currently being developed by the European Huntington's Disease Network (EHDN) Standards of Care Occupational Therapists working group. This article aims to describe the everyday functional problems experienced by people with Huntington's disease, the role of the occupational therapist, the systematic literature review which preceded the formulation of the guidelines and use excerpts from the guideline to illustrate some of the issues raised.