A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland's hospitals.

BACKGROUND: To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. METHODS: We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme's outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme's implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme's outcomes can be explained by the level of implementation. DISCUSSION: This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

Characterization of the polyphenol composition of 20 cultivars of cider, processing, and dessert apples (Malus × domestica Borkh.) grown in Virginia.

Polyphenols and maturity parameters were determined in 20 apple cultivars with potential for hard cider production grown in Virginia, U.S.A. Concentrations of five classes of polyphenols were significantly different across cultivar for both peel and flesh. Total polyphenol concentration ranged from 0.9 µg/g wwb in flesh of Newtown Pippin to 453 µg/g wwb in peel of Red Delicious. Harrison, Granny Smith, Rome, Winesap, and Black Twig cultivars contained the highest concentration of total flavan-3-ols in flesh, indicating potential to impart desired astringency and bitterness to cider under processing conditions where extraction of polyphenols from peel is minimal. These results can inform selection of fruit juice, extracts, and byproducts for investigations of bioactivity and bioavailability of polyphenols, and provide baseline data for horticultural and processing research supporting the growing hard cider industry in Virginia. Based on these data, cultivars Harrison, Granny Smith, Rome, Winesap, and Black Twig show high potential for cider production in Virginia.