Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ. 2015;350. https://doi.org/10.1136/bmj.h391. In exercising the discretion under section 114(1)(d) the court must have regard to the following (and any others it considers relevant): Most of the hearsay provisions apply equally to the defence and the prosecution, with the added safeguard for the defendant that any matters requiring proof must be proved to the criminal standard by the prosecution and on a balance of probabilities by the defence. Sarkies MN, White J, Morris ME, Taylor NF, Williams C, O’Brien L, Martin J, Bardoel A, Holland AE, Carey L, et al. Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol. Implement Sci. 2018;13(1):60. Hearsay is not explicitly defined in the CJA but the opening words of s.114(1) taken together with s.115(3) effectively define it as a representation of fact or opinion made by a person, otherwise than in oral evidence in the proceedings in question, when tendered as evidence of any matter stated therein. Statement

Two potential priority health contexts for the implementation of research evidence in practice are ‘management of community-acquired pneumonia’ and ‘nutrition in critically ill patients’. Community-acquired pneumonia is the second highest cause of mortality globally [ 26]. Evidence suggests that corticosteroid therapy may reduce mortality, need for mechanical ventilation, hospital length of stay, time to clinical stability, and severe complications [ 27, 28, 29]. Despite these findings, poor adherence to guidelines for the use of corticosteroids to treat community-acquired pneumonia has been reported [ 9, 30]. A second health context where current practice does not always align with the most contemporaneous research is nutrition in critically ill patients. Despite guidelines recommending the provision of early enteral nutrition for critically ill patients [ 31, 32, 33, 34, 35], many do not receive adequate nutritional support [ 34, 35, 36]. Siemieniuk RC, Meade MO, Alonso-Coello P, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(7):519–28.R was charged with murdering his wife. She had called 999 and said Get me police please. Operator described her voice as hysterical and she was sobbing. See section 127 below for the special rules governing the use by an expert witness of documents prepared for criminal proceedings. Police officers gave evidence of offers of sexual services made to them by women at a massage parlour. For a study with three levels of context and implementation strategy, a sample size of 50 clusters (unit of randomisation) per group (150 clusters total) would provide 80% power at a 0.05 significance level with a two-sample paired-proportions test adjusted for the relative efficiency of within-cluster designs examining a pairwise contrast between two levels of implementation strategy across all three contexts, under the assumption that 60% of those in an intervention group align with the desired practice change and 40% in the control group. This process begins with a sample size of 107 clusters (unit of randomisation) across 3 levels of context and implementation strategy levels, generating 321 cluster-level outcome measurement observations. In this first step, a power analysis for a two-sample paired-proportions test examining a pairwise contrast between two levels of implementation strategy across all three contexts would provide 80% power at a 0.05 significance level, under the assumption that 60% of those in an intervention group align with the desired practice change and 40% in the control group. In the second step, adjustment for the relative efficiency (RE) of repeated measures in a counterbalanced design can be performed using the formula: RE = 0.5[(1 − Pc − p)/(1 + ( n − 1) p)], where n is the number of units within each cluster across periods, p is the intra-class correlation coefficient (ICC) between units in the same cluster at the same time point, and Pc is the the inter-period correlation [ 49, 50]. One unit within each cluster across three periods, an assumed ICC of 0.001 between units and an inter-period correlation of 0.0442, leads to an estimated relative efficiency for crossover in the counterbalanced design of 0.4685. Once the between-cluster sample size is multiplied by the relative efficiency of within-cluster design (107 × 0.4685), this adjustment creates the target study sample size of 50 clusters (unit of randomisation) per group (150 total clusters total). Planning a counterbalanced implementation trial design Thornicroft G, Lempp H, Tansella M. The place of implementation science in the translational medicine continuum. Psychol Med. 2011;41(10):2015–21.

Consideration of hearsay may arise at various stages of the proceedings. Witnesses may become unavailable unexpectedly or a special measures application may be refused. Prosecutors should keep issues of hearsay under continual review and comply with the notice requirements wherever possible. Rules of court Whatever the reason for the absence of the witness, evidence relevant to the credibility or consistency of the maker of the statement may be admitted even where the evidence would not have been admissible had the witness given evidence in person.

Dobbins M, Hanna SE, Ciliska D, Manske S, Cameron R, Mercer SL, O’Mara L, DeCorby K, Robeson P. A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies. Implement Sci. 2009;4(1):1–16. Section 127 allows an expert to rely on a statement prepared by another person and refer to it in their evidence. The exception is subject to the following requirements: