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At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

How effective is the computer-based clinical practice guideline?

CONTEXT: The primary prevention of coronary artery disease in patients with diabetes could have a large impact on health care costs and outcomes. Guidelines for improving diabetic health indices are common, but significant challenges exist in implementing them. GENERAL QUESTION: How does integrating an evidence-based guideline into an electronic medical record affect patient care? SPECIFIC RESEARCH CHALLENGE: How can we implement the new guideline-enhanced medical record in a controlled manner and measure its impact on physician satisfaction, diabetes process measures, and the risk for cardiovascular disease? PROPOSED APPROACH: All patients in the University of Washington system have an electronic Web-based medical record. Patients with diabetes will be randomly assigned to a guideline-enhanced or standard electronic medical record. The electronic medical record allows measurement of most clinical process measures and outcomes. Physician satisfaction will be measured by survey. POTENTIAL DIFFICULTIES: Contamination may occur when guideline recommendations are applied to control patients as physicians gain experience with the guideline-enhanced record.

Coronary Disease↗
PubMedDate not supplied

Challenges and opportunities to the design and implementation of chemoprevention trials for prostate cancer.

Since 1991 and the activation of the Prostate Cancer Prevention Trial as well as similar prevention studies in several other organ sites, the interest in prostate cancer prevention has increased substantially. Despite such interest, the challenges to prevention trials-in design, implementation, prioritization, and allocation of resources-are substantial. Simultaneously, there has been an explosion in new targets and agents that may have an effect in the prevention of this disease. In this manuscript, we discuss these challenges to the study of prostate cancer prevention and provide a blueprint for prioritization of future studies.

Adenocarcinoma↗
PubMed1993

Overcoming the barriers to implementation of TQM/CQI in hospitals: myths and realities.

Many health care organizations are attempting to rapidly implement total quality management (TQM) and continuous quality improvement (CQI) philosophies and concepts. In the case of hospitals, a number of issues resulting from traditional organizational design and management practices as well as the characteristics of health care professionals pose significant challenges to rapid implementation. Recognizing and developing strategies to address these challenges, along with realizing that TQM and CQI represent viable processes for conducting organizational "preventive maintenance," may help in changing the focus of quality assessment and enhancement initiatives from processes that are "broken" to processes that should be "fixed" before they "break." This article discusses strategies for overcoming some of the major barriers and challenges to successful TQM and CQI implementation to the hospital setting.

Hospital Administration↗
PubMed2004

Prenatal screening for cystic fibrosis: past, present and future.

Prenatal screening for cystic fibrosis is reviewed. The disease, gene involved, molecular basis of disease, genotype/phenotype correlations and pilot trials are discussed, as well as historical perspectives, background and American College of Medical Genetics/American College of Obstetricians and Gynecologists recommendations. A number of complex challenges to the implementation of cystic fibrosis screening exist, including mutation testing of the cystic fibrosis transmembrane conductance regulator gene (CFTR), as well as laboratory and clinical issues. Current technologies for CFTR testing include reverse dot blots, amplification refractory mutation detection systems, oligonucleotide ligation assays, the Invader assay and NanoChip system. Emerging technologies are also considered, as well as quality assurance measures including analytical and clinical validation, reporting, residual risk calculations and prenatal diagnosis. An even greater challenge is clinical implementation, which focuses upon education and communication, choosing models, reporting, counseling and prenatal diagnosis.

Cystic Fibrosis↗
PubMed1998

Evaluating the Israeli health care reform: strategy, challenges and lessons.

Evaluating the implementation of health care reform provides important information on its effect, as well as a factual basis for deciding upon mid-course modifications. Although researchers in various countries are addressing the impact of reform, only few governments have initiated a structured, planned evaluation to accompany reform efforts. In Israel, the 1995 National Health Insurance Law earmarked 0.1% of the health care budget for research on the law, coordinated by the National Institute for Health Policy and Health Services Research. This paper describes the evaluation strategy of the JDC-Brookdale Institute which is taking part in the research efforts. Implementation of the evaluation strategy and the challenges of evaluating a major reform of the health system are discussed. The evaluation strategy combines elements of formative and summative evaluation using a 'case study' approach which seeks to integrate in-depth understanding of the changing health system and of health care provider's organizational behavior, with a variety of outcome measures. The Israeli case provides support for the proposition that an integrated approach to evaluating health reform provides a better understanding of the subject under review and thus a better basis for making useful recommendations to policy makers. In addition, such an approach enhances the validity and credibility of the data and thus the probability of making an impact, which is a main objective of formative evaluation. Examination of the Israeli case, provides important insights about evaluation of health system reform, and may benefit researchers in other countries attempting to evaluate health care reform.

Evaluation Studies as Topic↗
PubMed2002

Expanding pediatric psychology beyond hospital walls to meet the health care needs of ethnic minority children.

OBJECTIVE: To discuss the need for an ecological model and new approaches for meeting the psychological and physical health care needs of minority children. METHOD: I support approaches that are informal, empowerment oriented, and culturally sensitive and that address illness prevention and health promotion. DISCUSSION: Assessment, intervention, and research challenges involved in implementing these approaches are identified, and some strategies for overcoming these challenges are discussed. CONCLUSIONS: Pediatric psychology can be expanded to embrace the advocated model and intervention approaches to better meet the health care needs of minority children.

Adolescent↗
PubMed1998

Developing an integrated information system for specialized addiction treatment agencies.

This article outlines the development of an integrated information system for specialized alcohol and drug treatment agencies in Ontario, Canada. The system is being developed following a strategic planning process involving provincial funding ministries and coalitions of service providers. An overview of the system's development is provided and the implementation of one subcomponent, a client-tracking system, is described. Some challenges to the implementation of this component are identified.

Alcoholism↗
PubMed2006

Implementing a rapid response team: factors influencing success.

Rapid response teams (RRTs), or medical emergency teams, focus on preventing a patient crisis by addressing changes in patient status before a cardiopulmonary arrest occurs. Responding to acute changes, RRTs and medical emergency teams are similar to "code" teams. The exception, however is that they step into action before a patient arrests. Although RRTs are acknowledge as an important initiative, implementation can present many challenges. This article reports on the implementation and ongoing use of a RRT at a community health care setting, highlighting important considerations and strategies for success.

Algorithms↗
PubMed2005

Implementation of youth development programs: promise and challenges.

PURPOSE: The Community Coalition Partnership Program for the Prevention of Teen Pregnancy provided a unique laboratory for observing how youth development projects were implemented in 13 community-based settings. This article focuses on the scope of these efforts, the content of the projects, and their expected outcomes. METHODS: The investigators inventoried all youth development activities created within the grantee communities between 1997 and 2000 and then surveyed 28 site representatives by telephone. The scope and content of the identified youth development programs were compared with national registries of other such programs. RESULTS: The youth development efforts implemented by the 13 grantees were diverse, multi-faceted, and broad in scope. Most were short-term, but reflected a broad base of support for youth development principles among various community partners. Of the array of youth development efforts developed, more than two-thirds targeted three program areas: community services/outreach, education/training programs, or mentoring programs-a pattern found among youth development programs throughout the country. CONCLUSIONS: Within this partnership, youth development was a better-received framework for mobilizing community partners than were more traditional pregnancy prevention approaches. Communities were successful in creating diverse programs that may have benefits for individual youth, service agencies, and the community at large.

Adolescent↗
PubMed2001

Case study methodology in tissue viability. Part 2: A study to determine the levels of knowledge of nurses providing care for patients with leg ulcers in an acute hospital setting.

One of the main components of the clinical governance framework is a comprehensive programme of quality improvement activity that includes the implementation of evidence-based, everyday clinical practice. This paper addresses the challenges surrounding the implementation of one area of evidence-based practice, the management of leg ulcers in an acute hospital trust. The aim of the study was to distinguish the levels of knowledge of nurses providing care for patients with leg ulcers within an acute hospital setting. The design used was that of a collective case study. Each 'case' was a patient with a leg ulcer and the nurses who cared for that patient. They were studied in order to provide insight into the nurses' understanding of leg ulcer management. A number of themes were identified as being common to all the cases. They are: evidence-based practice, nursing skills, quality of life, patient understanding of their ulcer and pain. Each of these themes identified areas of knowledge deficit in the nurses. As part of the implementation of a leg ulcer policy an education programme is being developed to address these deficits.

Bandages↗
PubMed1995

Implementing standards for radiation sterilization. The challenges.

This article discusses the limitations of the methods offered in the radiation standards for selecting radiation dose. It highlights the difficulty of using these methods for product-specific dose-setting and, in particular, their inability to determine this for products with low bioburdens. Issues relating to the appropriateness of 25 kGy are also discussed.

Equipment and Supplies↗
PubMed1992

Computer-based radiological teaching programs: the challenge and trauma of development and implementation.

Computers are becoming an invaluable part of the radiologist's environment whether they are used as a source of the patient's clinical or laboratory information, to store x-ray or pathologic reports or as a viewing station for films. The use of computers in the educational environment is but a natural extension of the increased computerization of the radiologic department. This article reviews the use of personal computers in a teaching environment via the construction of the computed tomography teaching program entitled "CT: The Game." The decisions that must be made in terms of hardware and software prior to program development as well as the actual development are discussed. The potential of computers in terms of continuing education as well as in residency training programs is discussed with the potential for the future addressed.

Computer Systems↗
PubMedDate not supplied

Outcomes system implementation for subacute care.

The emergence of subacute care, seen as a cost-effective alternative to other, more expensive settings, is an important option for case managers. The current, rapid growth of subacute care, the diversity of subacute programs, the differences in patient types, and the lack of consistent standards to define subacute care illustrate the critical need for the case manager's role in balancing quality and cost. The lack of solid clinical outcomes data for patients treated in subacute care make it difficult for case managers to assess quality. Outcomes data, as a measurable dimension of quality, may include clinical effectiveness measures, associated costs, and patient/family satisfaction. Outcomes data can be used as a tool by the case manager to facilitate the coordination of patient care. Although there is an increased consumer interest in outcomes across all health care modalities, there is limited outcomes research available to document the efficacy of subacute care. As the pressure increases for outcomes data on subacute care by consumers and payers, efforts toward facility implementation of outcomes systems to assess subacute care are growing. The unique challenges to outcomes implementation in a skilled nursing facility-based setting are discussed, and strategies for successful implementation are presented. Basic subacute outcomes implementation issues of organizational support, staff participation, and data collection are reviewed. Ideas for case management involvement with facility implementation are discussed.

Case Management↗
PubMed1998

The challenge of exercise: practical advice for implementation into clinical practice.

Regular physical activity has important physiological and psychological benefits for all people. There are, however, special concerns for people with diabetes that require consideration before recommending an exercise program. Risks associated with exercise include exercise-induced hypoglycemia or hyperglycemia and worsening of long-term complications. Safe participation in all forms of exercise is possible through proper screening and teaching specific diabetes self-management skills.

Diabetes Mellitus, Type 1↗
PubMed2005

A CLIR Interface to a Web search engine.

Medical document retrieval presents a unique combination of challenges for the design and implementation of retrieval engines. We introduce a method to meet these challenges by implementing a multilingual retrieval interface for biomedical content in the World Wide Web. To this end we developed an automated method for interlingual query construction by which a standard Web search engine is enabled to process non-English queries from the biomedical domain in order to retrieve English documents.

Abstracting and Indexing↗
PubMed2004

Integrating telehealth into Aboriginal healthcare: the Canadian experience.

Telehealth, the use of information communication technologies to deliver health care over distance, has been identified as a key mechanism for improving access to health services internationally. Canada is well suited to realize the benefits of telehealth particularly for individuals in remote, rural and isolated locations, many of whom are of Aboriginal descent. The health status of Canada's Aboriginal population is generally lower than that of the non-Aboriginal population emphasizing the need for new health care solutions. The challenges associated with implementing telehealth are not unique to Aboriginal settings but, in many instances, are more pronounced as a result of cultural, political and jurisdictional issues. These challenges are not insurmountable however, and there have been a number of successes in Canada to serve as a blueprint for a national strategy for sustainable Aboriginal telehealth. This review will highlight challenges and successes related to telehealth implementation in Canadian Aboriginal communities including: geography, technical infrastructure, human resources, cross-jurisdictional services, and community readiness. The need for champions within government, community and health care settings and the use of a needs-driven and integrated approach to implementation are highlighted. Several Canadian examples are provided including lessons learned within the MBTelehealth Network.

Delivery of Health Care, Integrated↗
PubMed1998

Health management education and reformation of nursing education in the Slovak Republic.

This article details changes in nursing in the Slovak Republic. Nurses are an important part of the rapidly changing health care systems in the Slovak Republic, especially as nursing and health care move from a traditional to a more holistic approach. Nursing must adapt to the changes in the health care systems, including taking on more managerial responsibilities, requiring greater knowledge and skills. This article discusses the background and curriculum development of nursing education, from a traditional nursing education at the secondary school level to more advanced graduate-level programs, as nursing takes on a greater role in the Slovak Republic. Finally, the article details the need to implement the changes in education to the practice of nursing as well as the challenges of such implementation.

Curriculum↗