SEARCH · PubMed Health

Results for “Implementation challenges”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

PubMed1993

A model for implementing Healthy People 2000 objectives in African-American communities in California.

Using Healthy People 2000 as the source document, regional task forces were formed at the request of the Health Promotion Section of the California Department of Health Services to set health promotion objectives and recommendations for the state's ethnic populations. The topics chosen by regional African-American task forces were (1) violence and abusive behavior, (2) physical activity and fitness, (3) nutrition, (4) tobacco, (5) educational and community-based programs, (6) cancer, and (7) heart disease and stroke. Objectives were expanded, linked together, and revised to meet felt needs. The regional task forces presented the first draft of the document for review at the Multiethnic Health Promotion Conference held in Sacramento, California, June 11 through 13, 1991. The expanded task force, including conference participants, amended the recommendations and ranked the topic areas in order of priority. The group also responded to the challenge of developing implementation strategies for the recommendations. We discuss the early stages of dissemination and implementation of the agenda among California African-American communities. American Indian, Asian/Pacific Islander, and Latino Task Forces have prepared similar documents, and each document will be used to prepare the Multiethnic Health Promotion Agenda for California. We summarize the process by which the papers were developed and provide detailed analysis of the African-American process.

Black or African American↗

PubMed2002

Future improvements and implementation of animal care practices within the animal testing regulatory environment.

Animal welfare is an increasingly important concern when considering biomedical experimentation. Many of the emerging regulations and guidelines specifically address animal welfare in laboratory animal care and use. The current revision of the appendix of the European Convention, ETS123 (Council of Europe), updates and improves on the current animal care standardization in Europe. New guidelines from the Organisation for Economic Co-operation and Development and the European Federation of Pharmaceutical Industries Association focus specifically on safety testing. These guidelines will affect the way toxicity studies are conducted and therefore the global drug development process. With the 3Rs principles taken into account, consideration regarding animal welfare will demand changes in animal care practices in regulatory safety testing. The most significant future improvements in animal care and use practices are likely to be environmental enrichment, management of animal pain and distress, and improved application of the humane endpoints. Our challenge is to implement respective guidelines based on scientific data and animal welfare, through a complex interplay of regulatory objective and public opinion. The current goal is to work toward solutions that continue to provide relevant animal models for risk assessment in drug development and that are science based. In this way, future improvements in animal care and use practices can be founded on facts, scientific results, and analysis. Some of these improvements become common practice in some countries. International harmonization can facilitate the development and practical application of "best scientific practices" by the consensus development process that harmonization requires. Since the implementation of good laboratory practices (GLP) standards in safety testing, these new regulations and recommendations represent a new way forward for animal safety studies.

Animal Husbandry↗

PubMed2003

Community pediatricians collaborate with hospitalists to build a ward service.

Variations in hospitalist models carry advantages and disadvantages, many of which can be elucidated through the guidance of an experienced consultant or director. Implementation presents several challenges. Although there are common themes among various types of hospitalist programs, the specific activities of the team must be carefully tailored to the needs of the ward. The ideal would be to dovetail the hospitalist's activities with those of other services in the hospital, according to the preferences and expressed needs of the medical staff and hospital administration. This is an ambitious and elusive goal. One common thread is that the choice of hospitalist service requires considerable input from the community physicians in order to ensure success of the program. Program directors, hospital administrators, and medical staff organizations are strongly encouraged to seek the pediatricians' input early in the planning stages and throughout the course of design and implementation. In the end, a hospitalist program may serve to raise the level of care on the ward, support the needs of community pediatricians, and bring a new level of efficiency, consistency, and specialization to the care of the community's children.

Child↗

PubMed2005

A pilot project on hospital-based universal newborn hearing screening: lessons learned.

OBJECTIVE: This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation. METHODS: Data of 4437 babies screened from April 2003 to February 2004 at Hospital Universiti Kebangsaan Malaysia was analyzed to measure the performance of the newborn hearing screening programme. Quality indicators, which include the coverage rate, initial refer rate, return for follow-up rate, ages of diagnosis and intervention were calculated. Factors contributing to poor compliance for follow-up were examined through questionnaire survey of 341 parents who did not bring their babies for the initial screening follow-up. RESULTS: The findings of this study revealed unsatisfactory performance of the hearing screening programme compared to the Joint committee of Infant Hearing recommendation [Joint Committee on Infant Hearing Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, Pediatrics 106 (4) (2000) 798-817]. The coverage rate, initial refer rate, and return for follow-up rate were 84.64, 11.97 and 56.97%, respectively. The average age of diagnosis was 3.56 months (S.D. 1.33). Only 1 of the 16 babies identified as having hearing loss through the screening programme has been fitted with hearing aids. Delay in coming to audiological certainty was one of the reasons hampering early intervention of these children. The commonly cited reasons for not returning for screening follow-up reflect the need to create public awareness of the importance of early diagnosis and intervention of hearing loss. CONCLUSIONS: The implementation of the present screening programme needs to be reviewed. Factors contributing to its unsatisfactory performance must be identified and steps must be taken to resolve them so that early identification and intervention of permanent congenital hearing loss can become a reality.

Continuity of Patient Care↗

PubMed2001

The process of transitioning to digital operations in a clinic setting.

Transitioning to digital imaging operations in a department of radiology is often difficult for many radiologists, but it is a change that many have made effectively. Transitioning to digital operations in a clinic setting is even more difficult for the referring physician operating a business in the clinic. This paper will discuss our experience with transitioning several off site clinics to digital imaging operations. We will discuss the process followed to identify the physical equipment required to support clinic operations in a digital imaging environment, the process followed to help the physicians adjust their work patterns to allow them to practice in a digital imaging environment, and the benefits and pitfalls of implementing digital imaging in an off site clinic. Four off site clinic locations will be evaluated: 1. cancer clinic located immediately adjacent to the main hospital that relies heavily on CT and MRI images in their practice, 2. small clinic located about 60 miles from the main hospital that acquires xray images on site, 3. larger clinic located about 20 miles from the main hospital that acquires xray, MRI and CT images on site, 4. sports medicine clinic located about 2 miles from the main hospital that acquires xray images on site. Each of these clinics has a very different patient clientele and therefore operates differently in nearly all aspects of their daily operations. The physician's need for and use of film and digital images varies significantly between the sites and therefore each site has presented different challenges to our implementation process. As we explain the decisions that were made for each of these sites and reveal the methods that were used to help the physicians make the transition, the readers should be able to draw information that will be helpful to them as they make their own transition to a digital operation.

Computer Systems↗

PubMed2007

Family Medicine Curriculum Resource Project: the future.

Under contract to the Health Resources and Services Administration (HRSA), the Society of Teachers of Family Medicine (STFM) created an undergraduate medical education curricular resource designed to train physicians to practice in the 21st century. An interdisciplinary group of more than 35 educators worked for 4 years to create the Family Medicine Curriculum Resource (FMCR). By consensus, the Accreditation Council for Graduate Medical Education (ACGME) competencies were adopted as the theoretical framework for this project. The FMCR provides materials for the preclerkship years, the third-year family medicine clerkship, the postclerkship year, and faculty development, as well as guidance for integrating topics of special interest to the federal government (such as, geriatrics, Healthy People 2010, genetics, informatics) into a 4-year continuum of medical education. There are challenges inherent in implementing each component of the FMCR. For example, can the ACGME competency-based approach be adapted to undergraduate medical education? Can the densely packed preclerkship years be adapted to include more focused effort on developing these competencies, and whose job is it anyway? What is "core" to being a competent clinician, and what information can be obtained when needed from medical informatics sources? Will family medicine educators embrace the FMCR recommendations for their third-year clerkships? Will exit assessment of the competency levels of graduating medical students be achieved, and can it make them more capable residents? Can faculty in different clinical and educational settings integrate the teaching of "how to learn" into their repertoire? How will faculty development innovation progress in a time of increasing emphasis on clinical productivity? Developing a common language and adoption of core competencies for all levels of medical education is imperative in a society that is focusing on improving health care quality and outcomes. The FMCR Project has developed a curricular resource to assist medical educators in this task. The challenge for the future is to measure how the FMCR is used and to ascertain if it has an influence on better patient and system outcomes.

Curriculum↗

PubMed2006

Lessons from developing and running a clinical database for colorectal cancer.

BACKGROUND: Recent policy developments in the UK require the routine monitoring of the performance of cancer services. Developing and using clinical databases is one approach to meet this objective, but to date their implementation has been challenging. OBJECTIVE: To describe the development of the Thames Cancer Registry clinical database for colorectal cancer, and to present the lessons learnt in the first five years since its establishment. METHODS: Planning of this clinical database began in 1998. Detailed variables for the data set were derived by analysis of national standards and guidelines. Structured pro formas were designed to abstract data from clinical notes. A pilot study over 12 months collected 400 cases from seven hospital trusts in one cancer network. Data collection over the wider North Thames area began in 1999. RESULTS: The number of new records entered each year into the database rose from 747 in 1999 to 1107 in 2002. By 2004, it held a total of 8500. However, participation and completeness of data collection varied between trusts. Currently only 18 of 26 trusts in the area submit data and only 12 have done so every year. Overall completeness for key demographic and treatment variables has been between 80 and 100% but less so for more detailed diagnostic and treatment variables (40-60%). Barriers to implementation in trusts could be grouped as organizational, professional and data-related. Organizational barriers have included changes in the cancer networks, variability in trust commitment to different data sets and lack of personnel to enter data consistently. Professional barriers have included competing priorities and varying commitments within the multidisciplinary clinical teams. Data-related barriers include the wide range of database formats that are used in trusts, and a tendency for data to be collected at the end of the year rather than continuously. CONCLUSIONS: Creating and maintaining a clinical database is a time-consuming and complex undertaking. Completeness of ascertainment and quality are major issues of concern. Key lessons from this project have been that the commitment of clinicians and the ability of trusts to provide consistent support for data collection are crucial.

Colorectal Neoplasms↗

PubMedDate not supplied

Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program.

OBJECTIVES: To describe the development, implementation, and preliminary outcome of the Pain-Disability Prevention (PDP) Program. The PDP Program is a 10-week cognitive-behavioral intervention program that aims to increase daily involvement in goal-directed activity and minimize psychological barriers to activity involvement after occupational injury. Workers' Compensation Board claimants with soft tissue injuries to the back, who were still off work 6 weeks after injury and showed evidence of at least one "yellow flag," were offered participation in the PDP Program. DESIGN: A single-group, prospective treatment outcome analysis. PARTICIPANTS: Data from the first 104 claimants who participated in the PDP Program are summarized. RESULTS: Participation in the PDP Program was associated with a 60% success rate, where success was defined as return to work (45%) or readiness to return to work (15%). Initial scores on measures of catastrophizing, fear of movement/reinjury, and depression afforded 92% correct classification of treatment outcome. Early treatment changes in catastrophizing and fear of movement/reinjury were also predictive of treatment outcome. CONCLUSIONS: The findings suggest that a psychologically based activity mobilization program can be an effective means of yielding reductions in psychological risk factors for occupational disability. Challenges to program implementation, fidelity to protocol, and issues related to cost efficacy are discussed.

Adolescent↗

PubMed2006

Information system support as a critical success factor for chronic disease management: Necessary but not sufficient.

UNLABELLED: Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging. OBJECTIVE: To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice. DESIGN: A prospective case study of positive deviants using key informant interviews, process observation, and document review. SETTING: A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet. PARTICIPANTS: Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team. ANALYSIS: A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice. RESULTS: A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation. CONCLUSIONS: In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.

British Columbia↗

PubMed2006

Ethical and regulatory challenges associated with the exception from informed consent requirements for emergency research: from experimental design to institutional review board approval.

Clinical research studies conducted in emergency settings under the waiver of consent provision outlined in federal regulations are uncommon, yet the importance of such research that may result in potentially lifesaving interventions is indisputable. Surgeons, as well as health care professionals in other disciplines of medicine, should be aware of the multiple challenges facing them if they contemplate conducting a research trial without the prospective informed consent of enrolled subjects. The challenges associated with conducting research studies using the exception from informed consent requirements for emergency research are numerous, beginning with ensuring an appropriate study design, understanding state and federal regulations that govern such emergency research studies, and continuing through a complicated and sometimes arduous institutional review board (IRB) process that is unique to these studies. This article will describe the challenges encountered when implementing the exception from informed consent requirements for emergency research and will provide surgeon researchers with an understanding of the ethical controversies surrounding such studies.

Critical Illness↗

PubMed2004

Intellectual property conundrum for the biological sciences.

Policy regarding academically generated biomedical intellectual property (IP) has been shaped by two important events: the Vannevar Bush report to then President Roosevelt in 1945 and the Bayh-Dole Act of 1980. This policy, which vests the intellectual property produced from federally funded biomedical research from the government to the academic institution, was designed to promote technology transfer and thus promote the health of the U.S. economy. However, the policy has led to significant challenges, particularly in implementation. Here it is argued that the difficulties are due to differences in the structure of motivations between biomedical scientists, institutional officials, and private sector entrepreneurs. Understanding these differences may lead to a review of policy with the goal of enhancing technology transfer for the future.

Biological Science Disciplines↗

PubMed2005

Female prisoners with borderline personality disorder: some promising treatment developments.

BACKGROUND: The over-representation of female prisoners with borderline personality disorder (BPD) is an area of concern for HM Prison Service. Pilot programmes of Dialectical Behaviour Therapy (DBT) were undertaken for the first time in three British prisons for women diagnosed with BPD. Standard year-long programmes were piloted in two closed training prisons. Three short-format programmes were undertaken in a local allocation prison. METHOD: Evaluation measures included psychometric tests, behavioural data, and interviews with participants and key personnel. Sixteen of the 30 women who embarked on the programmes completed them, though five dropouts were transferred or released, leaving a voluntary attrition rate of 33%. Fourteen completed all measures. A waiting-list control group of eight participants was also set up. Five completed all measures. RESULTS: The vast majority of completers showed overall improvements in psychometric data often reaching statistical significance, and with notable effect sizes, while there was no significant overall change in the control group (though improvements were seen). A down-turn in overall self-harm was also seen. CONCLUSION: Results are tentative at this stage because of the small sample size. However, despite the numerous challenges associated with implementation, outcomes showed real promise for delivering DBT in a prison setting, and its efficacy in reducing criminogenic risk and improving the manageability and quality of life for this highly problematic group. Lessons learned for future implementation in correctional settings are discussed.

Adult↗

PubMedDate not supplied

Implications of decentralization for the control of tropical diseases in Tanzania: a case study of four districts.

Decentralization has been and is still high on the agenda in contemporary health sector reforms. However, despite extensive literature on the topic, little is known about the processes and results of decentralization, including the relationship with the control of major public health problems caused by communicable diseases. This paper reports from a study of decentralization and control of tropical diseases in districts implementing health sector and local government reforms in Tanzania. The study was undertaken in four districts, involving interviews and discussions with key stakeholders from individual household members to the district commissioner, and a review of official health policy, planning and management documents. The study findings reveal devolution of financial, planning and managerial authority being theoretical rather than practical, as district health plans are largely directed by national and international priorities rather than by local priorities. Vertical programmes still exist, focusing narrowly on single diseases. The local mechanisms for multisectoral collaboration, as well as community participation functions, are far from optimal. Further, inappropriate and weak information systems prevent adequate local responsiveness in setting priorities. In conclusion, decentralization might have a large potential for improving health system performance, but problems of implementation pose serious challenges to releasing this potential.

Communicable Disease Control↗

PubMed1993

Medical diagnostic reasoning: epistemological modeling as a strategy for design of computer-based consultation programs.

The complexity of cognitive emulation of human diagnostic reasoning is the major challenge in the implementation of computer-based programs for diagnostic advice in medicine. We here present an epistemological model of diagnosis with the ultimate goal of defining a high-level language for cognitive and computational primitives. The diagnostic task proceeds through three different phases: hypotheses generation, hypotheses testing and hypotheses closure. Hypotheses generation has the inferential form of abduction (from findings to hypotheses) constrained under the criterion of plausibility. Hypotheses testing is achieved by a deductive inference (from generated hypotheses to expected findings), followed by an eliminative induction, constrained under the criterion of covering, which matches expected findings against patient's findings to select the best explanation. Hypotheses closure is a deductive-inductive type of inference very similar to the inferences operating in hypotheses testing. In this case induction matches the consequences of the generated hypotheses against the patient's characteristics or preferences under the criterion of utility. By using the language exploited in this epistemological model, it is possible to describe the cognitive tasks underlying the most influential knowledge-based diagnostic systems.

Artificial Intelligence↗

PubMed1994

Teaching and learning methods for new generalist physicians.

This paper describes teaching and learning methods that can be used to build the competencies needed by the generalist physician. Supervised patient care, problem-based learning, and ongoing feedback through standardized patients all have proven efficacy in several domains. Computer-based learning has much to offer as a supplement to clinical teaching. New learning experiences in continuous improvement promise to cover areas that are not often reached by traditional methods, especially those of cost-effectiveness and quality of care. The authors review each method's principles, relationship to generalist competencies, examples of effective applications, and challenges to successful implementation. Where possible, they summarize what is known about the relationships of learning and teaching methods to career choices in generalism.

Adult↗

PubMed2000

Electronic imaging system implementation at Mayo Clinic Rochester: downtime procedures and communication plans.

Electronic imaging system implementation is a challenging process and requires: (1) thorough procedure documentation and communication plans; (2) systematic evaluation of processes by all involved personnel groups; and (3) anticipation of potential issues and documentation of new problems as they occur. Our department is continuously improving procedures and communications as opportunities arise. A downtime procedure manual and a basic communication plan has given us a foundation to build upon and will help us to maintain appropriate levels of patient care throughout electronic system failures.

Computer Communication Networks↗

PubMed2004

Skills for social and academic success: a school-based intervention for social anxiety disorder in adolescents.

This paper describes Skills for Academic and Social Success (SASS), a cognitive-behavioral, school-based intervention for adolescents with social anxiety disorder. Clinic-based treatment studies for socially anxious youth are reviewed, and a strong rationale for transporting empirically-based interventions into schools, such as SASS, is provided. The SASS program consists of 12, 40-min group sessions that emphasize social skills and in-vivo exposure. In addition to group sessions, students are seen individually at least twice and participate in 4 weekend social events with prosocial peers from their high schools. Meetings with teachers provide information about social anxiety and facilitate classroom exposures for socially anxious participants. Parents attend 2 psychoeducational meetings about social anxiety, its treatment, and approaches for managing their child's anxiety. Initial findings regarding the program's effectiveness are presented. We conclude by discussing the challenges involved in implementing treatment protocols in schools and provide suggestions to address these issues.

Adolescent↗

PubMed1990

The relative influence of the community and the health system on work performance: a case study of community health workers in Colombia.

A central component of the primary health care approach in developing countries has been the development and utilization of community-based health workers (CHWs) within the national health system. While the use of these front line workers has the potential to positively influence health behavior and health status in rural communities, there continues to be challenges to effective implementation of CHW programs. Reports of high turnover rates, absenteeism, poor quality of work, and low morale among CHWs have often been associated with weak organizational and managerial capacity of government health systems. However, no systematic research has examined the contribution of work-related factors to CHW job performance. The research reported in this paper examines the relative influence of reward and feedback factors associated with the community compared to those associated with the health system on the performance of CHWs. The data are drawn from a broader study of health promoters (CHWs) conducted in two departments (provinces) in Colombia in 1986. The research was based on a theoretical model of worker performance that focuses on job related sources of rewards and feedback. A survey research design was employed to obtain information from a random sample of rural health promoters (N = 179) and their auxiliary nurse supervisors about CHW performance and contributing factors. The findings indicate that feedback and rewards from the community have a greater influence on work performance (defined as degree of perceived goal attainment on job tasks) than do those stemming from the health system.(ABSTRACT TRUNCATED AT 250 WORDS)

Colombia↗