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Results for “Implementation challenges”

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At least 595 records · Page 33Linked to original sources

PubMed2005

Recent progress in plantibody technology.

Antibodies are an important class of proteins that can be used for the prevention, treatment and diagnosis of many diseases. Consequently, there is an intense and growing demand for recombinant antibodies, placing immense pressure on current production capacity which is based largely on microbial cultures and mammalian cells. Alternative systems for cost effective antibody production would be very welcome, and plants are now gaining widespread acceptance as green bioreactors with advantages in terms of cost, scalability and safety. Several plant-produced antibodies (plantibodies) are undergoing clinical trials and the first commercial approval could be only a few years away. The performance of the first generation of products has been very encouraging so far. In terms of product authenticity, differences in glycosylation between plantibodies and their mammalian counterparts have been defined, and the scientific evaluation of any possible consequences is underway. Ongoing studies are addressing the remaining biochemical constraints, and aim to further improve product yields, homogeneity and authenticity, particularly where the antibody is intended for injection into human patients. A remaining practical challenge is the implementation of large-scale production and processing under good manufacturing practice conditions that are yet to be endorsed by regulatory bodies. The current regulatory uncertainty and the associated costs represent an entry barrier for the pharmaceutical industry. However, the favourable properties of plants are likely to make the plant systems a useful alternative for small, medium and large scale production throughout the development of new antibody-based pharmaceuticals.

Animals↗

PubMed2002

Outcomes from the first two years of the Australian hepatitis C surveillance strategy.

The objectives of national hepatitis C surveillance are to identify those at risk in order to appropriately target prevention and care programs, and to evaluate the impact of these approaches. In 1998 the Communicable Diseases Network Australia New Zealand (CDNANZ) appointed the Hepatitis C Surveillance Committee to develop and implement approaches for improved hepatitis C surveillance in Australia. The Australian Hepatitis C Surveillance Strategy was endorsed in 1999 and provides a framework for improvements to national hepatitis C surveillance. The strategy covers two main surveillance activities: surveillance of incident and prevalent hepatitis C, and the long-term outcomes of hepatitis C. The committee (now the CDNA Viral Hepatitis Surveillance Committee) has continued to facilitate the implementation of the recommendations proposed. Progress towards improvement of hepatitis C surveillance in Australia includes the development of standard case reporting for hepatitis C, collation of data on incident and prevalent hepatitis C from a range of populations at lower and higher risk of hepatitis C, and collation of data from liver transplant registries. Advances in the implementation of the strategy are incremental. While there is enthusiastic commitment towards improving hepatitis C surveillance in Australia, the number of cases, the capacity and competing priorities of State and Territory health departments has meant that implementation has been challenging, highlighting the difficulties in introducing new systems into an already complex situation.

Australia↗

PubMed2026

Multi‑omics approaches to decipher the molecular mechanisms of exercise‑mediated bone protection: From mechanistic insights to personalized exercise prescription (Review).

The global burden of bone metabolic disorders necessitates a shift from generic exercise recommendations toward personalized prescription strategies. Exercise confers skeletal protection through mechanotransduction, yet the underlying molecular networks remain incompletely understood. Multi‑omics technologies, including transcriptomics, proteomics, metabolomics and single‑cell spatial approaches, have revolutionized the capacity to decode exercise‑mediated bone adaptation at the systems level. The present review synthesizes current single‑omics landscapes and integrative multi‑omics analyses that elucidate the core regulatory networks, mechanobiological coupling mechanisms and multiorgan crosstalk that are implicated in the bone response to mechanical loading. Translational applications across clinical scenarios such as osteoporosis, osteoarthritis and disuse bone loss are evaluated, and the technical, analytical and translational challenges limiting clinical implementation are addressed. Finally, the present review provides a framework for translating multi‑omics molecular signatures into personalized exercise prescriptions for optimized skeletal health.

Humans↗

PubMedDate not supplied

Tools, technologies, and informatics: supporting glycemic control.

OBJECTIVE: To overcome the challenges involved in the adoption and implementation of standards of glycemic control in the inpatient setting. METHODS: Three major barriers to effective glycemic control are examined, and solutions are discussed. RESULTS: The diabetes care process occurs at several levels of the hospital system, including the community level. Each level must be considered when solutions for glycemic control are determined and implementation planned. Workflow coordination is another challenge; it addresses the end users who provide patient care and use information support. Informatics, or the application of information technology to healthcare, can facilitate system-level and workflow integration efforts to improve glycemic control. CONCLUSION: Glycemic control can be achieved through coordinated and facilitated efforts at each level of the hospital system--individual, unit, and hospital-wide. Multidisciplinary team coordination, workflow integration, effective information sharing, and communication are required.

Hospital Information Systems↗

PubMed2004

Primary prevention of type 2 diabetes mellitus by lifestyle intervention: implications for health policy.

More than 18 million Americans currently have diabetes mellitus. The economic and human cost of the disease is devastating. In the United States, diabetes is the most common cause of blindness among working-age adults, the most common cause of nontraumatic amputations and end-stage renal disease, and the sixth most common cause of death. For the cohort of Americans born in 2000, the estimated lifetime risk for diabetes is more than 1 in 3. In the next 50 years, the number of diagnosed cases of diabetes is predicted to increase by 165% in the United States, with the largest relative increases seen among African Americans, American Indians, Alaska Natives, Asian and Pacific Islanders, and Hispanic/Latino persons. Compelling scientific evidence indicates that lifestyle change prevents or delays the occurrence of type 2 diabetes in high-risk groups. This body of evidence from randomized, controlled trials conducted in 3 countries has definitively established that maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk persons by about 40% to 60% over 3 to 4 years. The number of persons at high risk for type 2 diabetes is similar to the number of persons who have diabetes. This paper summarizes scientific evidence supporting lifestyle intervention to prevent type 2 diabetes and discusses major policy challenges to broad implementation of lifestyle intervention in the health system.

Behavior Therapy↗

PubMedDate not supplied

Getting guidelines into practice: a literature review.

BACKGROUND: Clinical guidelines have the potential to ensure that a research knowledge base underpins practice. Their development nationally and locally has increased dramatically in recent years. The challenge lies in implementing them. This literature review of guideline implementation was conducted to inform the development of implementation strategies for the Royal College of Nursing national clinical guidelines. CONCLUSION: The evidence base for guideline implementation is still developing and many ideas and strategies require further testing. Although strategies can be developed around some core principles, as yet there is no single definitive strategy. This selective literature review offers some insight into successful implementation strategies.

Attitude of Health Personnel↗

PubMed1992

Challenges and opportunities for personal selling.

Health care organizations are beginning to use sales forces in much the same way as traditional for-profit organizations have used selling programs in the past. However, numerous challenges to the implementation of selling in the health care industry have yet to be overcome. The authors report viewpoints expressed by administrators in a national survey of health care organizations.

Commerce↗

PubMed1993

The SSD's (social services department) management challenge.

Health services managers are used to organisational change, but social services departments have been addressing, and are still facing, major challenges associated with implementing the changes to community care provision. Norma Raynes gives a perspective on local authorities' culture and bureaucracy, which need to change if the community care revolution is to be sustained.

Community Health Services↗

PubMed1995

A physical examination of health care's readiness for a total quality management program: a case study.

Initiating a total quality management (TQM) effort can be a time-consuming and costly effort for a hospital. Perceptions of management and employees are important in initiating TQM because people function as if perceptions are fact. Assessing these perceptions and determining the levels of readiness or resistance to change are important steps in reducing costs, thus increasing organizational ability to address proactively challenges to the implementation and ultimate success of a TQM effort. Key assessment criteria are discussed including a comparison of management and employee perceptions in one hospital.

Efficiency, Organizational↗

PubMed1997

From electronic medical record to personal health record.

In this paper we attempt to provide a definition and purpose for the electronic patient record, point out the benefits of its use and outline the major challenges in wider implementation that are encountered world-wide. Finally, some trends are highlighted that are believed to play an important role in the future development and use of the electronic patient record.

Computer Communication Networks↗

PubMed1985

Microinfusion: clinical and cost-containment concepts.

This article provides a detailed overview of the concept of intravenous drug delivery. Recognizing the limitations inherent in a gravity-controlled system and the new advantages achieved in the technology of microinfusion, defined here as the (controlled) delivery of small volumes of concentrated solutions of drugs, we have described the concepts and advantages associated with a microinfusion system. The clinical advantages to such a system are far reaching and include lower incidences of bacterial contamination, phlebitis, embolization, and fluid overload as well as more accurate delivery of drug. Since financial advantages are a prerequisite for any new system in this era of fiscal restraint, the financial considerations associated with the use of a microinfusion system are also delineated. These advantages, which range from decreases in supply costs to decreases in the overall cost of patient care, support the argument for increased utilization of microinfusion systems. Overall, it is our contention that microinfusion offers a more rational approach to the delivery of drugs in many patient populations, and expanded implementation of this challenging concept should be further explored.

Boston↗

PubMed1998

From electronic medical record to personal health records: present situation and trends in European Union in the area of electronic healthcare records.

In this article we define the electronic healthcare record (EHR) and present its purpose as a tool for continuity of care. We consider the EHR system as a necessary tool for collaborative work of healthcare professionals linking the traditional stand alone physician's systems or departmental systems, which we refer to here as electronic medical record systems. We briefly describe the current usage of electronic medical records in EU and focus on the major challenges to wide implementation of electronic healthcare record systems. Finally, we point out trends that show stronger involvement of patients (citizens) in the health care process and discuss the impact on future EHR systems. We call the next generation of EHR that takes into account the new role of citizens Personal Health Records.

Confidentiality↗

PubMedDate not supplied

Formative evaluation of an Inspection Certificate Program (ICP) pilot in Toronto.

The inspection certificate program consists of food establishments voluntarily posting a certificate to inform patrons that inspection reports can be accessed from operators or the public health department. A three-month pilot program was evaluated for program improvement purposes. Only 65% of the selected operators were willing to participate, which suggests a challenge to fully implementing the program. Thirty-nine randomly selected restaurant operators participated. Most operators posted the certificate at the front entrance, and patrons indicated that reports were clear. Operators were supportive of the program. Some operators reported that the program was good for business and offered suggestions to improve it. A total of 583 requests for reports were made which suggests that the program empowered patrons to request reports, mostly from operators. Most patron evaluation forms came from a few operators that had no deficiencies, which limits generalizability.

Accreditation↗

PubMedDate not supplied

Linking outcomes management and practice improvement. Structured care methodologies: evolution and use in patient care delivery.

Structured care methodologies are tools that provide a comprehensive approach to patient care delivery. These tools have evolved in their application and purpose over the years. In many situations, multiple tools are needed to obtain the best outcomes for a patient. The presence of a SCM does not preclude clinical judgment. On the contrary, the fundamental purpose of any SCM is to assist practitioners in implementing practice patterns associated with good clinical judgment, research-based interventions, and improved patient outcomes. These tools support smooth operation and appropriate use of resources, establish a means of patient management across the continuum of care, facilitate collaboration among disciplines, reflect patient outcomes, and provide outcomes data. Data from SCMs permit benchmarking, comparison of pre-implementation and post-implementation outcomes, development of action plans for quality enhancement, identification of high-risk patients, identification of issues and problems in the system that require interventions, and the development of research protocols and studies. Structured care methodology development and implementation can be challenging, rewarding, and at times frustrating. When used appropriately, these tools can have a major impact on the standardization of care and the achievement of desired outcomes. However, individual patient needs may supersede adherence to a tool. The challenge then becomes one of balancing the unique needs of each patient and appropriate use of SCMs. Change comes slowly, but persistence pays off.

Algorithms↗

PubMed1976

Effect of new technologies in the training and utilization of dental auxiliaries in the US Army.

The combat strength, readiness, and effectiveness of the US Army is dependent, in part, upon the health of the American soldier. The conservation of his oral health is the mission of the Army Dental Corps. Confronted with steadfast mission requirements, increasing demands for dental services, and a reduction of professional staff, the Corps has responded to challenge with the implementation of an alternative to the limitations of established and traditional concepts of practice. In 1972, the Army Dental Corps introduced a new system of care delivery, based upon the expanded utilization of its auxiliary personnel and the team mode of practice. In a six year period, approximately 900 expanded duty auxiliaries, known in the Army as Dental Therapy Assistants, or DTA's were to be trained to extend professional capability to the performance of a variety of reversible dental procedures. They were to operate as members of care delivery teams, and to perform their expanded functions only upon the direction and under the supervision of the responsible team dental officer. To date, more than 500 DTA's comprize this new para-professional force, with more than 300 trained and operationally employed. Interim assessments of this endeavor have confirmed the antecedent research, which identified the impressive potential of Team Dentistry. DTA's have been trained to perform previously professional dental functions to a professional standard of quality; their proper team utilization returns a marked increase in professional capability, enabling the delivery of a greater number of dental services to more of the patient community; and their expanded role in care delivery has been well received by both the patient and the professional. Team Dentistry and the expanded duty auxiliary have added a new dimension to dental care delivery, as well as a promising route to mission accomplishment by the Army Dental Corps.

Delivery of Health Care↗

PubMed1999

Digital radiography--not if, but when.

Digital radiography can enhance the dental practice by facilitating diagnosis, enabling orderly filing and archiving, and allowing better communication with patients. Although the initial investment in equipment is substantial, it is quickly repaid and provides both a substantive and fiscal benefit. There are challenges involved in implementation, but they are quickly being overcome. It is only logical for dentistry to move along with the rest of society into the digital age and take advantage of its benefits.

Humans↗

PubMed2000

Information systems: the key to evidence-based health practice.

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems.

Decision Support Systems, Clinical↗

PubMed2000

Public health nutrition: results and research.

Public health nutrition is focused on the prevention of diet-related diseases and the attainment of good health, through policy, education and health promotion. It involves many sectors of the community, cooperating to improve the health and wellbeing of the population with emphasis on prevention, equity, wellbeing and improved quality of life. In the majority of western countries, an epidemic of coronary heart disease (CHD) began after World War One, reaching its peak in the 1970's. In Asia, the epidemic began after WW2 with the rapid economic development of the region. In western countries, of which Australia is a typical example, health promotion activities and improved hospital treatment have been effective in reducing the impact of the CHD epidemic. The life expectancy of the population has steadily grown to 75.6 years for males and 81.3 years for females. Despite major advances in the prevention and treatment of cardiovascular disease, it is still the leading cause of premature mortality and morbidity in Australia. Furthermore, cardiovascular disease shares common risk factors with other leading causes of death, including lifestyle behaviours (diet, physical inactivity, alcohol consumption, smoking), physiological states (obesity, hypertension, high blood cholesterol) and socioeconomic factors. For Asia, the challenge is to implement public health policies that will tackle the epidemic of chronic disease before it reaches its peak. Health Promotion policies will be important for all countries. The use of the disability adjusted life years (DALY) methodology to measure the association between the cause of disease and relate its occurrence to health outcomes will be an important public health planning tool.

Aged↗