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Results for “Implementation challenges”

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PubMed1998

Effects of implementing patient-centered care models on nurse and non-nurse managers.

Evaluation of new patient care delivery models often focuses on their impact on the role of the staff nurse and the introduction of a variety of assistive personnel. This article examines the effects of patient-centered care models on the roles of nurse and non-nurse managers. Interviews with 26 managers approximately 6 months after models have been implemented reveal a number of issues and challenges faced by the managers during and after implementation. The data provide a number of new insights not previously reported in the literature.

Allied Health Personnel↗

PubMed2005

Enabling environments and the reduction of drug-related harm: re-framing Australian policy and practice.

In this paper Moore & Dietze use data from their study of street-based injecting drug users and sex workers in the Melbourne suburb of St Kilda to challenge the dominant emphasis of drug policy in Australia. They remind us that while existing harm reduction strategies that encourage individual behaviour change should be continued, these measures need to be complemented and extended by further attention to the environmental aspects of drug-related harm. This is a timely call. Responses targeting individual behaviour change are relatively easy to implement and less politically challenging. However, if we are really serious about reducing drug-related harm in the Australian community, then broader systemic and structural barriers which undermine these efforts must be addressed.Simon LentonEditor, Harm Reduction Digest.

Adult↗

PubMed2005

Training police officers on domestic violence and racism: challenges and strategies.

Teaching about domestic violence and racism is a formidable task that requires the inclusion of material that challenges dominant ideologies about race and gender. A recent training for police officers about domestic violence and racism serves as a good example of how challenging the task can be. Drawing from this 1-day police training, from existing pedagogical literature, and from the authors' collective experiences teaching about these issues, the authors address challenges encountered and propose strategies to mitigate them. The authors propose a multilevel approach to implementing strategies to address these challenges, which includes ongoing involvement during three stages of the training.

Adult↗

PubMed1999

Positive employment service - facilitating employment for people living with HIV.

As treatments and therapies develop and improve, enhancing life expectancy, Human Immunodeficiency Virus (HIV) has been described by some as a long term chronic condition rather than an acute life threatening illness. As this change occurs, new issues become relevant for the person living with HIV, employment being one of these. In light of this, the Positive Employment Service was developed and implemented to explore and address some of the issues related to employment for people living with HIV. The original concept for the service was primarily focused on vocational rehabilitation; however, it soon became clear that there was a need for a prevocational service facilitating transition and adjustment to productivity roles. The service was developed using approaches from Vocational and Occupational Therapy Models of Practice. This article discusses the challenges of developing and implementing this service and explores the unique perspective that occupational therapy brings to a position of this kind.

Journal Article↗

PubMed2026

Artificial Intelligence for Colorectal Surgeons-Part II: Research Applications, Challenges in Adoption, and Practical Resources.

BACKGROUND: This is part II of a 2-part series examining artificial intelligence in colorectal surgery. Part I established foundational concepts and clinical applications. Implementation, however, requires understanding research methodologies, available resources, and the specific challenges currently limiting widespread adoption. These topics are the focus of part II. OBJECTIVE: To examine artificial intelligence's transformation of surgical research, provide practical implementation resources, address adoption challenges, and explore future directions in colorectal surgery. METHODS: Comprehensive literature review focusing on artificial intelligence research methodology, implementation barriers, educational resources, and emerging technologies relevant to colorectal surgeons. RESULTS: Artificial intelligence streamlines clinical trial design through predictive modeling and natural language processing, reducing enrollment challenges that contribute to failed or inadequate trial accrual. Machine learning enables heterogeneity analysis within clinical trials, identifying treatment-responsive subgroups. Foundation models unlock analysis of unstructured electronic health record data at scale. Professional societies and universities offer specialized artificial intelligence education programs, with open-access data sets facilitating research participation. However, implementation faces multifaceted challenges: technical infrastructure demands, with real-time processing requiring dedicated graphics processing unit clusters; regulatory frameworks struggling with continuously evolving algorithms; undefined liability distribution for artificial intelligence-assisted decisions; algorithmic bias risking health care disparities; and the "black box" problem limiting clinical trust. Economic barriers include substantial initial costs without clear reimbursement pathways. Future directions include multimodal artificial intelligence integrating imaging, genomics, and histopathology; cognitive robotic systems with real-time decision support; digital twin technology for patient-specific surgical simulation; and global surgical artificial intelligence networks enabling distributed learning across institutions. CONCLUSIONS: Although artificial intelligence offers transformative potential for colorectal surgery research and practice, successful implementation requires addressing technical, regulatory, ethical, and economic challenges. The surgeon's evolving role demands both traditional expertise and computational fluency. Future advances in multimodal integration, autonomous systems, and global collaboration will fundamentally reshape surgical practice but will require thoughtful implementation prioritizing patient benefit and clinical value.

Humans↗

PubMedDate not supplied

Balancing research and service: the experience of the cancer information service.

BACKGROUND: The National Cancer Institute's Cancer Information Service (CIS), the nation's foremost resource for cancer information, has supported cancer control research throughout its 22-year history. The Cancer Information Service Research Consortium (CISRC) is a consortium established to fully involve the CIS in theory-based cancer control research. METHODS: This paper focuses on the experiences of the CIS Project Directors in the development and implementation of three research projects within the CIS program. Conclusions are drawn from discussions that have taken place over time in such venues as conference calls, CISRC Members Council meetings, and project advisory meetings. RESULTS: Overall, the CISRC/CIS collaboration has been successful. A number of factors have contributed to this success, including the perceived value of the research within the CIS and the mechanisms and structures established to foster collaboration. The lessons learned, based on the challenges and opportunities of implementing these intervention research projects within the operations of the regional CIS offices, are discussed. CONCLUSIONS: Integration of research within a service program requires careful planning and preparation. Mutual benefit, shared ownership, consistency with current practice, staff training, and the value of research to each partner were essential ingredients to the success of this collaboration.

Communication↗

PubMed2005

The impact of two organizational interventions on the health of service sector workers.

Studies focusing on interactive service work that involves face-to-face interactions between employees and customers/clients have shown that employees tend to show symptoms of job dissatisfaction, stress, and emotional exhaustion because they are expected to display or suppress certain emotions in the performance of their jobs. To meet the health challenges and reduce sickness absenteeism among employees in this sector, two organizational interventions were implemented among service workers employed by the municipality and in a shopping mall in a medium-sized Norwegian city. In a field experiment, the authors evaluated the effect of this type of intervention on employee health. The experiment combined survey measures (pre- and post-intervention) with observations and unstructured interviews. The survey data showed positive changes on only two of the measured variables among the shopping mall employees, and no effect on the municipal employees. This article focuses on the qualitative data, which show how constraints related to time and to interactional and organizational practices impeded full involvement of the employees during implementation of the interventions. The authors discuss the results from the perspective of the general challenges of implementing interventions in the service sector.

Absenteeism↗

PubMed2005

Revised national TB control programme in India.

The Revised National TB Control Programme (RNTCP), an application in India of the Directly Observed Treatment, Short Course (DOTS) strategy to control TB is being implemented in the country since 1997. The goal of the RNTCP is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India Since 1999, achievements of the RNTCP have largely determined the global DOTS progress. It has been cited as the fastest expansion in the history of DOTS and in terms of patients being treated, it is the largest programme in the world. More than 50-fold expansion in RNTCP coverage has occurred since 1998 thus making DOTS accessible to more than 83% of the country's population. Quality of services has been maintained during this rapid expansion. As a result, the proportion of sputum positive cases confirmed in the laboratory is on par with international standards. By September 2005, the programme has initiated more than 3.5 million patients on treatment, thus saving over 600,000 additional lives. In 2003, new sputum positive case detection rate of 69% was achieved against target of at least 70% and treatment success rate of 86% has been achieved above the target of 85% Aggressive steps are being taken to meet global TB control targets by covering the entire country with RNTCP by 2005. Despite these achievements, there are many challenges for the RNTCP. Implementing DOTS in a diverse and large country, maintaining the quality of services during rapid expansion phase, decentralization of programme management to the states and, widening the reach of the programme to reach all sections of the society are some of the major challenges.

Antitubercular Agents↗

PubMed2001

Managing waterway health in the Goulburn Broken Catchment, Victoria, Australia.

Historically within most catchments, resource management programs have been planned and implemented in isolation of one another. This was once the case in the Goulburn Broken Catchment, a major catchment of the Murray Darling Basin, Australia. Although only 2% of the Murray Darling Basin's land area, the catchment generates 11% of the basin's water resources. Learning from the past, a cooperative and collaborative approach to natural resource programs has developed. This approach is the envy of many other catchment communities and agencies. Through a combination of "Partnership Programs", "Operational Initiatives" and community involvement, significant programs have been implemented within the catchment, which will benefit not only the local community but communities further afield. The outcomes of the waterway health program highlight the benefits provided through the establishment of cooperative and partnership resource improvement programs. These programs were founded on the ability of the community to recognise the need for integration, base management decisions on best available science and an ability to work together. Their effective delivery has been provided through the resources provided, to the local community, by the Natural Heritage Trust with matching and State and local allocations. While programs have shown success, challenges still face the community. These challenges include verification and implementation of environmental flows, storage of the catchment's vital water resources, and maintaining community involvement and participation in on-going works programs. The Goulburn Broken Catchment community, with the support of Federal, State and Local Governments, is looking at opportunities for continued improvements in waterway health.

Conservation of Natural Resources↗

PubMed2001

The prevention of youth violence. The rationale for and characteristics of four evaluation projects.

In response to the magnitude of violence in the United States, a number of violence-prevention programs have been implemented throughout the country. However, relatively few have been rigorously evaluated for effectiveness. To encourage development and evaluation of violence-prevention interventions that focus on young children and their families, the Centers for Disease Control and Prevention (CDC) provided funding to four projects in 1996. This paper briefly describes the rationale for funding these projects, which is based on our understanding of the development of aggressive and violent behavior and on the literature regarding promising approaches to prevent problem behavior in this age group. We provide an overview of the four specific projects funded by the CDC as well as a short discussion of some of the many challenges encountered during their implementation.

Aggression↗

PubMed2004

Implementation of the WHO Multicentre Growth Reference Study in India.

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent neighborhoods in South Delhi. This community was selected to facilitate the recruitment of children who had at least one parent with 17 or more years of education, a key factor associated with unconstrained child growth in this setting. A door-to-door survey was conducted to identify pregnant women whose newborns were subsequently screened for eligibility for the longitudinal study, and children aged 18 to 71 months for the cross-sectional component of the study. A total of 111,084 households were visited over an 18-month period. Newborns were screened at birth at 73 sites. The large number of birthing facilities used by this community, the geographically extensive study area, and difficulties in securing support of pediatricians and obstetricians for the feeding recommendations of the study were among the unique challenges faced by the implementation of the MGRS protocol at this site.

Child Development↗

PubMed2006

Complementary and alternative therapies: a new frontier for nursing education?

The field of complementary and alternative medicine (CAM) is relatively new to Western health care and scientific research. The American public is embracing the use of CAM, and consequently, health care professionals will have to integrate these therapies into their professional practice. With the addition of basic CAM components to the newest NCLEX-RN blueprint, nursing education programs at all levels must incorporate CAM into their curricula. There are challenges to be faced with the implementation of added content, but nurse educators have successfully faced these challenges in the past. Specific strategies for integrating CAM topics into nursing curricula are discussed.

Complementary Therapies↗

PubMed2001

Evidence-based decision making in dental hygiene education, practice, and research.

PURPOSE: The purpose of this article is to highlight key aspects of the white paper prepared in 1999 for the American Dental Hygienists' Association (ADHA) Institute for Oral Health on Evidence-Based Decision Making and its Application to Dental Hygiene Education, Practice, and Research. These aspects include the need for evidence-based decision making, how it supports contemporary practice and education, basic evidence-based concepts, and strategies for integrating evidence-based decision making into dental hygiene. METHODS: A review of the biomedical literature, evidence-based Internet sites and textbooks, and clinical guideline development was systematically conducted to identify models of evidence-based practice, skills needed to practice and teach evidence-based decision making (EBDM), and challenges faced by those implementing an EBDM approach. These resources were then analyzed and synthesized to develop a model for initiating the development of evidence-based dental hygiene practice. RESULTS: The need for using an evidence-based decision making approach was well supported throughout the literature. Consistency was found in how EBDM methodology and levels of evidence were defined and in the skills required for evidence-based practice. Implied in the use of an evidence-based approach were corresponding requirements in three areas: 1) redesigning educational programs to better prepare students and current practitioners to integrate the most current knowledge into their clinical decision-making; 2) conducting research for areas in which evidence applicable to clinical practice is lacking or limited; and 3) designing more effective dissemination tools making relevant research findings more easily accessible and part of every day practice. CONCLUSIONS: Variations in practice patterns, difficulties in keeping current with the scientific literature, and providing students with knowledge, skills, and competencies necessary for contemporary practice are challenges facing the health care professions today, including dental hygiene. To address these problems, an evidence-based approach has been recommended by national organizations. This paper reviews the issues and proposes a model and strategies for engaging dental hygiene clinicians, educators, and researchers in EBDM. Those involved in each area will need training in EBDM concepts and skills before this approach can be fully integrated into education and practice or used to guide research activities. National leadership will be needed to coordinate and prioritize research strategies, promote curricular changes, and improve access to clinically relevant information so that an EBDM approach can become the norm in practice.

Clinical Competence↗

PubMed2006

Dissemination and implementation of guidelines for the treatment of asthma.

Asthma remains a serious global health problem that affects people of all ages. Many asthma management guidelines, both national and international, are available, but they are seldom implemented. The implementation of guidelines remains a challenge worldwide, as barriers exist at several levels. These barriers are generic, such as poverty, inadequate resources and poor infrastructure, or specific, such as organisational, health care provider and patient factors. The barriers are, however, potentially correctable, and the goal of guideline implementation is to translate evidence-based asthma management recommendations into real-life practice to improve patient health. This state of the art article reviews the challenges and current status of and strategies for asthma dissemination and implementation globally, and highlights the specific strategies for such improvement in developing countries.

Asthma↗

PubMed2026

Validation of an integrated metagenomic pipeline combining optimized wet-lab processing and tiered reporting for CSF pathogen detection.

UNLABELLED: Metagenomic next-generation sequencing (mNGS) in the infectious disease diagnostic space has been gaining traction and is popular for aiding in the diagnosis of central nervous system infections. However, many challenges and obstacles remain in making this technology a gold standard for infectious disease diagnostic testing. One major challenge is being able to distinguish between the clinically relevant organisms from background contamination. We performed a validation study for mNGS on cerebrospinal fluid (CSF) that utilized positive clinical samples and contrived samples that incorporated a bioinformatics pipeline that can better distinguish between background contamination and clinically relevant organisms and used a three-tiered reporting algorithm meant to decrease the inherent subjectivity that comes with interpreting and reporting data from clinical metagenomic sequencing. The validation of this assay and category-based reporting pipeline revealed an overall concordance of 91.8%, with a sensitivity of 100% and a specificity of 72.4%. In addition, we improved the detection of clinically relevant RNA viruses to almost 100% in the CSF by modifying the wet lab processing of the sample. This bioinformatics pipeline with a category-based reporting algorithm will provide more confidence in reporting microorganisms detected with this technology, mNGS, and improving patient care. IMPORTANCE: Metagenomic next-generation sequencing (mNGS) can offer a broad, unbiased approach for the detection of infectious pathogens and has shown promise in diagnosing central nervous system infections. Despite its potential, clinical implementation remains limited by challenges in distinguishing clinically relevant organisms from background contamination. This study validated an mNGS assay for cerebrospinal fluid that incorporates an optimized bioinformatics pipeline with a three-tiered reporting algorithm designed to reduce subjectivity and enhance diagnostic confidence. The assay also has improved detection of clinically relevant RNA viruses through modified wet-lab processing. These findings support the clinical utility of a structured, category-based reporting approach for mNGS, advancing its reliability as a diagnostic tool in infectious disease testing.

Metagenomics↗

PubMed2006

Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges.

OBJECTIVE: To review progress with the implementation of intermittent preventive treatment (IPT) for the control of malaria in pregnancy in sub-Saharan Africa (SSA), in order to identify facilitating factors and operational challenges for scaling up IPT delivery. METHODS: Information on the status of IPT policy, programme and coverage indicators was extracted from published sources. Information on country experiences from both published and unpublished literature was supplemented with semi-structured interviews with malaria programme managers. RESULTS: Whilst countries in SSA have made important progress with IPT implementation, coverage levels remain low. High antenatal clinic (ANC) attendance alone is not sufficient to ensure high IPT coverage. Staff shortages, poor drug supply, poor ANC access and poor health worker practices are some of the operational challenges in delivering IPT. CONCLUSION: Country experiences show that IPT can be introduced and scaled up relatively quickly and effectively where there is political will, effective integration between malaria and reproductive health programmes, adequate funding and drug supply, high ANC attendance and community receptiveness. There is however urgent need to better document best practices and lessons as a basis for developing simplified guidelines for dissemination to countries embarking on IPT implementation.

Africa South of the Sahara↗

PubMed2000

Treatment outcome for a maltreated population: benefits, procedural decisions, and challenges.

OBJECTIVE: To review the benefits, challenges, and procedural decisions to consider when implementing and managing a treatment outcome program for a maltreated population. METHOD: We reviewed the reasons to implement a treatment outcome program, decisions regarding procedures, and challenges likely to be encountered based on literature in the field and the authors' 6 years of experience in developing and maintaining an outcome program at a center specializing in the treatment of maltreated children. RESULTS: The development of an outcome programs requires careful measurement selection, early and ongoing staff-involvement, support from higher management, a well-developed data base and client tracking system, a coordinator and support staff, clinical utility, planning for fiscal impact, and flexibility to contend with challenges. CONCLUSIONS: Based on our experience, the plethora of clinically rich and administratively useful information derived from an outcome program far outweighs the challenges and costs of establishing and maintaining an outcome program.

Child↗

PubMed2004

Blood conservation: the CEO perspective.

Hospital CEOs are concerned about more than just cost of services to their patients. The advancement of patient car along with maintaining or improving patient safety are also key elements to the CEO, to limit patient risks, hospital liability, and negative public relations. The CEO is accountable to the hospital staff, the patients, and the general public. Establishing programs such as blood management or bloodless medicine can be implemented by using a team approach. A physician champion with a clear business plan that addresses all issues and challenges is critical for successful implementation. As blood and blood product costs rise and supply decreases, alternatives such as cell saving techniques and the use of pharmacologic interventions can have a significant impact on net hospital expenditures.

Attitude of Health Personnel↗