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Results for “Implementation challenges”

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At least 811 records · Page 45Linked to original sources

PubMed1994

Design of the Project NetWork return-to-work experiment for persons with disabilities.

As the Nation's first rigorous large-scale evaluation of vocational rehabilitation (VR) assistance to persons with severe disabilities, the Project NetWork demonstration will provide a wide range of information to policy-makers, researchers, and other interest groups. The evaluation of Project NetWork addresses two key policy questions: Is it feasible to increase participation in VR services among Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants/recipients through a combination of intensive outreach, case management, and enhanced work incentives? Do the interventions tested produce net benefits from the perspective of participants, society, the DI Trust Fund, and the Federal Government, as a whole? The study utilizes a randomized field experiment design to evaluate the net impact of the demonstration on participant employment, earnings, receipt of transfer benefits, social and psychological well-being, and other variables of interest to policymakers. A combination of SSA administrative data, information from the demonstration's onsite management information system (MIS), and in-person interviews (containing a rich array of information on disability, health, and attitudes) supports the evaluation. This article summarizes three aspects of the evaluation: Its experimental and sample design; the methods and data to be used to analyze project benefits, costs, and participation; and the challenges faced during demonstration implementation. It also presents preliminary data on the characteristics of Project NetWork participants and eligibles.

Adult↗

PubMed1993

Peripherally-inserted central catheters: challenges for hospital management.

The peripherally-inserted central catheter (PICC) is an established technology in home intravenous (IV) therapy and its use is increasing in hospital and home-health settings. Institutions introducing PICCs as another form of IV therapy will realize cost savings. However, challenges may be encountered. Implementation and education programs for staff, patients, and home caregivers will maximize the benefits of PICC use.

Catheterization, Central Venous↗

PubMed1996

Problem-based learning in a home health course.

To provide nursing students with skills in problem solving, critical thinking, and collaboration, educators are faced with the challenge of designing and implementing effective teaching strategies. This article addresses how problem-based learning is used in a senior level course that focuses on complex health care problems in the community. Sequenced case studies based on realistic clinical situations were the vehicle for learning in this course.

Aged↗

PubMed1997

Perioperative system design and evaluation.

Moving toward an electronic record is both challenging and rewarding. The implementation of a computerized scheduling and management system for the operating room is evaluated. Components of the system include Scheduling, Personnel, Supply, Intraoperative, and InSight modules.

Equipment and Supplies, Hospital↗

PubMedDate not supplied

A place called HOPE: group psychotherapy for adolescents of parents with HIV/AIDS.

Project HOPE is a psychosocial support program for noninfected children of HIV-positive parents. The challenges of starting and implementing the program's psychotherapy group for grieving adolescents, and clinical examples of group process and effective interventions in group leadership, are described. Four stages in group development are explicated--safety, dependency, counterdependency, and independence--paralleling the adolescent separation-individuation process.

Adaptation, Psychological↗

PubMed1998

Research on mifepristone and levonorgestrel in comparison with the Yuzpe regimen.

Women should be informed that it is possible to prevent unwanted pregnancy after intercourse in most cases by effective emergency contraception (EC). The currently used hormonal method, the Yuzpe regimen, however, has unpleasant side effects. The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research training in Human Reproduction has worked on developing improved methods of EC for the last ten years. This research has focused on levonorgestrel and mifepristone. Now that results from large clinical studies are becoming available, they suggest that both these compounds are better tolerated and appear even more effective than the Yuzpe regimen. The challenge now is to implement the research results by making better emergency contraceptives a reality for women.

Abortifacient Agents, Steroidal↗

PubMed2005

Computerized physician order entry with clinical decision support in the long-term care setting: insights from the Baycrest Centre for Geriatric Care.

Although computerized physician order entry (CPOE) has been successfully implemented in many acute care hospitals, few descriptions of its use in the long-term care (LTC) setting are available. This report describes the experiences of one LTC facility in developing and implementing a CPOE system with clinical decision support (CDS). Even when a facility has the necessary resources and "institutional will," many challenges are associated with the implementation of this application. The system was designed to meet the needs of healthcare providers in the LTC setting, in particular by informing prescribing decisions, reducing the frequency of prescribing and monitoring errors, and reducing adverse drug event rates. Based on experience adopting this technology early, 10 insights are offered that it is hoped will assist others who are considering the implementation of CPOE systems with CDS in the LTC setting.

Adverse Drug Reaction Reporting Systems↗

PubMedDate not supplied

Implementing interpersonal psychotherapy in a psychiatry residency training program.

OBJECTIVE: Interpersonal psychotherapy (IPT) for depression is a brief, well researched treatment for acute major depression. This article describes the implementation of IPT as an evidence-based treatment for depression in a psychiatry residency program. METHOD: The authors tracked the implementation process over 5 years as interpersonal psychotherapy was systematically incorporated into residency training. RESULTS: The authors outline key ingredients for and challenges to effecting change. CONCLUSIONS: Implementation of interpersonal psychotherapy in psychiatry residency training was a cornerstone for learning evidence-based treatment approaches as well as for conveying core psychotherapy concepts.

Anxiety↗

PubMed1991

New fee schedule tests staff skills. The Health Care Group.

The Medicare Fee Schedule (MFS) picture is quite incomplete, with myriad details unsettled. But one thing is clear: the shift to a new reimbursement system is loaded with significant practice management implications and challenges. Now, before the MFS is implemented, physicians should evaluate their management operations and business systems, to meet the challenges ahead. Most physicians understand that practice viability will depend on increasing their patient base and the scope of services delivered to non-Medicare patients. Yet many do not understand the marketing and management challenges implied in such growth. The issues are these: how can a practice attract more non-Medicare patients? And how can such growth be accommodated without disproportionately increasing costs or inconveniencing patients and staff?

Fees, Medical↗

PubMed2007

Implementation and evaluation of the MSc course in health informatics in Greece.

OBJECTIVES: Health informatics is a well established and important multi-disciplinary and inter-disciplinary field that not only involves informatics but also medicine, nursing, engineering, biology and other-related subjects. The program has been organized on the basis of an inter-university approach with the participation of five Greek universities. The paper aims at providing a current description of the academic program and a preliminary evaluation of the implementation phase. METHODS: The paper presents a case study of a curriculum implementation from the phase of curriculum development to the phase of implementation and evaluation. Due to the interdisciplinary character of the course appropriate procedures were undertaken to ensure that mixed backgrounds can assimilate the broad spectrum of the teaching material taught. In the first stages of the implementation international students mainly from Europe attended the course. In addition, local graduates provided an extra dimension to the multi-layered difficulties and challenges of such a course implementation. RESULTS: The students registered in the course were from different backgrounds and disciplines. They were mainly from health sciences and engineering schools. The interdisciplinary arrangement of the course facilitated the proper exchange of thoughts, skills, and knowledge among and between students and teachers. CONCLUSIONS: The postgraduate course in health informatics at the University of Athens has now been running for more than fifteen consecutive years and is one of the first and longest standing courses in Europe. Continuous evaluation and adaptation is required to fit within the changing and evolving amazing field of biomedical and health informatics.

Computational Biology↗

PubMed1997

HIV counseling and testing: its evolving role in HIV prevention.

The development of an enzyme-linked immunosorbent assay (ELISA) for screening blood for antibodies to HIV was a major milestone in the history of AIDS prevention and treatment. Since early 1985, the Centers for Disease Control and Prevention (CDC) has provided public funds to state and local health departments to support a national HIV counseling-and-testing (HIV CT) program directed toward persons at risk of transmitting or becoming infected with HIV. The implementation and ongoing development of this national program has often been marked by intense policy debate, especially in the area of mandatory testing. Furthermore, the lessons learned during its 11-year program history are highly relevant to understanding the challenges that might arise when implementing other new biomedical or behavioral HIV prevention technologies. Using the construct of public health infrastructure, this article describes key features, events, lessons learned, and future challenges of this evolving national prevention program.

AIDS Serodiagnosis↗

PubMedDate not supplied

Research and development in the new NHS: another challenge for the profession.

The continued implementation of the NHS research and development (R&D) strategy is the latest pressure point in the interaction between the medical profession and the new NHS. As the established funding routes for the support of clinical research are scrutinised and desegregated, there will be disaffected losers as well as winners. Further discussion and debate are needed.

Cost Control↗

PubMed2006

Screening elite winter athletes for exercise induced asthma: a comparison of three challenge methods.

BACKGROUND: The reported prevalence of exercise induced asthma (EIA) in elite winter athletes ranges from 9% to 50%. Many elite winter athletes do not report symptoms of EIA. At present there is no gold standard test for EIA. OBJECTIVE: To establish the efficacy of screening for EIA and examine the role of the eucapnic voluntary hyperventilation (EVH) challenge and laboratory based and sport specific exercise challenges in the evaluation of elite winter athletes. METHODS: 14 athletes (mean (SD) age 22.6 (5.7) years, height 177.2 (7.0) cm, body mass 68.9 (16.9) kg) from the Great Britain short-track speed skating (n = 10) and biathlon teams (n = 4) were studied. Each athlete completed a laboratory based and sport specific exercise challenge as well as an EVH challenge, in randomised order. RESULTS: All 14 athletes completed each challenge. Two had a previous history of asthma. Ten (including the two with a previous history) had a positive test to at least one of the challenges. Ten athletes had a positive response to EVH; of these, only three also had a positive response to the sport specific challenge. No athletes had a positive response to the laboratory based challenge. CONCLUSIONS: Elite athletes should be screened for EIA. EVH is a more sensitive challenge in asymptomatic athletes than sport specific and laboratory based challenges. If sporting governing bodies were to implement screening programmes to test athletes for EIA, EVH is the challenge of choice.

Adolescent↗

PubMed1998

Voice recognition--an emerging necessity within radiology: experiences of the Massachusetts General Hospital.

Voice recognition represents a technology that is finally ready for prime time use. As radiology services continue to acquire a larger percentage of the shrinking health-care dollar, decreasing operating costs and improved services will become a necessity. The benefits of voice recognition implementation are significant, as are the challenges. This report will discuss the technology, experiences of major health-care institution with implementation, and potential benefits for the radiology practice.

Humans↗

PubMed1993

Antigenic stability of Borrelia burgdorferi during chronic infections of immunocompetent mice.

Mice were actively immunized by intradermal inoculation with 10(4) cloned Borrelia burgdorferi bacteria and then cured of the B. burgdorferi infection with an antibiotic after 90 days. They were resistant to intradermal 10(2)- or 10(4)-bacterium challenge infection with either the original cloned B. burgdorferi or B. burgdorferi isolated from each punch biopsies at 90 days of infection (prior to antibiotic treatment), including autologous B. burgdorferi isolates. In contrast, sham-infected (nonimmune) mice were susceptible to challenge infection with both early and late B. burgdorferi isolates. Since there was a potential for in vitro modification of the spirochetes during the 2-week culture period which would obscure results, an alternate means of challenge infection, using tissue transplants, was implemented. By using the same approach, mice were immunized by infection, treated with antibiotics, but challenged by subcutaneous transplantation of ear skin pieces biopsied and frozen prior to antibiotic treatment. Mice were infected for 15, 90, or 180 days before biopsy and antibiotic treatment and then transplant challenged with autologous infected tissue. Sham-immunized mice received infected tissue, and immune mice received uninfected tissue as controls. Mice infected for only 15 days, but not mice infected for 90 or 180 days, could be reinfected by autografts, whereas nonimmune mice became infected with tissues collected at each of these intervals and immune mice transplanted with normal skin were uninfected. These results indicate that immunity to B. burgdorferi is effective against the original inoculum, late isolates of the spirochete, or infected tissues collected at intervals of up to 180 days, suggesting that there is no significant antigenic change in B. burgdorferi during chronic infection.

Animals↗

PubMedDate not supplied

Leadership through interdisciplinary teams: a case study of an acute pain service.

Interdisciplinary teams are rapidly becoming the standard for the organization and delivery of acute care services. Increasingly, research is showing that an interdisciplinary approach has the potential to improve patient care. Implementing a team approach, however, has challenges because of the various perspectives that different disciplines bring. In this paper we present a case study of an Acute Pain Service to illustrate how an interdisciplinary team can work to improve pain management in hospitals. The development of the Acute Pain Service will be described along with a discussion of the challenges that were faced. Key lessons will be presented that may lend direction for the implementation of an Acute Pain Service or for any other interdisciplinary team.

Acute Disease↗

PubMed2001

Nutrition and women's health: challenge for the 21st century.

The recent release of Healthy People 2010 and the Dietary Guidelines for Americans were significant events, especially for the nutritional health of women. Given the number of women diagnosed with nutrition-related diseases and the increasing cultural diversity of the US population, implementing the dietary recommendations poses challenges for women clinicians. Clinicians must recognize and respect the cultural beliefs, behaviors, and traditions of their female patients if the goals of a healthy diet are to be achieved. And culturally sensitive interventions are needed to reduce women's risk of developing nutrition-related diseases over the next decade.

Cultural Diversity↗

PubMed2001

Handwashing and respiratory illness among young adults in military training.

OBJECTIVES: In response to increasing concerns about respiratory illness in military recruits, a simple handwashing program was developed and evaluated at a large Navy training center. METHODS: Clinical records from 1996 through 1998 were reviewed to determine weekly rates of respiratory illness before and after program implementation (1,089,800 person-weeks reviewed). A supplemental survey was given to a sample of recruits to assess self-reported respiratory illness and compliance with the handwashing program. RESULTS: A 45% reduction in total outpatient visits for respiratory illness was observed after implementation of the handwashing program. No change was noted in hospitalization rates for respiratory illness, which remained low during the observation period. Survey data supported clinical observations, as frequent handwashers self-reported fewer respiratory illness episodes when compared to infrequent handwashers. Surveys also revealed challenges with handwashing compliance. CONCLUSIONS: Implementation of a handwashing program in this population of healthy young adults was associated with a marked reduction in outpatient visits for respiratory illness. Despite its success, maintenance of the handwashing program has been challenging in the time-constrained setting of military training.

Adult↗