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PubMed2005

Institutional challenges for EIA implementation in China: a case study of development versus environmental protection.

This paper provides a complete case study analysis of environmental impact assessment (EIA) implementation in China from planning to legal challenge, which is typical but rarely reported. The analysis takes an historical perspective on the regulatory and institutional structures through which EIA has been implemented in China, in order to evaluate the extent to which EIA has matured over the last 10 years. The case study relates to a proposed recreation/tourist development at Dianshan Lake, a protected water resource for Shanghai. Legal and administrative challenge began in 1993, when the case was initiated with a letter from the public, and concluded in 1996, when the case was decided in a court judgment. More recent follow-up research indicates that many issues have continued to be problems for EIA implementation in China. Policy implications in terms of regulatory structure, institutional arrangement, EIA procedure, EIA practitioners, and public participation can be drawn, and lessons learned for both the government and the developers. The study emphasizes the problem of relying on reorientation of existing institutions to promote new (environmental) priorities.

China↗

PubMed2006

Optimal environmental management strategy and implementation for groundwater contamination prevention and restoration.

An innovative management strategy is proposed for optimized and integrated environmental management for regional or national groundwater contamination prevention and restoration allied with consideration of sustainable development. This management strategy accounts for availability of limited resources, human health and ecological risks from groundwater contamination, costs for groundwater protection measures, beneficial uses and values from groundwater protection, and sustainable development. Six different categories of costs are identified with regard to groundwater prevention and restoration. In addition, different environmental impacts from groundwater contamination including human health and ecological risks are individually taken into account. System optimization principles are implemented to accomplish decision-makings on the optimal resources allocations of the available resources or budgets to different existing contaminated sites and projected contamination sites for a maximal risk reduction. Established management constraints such as budget limitations under different categories of costs are satisfied at the optimal solution. A stepwise optimization process is proposed in which the first step is to select optimally a limited number of sites where remediation or prevention measures will be taken, from all the existing contaminated and projected contamination sites, based on a total regionally or nationally available budget in a certain time frame such as 10 years. Then, several optimization steps determined year-by-year optimal distributions of the available yearly budgets for those selected sites. A hypothetical case study is presented to demonstrate a practical implementation of the management strategy. Several issues pertaining to groundwater contamination exposure and risk assessments and remediation cost evaluations are briefly discussed for adequately understanding implementations of the management strategy.

Environmental Exposure↗

PubMed2005

Theory into practice: implementing ecosystem management objectives in the USDA Forest Service.

In the United States and around the world, scientists and practitioners have debated the definition and merits of ecosystem management as a new approach to natural resource management. While these debates continue, a growing number of organizations formally have adopted ecosystem management. However, adoption does not necessarily lead to successful implementation, and theories are not always put into practice. In this article, we examine how a leading natural resource agency, the United States Department of Agriculture Forest Service, has translated ecosystem management theory into concrete policy objectives and how successfully these objectives are perceived to be implemented throughout the national forest system. Through document analysis, interviews, and survey responses from 345 Forest Service managers (district rangers, forest supervisors, and regional foresters), we find that the agency has incorporated numerous ecosystem management components into its objectives. Agency managers perceive that the greatest attainment of such objectives is related to collaborative stewardship and integration of scientific information, areas in which the organization has considerable prior experience. The objectives perceived to be least attained are adaptive management and integration of social and economic information, areas requiring substantial new resources and a knowledge base not traditionally emphasized by natural resource managers. Overall, success in implementing ecosystem management objectives is linked to committed forest managers.

Conservation of Natural Resources↗

PubMed2001

Environmental policy implementation in rural China: a case study of Yuhang, Zhejiang.

The rapid growth of rural enterprises has transformed the Chinese countryside. Although rural industrialisation has resulted in increased financial well-being, it has also contributed to decreased environmental quality. While China has strong environmental protection laws, this paper will demonstrate that they are not being effectively implemented in a rural region in Zhejiang Province. This is due to a number of social, political, and economic barriers that prevent agencies from effectively enforcing environmental policies and regulatory mechanisms. This paper investigates the implementation of China's environmental policies through a case study in Yuhang County, Zhejiang Province. It demonstrates that the implementation of environmental impact assessment, discharge fees, and limited time treatment is limited by inadequate technology, low finances, limited human resources, poor public environmental awareness, faulty data, inferior agency reports, organizational conflict, relations based on guanxi, and low discharge fee prices.

China↗

PubMed1997

Climate Convention Implementation: An Opportunity for the Pacific Island Nations to Move Toward Sustainable Energy Systems

/ The impacts of global warming are among the more serious environmental threats for the Pacific Island countries. These nations justifiably argue that developed countries should give immediate priority to the implementation of climate change mitigation policies because of the severe nature of potential greenhouse impacts for the Pacific Islands. Another immediate priority acknowledged by these nations is the need for development of adaptation policies that plan for adjustment or adaptation, where possible, to the foreshadowed impacts of climate change. This article does not focus on adaptation or mitigation policy directly but on an allied opportunity that exists for the Pacific Islands via the auspices of the Climate Convention, because the existing very costly energy systems used in the Pacific Island region are fossil-fuel dependent. It is argued here that efforts can be made towards the development of energy systems that are ecologically sustainable because Pacific Island nations are eligible to receive assistance to introduce renewable energy technology and pursue energy conservation via implementation mechanisms of the Climate Convention and, in particular, through transfer of technology and via joint implementation. It is contended that assistance in the form of finance, technology, and human resource development from developed countries and international organizations would provide sustainable benefits in improving the local Pacific Island environments. It is also emphasized that mitigation of greenhouse gas emissions is not the responsibility of the Pacific Islands as they contribute very little on a per capita global scale and a tiny proportion of total global greenhouse gas emissions.KEY WORDS: Pacific Islands; Climate change; Renewable energy; Framework Convention on Climate Change.

Journal Article↗

PubMed2001

[Inpatient rehabilitation improves implementation of therapeutic guidelines for secondary prevention in patients with coronary heart disease].

In Germany, measures for secondary prevention in patients with coronary artery disease are poorly utilized. We therefore investigated whether a cardiac in-hospital rehabilitation and education program may enhance the implementation of respective guidelines in patients with severe coronary artery disease (CAD). Specifically, we developed a case-control design in siblings with severe CAD in order to achieve optimal matching for patients with or without participation in the rehabilitation program. By the screening of more than 200,000 patient charts in 15 cardiac rehabilitation clinics, we identified 1500 families in which at least two siblings suffered from severe coronary artery disease. In 268 such sibling pairs, siblings were discordant with respect to participation in a 3-4 week cardiac in-hospital rehabilitation program. The coronary risk profile was studied, first, retrospectively at the time of hospitalization for acute MI or revascularization procedures and, secondly, prospectively at the time of follow-up (on average 5.2 years later). At the time of the acute cardiac event, both groups showed an equal risk factor distribution suggesting appropriate matching. However, at follow-up the number of individuals taking antihypertensive medication and displaying effective antihypertensive treatment (< or = 140/90 mmHg) was significantly higher in the rehabilitation group (92.2 vs. 82.1%, p < 0.01; 59.7 vs. 37.2%). Accordingly, rehabilitation siblings presented with significantly lower systolic (137 +/- 1 vs. 145 +/- 1 mmHg; p < 0.01) and diastolic blood pressure (82 +/- 1 vs. 85 +/- 1 mmHg; p < 0.01). The utilization of CSE inhibitors was also significantly higher in siblings participating in the rehabilitation program (57.5 vs. 43.1%; p < 0.01), leading to significantly lower blood lipid levels in these siblings (total cholesterol 225 +/- 3 vs. 236 +/- 3 mg/dL, p < 0.01; LDL cholesterol 148 +/- 3 vs. 158 +/- 3 mg/dL, p < 0.01). Moreover, participation in the cardiac rehabilitation stimulated markedly more smokers to quit (80.8 vs. 57.6%, p < 0.01). Additionally, there was a strong temporal trend from 1997 until 2000 towards improved control of arterial hypertension in rehabilitation siblings. In parallel, the utilization of CSE inhibitors increased over time and LDL cholesterol decreased. These favorable temporal trends were also observed in siblings not participating in the rehabilitation program, however, to a lesser extent. Taken together, in the last four years, the implementation of secondary preventive strategies in patients with cardiac disease improved. Siblings who participated in a rehabilitation program displayed a better control of cardiovascular risk factors as compared to those not participating in such a program. Thus, an in-hospital cardiac rehabilitation program may successfully encourage the implementation of measures for secondary prevention and enhance the treatment of coronary risk factors.

Aged↗

PubMed2003

Evaluation of top-down implementation of health regulations in the transport sector in a 5-year period.

OBJECTIVE: A collective labour agreement concerning extended rest periods during long-distance shuttle bus trips of Dutch long-distance coach drivers was established in 1997. The main purpose of this study was to evaluate the extent to which top-down implementation of these health regulations, with respect to rest times and subjective health complaints in the private passenger-transport sector, succeeded in the year 2002. METHODS: A questionnaire study was carried out on 440 coach drivers and 97 of their employers. The questionnaire for coach drivers focused on the frequency they received the required rest times and on their health status. The questionnaire for employers focused on the number of rest hours that their companies scheduled for long-distance shuttle bus trips for their drivers. Motives for not scheduling the required rest hours were noted as well. RESULTS: Almost every employer (93%) and three-quarters of the drivers (72%) reported at least 12 h rest time before a long-distance shuttle bus trip, as required. Approximately half of the employers (57%) reported planning the required rest during and after these bus trips. Fewer than one-quarter of the drivers (24%) received at least 10 h rest at their destination and fewer than half of the coach drivers (42%) always receive the required 24 h rest after the trip. In addition, the significant results are indicative of a positive relationship between the duration of the rest period during and after the long-distance shuttle bus trip and the level of health complaints of the coach drivers. CONCLUSIONS: Top-down implementation of health regulations with respect to rest times resulted in successful implementation after 5 years in approximately half of the companies. Longer rest times during the high season of 2002 were associated with less health complaints at the end of that season.

Adult↗

PubMed2000

Recursive implementations of temporal filters for image motion computation.

Efficient algorithms for image motion computation are important for computer vision applications and the modelling of biological vision systems. Intensity-based image motion computation proceeds in two stages: the convolution of linear spatiotemporal filter kernels with the image sequence, followed by the non-linear combination of the filter outputs. If the spatiotemporal extent of the filter kernels is large, then the convolution stage can be very intensive computationally. One effective means of reducing the storage required and computation involved in implementing the temporal convolutions is the introduction of recursive filtering. Non-recursive methods require the number of frames of the image sequence stored at any given time to be equal to the temporal extent of the slowest temporal filter. In contrast, recursive methods encode recent stimulus history implicitly in the values of a small number of variables updated through a series of feedback equations. Recursive filtering reduces the number of values stored in memory during convolution and the number of mathematical operations involved in computing the filters' outputs. This paper extends previous recursive implementations of gradient- and correlation-based motion analysis algorithms [Fleet DJ, Langley K (1995) IEEE PAMI 17: 61-67; Clifford CWG, Ibbotson MR, Langley K (1997) Vis Neurosci 14: 741-749], describing a recursive implementation of causal band-pass temporal filters suitable for use in energy- and phase-based algorithms for image motion computation. It is shown that the filters' temporal frequency tuning curves fit psychophysical estimates of the temporal properties of human visual filters.

Algorithms↗

PubMed2006

Implementation of a palliative care team in an Austrian university hospital.

Implementation of hospital-based palliative care team is a new subject in German-speaking areas, especially in university hospitals. Our Section of Palliative Care was subsequently built up to a 12-bed palliative care unit, a home-based, and a hospital-based palliative care team. Analysis of the implementation strategies, development of the working profile, and documentation of the hospital-based palliative care team were done. During the first 2 years, quality and number of inquiries for palliative care increased significantly. In our opinion, a high degree of expertise, involvement of the nursing staff, and personal contact play a key role for a successful implementation of a palliative care team in a large university hospital.

Austria↗

PubMed2000

Video-assisted blebectomy using a flexible scope and a bleb implement.

We describe herein our new technique of performing video-assisted thoracic surgery (VATS) using a flexible scope and a bleb implement which allows for a reduction in the risk of overlooking small and flat blebs in patients with a spontaneous pneumothorax (SP). This technique was performed in 26 consecutive patients with a SP. A skin incision about 18 mm long was made in the area over which the patients had specified preoperatively, and meticulous observation of the apex and superior segment was performed using a bleb implement. Partial pneumonectomy with endoscopic staplers and laser ablation were carried out for pleural lesions. We found that VATS combined with a flexible scope and a bleb implement resulted in better visibility for detection and removal of any small and flat blebs.

Equipment Design↗

PubMed2001

The pros and cons of implementing PACS and speech recognition systems.

The installation and implementation of a hospitalwide image management system and a speech recognition dictation system has had a dramatic and positive impact on radiology report turnaround times at Elmhurst Hospital Center, a 543-bed municipal teaching hospital located in New York City's Borough of Queens. The "lost film" problem has been eliminated. As a result, the percentage of unreported examinations has dropped from 25% to less than 1%. These performance improvements have significantly benefited the entire medical staff. With the successful implementation of a HL-7 standards-based radiology information system (RIS), a speech recognition dictation system, around-the-clock staffing of Board Certified radiologists, and a picture archiving and communication system (PACS), report turnaround time improved dramatically. Eighty-six percent of all examinations now are reported formally within a 12-hour period compared with a 3% average before implementation of the changes. However, with the use of the PACS and speech recognition technologies, new problems have arisen within the radiology department. These technologies, designed to enhance communications capabilities, also have significantly reduced the amount of clinician/radiologist dialogue. Easy and rapid access to patient images and reports has had a detrimental effect on that face-to-face consultations with clinicians, which were commonplace before PACS, and now have almost completely disappeared. The radiologist/clinician interchanges, which occurred frequently before a final report was dictated, often resulted in better understanding of the clinical problem and, hence, a more meaningful final report. Although a conferencing feature to facilitate communication exists within the PACS, it is not utilized by the clinicians. The dilemma is that as information about patients is made more available to the hospital staff, less information is provided about patients to the radiologists. Although the speech recognition system benefits the hospital, its staff, and the patients served by reducing clinician time awaiting a diagnostic report and reducing clinic and emergency room waiting time by the patients themselves, it does not necessarily benefit the radiologists who use it. Speech recognition dictation systems slow down the individual productivity of the radiologists' dictation process by at least 25%. Radiologists are assuming the role of transcriptionists as well as diagnosticians. Mistakes occur that would not with the use of a traditional dictation system and professional transcriptionists.

Efficiency↗

PubMed2002

Association of the implementation of PACS with hospital revenue.

The purpose of this study is to assess the association of implementation of PACS with the inpatient and outpatient revenue of a general hospital. The authors analyzed the in- and outpatient revenue data of all general hospitals (212) in South Korea obtained from the Korean National Health Insurance Corporation (KNHIC) during the period from 1996 through 1999 using the mixed model for repeated measure data. The following variables were used in the analysis: status of picture archiving and communication systems (PACS) implementation, population size, state of competition, inhabitant's income, hospital location, hospital size, whether a tertiary hospital, whether public or private, the effect of year. The revenues from both in- and outpatient departments were significantly higher one year after the introduction of PACS while controlling for the confounding variables. Although the causality needs to be clarified, the implementation of PACS was correlated significantly to the increased amount of inpatient and outpatient revenue.

Analysis of Variance↗

PubMed2002

Changes in technologist productivity with implementation of an enterprisewide PACS.

The purpose of this report is to determine what effect filmless operation has on technologist productivity when compared with traditional film-based operation. Retrospective data on technologist productivity was collected from the study institution before and after implementation of PACS using workload reports and payroll records. Departmentwide technologist productivity was defined as the number of examinations per full-time equivalent (exams/FTE) and correlated with local and nationwide standards operating in traditional film-based operations. During film-based operation, technologist productivity was comparable between the study institution and nationwide standards, allowing for the unique examination volumes and modality mix. After implementation of a large-scale PACS, technologist productivity was found to increase 34% above that of national standards and 48% that of the local control site. Implementation of an enterprisewide PACS offers the potential to significantly improve departmentwide technologist productivity when compared with traditional film-based operation.

Efficiency↗

PubMed2006

Implementing a depression improvement intervention in five health care organizations: experience from the RESPECT-Depression trial.

A growing body of research provides strong evidence for the effectiveness of programs to improve the primary care of depression based on the chronic care model. At the same time these changes are difficult to sustain in their original research settings and more difficult to widely disseminate in primary care practice. The RESPECT-Depression trial tested an implementation and dissemination strategy by working through five community-based health care organizations (HCOs) to implement the Three Component Model (TCM) for improving depression care. This report describes the results of extensive interviews of project principals, health care program managers, depression care managers, and practicing primary care clinicians to understand the characteristics of organizations and the intervention components that were associated with implementation and dissemination of the TCM. In two of the organizations all 29 participating practices continued the TCM, while all 31 practices from the other three organizations did not. Successful continuation and dissemination appeared to be related to a broadly shared vision and commitment among all levels of the organization, clearly articulated by clinical leadership, for pursuing a systematic change strategy to improve chronic care that included, but extended beyond, depression, independent of clear evidence for cost-effectiveness of expanding depression management. Factors associated with inability to sustain the TCM included lack of a shared change strategy throughout the organization and inability to rationalize an economic model of depression care.

Depression↗

PubMed2005

Implementation of a pharmacist-led clinic for hypertensive patients in primary care--a pilot study.

OBJECTIVES: To implement a pharmacist-led Hypertension Management Clinic in one general medical practice. To evaluate the impact of the clinic on blood pressure (BP) control and prevention of coronary heart disease (CHD). METHOD: A total of 242 patients attended the pharmacist-led hypertension clinic over a 10-month period. Lifestyle and drug therapy alterations were implemented to achieve British Hypertension Society (BHS) target level BP. A sub-group of 160 patients were used to compare BP control in the clinic setting against that with the general practitioner (GP). Assessment was made of 10-year CHD risk in patients with no artherosclerotic disease. Patients with underlying artherosclerotic disease were prescribed statins, and antiplatelet drugs where indicated. MAIN OUTCOME MEASURES: Changes in numbers of hypertensive patients meeting the BHS target level BP. Changes in prescribing of antiplatelet agents and statins for primary and secondary prevention of artherosclerosis. RESULTS: In 206 patients with established hypertension, the number achieving target level BPs increased from 74 (36%) pre-clinic to 174 (85%) post-clinic; P < 0.001 chi-squared test. After attending the clinic, for 5 months 74 patients (80%) achieved target level BP in the clinic compared with 27 (40%) with standard GP care; P < 0.001 chi-squared test. Of 188 patients assessed for primary prevention therapy, 126 (67%) required treatment with aspirin and 37 (20%) with a statin. Post-clinic 101 (80%) received aspirin compared with 17 (13%) pre-clinic and 34 (92%) received a statin in comparison with 4 (11%) pre-clinic; both P < 0.001 chi-squared test.A total of 52 (96%) of 54 patients received an antiplatelet agent for secondary prevention of artherosclerosis compared with 40 patients (74%) pre-clinic. Thirty six of 54 patients required a statin for secondary prevention. Thirty five patients (97%) received a statin compared with 23 (64%) pre-clinic; both P < 0.01 chi-squared test. CONCLUSION: Implementation of a pharmacist-led clinic improved blood pressure control and appropriate prescribing of antiplatelet agents and statins for primary prevention of CHD and secondary prevention of artherosclerosis.

Aged↗

PubMed2006

Fidelity of implementation in Project Towards No Drug Abuse (TND): a comparison of classroom teachers and program specialists.

This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which we compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students' posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects.

Adult↗

PubMed1987

Effect of medical records' checklists on implementation of periodic health measures.

Recent re-evaluation of preventive health care has resulted in more limited and directed guidelines; nonetheless, physician compliance has remained poor. This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures. Residents in internal medicine were randomly placed into two groups: one received a copy of the appropriate checklist with each patient's medical record; the other did not. After one year, 200 randomly selected records were audited to determine the proportion of recommendations implemented for each patient. Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not (0.56 +/- 0.26 versus 0.39 +/- 0.22, p less than 0.002). The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received (0.70 +/- 0.21 versus 0.44 +/- 0.24 and 0.39 +/- 0.22, respectively, p less than 0.002). These data suggest that a physician's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance.

California↗

PubMedDate not supplied

Measuring of impact of patient counseling in the outpatient pharmacy setting: development and implementation of the counseling models for the Kaiser Permanente/USC Patient Consultation Study.

The Southern California region Kaiser Permanente Medical Care Program, which serves 2.2 million patients, and the University of Southern California School of Pharmacy have designed and implemented a patient consultation study to determine the cost-effectiveness of three different approaches to providing pharmacist consultation to outpatients. This paper describes the development and implementation of these three models. A total of 107 pharmacies (approximately 600 pharmacists) participated in the study and were assigned to provide one of the models of patient consultation, designated the Kaiser Permanente (KP) model, the state model, and the control model. The KP model (20 pharmacies) provided targeted pharmaceutical care services to high-risk patients based on drug use. The state model (67 pharmacies) provided California-mandated patient consultation to patients with new or changed prescriptions, instructions for use, relevant warnings and precautions, storage requirements, and the importance of compliance. The control model (20 pharmacies) provided consultation when deemed necessary by the pharmacist and provided care similar to that provided before mandatory consultation in California. The KP and state models used the same pharmacist/technician/clerk resources, but the control pharmacies limited personnel resources to those existing before the mandatory consultation law was passed in California. The paper describes the KP model in detail and provides a literature-based rationale for targeting particular high-risk patients for expanded services. The paper also describes the training process, gives an example of a high-risk patient intervention, provides information on documenting pharmacist interventions in all models, and explains the method used for monitoring implementation of the models.

Ambulatory Care↗