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PubMed1993

Implementation of a model for estimating tumor control probability for an inhomogeneously irradiated tumor.

This paper presents the details of a practical implementation of a model for the prediction of the tumor control probability (TCP) when a tumor is irradiated non-uniformly. The implementation is based on a previously published model and represents a simplified version of the model with a limited number (five) of parameters. We show how to derive the model parameters from clinically available data and offer pseudocode for computer implementation. The model should be a useful tool for evaluating and optimizing 3D dose distributions.

Humans↗

PubMed1995

Changes in midwives' attitudes to their professional role following the implementation of the midwifery development unit.

OBJECTIVE: to examine changes in midwives' attitudes to their professional role following the implementation of the midwifery development unit (MDU). DESIGN: prospective cohort study. SETTING: the MDU is based at a major teaching hospital in Glasgow, UK. The MDU midwives provide care via a new self-rostering system which is intended to improve continuity of care. Midwives aim to provide total care for each woman from the antenatal period through delivery and the postnatal period. PARTICIPANTS: 21 midwives who joined the MDU were compared with a group of 64 midwives at the hospital who were also eligible and who continued in their usual pattern of work (non-MDU midwives). MEASUREMENTS: an audit questionnaire was distributed to MDU and non-MDU midwives prior to the implementation of the unit and about 15 months afterwards. In addition, the MDU midwives were sent the questionnaire every three months. Extra questions were added at each time period in order to identify specific problems. This information was then fed back to the midwifery management team to aid in the planning and implementation of the care programme. FINDINGS: the MDU midwives experienced a significant positive change in attitudes; no significant change was evident for the non-MDU group. There was no evidence of increased stress in the MDU midwives. In general, both groups of midwives had positive attitudes towards the unit and felt that MDU-style care had a role to play in the future provision of maternity care. A number of areas of concern were also highlighted, such as the system of liaison with colleagues. CONCLUSIONS: innovative models of midwifery care such as an MDU can have a positive impact on midwives' attitudes towards their professional role. IMPLICATIONS FOR PRACTICE: if change is managed in a systematic manner which involves the midwives, it may be possible to increase midwives' professional satisfaction, while at the same time minimising any negative effects such as increased stress.

Adult↗

PubMed1984

Assessment and implementation of health care priorities in developing countries; incompatible paradigms and competing social systems.

This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practised by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health mass movements thrive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the re-assessment and implementation of health care priorities in developing countries with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between 'stage theory' and modern consumption-production Malthusianism. (a) Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. (b) In the context of under-development, increased productivity is at the necessary cost of public health. Orienting health care priorities in line with belief in the instrumentality of profit for eradicating the diseases of under-development is ideological and counterproductive. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading 'Basic Needs' orientation in the assessment and implementation of health care priorities derives. Marx said that "Countries of developing capitalism suffer not only from its development but also from its under-development". Rephrasing Marx, this paper points out that developing countries suffer not only from the under-development of capitalism but also from its development.

Delivery of Health Care↗

PubMedDate not supplied

Picture archiving and communication system (PACS) networking: three implementation strategies.

This paper outlines the diverse Picture Archiving and Communication Systems (PACS) networking implementation strategies at the University of California at Los Angeles, the University of Florida, and the University of Kansas. At the University of California at Los Angeles, a very high-speed network has been integrated into a hierarchical networking strategy, resulting in an entirely customized network for the local transmission of images. The University of Florida has chosen to implement networks for local transmission of images using commercially available equipment. The University of Kansas, specializing in teleradiology applications, uses commercial telecommunication circuits to implement long distance referral services to small hospitals.

Florida↗

PubMed2006

Implementation of computerized alcohol screening and advice in an emergency department--a nursing staff perspective.

Changes in attitudes towards alcohol prevention among nursing staff are evaluated after implementing an opportunistic computerized alcohol screening and intervention (e-SBI) at an emergency department. After having assessed the patients in the triage room the nurses asked patients to perform the e-SBI on a touch screen computer. Before the start of the project more than 60% of the nurses expected the patients to react negatively when asked about their alcohol habits. After one year of screening only 10% reported experience of negative reactions from the patients. More than 50% of the nurses found it easy or very easy to ask the patients to perform the e-SBI and more than 75% of the nurses agreed that the e-SBI did not affect their workload. The proportion of nurses who considered alcohol prevention to be part of their duties at the emergency department did not change (40%) after implementing the e-SBI. During the two-year study period, 1982 patients completed the e-SBI which constituted 10-20% of all patients between 16 and 70 years of age attending the department for a sub critical condition. The e-SBI seems to have better potential than ordinary alcohol screening and intervention for implementation into routine emergency departments due to its simplicity and low time consumption.

Adolescent↗

PubMed2006

Part II: preparing and assessing first-year radiology resident on-call readiness technical implementation.

RATIONALE AND OBJECTIVES: The effectiveness of using a Digital Imaging and Communications in Medicine (DICOM)-based interactive examination system in evaluating the readiness of first year radiology residents before taking overnight call in the emergency department (ED) was reported in part I of this article. This report describes technical aspects for the design and implementation of this system. MATERIALS AND METHODS: The examination system consists of two modules: Data Collection and Image Viewing. The Data Collection module was a personal computer (PC)-based DICOM storage server based on a free public domain software package, the Mallinckrodt Central Test Node. The Image Viewing module was a Java-based DICOM viewer created using another freeware package: zDicom ActiveX component. RESULTS: The examination takes place once a year at the end of the first 6-month rotation. Cases selected for the examination were actual clinical cases according to the American Society of Emergency Radiology core curriculum. In the 3-hour timed examination, each resident was required to read the cases and provide clinical findings and recommendations. Upper-level residents also participated in the examination to serve as a control. Answers were scored by two staff radiologists. CONCLUSION: We have been using this examination system successfully in our institution since 2003 to evaluate the readiness of the first-year residents before they take overnight call in the ED. This report describes a step-by-step procedure for implementing this system into a PC-based platform. This DICOM viewing software is available as freeware to other academic radiology institutions. The total cost for implementing this system is approximately 2000 US dollars.

Curriculum↗

PubMed2004

The implementation of game in a 20-day head-down tilting bed rest experiment upon mood status and neurotic levels of rest subjects.

This study evaluated the effect of the implementation of game on mental health among participants in a bedrest (BR) experiment. Subjects were 12 healthy males aged 20-26, who participated in a 20-day 6-degrees head-down tilting BR experiment. The participants were asked to complete psychometrical questionnaires before, during, and after the experiment. We entrusted the participants to manage their leisure time and they intended a game in which all of them could take part over the experiment period. The general conversation and light-hearted mood among the subjects continued during the experimental period. Longitudinal data analysis showed that levels of neurosis and mood status did not deteriorate during the experiment, while our previous experiments, which were performed under the same protocol as this study except for the implementation of the game showed a distinct deterioration in psychosocial status. We consider that the implementation of game autonomously contributes to the positive effects on the mental health among the participants.

Adaptation, Psychological↗

PubMed2006

Prepackaged hand hygiene educational tools facilitate implementation.

The Healthcare Infection Control Practices Advisory Committee released hand hygiene guidelines recommending that hospitals educate personnel to increase compliance with hand hygiene. However, few educational tools are available to assist hospitals in this effort. Eight hospitals were recruited to implement hand hygiene educational tools. Key informant interviews were conducted with infection control professionals (ICPs) at 5 participating hospitals. Lack of personnel time was the primary barrier to implementing the educational tools. Multimodal, prepackaged educational tools are needed to decrease barriers and facilitate implementation of interventions locally by ICPs.

Georgia↗

PubMed2005

Implementation of an innovative health service a "real-world" diffusion study.

BACKGROUND: Although reporting on the healthcare-setting level of continuance or discontinuance of an intervention once a trial is completed has been recommended, such "real-world" diffusion studies are rare. The present example was made possible by funding to explore opportunities for post-trial implementation of an innovative health counseling intervention for cardiovascular prevention in The Netherlands. METHODS: Between 2001 and 2004, in a longitudinal case study, we compared two healthcare settings: a cardiology outpatient clinic and general practices. Rogers' diffusion of innovations theory served as the theoretical background. Information was extracted from minutes of meetings and informal conversations with health counselors, and checked by the project manager. Additional data were collected from physicians with a short questionnaire. RESULTS: Implementation of the health counseling intervention was successful in the cardiology outpatient clinic, but was unsuccessful in the general practices. Success was related to a centralized diffusion system, stronger "change agent" efforts, avoidance of post-trial interruption of service delivery, easily achievable "reinventions," and positive physician perceptions of the service (i.e., not complex and compatible with current practice routines). Support came from changes in the organization of care that created opportunities for, instead of competition with, the innovative service. However, coincidental events may also have played a part. CONCLUSIONS: Our findings confirm the importance of most theoretically predicted individual and organizational diffusion variables. This implies that the implementation of innovative healthcare services requires attention at both levels.

Ambulatory Care↗

PubMed2004

Implementation of CIEMAT/NIST LSC efficiency tracing method in KRISS: (204)T1 standardization.

The CIEMAT/NIST efficiency tracing method has been widely used for radionuclide standardization. The method consists of the theoretical calculations of counting efficiencies and the experimental data obtained from a commercially available double photomultiplier detector. We have recently implemented the technique using (3)H as a tracer. Our implementation of the method was validated by participating into an international comparison of activity measurements of a solution of (204)T1. We report in this paper the procedure employed to implement the technique and compare our measurement result of (204)T1 activity with that of the international comparison.

Journal Article↗

PubMed2006

Implementation of a national metrology network of radionuclides used in nuclear medicine.

The Nuclear Medicine Services (NMS) in Brazil routinely use dose calibrators to measure the activity of solutions containing radiopharmaceuticals. These solutions are administered to patients with the intention to diagnose or treat illnesses. However, for optimal results, the activity of these radiopharmaceuticals must be determined as accurately as possible. The National Laboratory for Ionizing Radiation Metrology (LNMRI) led, since 1998, a comparison program for activity measurements of radiopharmaceuticals administered to patients in the NMS with the purpose promoting quality control. This program has been carried out successfully in Rio de Janeiro, but there is a need to implement it around the country. This can be resolved through the implementation of a network of regional laboratories at various locations throughout the national territory. Currently, such a network is active at a second site, located in Brasília, covering the needs of the Center-West Region, and at a third site, located in Porto Alegre, in the South Region. This work presents the results of comparisons for the radiopharmaceuticals nuclides 131I and 99Tcm and proves that the implementation of a radionuclide metrology network is feasible and viable.

Brazil↗

PubMedDate not supplied

Hardware optimization and serial implementation of a novel spiking neuron model for the POEtic tissue.

In this paper we describe the hardware implementation of a spiking neuron model, which uses a spike time dependent plasticity (STDP) rule that allows synaptic changes by discrete time steps. For this purpose an integrate-and-fire neuron is used with recurrent local connections. The connectivity of this model has been set to 24 neighbours, so there is a high degree of parallelism. After obtaining good results with the hardware implementation of the model, we proceed to simplify this hardware description, trying to keep the same behaviour. Some experiments using dynamic grading patterns have been used in order to test the learning capabilities of the model. Finally, the serial implementation has been realized.

Action Potentials↗

PubMed2026

Delphi study robot consenso: Strategies for the implementation of robotic surgery in general surgery in the Spanish hospital network.

INTRODUCTION: The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption. This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation. METHODS: A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall's W coefficient was used to assess concordance. RESULTS: High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways. CONCLUSIONS: This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre's context, case volume, and available resources.

Cirugía Asistida por Robot↗

PubMed2005

Healthcare reform implementation: stakeholders and their roles-the Israeli experience.

In early 1995, Israel implemented a healthcare reform. The course of any such reform depends largely on the strengths and interests of different stakeholders in the health system and their roles during the implementation phase. This paper discusses the roles of stakeholders in the recent Israeli healthcare reform, analyzes their motives, and describes their impact on the course of the reform. In retrospect, the Israeli healthcare reform had a profound effect on the country's overall healthcare environment and involved significant social, cultural, and financial changes and advancements. However, imbalances among stakeholders in the health system caused several aspects of the reform to stray from the original plan. Thus, in the first few years after the reform only first steps were taken toward the fulfillment of the vision of the reform, an equitable healthcare system that meets the health needs and welfare of the population from cradle to grave. A study of the stakeholders may further our understanding of the process of health-reform implementation.

Health Care Reform↗

PubMed2006

Implementation of neuroreflexotherapy for subacute and chronic neck and back pain within the Spanish public health system: audit results after one year.

Controlled randomized trials have demonstrated the efficacy, safety, effectiveness, and cost-effectiveness of neuroreflexotherapy (NRT) for the management of non-specific back pain. In this audit study, we describe the implementation of NRT into the routine practice of primary care within the Spanish public health service of the Balearic Islands and the results obtained after one year (2004). A referral protocol was made available to all general practitioners (GPs) who could refer eligible patients to specialized units in performing NRT interventions. A total of 1209 patients (median age 52 years, 68% women) were referred to NRT by 412 GPs (80% of all GPs), with a mean (standard deviation (S.D.)) referral rate of 1.57 (0.84) patients per month/10,000 persons affiliated to each practice, and an appropriate referral rate of 95.5%. Pain decreased from a median score (visual analog scale) of 8 at baseline to 1 at discharge, referred pain from 7 to 1, and disability (Roland-Morris Questionnaire) from 12 to 1. NRT was refused by 2.7% of patients. Adverse effects related to the procedure were only a skin reaction in 3.3% of patients. We conclude that it is feasible to implement NRT in the public health service complying with methods and application conditions used in previous randomized controlled trials (RCTs). In such conditions, implementation of this technology obtained positive audit results at one year.

Aged↗

PubMed2005

Computerized provider order entry system field research: the impact of contextual factors on study implementation.

Attention to contextual factors is essential to the conduct of high quality informatics field research. This is particularly true when the research focus is on complex information technology innovations like computerized provider order entry (CPOE) systems. From a field research perspective, CPOE systems are considered an organizational intervention. They are designed, implemented and used within an organizational context that encompasses cultural, economic, social and physical aspects. It is essential that informatics researchers address contextual factors when assessing the impact of CPOE systems. Inclusion of organizational contextual factors in CPOE system field studies permits a more accurate evaluation of the true impact these systems have on medication practice processes and outcomes. The goals of this paper are to: (1) identify contextual factors that influenced implementation of a federally-funded field study undertaken to examine the impact of a community hospital CPOE system on medication error outcomes; and (2) describe how these contextual factors influenced study methodology and implementation.

California↗

PubMed2006

Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region--Bridging the gap between knowledge and practice.

INTRODUCTION: Stockholm County Council is the largest health care provider in Sweden with an annual budget of US$ 5 billion and catering the needs of a metropolitan population of 2 million people. About 10% of health care costs are used on drugs. In 1996 Stockholm County Council decided to address the main problems associated with the process and the quality of drug prescribing. METHODS: A multiyear strategy was designed, including the establishment of a strong evidence-based organisation, Drug and Therapeutics Committees and editorial resources to adapt information to the IT-media and the development of the IT-architecture. The development and implementation of computerized tools such as a physician drug order entry system including decision support, a drug information website and electronic transmission of prescriptions were started in 1996. RESULTS: The implementation was slow at the point-of-care units. It took about 6 years before the implementation process gained speed. In September 2005 almost 1000 doctors could use the decision support system for prescribing drugs and more than 70% of all prescriptions were transmitted electronically in our region. CONCLUSIONS: The work with the strategy has shown that improvements in drug use can be accomplished by providing access to simple, rapid and safe electronic tools, but the information provided has to be associated with well-recognized regional and national expert organisations.

Delivery of Health Care↗

PubMed2005

Staff experiences in implementing guidelines for Kangaroo Mother Care--a qualitative study.

The aim of this study was to investigate staff experiences in implementing guidelines for Kangaroo Mother Care in neonatal care. The study was part of a randomized controlled trial, the overall goal of which was to assess the impact of external facilitation. A total of eight focus group interviews were held at two intervention and two control units. The establishment of a change team to implement the guideline resulted in activities that impacted staff behaviour, which in turn was perceived to influence patients' well-being. The guideline and contextual factors, such as leadership and staff colleagues' attitudes, were of significant importance in that process. The study intervention--facilitation--promoted implementation activities and was highly appreciated by the change teams. However, reviewing the development of events at one of the control units, the provided facilitation appeared to be no more effective than an improvement-focused organizational culture in which the nurse manager was actively involved in the change process. Overall, learning and behaviour change seemed to be a social phenomenon, something that greatly benefited from people's interaction with one another.

Adult↗