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Results for “Implementation challenges”

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At least 1,027 records · Page 57Linked to original sources

PubMed2005

Guidelines for the management of osteoporosis: the present and the future.

Evidence-based guidelines are increasingly used in the management of osteoporosis and have the potential to produce uniformly high standards of clinical care across different sectors of the health service. National guidelines for the prevention and treatment of osteoporosis are now available in a number of countries and, although sharing similarities, also differ in some respects. This review considers the challenges involved in the development and implementation of guidelines and proposes a paradigm for the unification of guidelines in the future.

Aged↗

PubMed2003

Time limitations and the challenge of providing infection-preventing dental care to hematopoietic stem-cell transplantation patients.

GOAL: Oral-dental infection foci should be eradicated before the ablative chemo-radiotherapy regimen of hematopoietic stem cell transplantation (HSCT) commences. The rationale of oral-dental treatment is to prevent the future development and spread of infections in patients with compromised immune systems. This study aims to shed light on the challenges facing hospital dentists in the implementation of optimal oral-dental treatment prior to HSCT. PATIENTS AND METHODS: Data regarding the medical status and dental treatment needs before HSCT were retrieved from the files of 86 consecutive patients post-HSCT. The timing of the oral-dental examination was also recorded. MAIN RESULTS: Dental treatments required before the HSCT were mainly combinations of scaling, plastic fillings, and extractions (47.8%, 39.1%, and 19.5% of the patients respectively). Patients presented at the clinic for oral-dental examination an average of 20.65+/-16.82 days before HSCT with a median of 15 (quarter interval range 10-15) days. CONCLUSIONS: Our data indicate a dense distribution of dental needs preceding the ablative conditioning regimen for HSCT. These facts accentuate the vital need for cooperation between hospital dentists and treating physicians.

Adult↗

PubMed2005

Virtual colonoscopy: issues related to primary screening.

Virtual colonoscopy (VC) is a minimally invasive CT examination that has continued to rapidly evolve and improve as a diagnostic screening tool. Current state-of-the-art VC technique has already been shown to be highly effective for screening at the University of Wisconsin. Although more widespread implementation of VC screening faces multiple challenges and barriers, these are all greatly overshadowed by the immediate need for increased patient compliance in effective colorectal screening programs. Given the wide availability of CT and the favorable safety profile compared with optical colonoscopy, VC holds significant potential for addressing a very important yet preventable public health concern. This paper will briefly address some of the major issues related to the general application of VC for colorectal screening, such as diagnostic performance, development of an acceptable screening algorithm, and several technique-related issues.

Algorithms↗

PubMed2005

Environmental benchmarks vs. ecological benchmarks for assessment and monitoring in Canada: is there a difference?

Environmental benchmarks are widely used in Canadian environmental assessment as a standard against which to monitor air or water quality in response to human activities in the environment. Recent work in Canada has developed the concept of ecological benchmarks as a complement to environmental benchmarks. However, implementation of ecological benchmarks may be challenging. This paper presents an analogy between ecological benchmarks and the more commonly used environmental benchmarks, as an attempt to increase understanding and use of ecological benchmarks in resource management, assessment, and monitoring. Ecological benchmarks, and their corresponding indicators, will be challenging to identify and use. However, through the use of the principles of adaptive management, effective ecological indicators and benchmarks can be established. Although it is essential that ecological benchmarks are site-specific, the analogy and general principles outlined here are applicable to assessment and monitoring in any part of the world.

Canada↗

PubMed2001

Impact of New Sexually Transmitted Disease Diagnostics on Clinical Practice and Public Health Policy.

Nucleic acid amplification tests (NAAT) offer enhanced sensitivity and excellent specificity for many sexually transmitted diseases. For some pathogens for which a practical diagnostic test does not exist, such as human papillomavirus (HPV), NAAT are also useful. Further, most NAAT can be applied to less "invasive" patient specimens, including urine and vaginal fluid. This dramatically increases opportunities to test persons outside of traditional clinic settings. Use of NAAT has resulted in revisions of the proportion of sexually transmitted diseases (STDs) that are asymptomatic, and has increased measured prevalence of some STDs, notably Chlamydia trachomatis. NAAT have helped to clarify the eitiologies of genital ulcer disease and urethritis, and have provided a more complete picture of the natural history of genital herpes and HPV. The ability of polymerase chain reaction to detect HPV may change the management of patients who have abnormal Pap smears. Efforts to bear the relatively high cost of NAAT, such as pooling urine, are under study. NAAT for bacterial STD should be in populations at high risk for asymptomatic STD, especially those who might not access routine STD screening at traditional settings. Working through the cost to health care systems, including the public health arena, and implementation at the laboratory level are challenges to overcome before NAAT become the standard of care in most settings.

Journal Article↗

PubMed1993

Rehydration and nutritional management.

Diarrhoea remains a leading worldwide cause of morbidity and mortality. In developing countries alone, 1.5 billion episodes of diarrhoea occur per year in children under 5 years of age and approximately 4,000,000 of these result in death. Early, appropriate therapy decreases the risk of complications and death due to diarrhoea. Regardless of the causative agent, oral rehydration and nutritional management are the mainstays of good management of infants, children and adults with diarrhoea. Diarrhoeal disease control programmes throughout the developing world have adopted the WHO case management plan as a standard. In this chapter, we review the history, successes and shortcomings of various oral rehydration therapies and recommend a case management approach that is similar to the WHO plan. Although ORT is safe, effective, convenient and economical, this therapy has not been universally implemented in health care settings. The challenge for clinical and public health practitioners in developing and developed countries is to identify and overcome the barriers that exist so that all patients with diarrhoea will have the opportunity to receive optimal care.

Administration, Oral↗

PubMed2006

Medication reconciliation: developing and implementing a program.

During the past 5 years since the medication reconciliation process was formalized and automated, it has become an independent redundancy. The patient intervention rates are maintained at 30% to 35%, with ADE rates related to medication reconciliation at zero. The medication process takes into account the accuracy and appropriateness of restarting prehospital medications and current ICU medications. It includes the omission of important home medications along with inaccuracies of dosages and frequencies. This form assures that the patient is receiving continuity of care ad decreases complications of the patients health related to the changing of medications. Until recently this concept was disseminated by the staff without consistent administrative support. It was a process developed by nurses and perpetuated by nurses. Recently the administration has mandated that the process be implemented throughout the institution. A Hopkins health care-based collaborative is working to implement medication reconciliation hospital wide. The challenge exists in standardizing a process that is now specific to each functional unit. Multidisciplinary monthly meetings provided a forum for working through the barriers to incorporate these changes. This low-cost, high-impact safely initiative, if planned and performed strategically, can have a significant effect on patient safety.

Academic Medical Centers↗

PubMed2004

Implementation of capecitabine (Xeloda) into a cancer centre: UK experience.

Switching patients from intravenous 5-FU/LV to oral capecitabine (Xeloda) for the treatment of metastatic colorectal cancer is associated with a reduction in the need for hospitalisations to manage 5-FU-associated delivery and complications, with resulting healthcare savings. However, implementing oral therapy with capecitabine within a cancer centre in the UK has required a considerable change in attitude within healthcare services. The resulting need for patients to take an active role in their treatment, and the co-ordination and monitoring of such a service at home has raised issues for chemotherapy services. To enhance patient involvement and compliance with medication a patient guide was developed to educate, and support individuals and enable them to understand the rationale for treatment and when to seek help. In addition, patients are encouraged to monitor and record symptoms in a diary. This change in service focus has required an investment in time educating and informing patients, community health workers and hospital practitioners. This change has been co-ordinated through the chemotherapy outpatient clinic. Effective communication between hospital and home has been important in implementing oral chemotherapy. While the initial challenge of monitoring and educating patients receiving capecitabine has been met, the Primary Care team and cancer centre need to continue to assess side effects and patient compliance in order to improve knowledge of capecitabine among healthcare professionals and ensure safe practice.

Administration, Oral↗

PubMed2026

Associations between smart infusion pump-electronic health record interoperability and healthcare outcomes: A systematic review.

OBJECTIVE: This study synthesized available evidence on the associations between smart infusion pump-electronic health record (EHR) interoperability and healthcare outcomes. METHODS: A systematic review of PubMed, CINAHL, Embase, and Scopus databases identified 901 records, which were imported into Rayyan® for duplicate removal, independent screening by three reviewers, and resolution of discrepancies. Eligible studies were peer-reviewed, data-driven, and reported associations between smart infusion pump-EHR interoperability and healthcare outcomes. Studies focused solely on technical validation or interoperability prototypes were excluded. A backward citation search identified additional studies. Two reviewers independently extracted and cross-validated study characteristics using standardized templates. Methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Twenty records of 14 full-text studies and 6 conference proceedings were included. Most records reported positive associations between smart infusion pump-EHR interoperability and outcomes related to safety (e.g., medication administration errors, safety-reported events, pump alerts, and compliance with interoperability and drug library), operational efficiency (e.g., programming and documentation time and technical issues), financial performance (e.g., charges captured, and cost avoided), and user experience domains. Most studies used observational designs, reflecting real-world interoperability implementations, where controlling confounding factors is challenging. Limited reporting of baseline characteristics, pump type, and sample sizes limited comparability across studies. CONCLUSIONS: Smart infusion pump-EHR interoperability was associated with improvements in patient safety, efficiency, charge capture, and user experience, with variable findings across studies. Future research should use rigorous methodologies and standardized measures, examine relationships across outcome domains, assess limitations of pump-EHR interoperability, and evaluate underexplored outcomes, including team communication, cognitive workload, and AI-enabled pumps. IMPLICATIONS FOR CLINICAL PRACTICE: Interoperability should be viewed as a component of a broader sociotechnical system, in which technology, user, workflow, clinical content, and organizational practices collectively determine overall effectiveness.

Humans↗

PubMed2006

Enhanced resolution for EPR imaging by two-step deblurring.

The broad spectrum of spin probes used for electron paramagnetic resonance imaging (EPRI) result in poor spatial resolution of the reconstructed images. Conventional deconvolution procedures can enhance the resolution to some extent but obtaining high resolution EPR images is still a challenge. In this work, we have implemented and analyzed the performance of a postacquisition deblurring technique to enhance the spatial resolution of the EPR images. The technique consists of two steps; noniterative deconvolution followed by iterative deconvolution of the acquired projections which are then projected back using filtered backprojection (FBP) to reconstruct a high resolution image. Further, we have proposed an analogous technique for iterative reconstruction algorithms such as multiplicative simultaneous iterative reconstruction technique (MSIRT) which can be a method of choice for many applications. The performance of the suggested deblurring approach is evaluated using computer simulations and EPRI experiments. Results suggest that the proposed procedure is superior to the standard FBP and standard iterative reconstruction algorithms in terms of mean-square-error (MSE), spatial resolution, and visual judgment. Although the procedure is described for 2D imaging, it can be readily extended to 3D imaging.

Algorithms↗

PubMed2006

Integrating new targeted agents into the treatment of non-small-cell lung cancer.

Lung cancer is the most common cause of cancer-related deaths worldwide, and the discovery and implementation of more effective therapy remains challenging. The development of agents that target the epidermal growth factor receptor/human epidermal growth factor receptor 1 (EGFR/HER1) signal transduction pathway have provided a class of novel targeted therapies that are applicable in the treatment of non-small-call lung cancer (NSCLC). Current challenges include the determination of how best these promising new agents can be integrated into current methods of treatment for patients with NSCLC, and clarification of the extent to which early lines of treatment can influence outcome in the later stages.

Animals↗

PubMed2026

A STORM-based protocol for nanoscale imaging and quantitative analysis of protein-associated and phospholipid-associated structures in natural rubber.

Stochastic Optical Reconstruction Microscopy (STORM) enables nanoscale mapping of molecular components beyond the diffraction limit; however, its reproducible implementation in hydrophobic polymer matrices remains challenging because fluorescence-labeling specificity, fluorophore photoswitching, three-dimensional localization, chromatic registration, and quantitative image analysis must be carefully controlled. This protocol presents a standardized experimental workflow for dual-color labeling, astigmatism-based three-dimensional STORM acquisition, and quantitative analysis of protein-associated and phospholipid-associated structures in natural rubber (NR). The workflow covers sample pretreatment, Cy5 NHS ester labeling of protein-associated primary amines, DiI labeling of phospholipid-rich domains, STORM imaging-buffer preparation, three-dimensional single-molecule localization, dual-channel registration, generation of standardized xy projections, aggregate-size analysis, and projected lateral spatial correlation assessment. Reproducibility is supported by defined acquisition and localization criteria, three independent sample preparations with at least five fields of view analyzed per condition, and unlabeled, single-color, dye-only matrix, and processing-associated Cy5 controls. Mean lateral localization precisions of 11.8 ± 2.3 nm for Cy5 and 13.5 ± 2.9 nm for DiI were obtained, while two-dimensional Fourier ring correlation analysis of the xy projections yielded effective lateral image resolutions of approximately 25 and 28 nm, respectively. Image-based particle segmentation and localization-coordinate-based density-based spatial clustering of applications with noise (DBSCAN) were applied to standardized xy projections as complementary quantitative approaches. Application of the protocol to untreated, centrifuged, and protease-treated NR samples demonstrated treatment-associated changes in the detected abundance and projected size distributions of protein- and phospholipid-associated aggregates, together with a non-monotonic change in their projected lateral spatial correlation. These observations describe alterations in nanoscale organization but do not, by themselves, establish stable protein-phospholipid complex formation. Unlike previous studies that primarily demonstrated the feasibility of STORM imaging in rubber materials, the principal contribution of this work is an end-to-end, step-by-step protocol incorporating defined controls, three-dimensional localization, image-quality metrics, chromatic-registration procedures, and complementary quantitative-analysis pipelines for non-expert users. The workflow may be adaptable to other hydrophobic polymers and soft-material systems after appropriate optimization and validation.

Rubber↗

PubMedDate not supplied

A nurse educator teaching with technologies course: more than teaching on the web.

This article describes a Web-based "teaching with technology" course that is part of the online Nurse Educator Certificate at University of Kansas (Journal of Professional Nursing . 2003;19:347-353). Challenges and strategies in developing and implementing the course, first in a Web-enhanced format and then in a Web-based format, are presented. Selected online activities and assignments are shared. Evaluative comments from students are included in this article and indicate that the course helps new educators focus on thoughtful and appropriate selection of how and where technology should be integrated to meet educational goals.

Curriculum↗

PubMed2006

Implementation of national schistosomiasis control programmes in West Africa.

Burkina Faso, Mali and Niger are countries endemic for schistosomiasis, with a high predominance of Schistosoma haematobium. With the support of the Bill and Melinda Gates Foundation through the Schistosomiasis Control Initiative, national control programmes were launched in these countries in 2004. Here, we describe the progress of implementation for each programme and the challenges for maintaining sustainability for schistosomiasis control in these countries.

Animals↗

PubMed2005

Incorporating geriatrics into the respiratory care curriculum.

The absolute number of adults over the age of 65 years is increasing nationwide and worldwide. Older adults today are more independent and self-sufficient than persons of that age were a generation ago. An increased incidence of acute and chronic disease results in relative morbidity but less mortality in those aged 65 years and older. The decision to incorporate or infuse education in geriatrics into existing respiratory care classes is not difficult. Implementation may be a little more challenging, but gradually adding geriatric components to courses over time is a perfectly reasonable way to introduce students to their future patient population. Fortunately, a growing number of elderly individuals desire to treat pathology rather than accept it as an inevitable consequence of aging. For these reasons, respiratory therapists have been brought into the realm of geriatric medicine, more by default than by organizational planning. The most passionate converts to the important role of geriatrics are physicians, nurses, and therapists who have recently attempted to shepherd their own aging parents through a health care system. If that experience that leads to these conversions could be measured and communicated, the world at large might be convinced of the value of education in geriatrics.

Aged↗

PubMed2005

Addressing the paediatric HIV epidemic: a perspective from the Western Cape Region of South Africa.

In the Western Cape province of South Africa, a prevention of mother-to-child-transmission (PMTCT) intervention programme, based on short-course nevirapine, achieved universal coverage in 2003. Despite this programme, an estimated 1,400-1,650 HIV-infected children were born in the province in that year. These crude estimates suggest that there are many children in the province who need medical care. Several strategies could collectively reduce the size of the paediatric epidemic and improve the outcome of HIV-infected children in the region, including intensification of the existing PMTCT programme and provision of antiretroviral therapy (ART) for children with moderate or severe disease. Progress towards implementing these interventions is discussed. Future challenges include understanding the factors that favour long-term survival of children on highly active antiretroviral therapy in resource-limited settings, identifying appropriate treatment for the metabolic complications of ART, and the provision of adolescent services for long-term survivors. Developments over the next few years will determine whether these challenges can be met.

Adolescent↗

PubMed1975

Malignant melanoma in the Igbos of Nigeria.

Twenty-one cases of malignant melanoma occurring in the Igbos of Nigeria have been analysed. The site of predilection is the sole of the foot. This result supports the conclusion that Negroes tend to have the disease in the non-pigmented parts. Since preventive surgery has been advocated in Caucasians in whom sole melanomas are not common, it merits consideration and, if possible, implementation in the African Negro. The challenge implicit in this form of preventive oncology should be accepted by plastic surgeons, including Africans who specialized in this field abroad.

Adult↗

PubMed2001

Combination vaccines.

The biotechnology revolution has stimulated vaccine development, blessing us with new, safe, and effective vaccines, but burdening our vaccination schedule. The incorporation of multiple individual vaccines into combination vaccines can simplify vaccine administration programs and permit the inclusion of new antigens in the vaccine schedule. Although the development, evaluation, and implementation of combination vaccines pose numerous challenges and raise controversies that remain unresolved, there is a reasonable prospect of United States licensure within the next few years of several new combination vaccines for infant use. Approval in the United States of combination vaccines in use elsewhere might be speeded by improved vaccination tracking systems and post marketing efficacy surveillance, which would provide confidence that material reductions in efficacy could be detected following licensure, and thereby ease concerns regarding moderate, but perhaps immaterial, declines in immunogenicity seen with some combinations.

Asia↗