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Results for “Implementation challenges”

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At least 1,099 records · Page 61Linked to original sources

PubMed2003

Barriers to interlock implementation.

This commentary reviews current and past vehicle interlock programs for impaired driving offenders with a focus on the challenges that courts and motor vehicle departments face in attempting to implement mandatory programs as required by current federal legislation. There are few offenders in interlock programs compared to the large number of impaired drivers arrested each year. This suggests that, to increase participation, courts will have to threaten more severe sanctions for those offenders who reject interlock programs. A combination of electronic house arrest with interlock programs is suggested as a method of maximizing interlock use.

Accidents, Traffic↗

PubMed2003

Barriers to interlock implementation.

Accidents, Traffic↗

PubMed2002

Psychosocial rehabilitation in a public psychiatric hospital.

Patients with chronic mental illnesses have complex treatment needs that often pose significant challenges to mental health professionals. This paper describes the implementation of a psychosocial rehabilitation program to meet the treatment needs of patients in a public psychiatric hospital providing long-term care. A core group of professional staff adopted psychosocial rehabilitation principles in order to transform a custodial model of care to a highly interactive educational and skills building program. A model of service delivery was established to address patients' skill deficits and barriers to returning to the community. This article describes the major steps and challenges faced in overcoming obstacles and implementing a psychosocial philosophy of treatment in an inpatient setting. It suggests that it is possible for the public hospital to reinvent itself into an environment that can stimulate recovery and hope.

Deinstitutionalization↗

PubMed2002

Putting outcomes into practice in physician offices.

Implementing outcomes in physician offices is a challenging area. Unlike hospitals, clinics typically have much fewer support staff and resources, electronic clinical data is difficult to access, and physician resistance may be significant. Yet, accountability for outcomes is coming to physician offices. In all outcome efforts, the key steps for guideline implementation are awareness, agreement, decision to adopt, and commitment to adherence. This article describes outcome management efforts in a 15-clinic medical group in the areas of diabetes, asthma, preventive health, pneumonia, heart failure, and patient satisfaction. Implementation strategies, barriers, impact, and outcome data results are described.

Adult↗

PubMedDate not supplied

Worldwide survey of AIDS vaccine challenge studies in nonhuman primates: vaccines associated with active and passive immune protection from live virus challenge.

An AIDS Vaccine Surveillance System (AVSS) was designed and implemented to track the rapidly growing international database supporting the development of promising AIDS vaccines. Both preclinical nonhuman primate (NHP) and clinical human trials are tracked by the AVSS. This report presents summary data generated from the AVSS on the NHP AIDS vaccine/live virus challenge studies only. Summary data on more than 100 preclinical HIV/SIV vaccines are presented within the framework of 1) 13 arbitrary Vaccine Types, 2) studies grouped by animal model (i.e., chimpanzee/HIV-1, and macaque/SIV, HIV-2), and 3) immunization approach (i.e., active and passive). Systematic and timely presentations of these summary data, both here and in future reports, aim to promote a clearer understanding of both earlier and more recent preclinical AIDS vaccine developments.

AIDS Vaccines↗

PubMed2003

Access to health care for youth leaving foster care: Medicaid and SCHIP.

PURPOSE: To examine how Medicaid and the State Children's Health Insurance Program (SCHIP) could improve health care access for youth aging out of foster care, a vulnerable population with multiple health concerns. METHODS: On the basis of an analysis of state and federal laws, state plans and amendments, and a telephone survey of state officials, this article identifies options in Medicaid and SCHIP for states to provide health insurance coverage for these youth, examines states' use of available options, and highlights other relevant federal health care programs. RESULTS: Numerous Medicaid and SCHIP eligibility categories could provide coverage for older adolescents leaving foster care. The federal Foster Care Independence Act of 1999 (FCIA) created a new Medicaid expansion option for this group and other opportunities for states to address their health care needs. Numerous other federal programs also finance health care that could serve this population. CONCLUSIONS: The potential exists through Medicaid or SCHIP to ensure that nearly all former foster youth have health insurance as they leave state custody, but Medicaid and SCHIP cannot alone meet all health care needs of these youth. Financing available through other public programs is essential. A few states have adopted the new FCIA Medicaid expansion option for former foster youth, and a larger number have implemented other relevant Medicaid options. Additional states have used other innovative approaches to facilitate health care access. Most states could do much more. A major challenge is to find approaches that can be implemented during times of severe budgetary limitations.

Adolescent↗

PubMed2000

The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough.

Applied behavior analysts have developed many effective interventions for common childhood problems and have repeatedly demonstrated that childhood behavior responds to properly managed contingencies. The success of these interventions is dependent upon their basic effectiveness, as demonstrated in the literature, their precise delivery by the clinician to the parent, and adherence to or consistent implementation of the intervention. Unfortunately, arranging the consistent implementation of effective parenting strategies is a significant challenge for behavior analysts who work in homes, schools, and outpatient or primary care clinics. Much has been done to address issues of adherence or implementation in the clinic, but relatively little has been done to increase our understanding of the contingencies that affect parental adherence beyond the supervised clinic environment. An analysis of the contingencies that strengthen or weaken adherence might suggest strategies to improve implementation outside the clinic setting. What follows is an analysis of the variables associated with adherence by parents to recommendations designed to solve common childhood problems.

Adult↗

PubMed2005

E-health: determinants, opportunities, challenges and the way forward for countries in the WHO African Region.

BACKGROUND: The implementation of the 58th World Health Assembly resolution on e-health will pose a major challenge for the Member States of the World Health Organization (WHO) African Region due to lack of information and communications technology (ICT) and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills. The key objectives of this article are to: (i) explore the key determinants of personal computers (PCs), telephone mainline and cellular and Internet penetration/connectivity in the African Region; and (ii) to propose actions needed to create an enabling environment for e-health services growth and utilization in the Region. METHODS: The effects of school enrolment, per capita income and governance variables on the number of PCs, telephone mainlines, cellular phone subscribers and Internet users were estimated using a double-log regression model and cross-sectional data on various Member States in the African Region. The analysis was based on 45 of the 46 countries that comprise the Region. The data were obtained from the United Nations Development Programme (UNDP), the World Bank and the International Telecommunications Union (ITU) sources. RESULTS: There were a number of main findings: (i) the adult literacy and total number of Internet users had a statistically significant (at 5% level in a t-distribution test) positive effect on the number of PCs in a country; (ii) the combined school enrolment rate and per capita income had a statistically significant direct effect on the number of telephone mainlines and cellular telephone subscribers; (iii) the regulatory quality had statistically significant negative effect on the number of telephone mainlines; (iv) similarly, the combined school enrolment ratio and the number of telephone mainlines had a statistically significant positive relationship with Internet usage; and (v) there were major inequalities in ICT connectivity between upper-middle, lower-middle and low income countries in the Region. By focusing on the adoption of specific technologies we attempted to interpret correlates in terms of relationships instead of absolute "causals". CONCLUSION: In order to improve access to health care, especially for the majority of Africans living in remote rural areas, there is need to boost the availability and utilization of e-health services. Thus, universal access to e-health ought to be a vision for all countries in the African Region. Each country ought to develop a road map in a strategic e-health plan that will, over time, enable its citizens to realize that vision.

Adult↗

PubMed2003

Quantum computing in the solid state: the challenge of decoherence.

The current status of solid-state implementations of quantum computing is briefly described. There are numerous candidate proposals, but only comparatively recently have some of them begun to progress to the point of demonstrating coherent motion of the individual quantum bits (qubits), and the controlled coupling of more than one qubit remains a significant challenge. We also present a generalization of the fluctuation-dissipation theorem that provides a relationship between the coherent evolution entangling two spatially separated qubits, and the associated irreducible decoherence. This relationship may be used to bound the maximum attainable figures of merit in proposed two-qubit gates.

Journal Article↗

PubMed2004

State perspective on ways to improve radiation protection principles.

State radiation regulators have a broad scope of regulatory authority. They are responsible for regulating both man-made and naturally occurring radioactive material, radiation-producing machines, and nonionizing sources of radiation. This broad-scope authority presents challenges to state radiation regulatory agencies that must implement and maintain a regulatory framework that incorporates radiation safety principles for all types of uses, without unduly hindering effective use of sources of radiation. The challenges include resource allocation, prioritization of risk in order to appropriately allocate resources, and the ability to effectively predict and respond to changing risk-informed priorities. Changes in radiation protection principles and policies must be accomplished through a partnership of stakeholders to be most effective and to meet these challenges.

Guidelines as Topic↗

PubMed2004

Implementation of an ADME enabling selection and visualization tool for drug discovery.

The pharmaceutical industry has large investments in compound library enrichment, high throughput biological screening, and biopharmaceutical (ADME) screening. As the number of compounds submitted for in vitro ADME screens increases, data analysis, interpretation, and reporting will become rate limiting in providing ADME-structure-activity relationship information to guide the synthetic strategy for chemical series. To meet these challenges, a software tool was developed and implemented that enables scientists to explore in vitro and in silico ADME and chemistry data in a multidimensional framework. The present work integrates physicochemical and ADME data, encompassing results for Caco-2 permeability, human liver microsomal half-life, rat liver microsomal half-life, kinetic solubility, measured log P, rule of 5 descriptors (molecular weight, hydrogen bond acceptors, hydrogen bond donors, calculated log P), polar surface area, chemical stability, and CYP450 3A4 inhibition. To facilitate interpretation of this data, a semicustomized software solution using Spotfire was designed that allows for multidimensional data analysis and visualization. The solution also enables simultaneous viewing and export of chemical structures with the corresponding ADME properties, enabling a more facile analysis of ADME-structure-activity relationship. In vitro and in silico ADME data were generated for 358 compounds from a series of human immunodeficiency virus protease inhibitors, resulting in a data set of 5370 experimental values which were subsequently analyzed and visualized using the customized Spotfire application. Implementation of this analysis and visualization tool has accelerated the selection of molecules for further development based on optimum ADME characteristics, and provided medicinal chemistry with specific, data driven structural recommendations for improvements in the ADME profile.

Absorption↗

PubMed2004

Fifteen best practice recommendations for bar-code medication administration in the Veterans Health Administration.

BACKGROUND: Since 2000, the Veterans Health Administration (VHA) has pioneered the development and deployment of a bar-code medication administration (BCMA) system. Based on VHA experience, 15 "best practices" for BCMA implementation, integration, and maintenance are recommended. METHODS: Data were collected on potential barriers to the effectiveness of BCMA to improve patient safety by direct observation of medication administration, simulated BCMA use in a laboratory setting, a survey of nursing informatics specialists regarding policies and procedures, and 30 unstructured interviews with diverse stakeholders. RECOMMENDATIONS: Fifteen practices were proposed, categorized by implementation and continuous improvement, training, troubleshooting, contingency planning, equipment maintenance, medication administration, and maintenance of paper patient wristbands. For example, Recommendation 15 ("Periodic replacement of wristbands") advises weekly bar-coded wristband replacement in long term care settings to improve the scanning reliability. DISCUSSION: Lessons learned about best practices to address challenges may offer insight to others considering implementation of bar-code technology.

Electronic Data Processing↗

PubMed1996

The role and impact of multiskilled health practitioners in the health services industry.

The utilization of multiskilled health practitioners (MSHPs) is one method of enhancing employee productivity and cost effectiveness of health services delivery. This article reviews the trend toward increasing specialization of health personnel in this century as well as its limitations and the potential of the MSHP to enhance productivity. Then research on factors that inhibit or facilitate adoption of the concept, the effectiveness of the concept, and implementation strategies that impact effectiveness are presented. The article concludes with guidelines and future challenges for health care executives, public policymakers, and researchers as regards implementation of the multiskilled concept.

Cost-Benefit Analysis↗

PubMedDate not supplied

Challenges to effective incident review management: administrative and clinical factors.

Incident review (IR) is a process for achieving a better understanding of problems related to the health and safety of clients and the integrity of healthcare facilities. The IR process ensures that the quality and the performance of care in a facility continue to be maintained and improved over time. Because of the practical realities of administrative and clinical care issues, the process of implementing IR and related interventions is often challenging. This paper examines the IR process and the barriers that affect and impede it.

Documentation↗

PubMed2002

Evaluation of quality improvement programmes.

In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement.

Evidence-Based Medicine↗

PubMed2006

HIV behavioral research online.

Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research.

Ethics, Research↗

PubMedDate not supplied

Applying research to practice: implementing strength training in a senior high rise.

One of the challenges of using research is applying the results of scientific investigation to the relatively uncontrolled real-life practice situations that health care professionals encounter. This process was used to design and implement a strength-training program for older adults in a senior high-rise building with 425 residents. The resulting program demonstrated that positive benefits can be obtained by applying research findings to the community with a relatively uncontrolled population.

Aged↗

PubMed2004

Development of a diabetes care management curriculum in a family practice residency program.

Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at the training facility include: 1) lack of a population-based perspective for service delivery; 2) weak support for self-management of illness; 3) incomplete implementation due to physician resistance or inertia; and 4) few incentives to change practices and behaviors. In order to overcome these barriers, training programs must take the initiative to implement DM training that addresses each of these issues. We report the implementation of a chronic illness management curriculum based on the Improving Chronic Illness Care (ICIC) Model. Features of this process included both patient care and learner objectives. These were: development of a multidisciplinary diabetes DM team; development of a patient registry; development of diabetes teaching clinics in the family practice center (nutrition, general management classes, and one-on-one teaching); development of a group visit model; and training the residents in the elements of the ICIC Model, ie, the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Barriers to implementing these curricular changes were: the development of a patient registry; buy-in from faculty, residents, clinic leadership, staff, and patients for the chronic care model; the ability to bill for services and maintain clinical productivity; and support from the health system key stakeholders for sustainability. Unique features of each training site will dictate differences in emphasis and structure; however, the core principles of the ICIC Model in enhancing self-management may be generalized to all sites.

California↗