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At least 1,117 records · Page 62Linked to original sources

PubMed2004

Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia.

Dysphagia is a common disability seen in stroke survivors that has been associated with high morbidity and mortality. Research has indicated that implementing clinical guidelines and algorithms improves dysphagia management and patient outcomes. A decision-making algorithm designed to enhance the assessment and dietary treatment of swallowing difficulties in the acute stroke patient was implemented on a dedicated neuroscience unit in January 2002. Following implementation, the medical records of 30 acute stroke patients consecutively admitted to the unit between February and May 2002 were reviewed for stroke and dysphagia characteristics, dysphagia-related complications, discharge dispositions, interdisciplinary baseline assessments, and nursing evaluations throughout the hospitalization. Of those patients admitted with stroke, 56.7% were dysphagic. As compared with the nondysphagic patients, the dysphagic patients had three times' longer inpatient stay, an increased incidence of complications, higher morbidity, and increased need for inpatient rehabilitation services and institutionalized care following discharge. Twenty percent of patients did not receive aformal evaluation of swallowing function within the first 48 hours of admission. In 10% of the patients, diets were changed following the formal evaluation of swallowing to change an unsafe, prescribed diet. More than 70% of patients showed clinical improvement in swallowing function during their hospitalization. Nurses tended to document assessments of general neurological factors (e.g., level of consciousness) related to swallowing function more frequently than factors felt to be more specific to swallowing (e.g., choking) and nutrition (e.g., tolerates diet). The results support the important role of the neuroscience nurse in the early and ongoing assessment of swallowing function and in providing directions to further improve the quality of care delivered to stroke patients with various degrees of swallowing dysfunction.

Aged↗

PubMed2001

Implementation of the quantum Fourier transform.

A quantum Fourier transform (QFT) has been implemented on a three qubit nuclear magnetic resonance (NMR) quantum computer to extract the periodicity of an input state. Implementation of a QFT provides a first step towards the realization of Shor's factoring and other quantum algorithms. The experimental implementation of the QFT on a periodic state is presented along with a quantitative measure of its efficiency measured through state tomography. Experimentally realizing the QFT is a clear demonstration of the ability of NMR to control quantum systems.

Journal Article↗

PubMed2001

A new implementation of the molecular replacement method using a six-dimensional Patterson vector search.

The current molecular replacement programs are primarily implemented in reciprocal space. In this paper a new implementation in direct (real) space is proposed by matching the model atomic vectors with the vectors in the Patterson vector space using a six-dimensional exhaustive search method. It is shown that this implementation can find the correct rotations and translations of alpha helices in a myoglobin crystal structure using experimental diffraction data at 2 A resolution. A comparison with previous Patterson vector search methods is discussed.

Journal Article↗

PubMed1998

Preliminary evaluation of the efficacy and implementation of the new NHS complaints procedure.

The increase (28.8 per cent) in the number of complaints from pre-New NHS Complaints Procedure to the implementation of the new procedures in 1996 is a matter of concern because it is estimated that the current figure represents only 40 per cent of the number of people with some dissatisfaction. The Wilson Report prompted Government initiatives in producing a new NHS Complaints Procedure. The new procedure allows for complaints to be dealt with at a local level, or in a minority of cases through Independent Review. The new procedures, which were introduced in April 1996, oblige Trusts, GP practices and Health Boards to establish a Written Local Resolution process for handling complaints, responsibility for implementation lying with individual trusts. A preliminary assessment of the New Procedures was carried out in Lothian. A qualitative approach was utilised and semi-structured taped interviews lasting on average one hour ten minutes were administered to the six complaints officers. This study concentrates on how the six Lothian NHS Trusts are implementing the new procedure, the openness in complaints handling, and the awareness of how complaints can be used to improve standards. The conclusion is that Local Resolution 1 has been successful, and that complaints do receive a speedy response. The process is much simpler and easier for the lay population to access. Reservations remain, however, towards the Independent Review procedure.

Data Collection↗

PubMed1998

Application of reconstruction-based scatter compensation to thallium-201 SPECT: implementations for reduced reconstructed image noise.

Scatter compensation in Tl-201 single photon emission computed tomography (SPECT) presents an interesting challenge because of the multiple emission energies and relatively large proportion of scattered photons. In this paper, we present a simulation study investigating reconstructed image noise levels arising from various implementations of iterative reconstruction-based scatter compensation (RBSC) in Tl-201 SPECT. A two-stage analysis was used to study single and multiple energy window implementations of reconstruction-based scatter compensation, and RBSC was compared to the upper limits on performance for other approaches to handling scatter. In the first stage, singular value decomposition of the system transfer matrix was used to analyze noise levels in a manner independent of the choice of reconstruction algorithm, providing results valid across a wide range of regularizations. In the second stage, the data were reconstructed using maximum-likelihood expectation-maximization, and the noise properties of the resultant images were analyzed. The best RBSC performance was obtained using multiple energy windows, one for each emission photopeak, and RBSC outperformed the upper limit on subtraction-based compensation methods. Implementing RBSC with the correct choice of energy window acquisition scheme is a promising method for performing scatter compensation for Tl-201 SPECT.

Phantoms, Imaging↗

PubMed1998

The implementation of a quality-net as a part of the European project DIABCARE Q-Net.

DIABCARE Q-Net is a European project with a consortium of partners in healthcare, industry, and research, which has the overall target of improvement in diabetes care by aggregation, evaluation, and feedback of anonymized patient data with the tools of modern telematics, resulting from the initiative of the St. Vincent-Declaration, St. Vincent, Italy. Based on standardized tools for quality improvement in diabetes care, i.e., the Basic Information Sheet (BIS) and recently developed data entry and feedback software (DIABCARE Data for Windows), DIABCARE Q-Net as a part of the Telematics Applications Program of the European Commission will improve diabetes care and disease management by the implementation of a quality network. Therefore, the project implements regional, national, and central nodes for processing of diabetes quality indicators. All participating centers (GP's and clinics in Europe) get feedback by standardized benchmarking. The pilot testing and the state of implementation of our network confirm the importance of improving the quality of life of diabetic patients in all participating countries.

Computer Communication Networks↗

PubMed2004

An analog neural network implementation in fixed time of adjustable-order statistic filters and applications.

In this paper, we show a neural network implementation in fixed time of adjustable order statistic filters, including sorting, and adaptive-order statistic filters. All these networks accept an array of N numbers Xi = S(Xi)M(Xi)2E(Xi) as input (where S(Xi) is the sign of Xi, M(Xi) is the mantissa normalized to m digits, and Ex is the exponent) and employ two kinds of neurons, the linear and the threshold-logic neurons, with only integer weights (most of the weights being just +1 or -1) and integer threshold. Therefore, this will greatly facilitate the actual hardware implementation of the proposed neural networks using currently available very large scale integration technology. An application of using minimum filter in implementing a special neural network model neural network classifier (NNC) is given. With a classification problem of l classes C1, C2,.. ., C1, NNC classifies in fixed time an unknown vector to one class using a minimum-distance classification technique.

Computers, Analog↗

PubMed2004

Guaranteed robust stability of the closed-loop systems for digital controller implementations via orthogonal hermitian transform.

In this paper, an approach for robust stability analysis of a digital closed-loop system for digital controller implementations subject to finite word length (FWL) effects is proposed. Uncertainties caused by the roundoff and computational errors subject to FWL effects are expressed in function of mantissa bit number when the mode of floating-point arithmetic is used in the process. Then, based on the Small Gain Theorem and the Bellman-Grownwall Lemma, a sufficient stability criterion for the digital closed-loop system is derived. The eigenvalue sensitivity of the closed-loop system is developed in terms of mixed matrix-2/Frobenius norms. Then, by minimizing this eigenvalue sensitivity and using orthogonal Hermitian transform as well, an optimal similarity transformation can be obtained. By substituting this optimal transformation into the stability criterion, a minimum mantissa bit number used for implementing the stabilizing digital controllers can be determined. The main contributions are that this approach provides an analytical closed-form solution for obtaining the optimal transformation and, in addition to the stability criterion, leads to the implementation of the stabilizing controllers with a lower mantissa bit number when using this optimal one. Finally, detailed numerical design processes and simulation results are used to illustrate the effectiveness of the proposed scheme.

Algorithms↗

PubMed2003

Flexible implementations of group sequential stopping rules using constrained boundaries.

Group sequential stopping rules are often used during the conduct of clinical trials in order to attain more ethical treatment of patients and to better address efficiency concerns. Because the use of such stopping rules materially affects the frequentist operating characteristics of the hypothesis test, it is necessary to choose an appropriate stopping rule during the planning of the study. It is often the case, however, that the number and timing of interim analyses are not precisely known at the time of trial design, and thus the implementation of a particular stopping rule must allow for flexible determination of the schedule of interim analyses. In this article, we consider the use of constrained stopping boundaries in the implementation of stopping rules. We compare this approach when used on various scales for the test statistic. When implemented on the scale of boundary crossing probabilities, this approach is identical to the error spending function approach of Lan and DeMets (1983).

Biometry↗

PubMedDate not supplied

Implementing a protocol for weaning patients off mechanical ventilation.

Weaning patients from ventilation can be a costly and time-consuming intervention. This article describes how a protocol was designed and introduced into the critical care unit of a district general hospital in 2003. A step-by-step approach was used based on that outlined by the Modernisation Agency and The National Institute for Clinical Excellence. The purpose of the project was to improve the weaning process in the unit by devising a protocol, which would give structure to weaning and help maintain continuity. It was hoped that the changes in practice would also reduce ventilator time and improve patient outcomes. A multi-professional group interested in weaning worked together to formulate a protocol, which was duly implemented into the unit. After implementation, the protocol was audited and subsequently adopted by the unit. Although it was agreed that the structure and the continuity of weaning had improved, reducing weaning times and patient outcomes was difficult to measure. This article explains how the protocol came to be written and how it was implemented into the unit.

Algorithms↗

PubMed2007

The effectiveness of implementing a bladder ultrasound programme in neurosurgical units.

AIM: This paper reports an evaluation of the differences among rates of unnecessary catheterization, urinary retention and urinary tract infection before and after implementing a bladder ultrasound programme to assess urine volume. BACKGROUND: Bladder ultrasound is a non-invasive alternative to urethral catheterization for the determination of bladder urine volume. Much of the literature available on bladder ultrasound technology addresses the accuracy of the equipment, with little research on the clinical outcomes or benefits of the intervention. METHODS: A quasi-experimental design was adopted. Data were collected from March 2001 to May 2001 in a control group in two neurosurgical units in Taiwan. During July and August 2001, nurses were taught how to operate a portable ultrasound machine and how to implement the programme. Data were collected from September to November 2001 in the study group. RESULTS: The rates of unnecessary catheterization in the control group and the study group were 35.3% and 7.0%, respectively. The urine volume (more than 500 mL) in the control group and the study group were 13.4% and 20.3%, respectively. The study group had a statistically significantly lower average catheterization volume than that of the control group (676.9 mL vs. 777.1 mL, t = 1.84, P < 0.05). During 3 months before and after the implementation of the programme, the urinary tract infection rates in the control group and the study group were 3.47% and 2.87%, respectively. After 6 months the urinary tract infection rates decreased to 1.39%. CONCLUSION: The bladder ultrasound programme was successful and could be used to manage patients with urination disorders in neurosurgical units.

Adult↗

PubMed2004

Perceived barriers and facilitators to implementing research findings in the Irish practice setting.

BACKGROUND: Studies have consistently demonstrated that nurses are increasingly recognizing the role research has to play in their daily practice. Despite this recognition the actual application of research findings in the practice setting is still poor. To date, the barriers to implementing research findings in the Republic of Ireland's practice setting have not been explored empirically. This study sought to address this gap. AIMS: The aims of this study were to ascertain what Registered Nurses practising in the Republic of Ireland perceive as barriers to the implementation of research findings in the practice setting and to explore what they perceive would facilitate them in using research findings in their daily practice. DESIGN: Cross-sectional survey. METHODS: A non-probability strategy was employed with all Registered Nurses who commenced a nursing-focused academic course accredited by the University of Dublin, Trinity College, between September 2001 and February 2002 invited to participate. The ethical rights of the participants in terms of anonymity, privacy and informed consent were assured through a number of mechanisms. Data were collected via the Barriers scale. FINDINGS: Eight of the top 10 ranked barriers were organization centred. The top barrier was a perception of insufficient authority to instigate change in the practice setting. The perceived key facilitators to implementing research findings included protected time for retrieval and evaluation of research findings, instrumental support from management, informed supportive personnel in the practice settings and accessible educational opportunities to augment critical reading skills. RELEVANCE TO CLINICAL PRACTICE: The Irish Government is committed to provide the people of Ireland with an evidence-based health service. From a nursing perspective the findings of this study indicate that a number of strategies have to be introduced or enhanced in the practice settings before this commitment can be realized.

Adult↗

PubMed2006

Understanding and overcoming the barriers of implementing patient decision aids in clinical practice.

Patient decision aids (ptDAs) have been developed to assist patients with difficult health-related decisions. Despite their proven effects on decision quality in numerous efficacy trials, we lack an evidence-based approach for implementing them as part of the process of care. Pragmatic trials of ptDAs have uncovered a myriad of implementation challenges; therefore we need a better understanding of the barriers and strategies to overcome them to facilitate their widespread uptake. The following paper provides an overview of the barriers related to the uptake of ptDAs within the process of care and the strategies, opportunities and research priorities to overcome them. This report is based on our interpretation of the literature and our collective experience in implementing ptDAs within trials and other contexts.

Communication Barriers↗

PubMed2005

Shared governance and shared leadership: meeting the challenges of implementation.

New forms of leadership are required if staff are to be effectively engaged and involved in decision-making and promoting clinical effectiveness. One such mechanism is shared governance and shared leadership to ensure practice is both practitioner owned and organizationally supported. Empowering staff is a great challenge requiring effective planning, preparation and commitment. Establishing the process of shared governance requires effective leadership, implementation of a suitable framework, multidisciplinary working and examination of the organization's structure and culture. This paper discusses the challenges of implementation, preparation of staff, and alignment with the organizational agenda. It emphasizes that shared governance is an ongoing and fluid process, requiring continual assessment and re-evaluation in order to be flexible and responsive to an ever-changing environment. The Christie model provides a sustainable framework for moving practice forward and successful implementation has led to greater coordination of practice development and sharing of best practice.

Humans↗

PubMed2005

Work-based learning: a leadership development example from an action research study of shared governance implementation.

AIM: An empowering action research study was undertaken to evaluate and strengthen the implementation of shared governance. One aim was to identify factors that acted as aids or barriers to effective decision-making by clinical leaders. As a work-based learning approach, action research was expected to lead to integration of learning into practice by researcher and participants alike. BACKGROUND: Shared governance replaces traditional hierarchies and requires and develops clinical leaders. Strategies are needed to maximize learning from introduction of such initiatives at the individual, group and organizational level. METHODS: Participant-observations and interviews were undertaken with shared governance council members from one model in north-west England. RESULTS: Leadership skills and knowledge and shared governance practices were significantly enhanced. Preparation for council roles was considered inadequate. Increased structured time for reflection and action planning was indicated. CONCLUSIONS: Implementation of shared governance has succeeded in developing leadership capacity. Evaluation findings have led to improvements in the overall shared governance model. Action research has been found to have great utility at optimizing work-based learning. Nurse Managers need to develop their coaching and facilitating skills and recognize there is no "quick fix" for developing clinical leaders. Implications include the need to support learners in identifying and implementing changes arising from work-based learning activities, the significant resource implications and the need to optimize the organizational climate if work-based learning approaches to leadership and management development are to succeed.

Decision Making, Organizational↗

PubMed1996

ISBT Code 128 and code changes as part of the implementation of a national IT system for the English National Blood Service.

The implementation of PULSE within the NBS will bring considerable advantages to the Service and to hospitals. A system of dual labelling has been developed to overcome intrinsic constraints identified with the ABC Codabar system. This should not, however, impact directly on hospitals which will be able to continue to utilize the ABC Codabar system. The dual labelling system incorporates the use of the ISBT Code 128 barcode system for transfusion centre use. This must be clearly differentiated from the implementation of ISBT code 128 within the UK. This latter development would bring considerable benefit to transfusion practice, increasing the overall safety of blood transfusion. It is, however, recognized that extensive discussion with appropriate stakeholders will be necessary before any implementation date can be determined for this initiative, particularly so given the significant logistical and financial implications inherent in such a change.

Blood Banks↗

PubMed2005

Clinical practice guidelines: barriers to durability after effective early implementation.

BACKGROUND: Clinical practice guidelines in general (General-CPG) may reduce variation in clinician performance and improve patient outcomes. Short-term evaluation is now routine, but demonstration of early successful implementation does not necessarily ensure longer-term effectiveness. AIM: To assess adherence to chronic obstructive pulmonary disease (COPD)-CPG recommendations at the Royal Melbourne Hospital (RMH), 2 years after successful implementation. To identify barriers to sustained success of General-CPG. METHODS: A multi-faceted evaluation was performed to document: (i) current adherence to COPD management recommendations (medical record audit); (ii) awareness of attitudes towards and barriers for the use of COPD-CPG and General-CPG (staff survey, focus groups and key informant interviews) and (iii) access to and quality of available General-CPG (internet review and random sample General-CPG evaluation. RESULTS: Adherence to COPD-CPG recommendations was highly variable. Adherence was higher in the Emergency Department than the general wards and for specific therapeutic recommendations. It was lower for non-pharmacological therapy and for recommendations relating to processes of care. Most health professionals were in favour of General-CPG. Barriers to use of General-CPG were in keeping with previous literature reports. Organizational issues including high levels of staff turnover and lack of integration of General-CPG into hospital quality frameworks were highlighted as major barriers. Hospital intranet access and presentation of General-CPG identified lack of consistency in terminology and presentation. CONCLUSION: Short-term effectiveness of COPD-CPG implementation did not ensure sustained success. Departmental organizational behaviours and organizational system barriers are major factors influencing durability.

Aged↗

PubMed1993

Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee.

The St Vincent Declaration, a joint initiative on diabetes care and research of the World Health Organization (Europe) and the International Diabetes Federation (Europe), includes 5-year targets for improvement in diabetes outcomes as a central tenet. Accordingly, the establishment of state of the art monitoring and control systems is urged as a basis for the implementation of quality management. As a prerequisite for both targets, a diabetes dataset (fields and definitions) has been agreed to allow common monitoring of diabetes throughout Europe. This dataset has been further developed as the foundation stone of DiabCare, an initiative for continuous quality development in diabetes care. In a formal consensus process using the Delphi method, over 130 European diabetologists from 21 countries contributed to the development of this dataset, which includes fields covering true patient outcomes, intermediate metabolic outcomes, markers of diabetes tissue damage, risk factors, pregnancy, and life-style. The tools for documentation of the quality of health status have been developed in three formats for use in different health care settings. These tools, the DiabCare Diabetes Dataset, the DiabCare Basic Information Sheet, and the DiabCare Computer Program, are designed to allow local feedback-driven improvement in the quality of care, but are also the subject of communication protocols to compare performance between centres, regions, and countries. Whether implemented with or without the benefits of modern information technology, these initiatives can be the basis for both monitoring the targets of the St Vincent Declaration and for implementation of continuing quality development in diabetes care.

Delivery of Health Care↗