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PubMed1987

The adoption and implementation of the fluoride mouthrinse program: descriptive results from school districts.

Systematic research is needed about the dissemination and use of effective caries prevention measures to establish adoption trends and to examine factors related to desired practice. This paper examines the adoption and implementation of the fluoride mouthrinse program (FMRP) in public school districts. It extends a similar study by Silversin and Coombs in 1979 by reporting telephone interview data from the same sample of school districts. The results indicate that the extent of FMRP adoption has increased since 1979, but that the recent rate of new adopters has slowed considerably. About one-quarter of the districts that had ever offered the FMRP have since discontinued it, most frequently by gradual abandonment. The reported accuracy of school level implementation was assessed in terms of seven required components of the FMRP. Only 57 percent of the sample reported implementing six or seven components correctly, showing at best only moderate accuracy of delivery at the local level.

Attitude to Health↗

PubMedDate not supplied

Lessons learned while implementing service quality improvement.

The successful implementation of quality improvement (QI) in an organization requires the organization's executives to visibly and consistently demonstrate an understanding of and commitment to QI principles. One means of developing this understanding is to give executives firsthand experience with QI tools and skills. This article details the lessons learned by personnel at a large medical center during the implementation of QI initiatives and highlights some aspects of the role hospital executives must play in achieving QI. Whatever approach an organization chooses for the implementation of QI, the exercise of discipline to do what is right inevitably will lead to the improvement of quality.

Academic Medical Centers↗

PubMedDate not supplied

Learning is fundamental: the impact of education on successful clinical pathway implementation.

Successful implementation of a clinical pathway program is a complex, multifaceted task. Medical and hospital staff education is often overlooked or minimized during the implementation process. Even with a clinically sound pathway and a state-of-the-art variance-tracking system, implementation can fail miserably if the medical and hospital staff do not completely understand and support the pathway initiative. A well-developed plan for education provides staff members with the foundation they need to be successful within the pathway program.

Critical Pathways↗

PubMedDate not supplied

Reaching out to clinicians: implementation of a computerized alert system.

Several published articles have identified that providing automated, computer-generated clinical alerts about potentially critical clinical situations should result in better quality of care. In 1999, the pharmacy department at a community hospital network implemented and refined a commercially available, computerized clinical alert system. This case report discusses the implementation process, gives examples of how the system is used, and describes results following implementation. The use of the clinical alert system in this hospital network resulted in improved patient safety as well as in greater efficiency and decreased costs.

Adverse Drug Reaction Reporting Systems↗

PubMed1998

Prediction of serum vancomycin concentrations using one-, two- and three-compartment models with implemented population pharmacokinetic parameters and with the Bayesian method.

Although previous studies have shown that vancomycin has a complicated pharmacokinetic profile requiring description using a two- or, better, three-compartment model, until recently predictions of serum vancomycin concentrations have been mainly based on one- or two-compartment models using computer software packages. In this study, we have predicted serum vancomycin concentrations in 59 patients using one-, two- and three-compartment models with implemented population pharmacokinetic parameters in the Abbott PKS program and by use of the Bayesian method. The percentage errors of predictions made using the one-compartment model were smaller when either the Bayesian method or implemented population pharmacokinetic parameters were used (medians of -8.61% and -9.49%, respectively). Predictions using the one-compartment model with the Bayesian method were less biased (median of -1.52 microgmL(-1). The best predictions were those made using the three-compartment model with the Bayesian method-they were most accurate (median of 3.40 microgmL(-1) and highly precise (median of 11.53 microg(2)mL(-1)). The results suggest that predictions made using the one-compartment model with implemented population pharmacokinetic parameters are preferable if no samples are available, otherwise predictions made using the three-compartment model with the Bayesian method are preferable. The results also supported our previous argument that the greater the number of compartments involved in individualization, the better the predictions obtained using the Bayesian method.

Adult↗

PubMed1998

Finite element implementation of anisotropic quasi-linear viscoelasticity using a discrete spectrum approximation.

The objective of this work was to develop a theoretical and computational framework to apply the finite element method to anisotropic, viscoelastic soft tissues. The quasilinear viscoelastic (QLV) theory provided the basis for the development. To allow efficient and easy computational implementation, a discrete spectrum approximation was developed for the QLV relaxation function. This approximation provided a graphic means to fit experimental data with an exponential series. A transversely isotropic hyperelastic material model developed for ligaments and tendons was used for the elastic response. The viscoelastic material model was implemented in a general-purpose, nonlinear finite element program. Test problems were analyzed to assess the performance of the discrete spectrum approximation and the accuracy of the finite element implementation. Results indicated that the formulation can reproduce the anisotropy and time-dependent material behavior observed in soft tissues. Application of the formulation to the analysis of the human femur-medial collateral ligament-tibia complex demonstrated the ability of the formulation to analyze large three-dimensional problems in the mechanics of biological joints.

Biomechanical Phenomena↗

PubMed2000

Dynamic and omni wedge implementation on an Elekta SL linac.

The concommitant use of a multileaf collimator (MLC) and a wedge can result in conflicts in the optimal collimator angle if both MLC and wedge are fixed relative to one another. This is particularly true of linacs in which a single wedge orientation is provided. In this paper, a solution is provided that makes use of two orthogonal universal wedges (omni wedge). Although this technique can be applied regardless of the means by which the wedged fields are implemented, the measurements reported in this paper were performed using a fixed, internal mechanical wedge coupled with a dynamic wedge, formed by the motion of one of the backup jaws. An implementation of a dynamic wedge for the Elekta SL series of linear accelerators is presented. Results of measurements of the dosimetric characteristics of both the particular implementation of the dynamic wedge and of the omni field are presented. For the dynamic wedge, measurements were made of the wedge factor and dose profile as a function of field size and depth. In addition, the effects of variables, such as dynamic delivery technique and direction of diaphragm motion, on the dynamic wedge profiles were studied and discussed. For the omni wedge, measurements were made of the degree to which the mathematical formalism for describing an omni wedge matches the measured isodose distributions. Comparisons between mechanical wedge dose distributions and the omni wedge were also made.

Dose-Response Relationship, Radiation↗

PubMed2000

Implementation and verification of virtual wedge in a three-dimensional radiotherapy planning system.

Virtual Wedge (VW) is a Siemens treatment modality which generates wedge-shaped dose distributions by moving a collimator jaw from closed to open at a constant speed while varying the dose rate in every 2 mm jaw position. In this work, the implementation and verification of VW in a radiotherapy treatment planning (RTP) system is presented. The VW implementation models the dose delivered by VW using the Siemens monitor units (MU) analytic formalism which determines the number of MU required to generate a wedge-fluence profile at points across the VW beam. For any set of treatment parameters, the VW algorithm generates an "intensity map" that is used to model the modification of fluence emanating from the collimator. The intensity map is calculated as the ratio of MU delivered on an axis point, divided by the monitor units delivered on the central-axis MU(0). The dose calculation is then performed using either the Clarkson or Convolution/ Superposition algorithms. The VW implementation also models the operational constraints for the delivery of VW due to dose rate and jaw speed limits. Dose verifications with measured profiles were performed using both the Clarkson and Convolution/Superposition algorithms for three photon beams; Siemens Primus 6 and 23 MV, and Mevatron MD 15 MV. Agreement within 2% or 2 mm was found between calculated and measured doses, over a large set of test cases, for 15, 30, 45, and 60 degree symmetric and asymmetric VW fields, using the manufacturer's supplied mu and c values for each beam.

Algorithms↗

PubMed2004

Full wave modeling of therapeutic ultrasound: efficient time-domain implementation of the frequency power-law attenuation.

For the simulation of therapeutic ultrasound applications, a method including frequency-dependent attenuation effects directly in the time domain is highly desirable. This paper describes an efficient numerical time-domain implementation of the power-law attenuation model presented by Szabo [Szabo, J. Acoust. Soc. Am. 96, 491-500 (1994)]. Simulations of therapeutic ultrasound applications are feasible in conjunction with a previously presented finite differences time-domain (FDTD) algorithm for nonlinear ultrasound propagation [Ginter et al., J. Acoust. Soc. Am. 111, 2049-2059 (2002)]. Szabo implemented the empirical frequency power-law attenuation using a causal convolutional operator directly in the time-domain equation. Though a variety of time-domain models has been published in recent years, no efficient numerical implementation has been presented so far for frequency power-law attenuation models. Solving a convolutional integral with standard time-domain techniques requires enormous computational effort and therefore often limits the application of such models to 1D problems. In contrast, the presented method is based on a recursive algorithm and requires only three time levels and a few auxiliary data to approximate the convolutional integral with high accuracy. The simulation results are validated by comparison with analytical solutions and measurements.

Acoustics↗

PubMed1999

Analog very large-scale integrated (VLSI) implementation of a model of amplitude-modulation sensitivity in the auditory brainstem.

An analog very large-scale integrated (VLSI) implementation of a model of signal processing in the auditory brainstem is presented and evaluated. The implementation is based on a model of amplitude-modulation sensitivity in the central nucleus of the inferior colliculus (CNIC) previously described by Hewitt and Meddis [J. Acoust. Soc. Am. 95, 2145-2159 (1994)]. A single chip is used to implement the three processing stages of the model; the inner-hair cell (IHC), cochlear nucleus sustained-chopper, and CNIC coincidence-detection stages. The chip incorporates two new circuits: an IHC circuit and a neuron circuit. The input to the chip is taken from a "silicon cochlea" consisting of a cascade of filters that simulate basilar membrane mechanical frequency selectivity. The chip which contains 142 neurons was evaluated using amplitude-modulated pure tones. Individual cells in the CNIC stage demonstrate bandpass rate-modulation responses using these stimuli. The frequency of modulation is represented spatially in an array of these cells as the location of the cell generating the highest rate of action potentials. The chip processes acoustic signals in real time and demonstrates the feasibility of using analog VLSI to build and test auditory models that use large numbers of component neurons.

Audiometry, Pure-Tone↗

PubMed2004

Practical implementation of a multiplex PCR for acute respiratory tract infections in children.

Molecular testing for acute respiratory infections (ARIs) has documented value but limited implementation due to questions that typically slow the acceptance of new tests. This study sought to address these questions and achieve implementation. Rhinovirus was added to a nested multiplex PCR (M-PCR), increasing its diagnostic yield. Over one winter, three hospital pediatric departments used the M-PCR to complement their direct fluorescent-antibody assay (DFA) for respiratory syncytial virus (RSV). Clinicians recorded "pretest probability estimates" (using continuous scales for various pathogen groups) for comparison with test results; treatments and test turnaround times were also recorded. Transnasal and throat swabs, with or without nasopharyngeal aspirate (NPA), were M-PCR tested. NPA-containing sample sets found to be RSV positive by DFA were not further tested. Single PCR for human metapneumovirus (hMPV) was performed retrospectively. Of 178 ARI episodes representing 172 patients, NPA was included in 97 sample sets; 54 (56%) were determined to be RSV positive. The other NPA-containing sample sets (n = 43) yielded 27 findings (63%), and the swab-only sets (n = 81) yielded 47 findings (58%); rhinovirus was found most often. Testing for hMPV yielded seven positive results. M-PCR median turnaround times were 4 days in swab-only samples and 5 days with NPA. Antibiotics were prescribed in 50 episodes, at rates similar for RSV and rhinovirus. Pretest probability estimates of a viral cause were lower in episodes caused by rhinovirus than in episodes caused by RSV. The hospitals continued to use M-PCR for NPA-containing samples found to be RSV negative by DFA. Test implementation is more likely with higher diagnostic yield and a protocol that reflects day-to-day clinical and laboratory operations.

Acute Disease↗

PubMed2004

Development, implementation, and impact of acceptability criteria for serologic tests for infectious diseases.

Serologic testing is essential for the diagnosis of some infectious diseases and yet is fraught with potential pitfalls. All parts of the diagnostic process must be optimized to ensure that serologic tests perform adequately. Recognizing that a lack of clinical data and correctly timed, paired sera frequently led to uninterpretable serology results at our laboratory, we developed and implemented simple acceptability criteria for serologic tests. We assessed the impact of these criteria by comparing submissions and results for the year before and the year after implementation of the criteria. The number of serologic tests performed declined by 25% after implementation of the acceptability criteria, despite an increase in requests for serologic tests. Inappropriate testing of acute-phase sera alone fell from 49 to 0% (P < 0.001) for the tests monitored. Appropriate submission of paired sera rose from 9 to 19% (P = 0.006). The proportion of results classified as interpretable rose from 52 to 100% (P < 0.001). We recommend that acceptability criteria be developed and applied to samples submitted to clinical microbiology laboratories for serologic testing.

Bacterial Infections↗

PubMed2001

Successful implementation of spacer treatment guideline for acute asthma.

AIMS: To develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination. METHODS: Defined strategies were used for the development and implementation of a guideline, assessed by a prospective, descriptive, study using notes review, and patient, nursing, and medical staff telephone contact. The setting was a tertiary referral hospital in Victoria, Australia with 25 000 yearly admissions, and asthma accounting for about 7% of total. The first 200 children and families to use the guideline after its introduction were evaluated. RESULTS: A total of 191 (95.5%) children were treated according to the guideline. Six (3.0%) children were given nebulisers appropriately based on severity; five (2.5%) were given nebulisers at parental or child choice; and four (2.0 %) who did not have severe asthma, received nebulised treatment inappropriately. CONCLUSIONS: Successful implementation of a new evidence based guideline can be achieved using specific strategies for promoting the application of research findings in the clinical arena.

Acute Disease↗

PubMed1994

Implementing findings of research.

There are unacceptable delays in the implementation of many findings of research. This results in suboptimal care for patients. A number of approaches may be effective in speeding up implementation, including evidence based guidelines, the influence of opinion leaders, and computer based decision support systems. An integrated approach to speeding up this process by means of a number of mechanisms is likely to be most effective. The results of systematic reviews of the research literature should be incorporated into programmes of continuing medical education and clinical audit. Professional associations have an important role to play in ensuring that research based information is included in educational activities and clinical guidelines. Purchasers of health care could promote the uptake of research findings during contract negotiations. Improved methods of informing health care users and the public about evidence of effectiveness could also have an impact. Policy makers should take more account of the results of research when formulating recommendations. Methods of improving the implementation of research findings require further investigation and greater resources devoted to them.

Diffusion of Innovation↗

PubMed1999

Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study.

OBJECTIVE: To explore general practitioners' perceptions of their role in implementing genetic technology. DESIGN: Grounded theory interview study. SETTING: Primary care. SUBJECTS: Purposive sample of 30 general practitioners with a further theoretical sample of 14. RESULTS: Inconsistencies were identified between policy makers' and general practitioners' definitions of general practitioners' role in implementing the new genetics. General practitioners emphasised the need to build on current practice, whereas policy makers focused on transforming practice to include the new specialised roles and skills. Two core themes were identified: genetics in a generalist context, which included appropriate generalist intervention, the ethical dilemmas implicit in the "therapeutic gap," the familial-hereditary distinction in primary care, and the implications for generalist identity, including the potential marginalisation of generalism. CONCLUSION: New technologies such as genetics that require implementation in general practice should be integrated within existing generalist frameworks.

Ethics, Medical↗

PubMed2005

It might work in Oklahoma but will it work in Oakhampton? Context and implementation in the effectiveness literature on domestic smoke detectors.

OBJECTIVE: To explore data on factors affecting implementation processes in papers contributing to a Cochrane systematic review (SR) of smoke alarm interventions, supplemented by further papers not included in the review. DESIGN: Screening for data on implementation on the basis of: (1) primary studies included in a Cochrane SR, (2) further papers relating to these and similar studies, and (3) approaches to authors of these and other relevant studies and reports. RESULTS: Relatively few data were found to help people seeking to implement smoke alarm promotion interventions. CONCLUSIONS: For practitioners and policymakers to be able to build on research evidence, researchers and journal editors need to ensure that sufficient data are published, or are otherwise available to interested parties to move from understanding the evidence to using it.

Female↗

PubMed2003

Design and implementation of injury prevention curricula for elementary schools: lessons learned.

OBJECTIVES: Project objectives were to: (1) design and produce an easy-to-use, replicable comprehensive injury prevention curriculum for elementary schools; (2) pilot the program to determine instructors' ease in teaching the material and its usefulness in enhancing student knowledge and behavior change; (3) present material in subject-integrated, grade-specific lessons that would meet state and national student learning objectives; and (4) submit and obtain adoption of the curriculum by the State Department of Education. METHODS: A pilot program was developed, implemented, and evaluated in six intervention and six control schools. The curriculum was revised and implemented in five other schools and finalized according to evaluation results and teachers' and parents' suggestions. Community resources such as police, fire, and county health departments participated in program implementation. RESULTS: The program showed a significant increase from 21% to 36% in seatbelt use during the school year in program schools compared with a 1% decrease in control schools. Bicycle helmet use increased from 0% to 10% in the program schools. Pre-test and post-test results showed significant differences in student knowledge, attitudes, and behaviors within the program schools, and in comparing the program and control schools. On a Likert scale of 1 (poor) to 7 (excellent), teachers rated lesson content, exercises, and the usefulness of materials and resources as 5.8, 5.5, and 5.4, respectively. Evaluations for the revised curricula ranged from 5.7 to 6.2. CONCLUSIONS: The favorable evaluation results resulted in the adoption of the curriculum as a state textbook, and widespread teaching of the curriculum. The product is appropriate and efficacious in these elementary schools and their communities.

Adolescent↗

PubMedDate not supplied

The Vanderbilt University fast track to IAIMS: transition from planning to implementation.

Vanderbilt University Medical Center is implementing an Integrated Advanced Information Management System (IAIMS) using a fast-track approach. The elapsed time between start-up and completion of implementation will be 7.5 years. The Start-Up and Planning phases of the project are complete. The Implementation phase asks one question: How does an organization create an environment that redirects and coordinates a variety of individual activities so that they come together to provide an IAIMS? Four answers to this question are being tested. First, design resources to be "scalable"--i.e., capable of supporting enterprise-wide use. Second, provide information technology planning activities as ongoing core functions that direct local efforts. Third, design core infrastructure resources to be both reusable and expandable at the local level. Fourth, use milestones to measure progress toward selected endpoints to permit early refinement of plans and strategies.

Academic Medical Centers↗