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PubMedDate not supplied

A diabetes control program in a public health care setting.

The Houston Diabetes Control Program is part of an effort by the State of Texas and approximately 30 other programs throughout the United States to ensure that persons with diabetes-related complications receive ongoing state-of-the-art preventive care and treatment. For the past 5 years, this program has served an urban, high-risk patient population with special cultural, ethnic, and economic challenges. The intervention has included the development and implementation of protocols for the prevention and care of diabetes-related complications of the eyes, lower extremities, and cardiovascular system, as well as general management of diabetes and patient and professional education. The program is ongoing in nine community health centers located in low-income neighborhoods of a large metropolitan area. The results thus far indicate an increase in sensitive eye examinations from 8 percent to 26 percent of the patient population, a reduction in incidence of legal blindness from 9.5 to 2.7 per 1,000 during a 4-year period, an increase in foot examinations from 18 percent to 44 percent of the patient population, and 77 percent of hypertensive patients in good control of blood pressure at less than 160 over 95 mmHg (millimeters of mercury). On the average, there have not been significant long-term improvements in weight reduction or blood glucose control. The major challenges for this program are (a) improvement in control of glycemia, hypertension, and cholesterol; (b) more effective diet and physical activity interventions; and (c) more effective education approaches that help patients to understand metabolic and cardiovascular functions. These challenges will require collaboration of health care professionals in constructive and imaginative ways through their unselfish commitment toward common goals.

Aged↗

PubMed2005

Development and implementation of an online master's degree in education program for health care professionals.

Technological advances, especially the Internet and the World Wide Web, have drastically changed educational practices by reforming the concept of education and knowledge transmission at a distance. Professionals in all disciplines have begun using this advanced technology to expand the number of learning opportunities for intellectual growth and professional development. As a result, many universities and educational institutions now offer online higher degree programs to provide opportunities for nontraditional students who have difficulty attending scheduled, campus-based classes. In medicine, a need has been identified for advanced graduate studies in education to develop the next generation of medical educators and to train them in educational research methods to validate their educational efforts. This need was identified by both informal needs assessment at local, regional, and national faculty development meetings and more formal literature review and government survey. The faculty development team of Cincinnati Children's Hospital Medical Center (Department of Pediatrics, University of Cincinnati College of Medicine) collaborated with the College of Education to develop an online Master's Degree in Education for health care professionals. The program was designed to apply these advanced technologies in order to make the program flexible and accessible to health care professionals whose busy schedules preclude more traditional, in-class graduate programs. This article presents how this program evolved and the problems, challenges, and solutions associated with the development and implementation of the program.

Education, Distance↗

PubMed2005

Perspectives on Drug and Therapeutics Committee policy implementation.

BACKGROUND: Drug and therapeutics committees (DTCs) are expected to make difficult decisions that may have an impact on the clinical and economic outcomes of drug use. There have been few studies investigating the barriers to DTC policy implementation, and little is known about ways to improve the process. OBJECTIVES: The specific objectives of this qualitative study were to explore stakeholder opinions with respect to (1) the perceptions of barriers to Drug and Therapeutics Committee (DTC) policy implementation and (2) ways to improve DTC policy implementation. METHODS: Stakeholders of Australian DTCs participated in focus group discussions. Discussions were audiotaped and transcribed verbatim. Thematic content analysis was conducted. RESULTS: Six focus group discussions were conducted. A number of barriers were identified (lack of resources, lack of follow-up, lack of ownership, low DTC profile within the organization, and overreliance on pharmacy to implement policy). Participants were of the opinion that prioritizing decisions, optimizing pharmacy roles, provision of real-time information, and active procurement of organizational commitment were some of the ways to improve DTC policy implementation. CONCLUSIONS: Although this study was conducted in an Australian setting, the challenges facing DTCs in other countries are likely to be similar. Ownership, social influence, and resources are important issues in the implementation of policy/guidelines for many DTCs, both in Australia and internationally. It is expected that these issues will have an impact on policy implementation. Therefore, the findings of this study may be widely applicable. This work reinforced the notion that the significance of DTCs lies beyond decision making alone. The time and expertise invested in decision making could be undermined, if DTC policies are not effectively implemented.

Adult↗

PubMed2003

Medicare program: review of national coverage determinations and local coverage determinations. Final rule.

This final rule will create a new process to allow certain Medicare beneficiaries to challenge national coverage determinations (NCDs) and local coverage determinations (LCDs). It will implement portions of section 522 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. The right to challenge NCDs and LCDs will be distinct from the existing appeal rights that Medicare beneficiaries have for the adjudication of Medicare claims.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2006

Implementation and synchronization of 3x3 grid scroll chaotic circuits with analog programmable devices.

The implementation of circuits with complex dynamics is a very challenging problem. In this paper we present a new chaotic circuit based on the dynamical equations introduced in IEEE Trans. Circuits Syst., I: Fundam. Theory Appl. 51, 2476-2490 (2004). This circuit has been realized by using programmable analog devices, and, in particular, field programmable analog arrays have been used to implement a two-dimensional 3x3 grid scroll chaotic attractor. The implementation of complex dynamics with low cost circuits is very appealing; moreover, the implementation of the chaotic attractor discussed in this paper is not present in the literature. The experimental results including the synchronization between two chaotic circuits show complete agreement with the simulation results reported in IEEE Trans. Circuits Syst., I: Fundam. Theory Appl. 51, 2476-2490 (2004).

Journal Article↗

PubMed2006

Models of preconception care implementation in selected countries.

Globally, maternal and child health faces diverse challenges depending on the status of the development of the country. Some countries have introduced or explored preconception care for various reasons. Falling birth rates and increasing knowledge about risk factors for adverse pregnancy outcomes led to the introduction of preconception care in Hong Kong in 1998, and South Korea in 2004. In Hong Kong, comprehensive preconception care including laboratory tests are provided to over 4000 women each year at a cost of $75 per person. In Korea, about 60% of the women served have known medical risk history, and the challenge is to expand the program capacity to all women who plan pregnancy, and conducting social marketing. Belgium has established an ad hoc-committee to develop a comprehensive social marketing and professional training strategy for pilot testing preconception care models in the French speaking part of Belgium, an area that represents 5 million people and 50,000 births per year using prenatal care and pediatric clinics, gynecological departments, and the genetic centers. In China, Guangxi province piloted preconceptional HIV testing and counseling among couples who sought the then mandatory premarital medical examination as a component of the three-pronged approach to reduce mother to child transmission of HIV. HIV testing rates among couples increased from 38% to 62% over one year period. In October 2003, China changed the legal requirement of premarital medical examination from mandatory to "voluntary." This change was interpreted by most women that the premarital health examination was "unnecessary" and overall premarital health examination rates dropped. Social marketing efforts piloted in 2004 indicated that 95% of women were willing to pay up to RMB 100 (US$12) for preconception health care services. These case studies illustrate programmatic feasibility of preconception care services to address maternal and child health and other public health challenges in developed and emerging economies.

Belgium↗

PubMedDate not supplied

Malaria control in Afghanistan: progress and challenges.

From the 1950s until 1979 malaria control in Afghanistan was implemented through a vertical programme managed by the government, but little of the original programme remained functional by the early 1990s. Delivery of basic health care including malaria diagnosis and treatment was done by non-governmental organisations (NGOs) and UN agencies, which organised cross-border operations from Pakistan and Iran and placed much less emphasis on vertical programming. From 1992 the situation in the east of Afghanistan became stable enough to allow the establishment of a network of NGO-supported clinics and to introduce standardised training and monitoring of microscopists and clinical staff, coordinated by a lead agency specialising in malaria. After the collapse of the Taliban in 2001 and the subsequent establishment of an interim government, the first steps in health-system rehabilitation have been taken. The gradual integration of malaria control into routine health-care delivery is planned. This process should be guided by the knowledge and experience gained during the complex emergency and a focus on malaria should be maintained until the disease is brought under control.

Afghanistan↗

PubMed1999

Outpatient PPS will create hospitals' greatest challenge. Part I.

Medicare's Outpatient Perspective Payment System is scheduled for implementation on July 1, 2000, and most providers will experience a reduction in revenue as a result. Ted Matson and Jim Georgoulakis of Ambulatory Care Advisory Group, Inc. provide an overview of this new reimbursement system and what it will mean for hospitals.

Aged↗

PubMedDate not supplied

Clinical supervision: a challenge for critical care nurses.

Clinical supervision is defined and its implementation nationally is charted. Recognised models and choosing the appropriate model for implementing clinical supervision are discussed. A description of the initiatives undertaken with regard to clinical supervision within Southend Hospital is included, with particular reference to the Adult Intensive Therapy Unit; possible ways forward are identified. Quantitative data, obtained through a pilot questionnaire, from identifiable intensive therapy units across the North Thames and Eastern Region, are analysed.

Critical Care↗

PubMedDate not supplied

Sharing the challenge: mobilizing nurses against HIV/AIDS in Africa.

For two years ICN implemented a WHO/GPA-funded project in Africa to increase the capability and effectiveness of selected national nurses' associations (NNAs) to participate in their countries' campaigns to prevent HIV transmission; reduce the impact of HIV/AIDS on individuals, families and communities; and decrease morbidity and mortality associated with HIV/AIDS. The results have been gratifying. Not only have the nurses from the participating NNAs become a force to be reckoned with in their countries' HIV/AIDS efforts but they have activated major changes in nursing practice and in the delivery of care. Serving as role models, these nurses (numbering over 800) are mobilizing not only their colleagues but all others involved in caring for persons with AIDS.

Africa↗

PubMedDate not supplied

Advanced Organizers: a framework to implement learning readiness in support of broad-scale change.

Staff development educators are challenged to bring value to the adoption of new organizational management tools to improve the health care of patients. One strategy used to pursue health care excellence is the adoption of the ISO 9000 standards. However, implementation of this quality management system requires acceptance at all levels of the healthcare organization. This article explores the concept of learning readiness and uses an example of a training design strategy called an "Advanced Organizer." The authors describe its use as a development readiness strategy, outline the methodology for development and implementation, and provide steps for successful implementation. The implications for staff development educators are reviewed for the concept of learning readiness and broad-scale performance improvement initiatives.

Attitude of Health Personnel↗

PubMed1994

Development of a nursing research utilization program in a clinical oncology setting: organization, implementation, and evaluation.

PURPOSE/OBJECTIVES: To describe a research utilization program in the nursing department of a National Cancer Institute-designated comprehensive cancer center, including prerequisites for its development, its relationship to the department's nursing research program, the research utilization model used in the program, and evolution, evaluation, and future directions of the program. DATA SOURCES: Computerized literature searches; published articles, abstracts, and books; personal communications; departmental, committee, and task force meetings; nursing grand rounds; workshops; and inhouse surveys of nursing staff. DATA SYNTHESIS: Review and use of available information led to a comprehensive, multicomponent, departmental research utilization program that addressed issues raised in both the literature and in clinical practice. CONCLUSIONS: The nursing department was able to implement a research utilization program under the aegis of its research program that was consistent with the department's philosophy, goals, and organizational structure. Although many challenges and issues arose, ongoing evaluation measures indicate wide acceptance, successful implementation and direct influence on practice. IMPLICATIONS FOR NURSING PRACTICE: With strong administrative support, a departmental nursing research utilization program that enables participation of nursing staff and results in research-based practice and professional development can be implemented.

Baltimore↗

PubMed2006

The challenges of transferring evidence-based dentistry into practice.

The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Although clinicians embrace this concept, its implementation in clinical practice has been slow. In this article, barriers against the implementation of evidence-based care are examined and possible solutions are offered. The dental profession is committed to providing the best possible dental care for patients. This is proving to be more complex due to a virtual "information explosion" on new therapies, techniques, and materials; increased consumer understanding of treatment possibilities and therapeutic outcomes; and changing sociodemographic patterns. Although the profession advocates the importance of evidence-based dental disease prevention and treatment, practitioners have been slow to implement this concept. In 2003, the California Dental Association (CDA) formulated an evidence-based dentistry (EBD) action plan that included the formation of a task force to monitor EBD efforts and implement programs to educate CDA members on this methodology. The challenges of transferring EBD into clinical practice were key issues addressed by the task force, and much of their deliberations and perspectives are reflected in this article. Possible solutions for eliminating barriers against evidence-based care will also be explored.

Attitude of Health Personnel↗

PubMed1998

The complexities embedded in family-centered care.

The recent movement toward family-centered care, which has been propelled by the implementation of the Education for All Handicapped Children Amendments of 1986, poses considerable challenges to professionals trained in client-centered models of service delivery. These challenges are compounded by the fact that our understanding of family-centered care lags considerably behind our attempts to implement responsive and efficacious services. When practitioners include family members more integrally as collaborators in pediatric treatment, their perceptions about families and the nature of the therapeutic experience is affected. In this article, we present a number of critical dilemmas that are based on data drawn from ethnographic research, descriptive studies, and training seminars we conducted with pediatric practitioners and parents of children with special health care needs. These dilemmas highlight the complexities involved in building effective partnerships among all the key players, the influence of multiple cultural worlds on everyday practices, and the need to provide supports to practitioners for the emotional and social dimensions of practice. Implications for practice and future research are presented.

Adolescent↗

PubMed2006

Functional behavioural assessment in people with intellectual disabilities.

PURPOSE OF REVIEW: The presence of problem behaviours often impede an individual's quality of life and ability to be fully included in the environments of his or her choice. Functional behavioural assessment has been gaining widespread use in all settings in which people with intellectual disabilities might present problem behaviours. Understanding the function of these problem behaviours is a critical component to developing an effective intervention plan. This paper presents a review of the current knowledge and findings regarding functional behavioural assessments. RECENT FINDINGS: The recent studies on functional behavioural assessment have supported the well established fact that success in reducing behaviour problems is closely linked to understanding the function of the problem behaviour. Implementing functional behavioural assessment in school settings has been met with some challenges. Although a complex process, recent research has shown promise in training nonprofessionals in learning to carry out a functional behavioural assessment and implementing the information gained from the functional behavioural assessment into an effective behavioural intervention. SUMMARY: The necessity of conducting a functional behavioural assessment is uncontested. Developing a behavioural intervention on the information obtained from a thorough functional behavioural assessment is part of best practice in the field of intellectual disabilities. We have the tools to conduct, and train others to conduct, a comprehensive functional behavioural assessment.

Comorbidity↗

PubMed2004

Meeting the nursing challenges in treating children with 131I-MIBG.

This article focuses on the role of advanced practice nurses as leaders on a health care team committed to providing a collaborative approach to a unique patient population. It describes the process of implementing a clinical trial for treatment of patients with neuroblastoma with the radioisotope 131I-MIBG. As new clinical trials emerge, staff nurses face challenges in providing care to complex patients and their families. Nurses are often required to acquire new knowledge, interact with other disciplines and departments, and develop new skills in order to provide care for these patients. Advanced practice nurses can provide a critical link between the principal investigator and staff members to meet these challenges. The process used to implement this trial can serve as a model for many other interdisciplinary projects.

3-Iodobenzylguanidine↗

PubMedDate not supplied

Local public health performance measurement: implementation strategies and lessons learned from aligning program evaluation indicators with the 10 essential public health services.

This case study summarizes the development and implementation of the evaluation framework, preliminary data results, and lessons learned for overcoming barriers and challenges. The framework development was based on best practices in evaluation and the Public Health Essential Services. Results were as follows: (1) implemented a department-wide framework for program evaluation; (2) developed and implemented 34 program evaluation plans; (3) collected data on 52 indicators across 492 measurable objectives; and (4) identified challenges and recommendations to improve evaluation processes. Although the importance of program evaluation is recognized in public health, program evaluation models do not take into account the variety of goals inherent in the diversity of public health programming. The case study presented provides guidance and lessons learned for the evaluation of public health practice in local governments.

Benchmarking↗

PubMed1998

Renal replacement therapy in critical care: implementation of a unit-based continuous venovenous hemodialysis program.

Implementing a program as complex as continuous venovenous hemodialysis without the involvement of nephrology nurses is a challenge. However, with proper planning, appropriate staff support, and the ability to make changes as implementation proceeds, a successful program can be developed. Our reward is that we are now able to offer a therapy that is important and potentially lifesaving to those critically ill patients with renal failure who are unable to tolerate intermittent hemodialysis.

Acute Kidney Injury↗