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Results for “Implementation”

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At least 1,315 records · Page 73Linked to original sources

PubMed1999

Developing, implementing, and evaluating a condom promotion program targeting sexually active adolescents.

This article describes the development, implementation, and evaluation of the Condom Campaign, a 1995 HIV prevention program promoting condom use among sexually active adolescents in three King County, Washington, urban communities. This program employed three main strategies: (a) mobilizing all levels of the target communities to support and guide program development and implementation; (b) creating and implementing a mass media campaign targeting sexually active teenagers that promoted correct condom use and favorable attitudes toward condoms; and (c) recruiting public agencies, community organizations, and businesses to distribute condoms from bins and vending machines. We evaluated the program through a series of cross-sectional interviews conducted in the three communities chosen for their elevated levels of adolescent sexual risk behavior. Overall, 73% of target youth reported exposure to the Condom Campaign; exposure did not differ by age, gender, race, or level of sexual experience. Levels of sexual activity remained stable throughout the media campaign.

Adolescent↗

PubMedDate not supplied

Implementing preventive health measures: a pilot study.

OBJECTIVE: Implementation of preventive services guidelines is performed inconsistently. In an attempt to reduce variation in guideline implementation, we developed a patient questionnaire based on the US Preventive Services Task Force Guide and the Health Plan Employer Data and Information Set 3.0 performance measures of the National Committee on Quality Assurance. SUBJECTS: 100 hospitalized patients of five primary-care physicians. METHODS: In a pilot study, 100 hospitalized patients of five primary-care physicians were questioned about their compliance with evidence-based, preventive healthcare recommendations. Information was requested on blood pressure measurement, cholesterol screening, fecal occult blood testing, smoking-cessation counseling, Pap testing, mammography, postmenopausal hormonal replacement therapy counseling, prostate examination and prostate-specific antigen (PSA) testing, use of aspirin and beta-blockers following an acute myocardial infarction, testing of diabetics for hemoglobin A1c and retinal eye examinations, questioning of the elderly for auditory and visual problems, and receipt of influenza and pneumococcal vaccines. Information on variations from the recommended preventive service was fed back to their physicians. Six months after the initial survey, the patients were requestioned to determine if compliance had improved with the recommendations. RESULTS: We found significant improvement in fecal occult blood testing, smoking cessation, Pap smear testing, mammography use, prostate examinations and PSA testing, hemoglobin A1c testing, seeing or hearing loss follow-up, and the administration of influenza and pneumococcal vaccines. CONCLUSIONS: Improving implementation of preventive services recommendations is a challenge. This pilot study suggests that involving the patient more in the process and informing the physician of the results may improve the process.

Adult↗

PubMed2000

[A study of the guideline of case management for persons with mental disorders analyzed with fidelity index. The conditions of effective implementation].

OBJECTIVE: The present study examines the condition of effective case management based on the guideline of case management for persons with mental disorders. METHODS: A total of 295 clients were admitted to a case management trial for about 2 months. A fidelity index of program implementation and outcome measures of case management were developed. The relationship between implementation of critical program components measured by fidelity index, and outcome was analyzed. RESULTS: Fidelity Index was significantly correlated with outcome measures of clients, staffs and the care system. Effective but not-easily-feasible elements of program were having case-conference, application, of informal support and development of services. CONCLUSION: It is necessary to facilitate application of informal support with liaison with public health nurses, to standardize case-conference and to place development of care services in the core of programs for ensuring effective implementation of case management for persons with mental disorders in Japan.

Adult↗

PubMed2000

Assessing the implementation of workplace health programs outside of controlled environments.

The study explored the implementation of workplace health programmes in 14 NHS Trusts (hospitals). It sought to identify different approaches to implementation and measures that could be used to guide future development. The study comprised inter-related elements examining the process of implementing workplace health and the impact on staff. An innovative action research approach was applied to the evaluation. The aims of the evaluation were to generate activity and learning within the organisations which was sustainable (long term) and transferable outside the study organisations. The study is described in terms of the multiple methods and the ways in which these have been brought together in the analysis. The approach has been informed by a shift from an individualistic perspective towards one which sees the health of workers within the broader context of organisational development and management. The research identified a number of dilemmas for workplace health with its focus on the health of the individual. A typology was developed which describes different approaches to workplace health and their impact on sustaining such initiatives. It suggests that for workplace health to be successful it must address the organisational context as well as individual staff needs. Results from a survey of staff in the 14 trusts seems to demonstrate an association between the approaches, described in the typology, and an impact on staff. Workplace health programmes need to shift towards approaches where the individual's health is seen within the wider context of the organisation.

Health Promotion↗

PubMedDate not supplied

Design and implementation of an outcomes management model.

In today's capitation-based reimbursement environment, acute care staff nurses must coordinate patient care considering the full continuum of care. To do so effectively, staff nurses need tools to accurately predict patient needs, adjust service intensity accordingly, and evaluate the outcomes of the care provided. The design and implementation of a model to support acute care staff nurses in that effort is described. The model's implementation was evaluated, in part, using a ten-item pre- and post-implementation survey. The survey showed that staff nurses who participated in the final educational offering on the model increased significantly their reported use of aggregate data for planning care. To achieve the greatest impact, the model needs to evolve so that it is applied earlier in the care process than at initial hospitalization. Ideally, this should occur during a wellness visit or enrollment in a health plan.

Acute Disease↗

PubMed2001

On the need for massive additional shielding of a catheterization laboratory for the implementation of high dose rate 192Ir intravascular brachytherapy.

Purpose: There is a widespread belief in the cardiology and radiation oncology community that high dose rate 192Ir intravascular brachytherapy cannot be implemented without massive additional shielding of the conventional catheterization labs. The purpose of this work is to show that this is a myth, which is not based on sound radiation protection principles.Methods: Exposure rates in air were calculated for a variety of point and line sources of 192Ir. Exposures per treatment at different distances from the source were calculated for a typical intravascular brachytherapy treatment of a 15-Gy dose at a radial distance of 2 mm from the source and for source lengths in the range of 0 to 10 cm. Additionally, exposure rates outside the catheterization lab were calculated for various lead shielding thicknesses typical of conventional X-ray facilities. These rates were used along with the NCRP recommendations on radiation facility design to assess shielding requirements.Results: For a treatment dose of 15 Gy at 2 mm, the occupational exposure per treatment at 2 m in air without any tissue attenuation or shielding was 7.8 mR for a lesion length of 3.0 cm. This exposure/treatment is independent of the dose rate or the activity of the source. However, it increases as lesion length is increased, increasing from 5.4 to 24.9 mR as lesion length increased from 2 to 10 cm. Exposures in unrestricted areas outside the catheterization lab using the NCRP shielding rationale can be kept below 2 mR per treatment and using appropriate workload, use, and occupancy factors below 2 mR per week.Conclusions: The feasibility of implementing a high dose rate 192Ir intravascular brachytherapy program in a catheterization laboratory is totally independent of the dose rate or the activity of the source. If it is feasible to implement 192Ir brachytherapy in a conventional catheterization lab using low activity 192Ir seeds, then it is also feasible to do so with a high activity 192Ir afterloader.

Journal Article↗

PubMed2000

A systematic process for converting text-based guidelines into a linear algorithm for electronic implementation.

Clinical practice guidelines are increasingly important for improving the quality and the process of healthcare delivery. Unfortunately, most guidelines are available only in a text-based format, which is difficult to integrate into clinical practice. Computers can facilitate guideline integration into clinical practice; however, this migration to computers requires translating text into intermediary representations. One type of representation that is readily adaptable for computerization is a linear algorithm. This paper describes a systematic process to convert text-based clinical practice guidelines into a linear algorithm with structured content, as an intermediate step to electronic implementation. The process includes: 1) defining applicability criteria, 2) identifying entry points, 3) defining decision points, 4) defining actions, 5) creating a linear algorithm that links decision points and actions, and 6) adding supporting resources. This process has been used successfully to prepare more than two dozen guidelines for computerization. It has been tested by several physicians and informaticians and shown to be transferable to various user groups. The availability of a systematic process to convert text-based guidelines into a structured intermediary format for electronic implementation can facilitate the computerization of guidelines and can inform guideline content developers regarding the critical elements that need to be explicitly stated in guidelines to support electronic implementation.

Algorithms↗

PubMedDate not supplied

Assessing the implementation of clinical process innovations: a cross-case comparison.

Clinical process innovations (CPI) are central to the ability of organizations to negotiate the challenges of cost containment and quality improvement, yet many CPI have not met expectations. Perhaps most alarming is that the dissemination and implementation of CPI is not well understood. This is the second of two articles addressing the dissemination and use of CPI in integrated delivery systems. This article discusses those factors that have been identified as either facilitating or impeding the various stages in implementing CPI and suggests some intervention strategies to enhance opportunities for continuous CPI. Identifying the process and the factors driving the implementation of CPI is only part of the challenge. The development of CPI adequate to fully meet current challenges will require managers to re-examine existing paradigms and values influencing their actions to date. Within this context, the necessary staging of the innovation process within the life cycle, developing partnerships both within and outside the organization to gather the necessary resources and support, and multidimensional performance monitoring and feedback can prepare organizations and managers to better face the reality of managing the innovation process.

Communication↗

PubMed2000

Technology development and implementation in the public health institutions: a strategic and pedagogical task for the learning organization.

The article presents two overall problem issues for IT in the health sector. A strategic problem: Which organization structure and which work routines should be enhanced by technology? A pedagogical problem: How does the personnel learn to think, act and express work through IT-tools? The suggested solution is to put technology development and implementation together within a theoretical frame for the learning organization where reciprocal demands and terms exist for both the IT-tools and the personnel. The personnel makes demands to which goals should be reached through technology and technology demands that the personnel is acquainted with hardware and software. As a communication system, technology offers new possibilities of realizing other forms of cooperation. The suggested solution is a synthesis between the strategy for organization development through technology and the implementation of IT as a learning process for the personnel. The synthesis between the mutual demands of the organization and its personnel provides for IT-tools which are in concordance with the principal values of the health practice rather than merely economic and management values. The analysis builds on a qualitative, in-depth investigation of IT-implementation in the secondary sector. The investigation indicated that the use of IT is a learning process which requires three types of knowledge and that continued IT-development in the organization requires a new fourth knowledge.

Attitude to Computers↗

PubMed2000

Implementing HIPAA security in a membership organization.

The upcoming HIPAA security regulations are forcing a change in business and operating procedures that many, if not most, healthcare organizations are ill-prepared to tackle. Of all healthcare organizational structures, membership organizations will most likely face the greatest number of obstacles in preparing for and implementing the HIPAA security regulations. This is because the membership organization as a whole must find a way to accommodate the disparate technologies, business and operating methodologies and processes, and available, limited resources of its individual member organizations, and integrate these into a uniform implementation plan. Compounding these obvious difficulties is the unique challenge of enforcement authority. The individual member organizations are autonomous business entities, whereas the membership organization as a whole merely acts as an advisor or consultant, and has only limited enforcement authority over any individual member organization. This article explores this unique situation in depth. We focus on PROMINA Health System, a nonprofit healthcare membership organization that consists of five disparate member healthcare organizations. We examine the challenges PROMINA has encountered in its quest to institute an organization-wide HIPAA security program and its methodology for accomplishing program implementation.

Computer Security↗

PubMedDate not supplied

On the need for massive additional shielding of a catheterization laboratory for the implementation of high dose rate 192Ir intravascular brachytherapy.

PURPOSE: There is a widespread belief in the cardiology and radiation oncology community that high dose rate 192Ir intravascular brachytherapy cannot be implemented without massive additional shielding of the conventional catheterization labs. The purpose of this work is to show that this is a myth, which is not based on sound radiation protection principles. METHODS: Exposure rates in air were calculated for a variety of point and line sources of 192Ir. Exposures per treatment at different distances from the source were calculated for a typical intravascular brachytherapy treatment of a 15-Gy dose at a radial distance of 2 mm from the source and for source lengths in the range of 0 to 10 cm. Additionally, exposure rates outside the catheterization lab were calculated for various lead shielding thicknesses typical of conventional X-ray facilities. These rates were used along with the NCRP recommendations on radiation facility design to assess shielding requirements. RESULTS: For a treatment dose of 15 Gy at 2 mm, the occupational exposure per treatment at 2 m in air without any tissue attenuation or shielding was 7.8 mR for a lesion length of 3.0 cm. This exposure/treatment is independent of the dose rate or the activity of the source. However, it increases as lesion length is increased, increasing from 5.4 to 24.9 mR as lesion length increased from 2 to 10 cm. Exposures in unrestricted areas outside the catheterization lab using the NCRP shielding rationale can be kept below 2 mR per treatment and using appropriate workload, use, and occupancy factors below 2 mR per week. CONCLUSIONS: The feasibility of implementing a high dose rate 192Ir intravascular brachytherapy program in a catheterization laboratory is totally independent of the dose rate or the activity of the source. If it is feasible to implement 192Ir brachytherapy in a conventional catheterization lab using low activity 192Ir seeds, then it is also feasible to do so with a high activity 192Ir afterloader.

Brachytherapy↗

PubMedDate not supplied

Evaluation of documentation before and after implementation of a nursing information system in an acute care hospital.

Economic pressures on healthcare systems have intensified the necessity of demonstrating the unique contribution of nursing care to patient outcomes. The use of nursing information systems (NIS) has increased completeness of some nursing documentation elements. This study's purpose was to evaluate differences in documentation completeness of nurse assessments of patient outcomes (NASSESS), achievement of patient outcomes (NGOAL), nursing interventions done (NQUAL), and routine assessments before and after implementation of an NIS in a 100-bed urban university hospital in west Tennessee and before and after retraining in NIS use and care planning. NIS implementation did not improve documentation within the first six months. However, retraining and continued NIS use did significantly improve NASSESS, NGOAL, NQUAL, and blood pressure documentation 18 months postimplementation. Nurses must evaluate documentation completeness before and periodically after NIS implementation, using results to improve patient record data validity for patient care decisions, quality improvement, and research.

Acute Disease↗

PubMed2001

Antibiotic use in public hospitals in Taiwan after the implementation of National Health Insurance.

BACKGROUND AND PURPOSE: Only limited data is available on the patterns of antibiotic use in hospitals in Taiwan before and after the implementation of national health insurance. This study aimed to determine the patterns of use of antibiotics in public hospitals in Taiwan after the implementation of the National Health Insurance program and to compare these with patterns prior to the implementation. METHODS: Data on the annual use of all antibiotics in public hospitals in Taiwan during the period from fiscal year (FY) 1994-1995 to 1997-1998 were collected and analyzed. Hospitals included seven medical centers, 19 regional hospitals, 53 district hospitals, and eight specialty service hospitals. RESULTS: The annual cost of antibiotics made up 17.4% of the annual cost of all medication used in these hospitals in FY 1994-1995, and decreased year by year to 12.6% in FY 1997-1998. During the study period, 57.4% of the total cost of antibiotics were incurred by medical centers, 24.6% by regional hospitals, 16.2% by district hospitals, and 1.8% by specialty service hospitals. The most commonly used class of antibiotic was cephalosporins, accounting for 48.0% to 54.3% of total antibiotic costs. The second most commonly used class of antibiotic was penicillins, accounting for 15.9% to 17.4% of total antibiotic costs. In FY 1994-1995, the next most commonly used classes of antibiotics were aminoglycosides, fluoroquinolones, and other beta-lactams, respectively, but by FY 1997-1998 these had changed to fluoroquinolones, glycopeptides, and aminoglycosides, respectively. Among the various cephalosporins used, first-generation cephalosporins accounted for 76.1% of all cephalosporins used in FY 1994-1995, which increased year by year to 84.0% in FY 1997-1998. Second-generation cephalosporins accounted for 20.7% of all cephalosporins used in FY 1994-1995, decreasing to 13.2% in FY 1997-1998. CONCLUSION: The introduction of the National Health Insurance program in Taiwan brought about a major change in antibiotic use patterns in public hospitals.

Anti-Bacterial Agents↗

PubMedDate not supplied

The implementation of the United Nations Convention on the Rights of the Child: global commitments and local realities.

Papua New Guinea (PNG) is a signatory to the United Nations Convention on the Rights of the Child (CRC) and the World Health Organization Alma Ata Declaration of Health for All by 2000. The inherent rights of all children include accessible, affordable and quality health care and protection from all forms of violence, abuse, neglect and maltreatment. In 2000 PNG is challenged in implementing the CRC and has deferred achievement of targets in the Alma Ata declaration until 2010. Constraints to CRC implementation include lack of public awareness about the Convention, even among people whose work directly relates to child issues; deterioration in many essential social services; massive social change; and decentralization of health care systems without adequate accompanying support. New health problems, including alcohol and drug abuse and AIDS, now face many children and adolescents, but the problems that have existed for generations, particularly acute respiratory infections, tuberculosis and malnutrition, have not yet been dealt with. It is unlikely that primary health services can be rebuilt as they were 20 years ago and for most children throughout PNG the basic right of access to quality health care is not a reality. Programs for training village-based child health and child protection workers, who are volunteers and who are integrated into the loose health network that currently exists, would fill some of the gaps. More recognition and funding are needed from governments for church and non-government organizations involved in successful existing maternal and child health programs. There needs to be a substantial public awareness program on child rights, establishment of a mandated national coordinating body and a realistic timetable for CRC implementation. Both political will and administrative action are desperately needed.

Child↗

PubMed2001

Implementation of a medical geographic information system: concepts and uses.

This paper introduces a medical geographic information system which has been implemented to enhance public-health research by facilitating the modelling of spatial processes of disease, environment, and healthcare systems in a rural area of Bangladesh. In 1966, a surveillance system was implemented to record all vital demographic events in the study area. Selected information on reproductive and child health, socioeconomic conditions, and health and family-planning interventions is being collected for the surveillance database. This paper discusses the conceptual design of integrating the surveillance database with the medical geographic information system and its use in conducting multidisciplinary health research. The paper is intended to help those who wish to implement a health-based geographic information system to understand the links between people and their environments and to better meet the health needs of target communities.

Bangladesh↗

PubMed2001

An evaluative study of the effects of the implementation of UBSG on nurses' perceptions of professional governance.

Health care reform has been a major economic and political challenge in Taiwan. Successful implementation of change in hospitals requires managers to learn new skills. Unit-based shared governance (UBSG) is one innovation used to restructure health care organizations to promote the performance of professionals and to achieve goals for organizations. This research, conducted in a 150-bed community hospital, was a quasi-experimental study designed to evaluate the effectiveness of implementing UBSG. This article describes and compares the degree of nurses' perceptions of professional governance between a UBSG group (n = 29) and a control group (n = 24). The findings of this study indicate that the majority of UBSG respondents scored at a high level of participation in decision-making and professional practice (p < .05). Nurses in the UBSG group shared more in professional governance activities (p < .05). It is suggested that decentralized UBSG within a division of nursing can empower nurses. The study provides an empirical basis for implementing UBSG.

Adult↗

PubMed2001

An approach to guideline implementation with GEM.

Implementation of practice guidelines refers to the creation of strategies and systems to operationalize the knowledge and recommendations set forth by guideline developers. We describe an approach to guideline implementation that makes direct use of the guideline document as a knowledge base. The Guideline Elements Model (GEM) provides an XML-based guideline document model that facilitates implementation of guidelines. Knowledge extraction using GEM requires document markup rather than programming and can promote authenticity and consistent knowledge encoding. Knowledge customization for the local enterprise requires addition of meta-information to pertinent components of the GEM hierarchy in a design database. GEM provides an audit trail to track local adaptation. Knowledge integration with patient data can be promoted using information management services. A design goal is to devise a system that can be applied by local clinical domain experts, quality assurance experts, and information systems programmers without requiring trained informaticians and knowledge engineers to serve as intermediaries

Artificial Intelligence↗

PubMed2001

Implementation of neuromorphic systems: from discrete components to analog VLSI chips (testing and communication issues).

We review a series of implementations of electronic devices aiming at imitating to some extent structure and function of simple neural systems, with particular emphasis on communication issues. We first provide a short overview of general features of such "neuromorphic" devices and the implications of setting up "tests" for them. We then review the developments directly related to our work at the Istituto Superiore di Sanità (ISS): a pilot electronic neural network implementing a simple classifier, autonomously developing internal representations of incoming stimuli; an output network, collecting information from the previous classifier and extracting the relevant part to be forwarded to the observer; an analog, VLSI (very large scale integration) neural chip implementing a recurrent network of spiking neurons and plastic synapses, and the test setup for it; a board designed to interface the standard PCI (peripheral component interconnect) bus of a PC with a special purpose, asynchronous bus for communication among neuromorphic chips; a short and preliminary account of an application-oriented device, taking advantage of the above communication infrastructure.

Computer Communication Networks↗