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Results for “Implementation challenges”

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PubMed2001

Exercise prescription for the elderly: current recommendations.

The benefits for elderly individuals of regular participation in both cardiovascular and resistance-training programmes are great. Health benefits include a significant reduction in risk of coronary heart disease, diabetes mellitus and insulin resistance, hypertension and obesity as well as improvements in bone density, muscle mass, arterial compliance and energy metabolism. Additionally, increases in cardiovascular fitness (maximal oxygen consumption and endurance), muscle strength and overall functional capacity are forthcoming allowing elderly individuals to maintain their independence, increase levels of spontaneous physical activity and freely participate in activities associated with daily living. Taken together, these benefits associated with involvement in regular exercise can significantly improve the quality of life in elderly populations. It is noteworthy that the quality and quantity of exercise necessary to elicit important health benefits will differ from that needed to produce significant gains in fitness. This review describes the current recommendations for exercise prescriptions for the elderly for both cardiovascular and strength/resistance-training programmes. However, it must be noted that the benefits described are of little value if elderly individuals do not become involved in regular exercise regimens. Consequently, the major challenges facing healthcare professionals today concern: (i) the implementation of educational programmes designed to inform elderly individuals of the health and functional benefits associated with regular physical activity as well as how safe and effective such programmes can be; and (ii) design interventions that will both increase involvement in regular exercise as well as improve adherence and compliance to such programmes.

Aged↗

PubMed2002

Oral health status and its inequality among education groups: comparing seven international study sites.

This study compares oral health status and its inequality among education groups across seven study sites in five countries: Erfurt, Germany; Lodz, Poland; Yamanashi, Japan; New Zealand; and Baltimore and the Lakota and Navajo Indian Health Service sites in the United States. The data, from the International Collaborative Study of Oral Health Outcomes, were collected through personal interviews and clinical examinations. The research group measured the study sites' overall oral health, examining the percentage of the population with five or more missing and two or more decayed teeth. The group also assessed the magnitude of inequality among education groups by using indices of excess morbidity. Baltimore had the lowest percentage (10.8 percent) of decayed teeth and second lowest percentage (17.3 percent) of missing teeth, but the greatest indices of excess morbidity (79.2 percent for missing, 73.1 percent for decayed). Lodz, by contrast, had the worst overall dentition status (75.3 percent for missing, 70.3 percent for decayed) but the lowest inequality indices (10.6 percent for missing, 13.8 percent for decayed). This study demonstrates the need for policymakers in the study countries to consider not only overall levels but also the distribution of oral health, and it presents various challenges for oral health professionals in designing and implementing oral health programs.

Baltimore↗

PubMed1996

Quality assurance for abdominal CT: a rapid, computer-assisted technique.

OBJECTIVE: Maintaining high standards in a large CT imaging department with multiple scanners, a large technical and clerical staff, and a rotating staff of radiologists is an ongoing challenge. We undertook a project to design and implement a simple, rapidly performed computer-assisted system of quality assurance (QA) for use in abdominal CT. In our project, we also analyzed the results of that QA system. MATERIALS AND METHODS: We graded 1810 abdominal CT studies done in a 50-week period, using a three-point scale to indicate the quality of the following five parameters of technical quality: IV contrast enhancement, oral contrast opacification, window settings and artifacts, conformity to radiologists' protocol, and completeness and accuracy of header and scout data. In addition, a parameter reflecting performance of the film library and clerical staff was similarly graded. To provide a measure of peer review for radiologists, any disagreements with prior CT study reports were recorded when comparison studies were reviewed in the process of CT interpretation. A commercially available spreadsheet and database software program was tailored to allow rapid, easily performed data entry and analysis. Tables and graphs showing performance of technologists and film library and clerical staff were generated. This customized program was made available on the radiology department computer network. Results generated by the program were further analyzed with linear regression models. RESULTS: Our QA system was successfully integrated into the routine operation of the abdominal CT division. During the first 11.5 months of operation, the system reflected improvement in each of the technical parameters with a statistically significant improvement in the combined average technical score (from 1.15 to 1.68 on a scale of 0-2; p < .0001). The "Throughout Speed/Old Exams" parameter for performance of the film library and clerical staff, which was analyzed separately from the technical parameters, also improved significantly (from 1.3 to 1.8; p < .02). Improvements were statistically significant, even when we controlled for potential variations in quality among different CT scanners and variations among the radiologists who rated the quality of the examination. Thirty-eight disagreements with previous scan interpretations (5% of all scan comparisons) were recorded for evaluation at peer review conferences. CONCLUSION: The ability to monitor performance continuously using a rapid, computer-assisted system has effected measurable improvement in our CT service. Technologist and film library and clerical staff performance improved for all parameters studied. Deficiencies were revealed and trends demonstrated. The QA system allowed us to identify disagreements in interpretation of CT examinations for subsequent peer review by radiologists. Our QA software program has been made available on the Internet as freeware to licensed Excel users via anonymous file transfer protocol at Internet Protocol 134.192.6.110.

Administration, Oral↗

PubMed2006

The obese adolescent.

Childhood obesity is one of the formidable challenges that healthcare providers face. Early recognition and implementation of preventive strategies is crucial in combating this problem. Inculcation of a healthy lifestyle in our youth by encouraging physical activity, decreasing sedentary pastimes, and making healthy food choices is critical right from the start, before poor habits become ingrained. More research is needed to find more effective ways to treat obesity in childhood and adolescence.

Adolescent↗

PubMed2005

Managing conflict in the age of senior care.

As the aging population continues to grow and the Medicare drug benefit is implemented next year, pharmacists will face even more challenges in senior care settings. This article describes conflict management techniques that can help pharmacists successfully resolve, and even prevent, conflicts with physicians other interdisciplinary team members, patients, and family members. Some of these techniques are proven and widely studied; others are new and cutting edge. Yet, they all can enable senior care pharmacists to take a leadership role in addressing and avoiding conflicts.

Journal Article↗

PubMedDate not supplied

Work-based learning: challenges and opportunities.

This article discusses some of the challenges and opportunities arising from the development and implementation of an innovative work-based open and distance learning programme available exclusively to healthcare assistants working in general health and mental health practice. The programme is based on a partnership between the sponsoring organisation and the Open University. The focus is on the development of standards of proficiency, service user involvement, partnership working, skills development and the pedagogic implications of a work-based learning format.

Adult↗

PubMed1990

Turning danger into opportunity.

Brian Edwards looks at the management of change required to pave the way for successful implementation of the white paper, and sees a challenging time ahead.

Administrative Personnel↗

PubMed1990

An ideal model.

Responding to the challenges faced by community services, Medway HA has implemented a system to model the changes. Brian Clover explains, in the second article on planning models.

Community Health Services↗

PubMed1994

Shared governance and imaging: "pyramid power" revisited.

Shared governance is a concept that is gaining wide acceptance in the United States; however, it is still in its infancy in Canada. This article introduces shared governance principles to diagnostic imaging administrators and staff and informs them of the rationale, benefits and challenges of this management philosophy. In addition, the implementation of an imaging department empowerment program will be explored, as will its relationship to a facility-wide shared governance program.

Canada↗

PubMed1996

Restructuring critical care services. Part III: Successful implementation preparation.

Successful implementation in a redesigning organization does not happen without a sound design, good implementation planning and effective leadership. The focus of the implementation preparation must change prior to and after the "go live" implementation date. Implementation preparation requires intentional steps to build systems, communicate effectively and develop operational understanding among clinicians, physicians and management. Early effort should focus on planning for efficient day-to-day operations, development of measurement systems and contingency planning. Immediately prior to and after implementation the focus should be on communication, goal setting, issues prioritization and fact-based issues resolution. After the first couple of months of implementation, the focus should move toward mentoring teams/individuals, building outcome measurement systems, identifying sources of future improvement and transferring more authority as appropriate to teams. Commit to comprehensive implementation preparation. Time spent on implementation preparation will pay large dividends during the challenging times of transitioning your organization to a redesigned world.

Communication↗

PubMed1988

Making room in the marketplace: a special initiative for the poor.

Faced with increased concern over the role of the voluntary healthcare sector, specifically Catholic providers, in the care of the poor, Mercy Health Services (MHS), a healthcare system, established a two-year, three-phase planning and development effort known as the Special Initiative for the Poor (SIP). Established in March 1986, SIP was designed to find out: Who are the poor? What are their needs? What is MHS's responsibility in meeting these needs? Among its objectives, SIP was charged with: 1. Educating and raising awareness of governance and management staffs. 2. Developing a way to assess human needs. 3. Determining the financial implications of the organization's commitment to the poor. 4. Recommending ways to enhance the understanding, energy, and commitment to the poor throughout the system. During the first six months, SIP staffers traveled to hospitals and subsidiaries throughout the system, meeting with management and staff, explaining the project, laying the groundwork, and gaining support. In the development phase, SIP created the Community Assessment of Human Needs, a systematic approach to identify and understand the unmet human needs of the poor. It also developed a simple inventory formula to help hospitals determine which of their programs were specifically for the poor and determine what these programs cost. Finally, in the implementation stage, several of SIP's recommendations are challenging the organization to move beyond its current commitments.

Catholicism↗

PubMed2000

The status and prospects of tuberculosis control in India.

SETTING: India, where much of the global strategy for tuberculosis control was established, but where, every year, there are an estimated 2 million cases of tuberculosis. OBJECTIVE: To describe the policies, initial results, and lessons learned from implementation of a Revised National Tuberculosis Control Programme using the principles of DOTS (Directly Observed Treatment, Short-course). DESIGN: A Revised National Tuberculosis Control Programme (RNTCP) was designed and implemented starting in 1993. With funding from the Government of India, State Governments, the World Bank and bilateral donors, regular supply of drugs and logistics was ensured. Persons with chest symptoms who attend health facilities are referred to microscopy centres for diagnosis. Diagnosed cases are categorized as per World Health Organization guidelines, and treatment is given by direct observation. Systematic recording and cohort reporting is done. RESULTS: From October 1993 through mid-1999, 146,012 patients were put on treatment in the programme. The quality of diagnosis was improved, with the ratio of smear-positive to smear-negative patients being maintained at 1:1. Case detection rates varied greatly between project sites and correlated with the percentage of patients who were smear-positive among those examined for diagnosis, suggesting heterogeneous disease rates. Treatment success was achieved in 81% of new smear-positive patients, 82% of new smear-negative patients, 89% of patients with extra-pulmonary tuberculosis, and 70% of re-treatment patients. CONCLUSION: The RNTCP has successfully treated approximately 80% of patients in 20 districts of 15 states of India. Treatment success rates are more than double and death rates are less than a seventh those of the previous programme. Starting in late 1998, the programme began to scale up and now covers more than 130 million people. Maintaining the quality of implementation during the expansion phase is the next challenge.

Adolescent↗

PubMed2000

[Open access echocardiography in patients with suspected or confirmed heart failure].

Cardiac failure is a disease still characterized by high morbidity and mortality. The use of clinical criteria is not yet considered sufficient for the diagnosis of this disease by main scientific associations. Echocardiography can give important information not only for diagnosis, but also for prognosis and management of the disease. As a growing demand for echocardiography is expected in the near future scientific community should be ready to face this difficult challenge. In fact it will be necessary to implement and organize structures in which this technique will be readily and easily available, in order to facilitate the diagnosis and allow "personalized" management and follow-up in these patients.

Age Factors↗

PubMed2002

Will the nation be ready for the next bioterrorism attack? Mending gaps in the public health infrastructure.

This paper provides an overview of critical weaknesses in existing public health preparedness capabilities and discusses current policy initiatives to address these shortcomings. It examines developmental needs related to communication and coordination, information systems, laboratories, the development and distribution of vaccines and other countermeasures, emergency medical preparedness and response, and the public health workforce. The paper summarizes the current status of federal and state plans to respond to these developmental needs and touches on the future challenges likely to emerge as these plans are implemented.

Bioterrorism↗

PubMed2003

Alzheimer's Caregiver Support Online: lessons learned, initial findings and future directions.

Family caregivers of older adults with progressive dementia (e.g., Alzheimer's disease) are faced with a variety of emotional and behavioral difficulties, such as dealing with persistent, repetitive questions, managing agitation and depression, and monitoring hygiene and self-care activities. Although professional and governmental organizations have called for the creation of community-based education and support programs, most dementia caregivers continue to receive little or no formal instruction in responding effectively to these challenges. The current paper describes the development and implementation of Alzheimer's Caregiver Support Online, a Web- and telephone-based education and support network for caregivers of individuals with progressive dementia. Lessons learned from the first two years of this state-supported initiative are discussed, followed by the findings of a Robert Wood Johnson Foundation-funded strategic marketing initiative and an initial program evaluation of AlzOnline's Positive Caregiving classes. Finally, clinical implications and future directions for program development and evaluation research are proposed.

Aged↗

PubMed2003

PropeR revisited.

The PropeR EHR is a multidisciplinary EHR system that is built using existing open source components. This paper discusses the implementation of this system and the advantages and challenges encountered when using open source components.

Computers↗

PubMed2004

Creating telehealth networks from existing infrastructures.

Implementing a telehealth program can be a financial challenge due to associated costs such as hardware, software, networking, administration and clinical expertise. To maximize potential and minimize costs, it makes sense to leverage existing telecommunications infrastructures and tailor the program based on what is available.

Capital Financing↗

PubMedDate not supplied

[Is it possible to sustain health promotion programs in private companies? The case of four Quebec private companies of blue collar workers].

OBJECTIVE: Sustained health promotion programmes in the workplace (HPPW) continues to be a public health challenge. This article presents an evaluation of the implementation and sustainability of such programmes in private blue-collar companies in Quebec to shed light on issues specific to this type of setting. METHOD: A multiple case (4 sites), longitudinal (7 years) and interpretive study method was used. The interpretation framework considered that the implementation and sustainability of HPPW in companies are the result of organizational learning in health promotion, determined by the strategies of individuals in a position of control who shape the decisional processes related to these programmes. RESULTS: After seven years of observation, two of the four sites had continued their HPPW, although these programmes were no longer applied within these companies. The health promotion organizational learning processes in both sites were defined according to targeted organizational purposes set by the decision-makers who supported HPPW. However, these gains were largely lost when HPPW were no longer retained as a component of their organizational development strategy. DISCUSSION: The organizational conditions that are conducive to HPPW are difficult to put together and sustain in companies like those in our study. Businesses implement these programmes mainly for the organizational benefits they expect to reap in the short term, whereas improvement in the health of workers in the longer term is not a priority.

Feasibility Studies↗