PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Implementation challenges”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,369 records · Page 76Linked to original sources

Pressure ulcer prevention and care: preventing and managing pressure ulcers in long-term care: an overview of the revised federal regulation.

Although the Centers for Medicare and Medicaid Service's Federal Regulation as it relates to pressure ulcer prevention and care in long-term care facilities has not changed, the Guidance to Surveyors (F-314) has been expanded significantly. In addition to more clearly defining commonly used terms, the new guidance document emphasizes the use of pressure ulcer risk assessment and prevention strategies, pain assessment and treatment, and monitoring the care outcomes. The Centers for Medicare and Medicaid Service has clearly raised the bar on pressure ulcer care. Based on currently available evidence, the guidance document is clear in its intent to encourage all long-term care facilities to adopt evidence-based pressure ulcer protocols of care. This transition, and the development and implementation of this guidance document, may present considerable challenges to some long-term care facilities. However, the lack of ambiguity in the F-314 document and its consistency with currently available evidence may be helpful to staff and improve outcomes of care.

Humans↗

[Epidemiological transition and health impact of cardiovascular disease in Tunisia].

OBJECTIVE: We aim at analysing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. METHODS: Data are recorded through the Tunisian National Morbidity and Mortality Survey (TNMMS). In order to assess the CVDs (CHDs vs RHDs) trend, two representative samples of Cardiology Departements patients were compared one is selected from the TNMMS and the second from the hospitalisations recorded in 1992. Causes, stay duration, status at the end of the hospitalisation, transfer to another hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. RESULTS: CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectivly 58.8% and 38.2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. CONCLUSION: This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological, social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities.

Adult↗

Advanced Information Retrieval Using XML Standards.

The bulk of clinical data is available in an electronic form. About 80% of the electronic data, however, is narrative text and therefore limited with respect to machine interpretation. As a result, the discussion has shifted from "electronic versus paper based data" towards "structured versus unstructured electronic data". The XML technology of today paves a way towards more structured clinical data and several XML based standards such as the Clinical Document Architecture (CDA) emerge. The implementation of XML based applications is yet a challenge. This paper will focus on XML retrieval issues and describe the difficulties and prospects of such an approach. The result of our work is a search technique called "topic matching" that exploits structured data in order to provide a search quality that is superior to established text matching methods. With this solution we are able to utilize large numbers of heterogeneously structured documents with only a minimum of effort.

Databases, Factual↗

Washington State's Basic Health Plan: choices and challenges.

The current turbulence characterizing the health sector has engendered a limited number of state-level experiments to provide health services for the nation's 37 million uninsured. The issues and challenges generated by each program's design and implementation vary. By examining the experience of one such state program, the Washington Basic Health Plan, in some detail, this paper contributes to the policy debate regarding the possible range of solutions available to address the issue of "the uninsured." By analyzing the array of design choices available at the time the program was enacted, and why certain options were chosen rather than others, this paper points to the complex interaction of political dynamics, public policy development, and program implementation.

Health Policy↗

Reducing overcrowding on student practice placements.

The UK is facing a major shortage of registered nurses. One government strategy for addressing this shortage has been the nationwide increase in the nursing student population. Large student cohorts have resulted in placements being overcrowded with students and, as a consequence, the quality of learning experiences has diminished. A mental health NHS trust in London in partnership with local higher education institutes has created a framework to relieve the pressure on placements. This article discusses the implementation of the framework and outlines the results, challenges and recommendations.

Education, Nursing↗

CPOE: It's not a ... say the experts, so the time to prepare is now.

The implementation of Computerized Physician Order Entry can be challenging and complicated, but you can make the process much smoother with careful planning. Staff up before going live. The first several weeks will slow down the department. Have enough computers for all staff, including residents and attendings. Take a "go-slow" attitude when it comes to installing medication allergy alarms.

Decision Making, Organizational↗

Implementing evidence-based treatment of manic and mixed episodes.

Manic and mixed episodes can be challenging to treat despite published guidelines and algorithms. An alternative iterative approach that offers evidence-based treatment options at critical decision points may help to individualize care. Implementing such an approach begins with making a diagnosis and recognizing individual patient factors, weighing treatment options, and developing a menu of reasonable treatment choices based on the best available evidence. A critical review of the evidence is needed to ensure that interventions with the highest quality evidence are offered preferentially and that relevant individual factors are considered. Educating patients, negotiating treatment options, and selecting a pathway of care with the patient are important steps before initiating an intervention. After initiating an intervention, follow-up proceeds by measuring efficacy and adverse events with the aim of determining whether or not the patient is benefiting from treatment. Based on this knowledge, new individual factors are known and new evidence can be reviewed, so the cycle begins again. Using this iterative approach to treat patients with bipolar disorder in manic and mixed episodes promotes personalized care and relies on understanding the quality of evidence for the treatments commonly used to treat these phases of bipolar disorder.

Acute Disease↗

Fistulas: a nursing challenge.

Enterocutaneous fistulas are dreaded complications that result in a delayed recovery and longer hospitalization. The nursing and medical management can indeed be a challenge. Nursing has the responsibility to plan and implement care that will protect skin integrity, control odor, contain drainage, and provide emotional support.

Humans↗

Changing to a conceptual base curriculum.

The movement of undergraduate nursing education from the hospital to tertiary institution in Australia has highlighted the need for nursing to develop curricula that reflect a more rigourous academic basis and the universality of nursing care. This change demands that nursing faculty must articulate a philosophy and concept of nursing upon which to base a curriculum in order to meet present and future needs of society for health care. The faculty in the School of Nursing of Curtin University of Technology in Western Australia has responded to this challenge and is currently in the process of implementing its conceptual model of nursing.

Curriculum↗

Prevention and control of occupational lung disease.

Prevention is the ultimate purpose of efforts to identify and understand occupational lung diseases. A major challenge for this decade will be the effective implementation of preventive programs which allow utilization of the developing information base on incidence and pathogenesis. Much of the basic methodology for prevention has yet to be developed, and many basic social and philosophic decisions will be forthcoming. It is clear that prevention of occupational lung disease will require a cooperative effort among pulmonary physicians, occupational physicians, epidemiologists, industrial hygienists, basic researchers, toxicologists, government regulators and members of many other disciplines.

Dust↗

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.

Cross-Sectional Studies↗

Interagency coordination: the key to mainstreaming children with special needs into day care.

While the need for mainstreamed day-care services continues to increase, many barriers remain that prevent or delay providers from enrolling children with special needs. The suggestions in this article to coordinate local resources will help programs begin to provide initial necessary services to children with special needs. The use of volunteers will help supplement the staffing needs of a day-care center and allow for more individualized care of the children. Unfortunately, the absence of public funds for child day care continues to be a major barrier to creating appropriate programs for children with special needs. State and federal policies need to be expanded to support day care in general and children with special needs specifically. Part H of PL 99-457 (now Part H of IDEA PL102-119) is a national impetus to promote interagency collaboration at state and local levels. This is a beginning, but more state and federal funding is needed. In addition, regulations need to be developed that will make it easier rather than more difficult for local agencies to participate. Day-care providers and professionals in every community must work together to provide appropriate services to children with special needs. The most effective services use interdisciplinary teams to work together to plan and implement the care. Let us pick up the challenge of this mandate and develop programs that will help future generations recognize and accept the differences between individuals as well as see the similarities.

Child↗

Developing and implementing a standard of care for intra-aortic balloon counterpulsation.

This article summarizes the process for developing one standard of care for IABC within an integrated hospital system. Practice variations and new research findings create a need to review and update standards of care regularly. Assessing current practice, reviewing the literature, and consulting experts are part of the development process. Implementation of a new standard is a multifaceted challenge that involves several educational strategies. Evaluation of a standard of care is accomplished by assessing quality outcome indicators.

Humans↗

[Public health work in connection with a new international airport].

During the six years between the parliament decision in 1992 to build a new international airport and the opening of this airport at Gardermoen, public health authorities experienced strong challenges when exercising their authority, when planning and implementing the airport health services, and when trying to describe possible health hazards to the population living in the area. Environmental and population health considerations led in some instances to opposite conclusions. The opinions of local health authorities were overruled by national authorities as regards noise limits. The food control authorities were not included in the first stage of planning. Efforts to cooperate emergency health services, ambulance services, and services for the prevention of contagious diseases did not succeed initially. Population studies before and during the airport construction period showed that persons being forced to move because of the new airport reported increased illness, developed a lower self-assessed health quality, more often generalized pain, and more often moderate mental problems.

Aircraft↗

Issues in accommodating national changes and local variation in a computer-based guideline for childhood immunization and in related knowledge maintenance tools.

As clinical practice guidelines are increasingly implemented in computer-based form, a major challenge will be to maintain their domain knowledge as new national recommendations are developed and as local customization is required. This maintenance may also need to be performed for any computer-based tools developed to help in the guideline knowledge maintenance process itself. This paper uses the domain of childhood immunization to explore certain issues involved. It describes 1) two recent changes to the national recommendations dealing with the DTP and Polio vaccine series, and 2) several customizations requested by the immunization registries of the State of Oregon and the US Indian Health Service. It then describes how these guideline practice variations are currently handled in three computer-based tools, IMM/Serve, IMM/Def, and IMM/Test. Finally, it discusses how the use of these tools can provide one approach to characterizing the complexity of guideline variations.

Artificial Intelligence↗

Rural outreach in home telehealth: assessing challenges and reviewing successes.

Most home health agencies that adopt home telehealth tend to be located in urban or metropolitan areas. This paper discusses a 3-year pilot of home telehealth in four rural areas. Several challenges related to the rural nature of the home health agencies were recognized. These challenges are discussed with recommendations for assessing rural home health agencies for home telehealth. Our findings suggest ways to improve the implementation of home telehealth for rural home health agencies. In addition to the challenges, successes were realized as well. Approximately 145 travel hours and 7500 miles of nurse travel were avoided through the use of home telehealth during the program. Patient examples show improvements in their medical conditions, which the nursing staff thought would not have been accomplished without the more frequent monitoring that home telehealth allowed the agencies to provide.

California↗

Health psychological theory in promoting population health in Päijät-Häme, Finland: first steps toward a type 2 diabetes prevention study.

In public health promotion, behavioural science theories and theory-based methods should be translated into practical strategies that fit environmental conditions and are feasible for implementation. In this article, an effort to meet this challenge is presented. As a starting point we describe the conditions for development and success of the previous generation of public health promotion programmes in Finland. However, changes both in the population structure and in the population health bring new demands for programme development. We consider possibilities offered by health psychology and give a practical example of how theories and theory-based methods are applied in a community programme for type 2 diabetes prevention implemented in the Finnish primary health care.

Behavioral Medicine↗

Ergonomic standards, guidelines, and strategies for prevention of back injury.

Now is the time for ergonomics to be taken seriously. OSHA and other regulatory agencies are concentrating on ergonomic issues, directing greater efforts in developing ergonomic guidelines and standards. Employers are being required to develop multifaceted programs to include prevention, education, and treatment. Ergonomics will become one of the direct responsibilities of ergonomists, safety professionals, and health care providers. Progress in preventing musculoskeletal injuries and illness will depend on the cooperation and availability of trained safety and health professionals who are knowledgeable about ergonomics and the extent of musculoskeletal problems in the workplace. These trained personnel must be able to educate workers and employers about risk factors and to assist them in implementing effective control procedures for prevention. Those responsible for the program will need to keep up-to-date with current engineering and medical trends in the field and be required to keep abreast of the latest legislation and regulations. The challenge is great but the rewards are even greater. Employers implementing ergonomic programs have not only reduced recordable injuries, saved hundreds of thousands of dollars in labor and materials, and reduced turnover, but have experienced increases in production and quality. The reduction in human suffering alone is reason enough to develop an effective proactive ergonomic management program.

Back Pain↗