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At least 1,387 records · Page 77Linked to original sources

PubMed2006

Implementation of evidence-based alcohol screening in the Veterans Health Administration.

BACKGROUND: Despite evidence-based guidelines, brief alcohol screening and counseling have not been routinely integrated into most primary care practices in the United States. OBJECTIVE: To describe the results of the implementation of evidence-based alcohol screening by the Veterans Health Administration (VA) in 2004, as the first step toward implementation of brief alcohol counseling. STUDY DESIGN: This observational study of outpatients from all 21 VA networks relied on the following 2 data sources from the VA Office of Quality and Performance: (1) Medical record reviews, designed to compare VA networks quarterly, evaluated whether established VA patients had documented screening for alcohol misuse and documented follow-up assessment for alcohol use disorders among those who screened positive for alcohol misuse (January-March 2005); and (2) Mailed patient satisfaction surveys from 2004, which oversampled patients new to the VA (response rate, >70%), included the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions and asked about past-year advice "to drink less or not to drink alcohol" from a VA provider. RESULTS: Based on 10 115 medical record reviews, 93% (range, 89%-96% across networks) of outpatients were screened for alcohol misuse, and 25% (range, 11%-36%) screened positive. Among screen-positive patients, 42% (range, 5%-84%) had documented follow-up assessment, but absolute numbers of screen-positive patients evaluated were small (27-80 patients per network). Based on 235 481 patient surveys, the prevalence of alcohol misuse was 22% (range, 15%-27% across networks), and 28% (range, 20%- 36%) of screen-positive patients reported receiving alcohol-related advice. Alcohol-related advice increased as AUDIT-C scores increased. CONCLUSION: The VA successfully implemented evidence-based alcohol screening, but the rate of follow-up among screen-positive patients remained low.

Alcoholism↗

PubMed2006

Evaluation and implementation: a call for action.

OBJECTIVES: To raise awareness for actions that are urgently needed to accompany the large scale implementations of ICT in Health Care that are currently taking place in many countries around the world. METHODS: An analysis of a few studies that have recently been described in the literature guided by recent suggestions for research and development of evaluation of health ICT. RESULTS AND CONCLUSION: Six specific recommendations for action are specified: Development of good implementation practice, Development of an experience base of implementation of ICT in health care, Setting up a surveillance system for unintended effects, Build an evidence base of best evaluation practice, Developing guidelines for proper reporting of evaluation studies, Education of clinicians and decision makers.

Evaluation Studies as Topic↗

PubMed2006

Factors affecting the implementation of telenursing in Korea.

The purpose of this study is to deduce and prioritize the factors affecting the implementation of telenursing in Korea. For this study, Delphi methods were used. Thirty professors and specialists in the field of nursing informatics and telemedicine contributed to two rounds of Delphi survey. The factors necessary for the introduction of telenursing were divided into systematic, economical, societal and technical aspects. The critical factors of each aspect were prioritized to produce a guide to support the feasible implementation plan for telenursing. They are: Governmental support to control the regulatory issues, verification of telenursing as a cost-effective health care delivery system, value verification of telenursing versus on-site consultation, social trust building, and development of characteristic telenursing content which consumers willingly pay for. The results of this study will enable health professionals to understand the prospect and necessity of telenursing implementation. In addition, they will be used efficiently in a variety of e-health milieus as a practical strategy for the improvement of health care in Korea.

Diffusion of Innovation↗

PubMed2006

[Incidence of breast cancer before and after implementation of mammography screening].

BACKGROUND: A nationwide governmentally founded breast cancer screening program for women aged 50 - 69 years was gradually implemented in all Norwegian counties between November 1995 and February 2004 (the Norwegian Breast Cancer Screening Program, NBCSP). Such an implementation is expected to give an initial increased incidence followed by a decrease. We here present general and stage-specific incidences of breast cancer by age groups, in the first 9 counties that implemented the NBCSP. MATERIAL AND METHOD: The incidence of invasive breast cancer is shown for the counties Akershus, Hordaland, Oslo and Rogaland (AHOR), and Agder (east and west), Telemark, Troms and Finnmark (AgTmTF) for the period 1990-2003. AHOR started the NBCSP in 1995/1996, and AgTmTF started in 1999/2000. The incidence is based on recordings in the main database at the Cancer Registry, and is shown in rates per 100,000 women years. RESULTS: The incidence of breast cancer in women aged 50-69 years increased from 200 to 350 per 100,000 women years at start-up of the NBCSP and subsequently decreased to approximately 250. Before starting the program, the incidence was higher in women aged 70-74 years than in those aged 50 - 69. This changed in the subsequent period. During 1990-2003, the incidence of breast cancer was stable in women aged 20-49 and in those older than 74 years. At start-up of the NBCSP, a higher proportion of breast cancers in Stadium I were diagnosed as compared to the period before, especially among women aged 50-69 years. INTERPRETATION: Introduction of the NBCSP has changed the incidence of breast cancer in women aged 50-69 and in those aged 70-74 years.

Adult↗

PubMed2006

[Peer-mediation in schools: experiences in implementation and training of mediators].

Many schools implement peer-mediation-projects with the goal to improve the conflict- and talking-culture of their pupils. They hope to prevent violence. This goal is only to be reached if the project is based on a long-term planning and if it is well implemented. After describing the basics of peer-mediation and the perspective of transformative mediation the author discusses which factors have to be considered in the process of planning and implementation of such a mediation-project. She reports her experiences as trainer in mediation for pupils and teachers. In the last chapter she presents a concept for mediation-training in schools, which was developed from the IMS (Institut für Mediation, Streitschlichtung und Konfliktmanagement e. V.). Finally she describes the curriculum and the teaching method of a two-day-basic-training with additional three-hour-units.

Adolescent↗

PubMedDate not supplied

Serial echocardiographic changes in patients on hemodialysis: an evaluation of guideline implementation.

BACKGROUND: Few studies have addressed the description of serial changes in left ventricular mass (LVM) and relevant risk factors. All these studies were initiated before the implementation of EBPG or K/DOQI guidelines. The aims of our study were to prospectively describe trends in left ventricular (LV) structure and function, evaluate risk factors for progression of LVM derived from serial echocardiographic measurements starting January 2003, 6 months after full implementation of EBPG in our unit. METHODS: One hundred seventy-six patients were enrolled at baseline, between 1 January 2003 and 1 October 2004; 33 patients were excluded from analysis due to poor echocardiographic window, 14 patients died and 26 were transplanted or transferred during the follow-up period of minimum 12 months. One hundred and three patients were included in the final analysis (mean age 51 years, mean follow-up 24.1 +/- 14.4 months). Echocardiography was performed at inclusion and at the end of study. Biochemical, blood pressure (BP) and medication data were collected and the means of monthly values were used. RESULTS: At baseline, 86.4% of the patients had left ventricular hypertrophy (LVH) (56.3% concentric hypertrophy, 30.1% eccentric hypertrophy, 6.8% concentric remodeling and only 6.8% normal LV geometry), 25.6% had systolic dy-sfunction and 50.5% had abnormal LV volume index (LVVI). Similar data were recorded at follow-up (82.5%, 44.7%, 37.9%, 7.7%, 9.7%, and 19.5%, respectively). Baseline left ventricular mass index (LVMI) significantly correlated with hemoglobin (Hb) and total protein level. LVMI at follow-up correlated to Hb, SBP, PP, mean level of serum phosphate, calcium x phosphate product and cholesterol. Independent predictors for LVMI (multiple regressions) were anemia and mineral metabolism markers. In our population, 62.1% of the patients had a regression of LVMI, with a mean decrease in LVMI of 12 g/m 2 (1.7 +/- 11.7 g/m 2 /month) over more than 12 months of guideline implementation. Regressors had a significant improvement of anemia, serum phosphate level and calcium x phosphate product (p<0.05). CONCLUSION: Our study suggests that a holistic interventional approach, targeting various pathogenic mechanisms, as per guidelines, can elicit at least a partial regression in LV structural and functional abnormalities in hemodialysis patients.

Echocardiography↗

PubMed2006

Controversies in prostate cancer staging implementation at a tertiary cancer center.

OBJECTIVE: To assess accuracy of recorded prostate cancer stage after implementation of a quality assurance staging improvement plan. METHODS AND MATERIALS: Genitourinary multidisciplinary TNM staging guidelines were prospectively implemented. Educational programs for health records technicians (HRT) and clinicians preceded implementation of the new guidelines. Patient stage information was entered into the Oncology Patient Information System (OPIS) as part of the usual operations of the cancer center by an HRT. Physician and HRT auditors performed a subsequent quality assurance audit on 97 prostate cancer patients seen over a 2-month period. Assessment of staging accuracy and reasons for discrepancies between the OPIS stage and auditor stage were analyzed and reported. RESULTS: Fifty-four (52%) charts showed discrepancies between auditors. Of the fifty-four, twelve (22%) had discrepancies between OPIS and auditor, thirty (56%) showed discrepancies between auditors, and twelve (22%) had discrepancies between OPIS, physician auditor, and HRT auditor. Forty-three (41%) cases had no discrepancies. Reasons for discrepancies included: misinterpretation of the digital rectal examination (16/54), inappropriate use of TRUS/MRI (9/54) in staging, stage not assigned at initial diagnosis (9/54), misinterpretation of pathology (7/54), TNM staging confusion (4/54), OPIS update not performed (3/54), inappropriate use of biopsy data (3/54), disagreement between consultants (2/54), and misinterpretation of TURP result (1/54). Overall staging accuracy was 76% for OPIS, 65% for the physician auditor and 62% for the HRT auditor. CONCLUSIONS: Despite guidelines and educational interventions, computer registry staging accuracy remains an issue. On-going audit procedures are proposed to identify and correct both published and institutional staging guidelines.

Canada↗

PubMed2007

Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention.

BACKGROUND: Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. OBJECTIVE: To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. METHODS: Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. RESULTS: Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. CONCLUSIONS: The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

Adult↗

PubMed1991

The University Hospital Nurse Extender Model. Part II, Program implementation.

This second article in a four-part series provides a detailed discussion of each phase of the implementation process, along with a demographic summary of the University Hospital Patient Care Technicians' Program 2 years after program implementation. Part I provided the overview and conceptual framework for the model. Parts III and IV will present the results of a year-long evaluation of the model and the lessons learned during the implementation process.

Female↗

PubMed1991

Implementing information systems.

Effective implementation and system selection are equally important for a successful information system. Many new challenges exist in laboratory management and information system operations. Philosophy, strategy, and selected details of system implementation are presented in the context of practical examples of implementation issues.

Clinical Laboratory Information Systems↗

PubMed1990

Mortality following hip fracture before and after implementation of the prospective payment system.

Recent studies of patients with hip fractures from two hospitals have suggested that the marked reduction in length of stay that occurred following implementation of the Medicare prospective payment system (PPS) resulted in decreased quality of care for these patients. To assess whether this change influenced mortality, we studied patients with hip fractures aged 65 years or older from a 20% sample of Michigan Medicare enrollees. There were 2130 such patients in the 2 years preceding (October 1981 through September 1983) and 2238 in the 2 years following (October 1984 through September 1986) implementation of PPS. Although the demographic characteristics of patients with hip fractures did not change after PPS, the mean length of stay (95% confidence interval) decreased by 4.4 (4.1 to 4.7) days. However, mortality in the year following the fracture did not change: 23.2% before PPS, 23.7% after PPS; rate difference of 0.5% (-2.0 to 3.0). This finding was consistently present within subgroups defined by patient demographic characteristics. Furthermore, when the analysis was restricted to patients treated in those hospitals with the greatest reduction in average length of stay following PPS (7.5 days, or 35%), there was no significant change in 1-year mortality. For those patients who were enrolled in Medicaid and not in a nursing home at the time of the fracture, there was no increase in the rate of nursing home residence 1 year after the fracture. Thus, the findings of this population-based study suggest that the key outcomes of postfracture mortality and nursing home residence were not affected by the implementation of PPS.

Aged↗

PubMed1990

[The status of implementation of the 38 goals of the WHO document "Health for All by the Year 2000" which were accepted by European member nations of WHO].

The author gives an account of 38 targets adopted by 33 member countries of the European Region of WHO to implement the global world strategy "Health for All by 2000". Some required approaches for monitoring of the implementation of these targets are mentioned, as well as research trends outlined by WHO to promote these targets. The present position is evaluated, as well as prerequisites for the further implementation of WHO targets and relations with targets of the health policy in Czechoslovakia. In 1990 the European Regional Office of WHO will evaluate the regional targets in cooperation with member countries to simplify the monitoring.

Europe↗

PubMed1989

Development and implementation of a strategic-planning process at a university hospital.

The development and implementation of a long-range strategic plan for the pharmacy department at a university hospital is described. Because of rapidly occurring changes in health-care delivery, financing, and education, the pharmacy department at the University of Illinois Hospitals decided to create a strategic plan that would stimulate growth, be responsive to a changing health-care environment, and emphasize the department's philosophy of striving for professional leadership in education, research, and innovation. Actual strategy development was done during a three-day administrative retreat, which was conducted according to a structured agenda that facilitated extensive brainstorming and discussion. As a result, the department developed eight major strategies that have been directing its growth and development over the last four years. Each strategy had an implementation plan that included substrategies with statements of specific results that were expected, an action plan (a list of specific tasks to be accomplished), and a general statement summarizing the benefits of each substrategy. Annual meetings were held to review the continued appropriateness of these strategies. Implementation of the strategic plan has resulted in major improvements in drug cost containment, improved ambulatory-care pharmaceutical services, a results-oriented performance-appraisal system, more support for clinical education programs, and a substantial increase in support for research. The strategic plan has allowed the department to constructively participate in two downsizing events within the hospital without major adverse effects on its own services and programs. Use of the strategic-planning process should be considered by other hospital pharmacy departments as a means of responding to the external and internal forces of change that currently affect most hospitals.

Chicago↗

PubMed1989

[Personal experience with implementation of the nationwide program in cardiology in the West Bohemia Region].

The authors submit experience regarding the implementation of the cardiovascular programme in the West Bohemian region. The implementation of the programme is pretentious as regards staff as well as investments and treatment. In these spheres reasons must be sought why the cardiovascular programme is not always implemented, as required by the authorities and our medical responsibility.

Cardiovascular Diseases↗

PubMed1987

The implementation of nursing diagnoses. The Iowa Veterans Home experience.

This article has reviewed the process of implementing nursing diagnoses in one long-term care agency. Nursing diagnoses improved nursing process skills, made problem identification more accurate, and aided the identification of nursing interventions and desired outcomes. Nursing diagnoses have become the organizing framework for quality assurance, staff development, specialization and consultation, and computer applications. The presence of a professional model of nursing practice facilitated the use of nursing diagnoses. Prior to implementing nursing diagnoses, IVH nurses had defined the scope of nursing practice and formed a committee structure for decision-making by all RNs. The structure included mechanisms for collective and individual accountability. All nurses participated in the decision to use nursing diagnoses in their practice. Each nurse had the opportunity to influence the process of change. The process of implementing nursing diagnoses at IVH continues. Nurses recognize the need to establish the validity of each diagnostic statement. Skill with the diagnostic process is expected to improve. Nurses also recognize the need to test interventions for specific diagnoses. The standard nomenclature will continue to be used for the improvement of nursing practice and for nursing department programming. The use of nursing diagnoses is the basis of the continued development of a professional model of nursing practice.

Adult↗

PubMed1988

Implementing Orem's self-care deficit theory. Adopting a conceptual framework of nursing. Part II.

This is the second of a two-part article describing the implementation of Dorothea Orem's Self-Care Deficit theory of nursing by the Nursing Department at Toronto General Hospital. Part II focuses on the implementation process and the results observed to this point in time. Implementing theory-based practice documents the selection of five pilot units and activities that were carried out by various project committees. Observations made by staff nurses and managers of the pilot units are conveyed. Benefits to nurses, patients, managers and the units are described along with some of the difficulties encountered along the way. Recommendations and future plans are identified.

Humans↗

PubMed1988

Implementation and evaluation of a new approach to clinical instruction.

An approach to clinical instruction based on the Learning Vector model was introduced in a hospital laboratory during the 1985-86 academic year. Fifteen clinical instructors and nine medical technology students participated in the study. Clinical instructors attended an initial workshop on the model and met monthly during the academic year with the project directors to discuss their progress. The implementation of the model and the reactions of students and instructors to the model were evaluated using attitudinal questionnaires, interviews, and observations. Instructors were most successful using the model during the learning activities component of clinical instruction and were less consistent in implementing the model in the expectation-setting and evaluation components of instruction. According to instructors and students, advantages of this approach included improved communication, guidance and organization of instruction, and an increased emphasis on feedback and evaluation. The major constraint to implementation was a limited amount of time spent with students, due to scheduling or workload.

Allied Health Personnel↗

PubMed1987

Implementation of nursing diagnoses. An overview.

Widespread interest in nursing diagnosis, its incorporation in most nursing textbooks, and the increasing amount of published research suggest that nurses are finding nursing diagnoses useful in clinical reasoning and judgment. Implementation is important for this reason and, as discussed, for professional, legal, and ethical reasons. Additional reasons for implementation relate to activities supporting or evaluating nursing care. Consistency of the nursing focus is important in both direct and indirect care activities. As nursing diagnosis-based planning of care is implemented, consideration has to be given to the use of diagnosis-based documentation systems, quality assurance programs, staffing, and other support or evaluative activities. Great progress has been made in the classification of nursing diagnoses since the 1970s but much still remains to be done. The role of the North American Nursing Diagnosis Association in this work has been briefly summarized.

Humans↗