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Results for “Implementation challenges”

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

PubMed2004

Cluster randomized trial of an active, multifaceted information dissemination intervention based on The WHO Reproductive health library to change obstetric practices: methods and design issues [ISRCTN14055385].

BACKGROUND: Effective strategies for implementing best practices in low and middle income countries are needed. RHL is an annually updated electronic publication containing Cochrane systematic reviews, commentaries and practical recommendations on how to implement evidence-based practices. We are conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library (RHL). METHODS: A cluster randomized trial to improve obstetric practices in 40 hospitals in Mexico and Thailand is conducted. The trial uses a stratified random allocation based on country, size and type of hospitals. The core intervention consists of three interactive workshops delivered over a period of six months. The main outcome measures are changes in clinical practices that are recommended in RHL measured approximately a year after the first workshop. RESULTS: The design and implementation of a complex intervention using a cluster randomized trial design are presented. CONCLUSION: Designing the intervention, choosing outcome variables and implementing the protocol in two diverse settings has been a time-consuming and challenging process. We hope that sharing this experience will help others planning similar projects and improve our ability to implement change.

Female↗

PubMed2004

[Community participation: need, excuse, or strategy? What are we talking about when we refer to community participation?].

This paper evaluates the strategy of including community participation in health care and health promotion programs, taking into account three dimensions: the pertinence of the practice, the characteristics of its implementation, and the results generated by it. After doing a critical review of the bibliography on the issue, we came to the conclusion that many heterogeneous programs are grouped under the term "community participation". This requires a specification of what king of community participation is being talked about. As a consequence, the study proposes a classification of the different practices grouped under this heading. The following criteria were used in the classification: 1) theoretical and ideological conceptions underlying the practice of community participation; 2) aspects to be implemented and subjects to be influenced by intervention; and 3) forms that community participation takes in practice. The study also analyzes the articulation between these three aspects. Finally, the role of social research and qualitative methodology in the implementation of community participation for health care programs is considered. The study also considers challenges that overall proposals must face in order for strategies to develop successfully, beyond their differences in conception and implementation.

English Abstract↗

PubMed2003

Update on population-based preconception and prenatal cystic fibrosis carrier screening.

Implementation of population-based cystic fibrosis (CF) carrier screening for all preconception and prenatal patients has encountered numerous challenges. Continuing education of the practitioner and patient is critical for ensuring the successful implementation of CF population-based carrier screening as well as other anticipated population-based molecular screening tests resulting from the completion of the Human Genome Project. To assist the practitioner, this article provides a brief review of cystic fibrosis genetics, the recommended screening guidelines and benefits of carrier screening, in addition to highlighting clinical dilemmas that have arisen since widespread CF carrier screening was initiated.

Cystic Fibrosis↗

PubMed2002

An evaluation of the baccalaureate-nursing program within the (MOPH), Thailand.

This research study was designed to evaluate the baccalaureate-nursing curricula undertaken in the nursing colleges under the jurisdiction of the Ministry of Public Health (MOPH), Thailand. A stakeholder approach was used to incorporate mixed methods of data collection and models of evaluation within the research framework. Both qualitative and quantitative approaches were used. Newly registered nurses and their colleagues were generally positive about the course outcomes. However, qualitative data demonstrate a need to focus more on the development of abilities related to life-long learning and critical thinking. The findings suggest challenges in achieving program outcomes attributed to the feasibility of implementation strategies. Concepts in the curriculum plan are not fully translated into practice. A number of factors have a major impact on the actual program implementation or course organisation and teaching/learning processes. There is evidence of competing or conflicting ideologies about nursing practice and education. Findings suggest that the preferable educational models for contemporary and future nursing education are process rather than content-based. It is challenging to develop ways of accommodating the more desirable professional nursing and educational approaches within the context of Thailand and MOPH nursing education policies where resources are limited and the maintenance of Thai culture is of paramount importance.

Curriculum↗

PubMed2005

Examples of implementation and evaluation of treatment fidelity in the BCC studies: where we are and where we need to go.

Treatment fidelity plays an important role in the research team's ability to ensure that a treatment has been implemented as intended and that the treatment has been accurately tested. Developing, implementing, and evaluating a treatment fidelity plan can be challenging. The treatment fidelity workgroup within the Behavior Change Consortium (BCC) developed guidelines to comprehensively evaluate treatment fidelity in behavior change research. The guidelines include evaluation of treatment fidelity with regard to study design, training of interventionists, delivery and receipt of the intervention, and enactment of the intervention in real-life settings. This article describes these guidelines and provides examples from four BCC studies as to how these recommended guidelines for fidelity were considered. Future work needs to focus not only on implementing treatment fidelity plans but also on quantifying the evaluations performed, developing specific criteria for interpretation of the findings, and establishing best practices of treatment fidelity.

Behavioral Research↗

PubMed2003

The nursing management of enterocutaneous fistulae: a challenge for all.

This article focuses on the principles of managing patients with enterocutaneous fistulae. Successful management involves comprehensive assessment, planning, implementation and evaluation of care and involves all members of the multidisciplinary team in both primary and secondary care. The main challenge for the nursing team is effective containment of the effluent to prevent excoriation of the skin thereby ensuring patient comfort. The article includes suggestions for choice and application of suitable appliances which have been successfully used by the authors. Early involvement in of patient and carer in all aspects of management is recommended for successful discharge of patients into the community.

Cutaneous Fistula↗

PubMedDate not supplied

Back breaking business: the implementation of a spinal education program.

Patients with potential or confirmed spinal injuries are challenging for hospitals delivering care for trauma patients. In order to minimize further injury and complications, to maximize positive patient outcomes and to reduce length of stay, efficient and effective methods of caring for such patients are required. The purpose of this paper is to describe the creation and implementation of a "Spinal Education Program" at a Level I trauma center in Canada. It was designed to teach a large group of health care professionals how to care for patients with potential or confirmed spinal injuries in a comprehensive and consistent manner.

Analysis of Variance↗

PubMedDate not supplied

Synchronous independent lung ventilation.

Ventilated patients with unilateral lung disease present a unique challenge because each lung requires independent FiO2, PEEP, and mode settings. With early implementation of Synchronous Independent Lung Ventilation, each lung is treated individually and chances for survival may increase. Critical care nurses face new challenges in assessing and preventing complications for these patients.

Critical Care↗

PubMed2004

Implementation of bioavailability in standard setting and risk assessment.

Bioavailability is, to an increasing extent, recognised as the key issue linking the increased levels of toxicants to actually occurring adverse effects in ecosystems, whilst taking the modifying effects of the abiotic components of the environment into account. Various factors may affect bioavailability in the field, and these factors are often time and space dependent. This is one of the main reasons why legislators have been reluctant to implement bioavailability in risk assessment procedures. Over the last few years, however, considerable scientific progress has been made with regard to increasing our understanding of the chemical and ecological mechanisms responsible for rendering chemicals available for uptake and toxicity. As a consequence, legislators face the challenge of having to anticipate the scientific progress and to implement bioavailability in legislation. This contribution reports on the possibilities of implementing various methodologies within a maximum time period of three years.

Animals↗

PubMed2026

Decoding the spatiotemporal patterns of food spoilage microbial communities: Integrating multi-omics and artificial intelligence to enable precision preservation.

In the global food supply chain, food wastage caused by spoilage has resulted in significant economic losses, food shortages, and environmental pressure. This process is fundamentally driven by the spatiotemporal dynamics of microbial communities. However, traditional research methods struggle to elucidate the complex mechanisms of spatial heterogeneity, interspecies interactions, and functional succession. This limits the development of effective preservation strategies. This review systematically reviews the cutting-edge progress of integrating multi-omics technologies and artificial intelligence (AI) to study food spoilage microbial communities, breaking through this bottleneck. We propose an intelligent theoretical framework that could potentially analyze microbial metabolic activities and predict dynamic shelf life if implemented. The conceptual framework integrates multidimensional data, including spatial metabolomics, temporal metatranscriptomics, single-cell transcriptomics, and longitudinal metagenomics. It can also be combined with AI models, such as graph neural networks. The article elaborates on the principles and applications of spatio-temporal monitoring technologies, such as nano secondary ion mass spectrometry, hyperspectral imaging, and the Internet of Things sensing. Through illustrative cases of typical perishable foods, it also explores how such a multi-omics - AI system might be applied to spoilage warning and precise intervention. Additionally, the article addresses the current challenges in data coverage, model generalization, and federated learning implementation. Then the research further explores emerging areas such as engineered probiotics, edge AI, and microfluidic sensing. These areas are targeted at transforming food preservation from an empirical control approach to a data-driven, precise regulatory framework. This transformation provides theoretical support and technical approaches for developing a smart, sustainable food preservation system.

Multiomics↗

PubMed1991

Challenges to equity in health and health care: a Zimbabwean case study.

The current economic crisis in Africa has posed a serious challenge to policies of comprehensive and equitable health care. This paper examines the extent to which the Zimbabwe government has achieved the policy of "Equity in Health" it adopted at independence in 1980, that is provision of health care according to need. The paper identifies groups with the highest level of health needs in terms of both health status and economic factors which increase the risk of ill health. It describes a series of changes within the health sector in support of resource redistribution towards health needs, including a shift in the budget allocation towards preventive care, expansion of rural infrastructures, increased coverage of primary health care, introduction of free health services for those earning below Z$150 a month in 1980, increased manpower deployment in the public sector and the reorientation of medical training towards the health needs of the majority. The implementation of equity policies in health have however been challenged by several trends and features of the health care system, these becoming more pronounced in the economic stagnation period after 1983. These include the reduction in allocations to local authorities, increasing the pressure for fees, the static nominal level of the free health care limit despite inflation, the continued concentration of financial, higher cost manpower and other resources within urban, central and private sector health care and the lack of effective functioning of the referral system, with high cost central quaternary facilities being used as primary or secondary level care by nearby urban residents. While primary health care expansion has clearly been one of the success stories of Zimbabwe's health care post 1980, the paper notes plateauing coverage, with evidence of lack of coverage in more high risk, socio-economically marginal communities. Measures to address these continuing inequalities are discussed. Their implementation is seen to be dependent on increasing the capacity and organisation of the poor to more strongly influence policy and resource distribution in the health sector.

Financial Management↗

PubMed2000

Provider education to promote implementation of clinical practice guidelines.

STUDY OBJECTIVES: Although the interest in and promulgation of clinical practice guidelines have significantly increased in the past 2 decades, concern exists about their actual implementation. This article focuses on one strategy to encourage guideline implementation at the clinician level: clinician education. The objectives of the article are to review educational strategies, to consider them within the context of complementary strategies carried out at the organizational and clinic setting levels, and to outline challenges and recommendations for clinicians' continuing education. METHODS: Experience and data from relevant randomized clinical trials within an educational framework are reviewed. OBSERVATIONS: Implementation of clinical practice guidelines requires a variety of skills, including assessment, appropriate delineation of a treatment and monitoring plan, patient tracking, and patient counseling and education skills. Continuing education strategies must reflect the content and teaching methods that best match the learning objectives. The pressures of current-day practices place limits on the resources, particularly clinician time, that are available for continuing education. Organizational resources must be committed to build the complementary supportive systems necessary for improved clinician practice. In addition to physicians, education must be directed at nonphysician clinicians, office staff, and administrators who also are responsible for guideline implementation. CONCLUSIONS: To meet the challenges of developing clinician motivation, balancing competing demands, and treating patients with complex medical conditions, all within time constraints, clinical leaders need to design education activities that have leadership support, reflect compelling evidence, use multiple strategies and teaching techniques, and engage learners in skill building and problem solving.

Asthma↗

PubMedDate not supplied

Never too old to climb.

This nurse-administrated program has added another dimension to the hospital environment. It provides a real challenge and opportunity for reaching out in planning and implementing a program for the elderly, long-term psychiatric hospitalized resident. It has been successful because of a sincere and dedicated staff who consistently communicated, verbally and non-verbally, that "we cared"--by listening, keeping open minds, establishing and maintaining an environment conducive to growth, acceptance, encouragement, social contacts, and creating a genuine relationship based on trust. It was through these media that we achieved a milestone with the new program. Demonstration of concern, patience and interest seemed to have been a motivating force which stimulated a desire to achieve optimum growth for a majority of the residents, which has affected every service in this hospital. The freedom to plan and execute, with administrative support, challenged staff, who reached out and grasped the opportunity to turn away from the traditional ways of providing care to new ways of improving and delivering quality care to the elderly, long-term psychiatric residents. This program has been in not, however, been a panacea for all residents. Assuming responsibility, freedom to make decisions and thoughts of leaving the hospital have been somewhat difficult adjustments for a few residents. As of December 1974, approximately 5 per cent of those placed in the community were returned to the structured environment of the hospital. The successes, however, have far outnumbered the adversities in that 34 have been discharged and three are ready to be discharged in the near future.

Activities of Daily Living↗

PubMed1996

Year one of HIV prevention community planning: a national perspective on accomplishments, challenges, and future directions.

Two of the most important principles for the implementation of successful human immunodeficiency virus (HIV) prevention programs are the following: (a) planning for the programs must be done in conjunction with members of affected communities; and (b) the foundation of the programs should consist of solid behavioral, social, and epidemiological science. In 1994, the Centers for Disease Control and Prevention and its prevention partners formally implemented HIV prevention community planning in order to address these two key factors. The occasion of the one year anniversary of HIV prevention community planning is marked by taking stock of progress-to-date from a national perspective. This article reviews year one accomplishments and difficulties, and describes the trajectory of HIV prevention community planning for year two and beyond.

Centers for Disease Control and Prevention, U.S.↗

PubMedDate not supplied

Manager's reports of variation in coding accuracy across U.S. oncology centers.

Advances in high-speed data processing capabilities, and the increasing reliance on information systems in comparative data assessment, are creating greater dependence on information systems, with a related need for more timely assessment of coding quality. Assessing the accuracy of coded and classified data becomes critical as the implementation of government compliance management requirements, along with the growing adoption of evidence-based medicine in error detection, serve to challenge healthcare researchers to consider the quality of coded data in management assessments. The implementation of larger, faster and more comprehensive databases in healthcare delivery settings is one response to this changing environment, but at a national level there will need to be some degree of uniformity in their utilization and management, if researchers are expected to rely on comparative benchmarks to fully assess organizational performance. In a nationwide survey of health information managers we found about 81 percent of respondents reported that significant coding errors existed in 5 percent or less of the records in their institutions. About 11 percent of respondents, however, reported that the coding errors existed in six to ten percent of their records. Regional and practice setting variation in reported coding error ranged widely, occurring across organizations as well as area locations. Related impact on comparative data-driven management assessment is discussed.

Abstracting and Indexing↗

PubMed2004

Implement balanced scorecard to translate strategic plan into actionable objectives.

Faced with challenges ranging from declining reimbursement to staff shortages, health care organizations--integrated delivery systems, physician group practices, disease management providers, and others--increasingly are turning to general business models to map out step-by-step action plans for performance measurement and process improvement. Creating a "balanced scorecard" is an obvious starting point for assessing and improving clinical and financial performance.

Delivery of Health Care↗

PubMed2000

The effect of welfare reform on SSA's disability programs: design of policy evaluation and early evidence.

During the past several years, the U.S. social safety net has gone through substantial changes involving an emphasis on personal responsibility and incentives, the shift of certain responsibilities to the states, and new limits on entitlements for benefits. Two pieces of recent legislation affected the Social Security Administration's (SSA's) disability programs. Section 105 of Public Law 104-121, enacted on March 29, 1996, mandated the removal of persons from the Supplemental Security Income (SSI) and Social Security Disability Insurance (DI) rolls for whom drug addiction and alcoholism (DA&A) were material to the determination of disability. It eliminated allowances on the basis of DA&A immediately and required the termination of benefits to all persons receiving benefits at the time of enactment. The other major piece of legislation was the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, which was later amended by the Balanced Budget Act (BBA) of 1997. PRWORA converted the Aid to Families with Dependent Children (AFDC) program from an open-ended entitlement program into a block grant, Temporary Assistance for Needy Families (TANF), incorporating time limits on the receipt of benefits as well as strict work requirements. PRWORA also tightened child eligibility for SSI, narrowed eligibility for noncitizens, and reduced funding for food stamps. The BBA restored SSI eligibility for noncitizens receiving SSI prior to August 1996 and for legal noncitizens residing in the United States prior to August 1996 who become disabled in the future. SSA designed three studies to assess the effects of this legislation. Two of the studies focused on direct effects on SSA's disabled beneficiary population, targeting drug addicts and alcoholics and SSI children. The third study focused on the indirect effects of PRWORA, particularly the replacement of AFDC with TANF, on SSA's programs. The three studies were tied together by a concern of the overall effects--direct or indirect--of the legislative changes on SSA's beneficiary populations and a host of interrelated evaluation issues. The key methodological challenge of these evaluations is the nonexperimental nature of the evidence. The legislative pieces mandating the changes designed to affect SSA's target populations were implemented nationally, without prior demonstration projects. Nonexperimental strategies, such as comparison group designs, must therefore be used to measure the effects of interest. Other challenges relate to the time frames. Since implementing the changes requires a certain amount of time, and outcomes are realized over a period of time after that, the information that can be made available to interested policymakers in the short run is inherently limited to descriptive data on the populations affected and to impressionistic evidence from case studies and process study analyses. The timing problem is particularly acute with respect to measuring the indirect effects of replacing AFDC with TANF, because the most important likely effects will occur over a period of several years, and this time frame may substantially vary across states as a result of the decentralized nature of TANF programs. Finally, the analyses that can be conducted are constrained by the lack of relevant data from existing surveys. Administrative record data alleviate the need for survey information for some purposes, but the lack of survey data still seriously constrains the analyses that can be done in the short term. Because of these methodological challenges, SSA designed an evaluation strategy that uses several methods and data sources, including quantitative analyses of data from surveys and administrative records (particularly data from the Survey of Income and Program Participation, or SIPP, matched to data from administrative records) and qualitative analyses through case studies. (ABSTRACT TRUNCATED)

Alcoholism↗

PubMed2004

The Johns Hopkins Hospital: identifying and addressing risks and safety issues.

BACKGROUND: At The Johns Hopkins Hospital (JHH), a culture of safety refers to the presence of characteristics such as the belief that harm is untenable and the use of a systems approach to analyzing safety issues. PATIENT SAFETY AS A LEADERSHIP AND ORGANIZATIONAL PRIORITY: The leadership of JHH provides strategic planning guidance for safety and improvement initiatives, involves the patient safety committee in capital investment allocation decisions and in designing and planning new hospital facilities, and ensures that safety and quality head the agenda of board-of-trustees meetings. Although JHH takes a systems approach, structures such as monitoring staff behavior trends are used to hold people accountable for job performance. CHALLENGES AND LESSONS LEARNED: JHH encountered three major hurdles in implementing and sustaining a culture of safety. First, JHH's decentralized organizational structure contributes to a silo effect that limits the spread of ideas, practices, and culture. JHH intends to create an internal collaborative of departmental safety initiatives to foster opportunities for units to share ideas and results. Second, in response to the challenge of encouraging teams to think and act in an interdisciplinary fashion, communication and teamwork training are being used to enhance the effectiveness of interdisciplinary teams. Further development of valid and meaningful safety-related measurement and data collection methodologies is JHH's largest remaining challenge.

Academic Medical Centers↗