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 1,423 records · Page 79Linked to original sources

PubMed2004

The process of changing national malaria treatment policy: lessons from country-level studies.

Widespread resistance of Plasmodium falciparum parasites to commonly used antimalarials, such as chloroquine, has resulted in many endemic countries considering changing their malaria treatment policy. Identifying and understanding the key influences that affect decision-making, and factors that facilitate or undermine policy implementation, is critical for improving the policy process and guiding resource allocation during this process. A historical review of archival documents from Malaŵi and data obtained from in-depth policy studies in four countries (Tanzania, South Africa, Kenya and Peru) that have changed malaria treatment policy provides important lessons about decision-making, the policy cycle and complex policy environment, while specifically identifying strategies successfully employed to facilitate policy-making and implementation. Findings from these country-level studies indicate that the process of malaria drug policy review should be institutionalized in endemic countries and based on systematically collected data. Key stakeholders need to be identified early and engaged in the process, while improved communication is needed on all levels. Although malaria drug policy change is often perceived to be a daunting task, using these and other proven strategies should assist endemic countries to tackle this challenge in a systematic fashion that ensures the development and implementation of the rational malaria drug policy.

Africa↗

PubMed2002

Clustering gene expression data using a graph-theoretic approach: an application of minimum spanning trees.

MOTIVATION: Gene expression data clustering provides a powerful tool for studying functional relationships of genes in a biological process. Identifying correlated expression patterns of genes represents the basic challenge in this clustering problem. RESULTS: This paper describes a new framework for representing a set of multi-dimensional gene expression data as a Minimum Spanning Tree (MST), a concept from the graph theory. A key property of this representation is that each cluster of the expression data corresponds to one subtree of the MST, which rigorously converts a multi-dimensional clustering problem to a tree partitioning problem. We have demonstrated that though the inter-data relationship is greatly simplified in the MST representation, no essential information is lost for the purpose of clustering. Two key advantages in representing a set of multi-dimensional data as an MST are: (1) the simple structure of a tree facilitates efficient implementations of rigorous clustering algorithms, which otherwise are highly computationally challenging; and (2) as an MST-based clustering does not depend on detailed geometric shape of a cluster, it can overcome many of the problems faced by classical clustering algorithms. Based on the MST representation, we have developed a number of rigorous and efficient clustering algorithms, including two with guaranteed global optimality. We have implemented these algorithms as a computer software EXpression data Clustering Analysis and VisualizATiOn Resource (EXCAVATOR). To demonstrate its effectiveness, we have tested it on three data sets, i.e. expression data from yeast Saccharomyces cerevisiae, expression data in response of human fibroblasts to serum, and Arabidopsis expression data in response to chitin elicitation. The test results are highly encouraging. AVAILABILITY: EXCAVATOR is available on request from the authors.

Algorithms↗

PubMed1998

Improvement during baseline: three case studies encouraging collaborative research when evaluating caregiver training.

The trend in cognitive rehabilitation toward reduced services, which provide more functionally relevant outcomes and the recognition of limited maintenance and generalization with many existing interventions, challenges current research models. There is a need to develop and evaluate interventions that can be implemented by persons other than rehabilitation professionals and that are well suited to naturalistic settings. The researchers responded to these challenges by designing a series of single subject experiments evaluating the effectiveness of training caregivers to provide appropriate cognitive support to persons with brain injury within their own natural living environments. The goal of the original research project included evaluating a collaborative mode of interaction with the subjects and their support persons (as opposed to traditional directive treatment models) where the caregivers and subjects were instrumental in designing the intervention and collective performance data. This paper presents the data from the initial three subject/caregiver groups all of whom demonstrated improvement in the target behaviours during the baseline period. It appeared that the act of measuring client performance changed the behaviours of the support persons and resulted in positive changes in baseline levels. The research and clinical implications of these findings are discussed.

Accidents, Traffic↗

PubMed2005

Evaluating cultural competence among behavioral health professionals.

Persistent racial and ethnic disparities in access and utilization of behavioral health services have highlighted the need for cultural competence among providers. In response, many agencies are now implementing education and training programs to ensure that behavioral health professionals improve their skills when serving diverse ethnic, racial, and cultural populations. The evaluation of these trainings is vital to ensure that they both improve the cultural competence of providers and promote recovery among persons with severe mental illnesses. This paper discusses the philosophical and practical issues related to measuring cultural competence, based on the evaluation of statewide cultural competence trainings for behavioral health professionals. The evaluation process illustrates the challenges of operationalizing cultural competence, balancing the needs of program implementers and evaluators, and developing a robust and feasible evaluation design, which assesses outcomes both for persons in recovery and providers.

Behavioral Medicine↗

PubMed2002

Responding to the challenge of communicable disease in Europe.

In the 1960s and 1970s, communicable disease seemed a minor threat, but since then the emergence of new infections and the reemergence of old diseases has provoked a renewed focus on European communicable disease surveillance and control. A "network approach" among European countries has been successful in detecting some international outbreaks, but management and funding aspects remain unresolved. Surveillance outside the European Union has faced new challenges as a result of economic and political change following the collapse of communism. Subsequently, innovative international surveillance schemes are currently being implemented in the countries of Central and Eastern Europe and the former Soviet Union. The challenge for surveillance in Europe is to ensure that it has the capacity to meet both the needs of today and the diseases of the future.

Communicable Disease Control↗

PubMed2006

New challenges, emerging trends, and issues in regulation of migrating nurses.

The delivery of nursing and health care services is increasingly global in nature, largely as the result of international trade and migration. For the delivery of care and services to be safe, international regulation must come into play. Ensuring nurse competency depends on evaluation in three fundamental areas: knowledge and skills, clinical judgment, and language competency. Countries use a variety of regulatory methods, and there is no perfect regulatory model. Each presents its own challenges in the areas of screening, supervision, and testing. Regulation is going international with several regions having developed mutual recognition agreements. The implementation of trade agreements such as General Agreement on Trades in Services may pose new challenges for international regulation in nursing, the basic purpose of which must remain protection of the public.

Developed Countries↗

PubMed2005

Targeting smokers in priority groups: the influence of government targets and policy statements.

BACKGROUND: Cessation services were instructed to make special attempts to attract smokers from three 'priority groups': those who were young, pregnant and economically disadvantaged. Progress with attracting priority groups was not assessed formally, but services were set monitored targets to encourage throughput of smokers. Initial research suggests that services have been successful in attracting smokers who live in disadvantaged areas. This paper investigates how smoking cessation services responded to targets and instructions to attract priority groups and discusses the relative impact these on service development. OBJECTIVES: To describe how monitored throughput targets influenced the development of smoking cessation services, including attracting priority groups. To describe the range of priority groups that smoking cessation services targeted, methods used and reported progress with this. METHODS: Postal surveys of English smoking cessation coordinators conducted in April 2001 and April 2002. Seventy-eight qualitative, semistructured interviews with cessation service staff in two former English health regions conducted in autumn 2001 and 1 year later. FINDINGS: A total of 69.3% of coordinators responded to the first survey (79% to the second survey). In the first survey 91% reported targeting priority groups (100% in the second survey). The proportions (second survey in brackets) who reported targeting the different priority groups were: pregnant women 86% (99%), economically disadvantaged 79% (100%) and young smokers 20% (75%). Interviews showed that coordinators gave the greatest priority to reaching monitored targets as they came under pressure to achieve these. Service staff were generally unclear about how to attract priority groups and developing strategies for this was hindered by the need to meet throughput targets. Locating services in poor areas was thought to attract economically disadvantaged smokers and specialist staff were being appointed to work with pregnant smokers, but otherwise there was little evidence of active strategies for attracting priority groups being applied in practice. CONCLUSIONS: Monitored targets for smoker throughput ensured that services quickly began to treat smokers, but this rapid implementation diverted service staff from devising methods for attracting priority group smokers. Coordinators found reaching priority groups challenging and, particularly in the case of young smokers, would have appreciated clear instructions for this aspect of service implementation. Those implementing services in other countries should consider whether similar targets would be helpful to stimulate service development within their health systems.

England↗

PubMed2003

Implementation of evidence-based practices in state mental health systems: implications for research and effectiveness studies.

There is a huge gap between knowledge and practice, and between what is known through research and what is actually implemented in public mental health systems. In the past 2 decades, rigorous research has demonstrated the effectiveness of various treatments and interventions but these findings have not resulted in broad-based implementation. A major contention of this article is that while there is a growing body of knowledge related to evidence-based practices, there is a lack of understanding and research related to factors critical for implementation. This article reviews the current status of implementation of evidence-based practices in the public mental health system and identifies challenges and barriers related to their dissemination. Based on this analysis, this article proposes a research agenda that promotes the development of a science of implementation of evidence-based practices.

Evidence-Based Medicine↗

PubMed2002

Implementing preterm labor guidelines: a collaborative care improvement process.

Health care organizations today are being challenged to deliver care that is cost-effective, satisfying to patients, and based on quality outcomes. Urgency created by inadequate bed capacity as well as financial opportunity prompted United Hospital's Birth Center to launch care improvement activities aimed at assessing appropriateness of antepartal length of stay. Collaboration between all members of the health care team enabled a steering committee to implement evidence-based provider practice guidelines targeting variance around preterm labor management. Other multidisciplinary strategies implemented include a home care prescreening process, case management, and establishment of a peer review process. Within the 1-year care improvement process, the Birth Center successfully decreased the length of stay for preterm labor patients from 6.9 days to 5.3 days. This article describes one institution's efforts to improve care by implementing guidelines for the inpatient management of preterm labor.

Birthing Centers↗

PubMed2004

The case and opportunity for public-supported financial incentives to implement integrated pest management.

Food, water, and worker protection regulations have driven availability, and loss, of pesticides for use in pest management programs. In response, public-supported research and extension projects have targeted investigation and demonstration of reduced-risk integrated pest management (IPM) techniques. But these new techniques often result in higher financial burden to the grower, which is counter to the IPM principle that economic competitiveness is critical to have IPM adopted. As authorized by the 2002 Farm Bill and administered by the U.S. Department of Agriculture (USDA) Natural Resources Conservation Service (NRCS), conservation programs exist for delivering public-supported financial incentives to growers to increase environmental stewardship on lands in production. NRCS conservation programs are described, and the case for providing financial incentives to growers for implementing IPM is presented. We also explored the opportunity and challenge to use one key program, the Environmental Quality Incentives Program (EQIP), to aid grower adoption of IPM. The EQIP fund distribution to growers from 1997 to 2002 during the last Farm Bill cycle totaled approximately 1.05 billion dollars with a portion of funds supporting an NRCS-designed pest management practice. The average percentage of allocation of EQIP funds to this pest management practice among states was 0.77 +/- 0.009% (mean +/- SD). Using Michigan as an example, vegetable and fruit grower recognition of the program's use to implement IPM was modest (25% of growers surveyed), and their recognition of its use in aiding implementation of IPM was improved after educational efforts (74%). Proposals designed to enhance program usefulness in implementing IPM were delivered through the NRCS advisory process in Michigan. Modifications for using the NRCS pest management practice to address resource concerns were adopted, incentive rates for pest management were adjusted, and an expanded incentive structure for IPM technique adoption was tabled for future consideration. The case is strong for using public-supported financial incentives offered by the EQIP to aid grower adoption of IPM as a means to address resource concerns, but current use of the EQIP for this purpose is modest to meager. With appropriate program adjustments and increased grower awareness, USDA NRCS conservation programs, and the EQIP in particular, may provide an important opportunity for growers to increase their use of IPM as a resource conservation and farm management tool.

Agriculture↗

PubMedDate not supplied

Electronic health record: implementation across the Michigan Academic Consortium.

The Michigan Academic Consortium of academic nurse-managed primary care centers supported member sites to venture into computer-based advances with the potential to improve quality of health services and students' educational experiences. The experiences of this consortium as it incorporated electronic health records in tandem with an electronic patient management system at several of its member sites reveal the benefits and challenges of such an endeavor. The processes of selection, adoption, and implementation of the electronic health record are discussed in this article. Many lessons learned in the process are discussed.

Attitude of Health Personnel↗

PubMed2025

ATAC-seq in Emerging Model Organisms: Challenges and Strategies.

The Assay for Transposase-Accessible Chromatin with sequencing (ATAC-seq) is a versatile and widely utilized method for identifying potential regulatory regions, such as promoters and enhancers, within a genome. ATAC-seq has been successfully applied to a wide range of established and emerging model organisms. However, implementing this method in emerging model systems, such as arthropods, can be challenging due to several factors that influence data quality. These factors include the availability of a sufficient amount and quality of tissue or cells, the need for species- and tissue-specific protocol optimization, the completeness and accuracy of the reference genome, and the quality of the genome annotation. In this article, we emphasize the key steps in the ATAC-seq protocol that, based on our experience, have the greatest impact on data quality when adapting this method for emerging model organisms. Specifically, we discuss the importance of nuclei isolation, the incubation conditions of the Tn5 transposase, and PCR amplification of the library. Furthermore, we outline essential quality checkpoints during the bioinformatic analysis of ATAC-seq data to assist in assessing data integrity and consistency. Given that many emerging model organisms may not be readily available in laboratory cultures, we also emphasize the importance of evaluating how different preservation methods affect ATAC-seq data quality. Based on examples in one spider and one ant species, we demonstrate that replication and thorough quality controls at all steps of the protocol and data analysis are essential to assess the usability of ATAC-seq data. Our data highlights the importance of isolating the right number of intact nuclei, as well as ensuring optimal amplification conditions during library preparation to obtain good-quality sequence data for downstream analyses. We recommend using fresh tissue samples if possible because we show that direct cryopreservation of the tissue may affect chromatin integrity. This effect could be avoided or reduced by preserving the homogenate in cell culture medium. Overall, we explain the ATAC-seq protocol and downstream analyses in detail and give step-by-step advice to researchers who are new to the field and want to implement this method. With careful planning and validation, ATAC-seq can reveal the regulatory landscape of a genome and aid in identifying elements that govern gene expression.

Animals↗

PubMed1996

Accuracy of least squares designed spatial FIR filters for segmentation of images of fluorescence stained cell nuclei.

A method for accurate, real-time image segmentation is needed for the development of a fully automated image cytometer that combines the speed and case-of-use of flow cytometry with the detailed morphometry of imaging. Object intensity variation and inherent optical blur make real-time segmentation challenging. The best spatial finite impulse response (FIR) filter, implemented as a convolution, was tested for sharpening edges and creating the required contrast. The filter and threshold segmentation steps were treated as a two-category linear classifier. Best 3 x 3 through 25 x 25 filters were designed utilizing the perceptron criterion and nonlinear least squares, and tested on ten montage images of a combined 1,070 manually segmented DAPI stained cell nuclei. The resulting image contrast, or class separation, led to simple automatic thresholding via the histogram intermodal minimum. Image segmentation accuracy began to plateau at 7 x 7 filters and did not increase above 15 x 15. Little loss in accuracy occurred with application to the images not used for design. This segmentation method provides a systematic, fast and accurate means of creating binary object maps useful for subsequent measurement, processing and cell classification.

3T3 Cells↗

PubMed2005

Sharing the diagnostic process in the clinical teaching environment: a case study.

Revealing or visualizing the thinking involved in making clinical decisions is a challenge. A case study is presented with a visual implement for sharing the diagnostic process. This technique adapts the Bayesian approach to the case presentation. Pretest probabilities and likelihood ratios are gathered to obtain post-test probabilities of every question considered in a patient. The technique advocates for the judicious use of diagnostic options based on the best evidence available. Clinical decisions, presentation skills, and critical evaluation of the literature are also important elements considered in this method.

Bayes Theorem↗

PubMed2006

Improved cell typing by charge-state deconvolution of matrix-assisted laser desorption/ionization mass spectra.

Robust, specific, and rapid identification of toxic strains of bacteria and viruses, to guide the mitigation of their adverse health effects and optimum implementation of other response actions, remains a major analytical challenge. This need has driven the development of methods for classification of microorganisms using mass spectrometry, particularly matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS), that allows high-throughput analyses with minimum sample preparation. We describe a novel approach to cell typing based on pattern recognition of MALDI mass spectra, which involves charge-state deconvolution in conjunction with a new correlation analysis procedure. The method is applicable to both prokaryotic and eukaryotic cells. Charge-state deconvolution improves the quantitative reproducibility of spectra because multiply charged ions resulting from the same biomarker attaching a different number of protons are recognized and their abundances are combined. This allows a clearer distinction of bacterial strains or of cancerous and normal liver cells. Improved class distinction provided by charge-state deconvolution was demonstrated by cluster spacing on canonical variate score charts and by correlation analyses. Deconvolution may enhance detection of early disease state or therapy progress markers in various tissues analyzed by MALDI-MS.

Algorithms↗

PubMed1999

How the health care system can influence cardiovascular disease risk factors.

Only a small fraction of the health-care dollar is directed toward lifestyle changes that would reduce the social burden from cardiovascular diseases (CVD). Here we discuss the challenge, opportunity, methods, and potential for managed care to implement risk reduction strategies and preventive care. A systematic team approach involving nurses, nutritionists, exercise physiologists, and behavioral experts has been shown to be effective, along with physicians, in reducing CVD risk. This approach is increasingly accepted by and practiced in the CVD community and the managed care industry.

Cardiovascular Diseases↗

PubMed2006

Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study.

The future challenge for improving stroke patients' outcome will be to implement new Stroke Units (SUs) worldwide. However the best SU model remains uncertain. The aim of this study was to evaluate the number of SUs and the quality characteristics of acute stroke care in Italy. We conducted a SU survey in Italy, interviewing the directors of the hospital wards that discharged at least 50 acute stroke patients a year. A SU was defined as an acute ward area with stroke-dedicated beds and staff. To compare the quality of care provided in SUs with that in general wards (GWs) we investigated the characteristics of five domains: hospital setting, unit setting, staffing, process of care and diagnostic investigations. We identified 68 SUs and 677 GWs. Multivariate logistic regression analyses demonstrated that SUs compared to GWs had higher quality scores in unit setting (ROC area=0.9721), staffing (ROC area=0.8760) and care organisation (ROC area=0.7984). The hospital setting (ROC area=0.7033) and the availability of rapid diagnostic investigations (ROC area=0.7164) had lower power in discriminating SU from GW. In Italy in 2003/04 only 9% of the hospital services had organised SU care. The study demonstrated that SUs admitted more than 100 patients per year, had more monitoring equipment and staffing time, and practised multidisciplinary meetings and early mobilisation. The utility of these structural and performance characteristics needs validation from outcome studies.

Female↗

PubMed2006

Hospital case payment systems in Europe.

Since the introduction of the system of diagnosis related groups (DRGs) for USA Medicare patients in 1983, case payment mechanisms have gradually become the principal means of reimbursing hospitals in most developed countries. The use of case payments nevertheless poses severe technical and policy challenges, and there remain many unresolved issues in their implementation. This paper introduces a special issue of the journal that describes and compares experience with the use of case payments for reimbursing hospitals in nine European countries. The editorial sets the policy scene, and argues that DRG systems must be seen both as a technical reimbursement method and as a fundamental incentive mechanism within the health system.

Diagnosis-Related Groups↗