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PubMed1997

Implementation of the WHO Global Strategy for Occupational Health for All. Plan of action: covering the specific period 1996-2001. Part I.

The WHO Executive Board, at its Ninety-Seventh Session, in January 1996, recognized the vital role of occupational health in sustainable development and public health as a whole, endorsed the WHO Global Strategy for Occupational Health for All (Resolution EB97.R6). In May 1996, the World Health Assembly discussed occupational health and adopted a resolution on the WHO Global Strategy for Occupational Health for All (WHA49.12), requesting the Director-General to promote the implementation of the Global Strategy for Occupational Health for All within the framework of the Ninth General Programme of Work. Member States were urged to devise national programmes on occupational health for all, based on the global strategy, with special attention to pull occupational health services for the working population, including migrant workers, workers in small enterprises, in the informal sector, and for other occupational groups at high risk and with special needs, including children at work. Therefore, the draft Plan of Action for the Implementation of the WHO Global Strategy for Occupational Health for All has been prepared. The description of all 10 objectives of the global strategy, at both the international and national levels, are merged with appropriate activities of WHO and other contributing organizations. The Global Network of the WHO Collaborating Centres in Occupational Health is given a special role in the implementation of the global strategy.

Computer Communication Networks↗

PubMedDate not supplied

Implementing a clinical pathway for the treatment of Medicare patients with cardiac chest pain.

BACKGROUND: A small urban hospital identified angina pectoris (DRG 140) as a high-cost and low-reimbursement DRG. Variation in the process of care for patients with cardiac chest pain was related to the timing of decisions on stress tests and whether inpatient GI workups were performed. Underutilization of aspirin was identified as a quality of care issue. In collaboration with Texas Medical Foundation (TMF), the Quality Improvement Organization (QIO) for Texas, this became the initial Health Care Quality Improvement Program (HCQIP) project and the first effort by the hospital at pathway development. INTERVENTION: A team effort lead by physicians, including other healthcare groups at the hospital, identified elements considered essential to providing ideal care for patients with cardiac chest pain, formulating these elements into a clinical pathway. RESULTS: Emergency room physicians, an essential stakeholder group, had not been included in the initial pathway development, which proved to be a critical factor to effective implementation. Pathway implementation was associated with increased administration of aspirin by 45.7% (p < 0.001), reduced length of stay by 1.0 days (p = 0.064), and reduced total charges by an average of $1710.20 (p = 0.039). DISCUSSION: These results suggest that process of care improvement, i.e., clinical pathway implementation, in collaboration with a QIO, contributed to reduced variation in the process of care. Participation by all stakeholders from the beginning in process of care improvement is essential.

Angina Pectoris↗

PubMed1997

Implementing computers in ambulatory care: implications of physician practice patterns for system design.

This paper presents pre-implementation data from the internal medicine division of a large physician group practice scheduled to implement an electronic medical record (EMR). Data were gathered through short-term participant observation and interviews. Findings indicate that (1) most physicians anticipate enough benefits to be willing to use the system; (2) computers must be accessible, easy to log into, and provide for physician movement and interrupted sessions; (3) many physicians are concerned about losing eye contact with patients; (4) it is unrealistic to expect even good typists to enter their own long notes; (5) staged implementation, with order entry introduced first, may help physicians adapt gradually; and (6) training should include protected time for instructional sessions for physicians, simulated patient encounters to help physicians adapt their practice patterns, and tutors available to answer questions in the clinical setting.

Ambulatory Care↗

PubMed1997

[CT-guided lung needle biopsy using a new supporting implement].

We contrived a new supporting implement to increase the hit rate of CT-guided needle biopsy (CTNB) for localized pulmonary lesions. Using this implement, twenty-two CTNB examinations for localized pulmonary lesions were performed. In 21 out of the 22 examinations (95%), the lesions were hit, and specimens appropriate for cytological or histological diagnosis were obtained. The course of needle insertion, which was difficult to define in the past, has become to be easier and more precise with this method. Using this new implement, CTNB is now applicable to smaller and deeper lesions.

Adult↗

PubMedDate not supplied

[Evaluation of the implementation of an educational curriculum: optimal interventions for the adoption of an educational program of health in elementary schools].

A multiple case study design is used to explain the level of implementation of a "Heart Health" curriculum by grade four teachers of eight schools in a Montreal multiethnic and underprivileged district. An interview and logbook examine the following variables: 1) personal characteristics of the teachers; 2) organizational characteristics of the schools; 3) characteristics of the program; 4) collaboration between the health and educational sectors; and 5) curriculum level of use and fidelity of implementation. The results show in particular that the personal characteristics of the teachers and the characteristics of the program explain the level of implementation of the Heart Health curriculum.

Cardiovascular Diseases↗

PubMed1998

The philosophy of clinical practice guidelines: purposes, problems, practicality and implementation.

There are a number of technical and professional challenges to the use of clinical practice guidelines in the United Kingdom. Until recently, many guidelines have been consensus-based rather than being explicitly linked to evidence of effectiveness and have also been of variable quality. Moreover, clarity of purpose has been lacking with some guidelines being developed as a means of limiting access to secondary care rather than as a means of assisting clinical decision-making. Implementation of new research into practice and of clinical practice guideline recommendations shares many of the same barriers to changing clinician behaviour. Without local support systems to assist with implementation, including clinical audit programmes and methods of feeding back information on current practice, it is unlikely that guidelines will change practice in the majority of clinicians. Progress on the implementation of guidelines in the British National Health Service is discussed.

Employee Performance Appraisal↗

PubMed1998

Planning and implementing an anesthesia crisis resource management course for student nurse anesthetists.

Development of Anesthesia Crisis Resource Management (ACRM) skills is a highly desirable outcome of a nurse anesthesia educational program. Access to an ACRM course is limited by a variety of factors including cost, availability of a center, time constraints, and the lack of adequately prepared CRNA faculty. The authors describe a Nurse Anesthesia Program's planning and implementation of an ACRM course by using a high fidelity human simulator. Key supportive and logistical elements necessary to implement an ACRM course are described. The authors address administrative concerns, faculty preparation needs, and explain the process of course design. Strengths of the course and problems encountered during the implementation of the experience are described. Feedback from participating students, faculty perceptions, and lessons learned from the experience are shared.

Clinical Competence↗

PubMed1998

Theory and implementation of infomax filters for the retina.

In the first part of this paper we discuss a technical visual sensory system, which--in analogy with the retina--includes some preprocessing of visual information. In so doing, we use an information-theoretic criterion, the infomax ansatz, to optimize the response of the sensory system. In particular, it is shown that the lattice structure of the photoreceptor array has to be taken into account. By a discrete Fourier transformation on a triangular lattice we derive the frequency response of the infomax filter within the first Brillouin zone. To illustrate the response properties, infomax filters adapted to different noise levels are applied to images with different signal-to-noise ratios. This clearly demonstrates the necessity of adaptation of the filter properties to the given noise level. Furthermore, it is shown how to efficiently implement infomax-like filters by simple networks with only nearest-neighbour interactions. A two-layered network topology proves to be very advantageous in implementing the desired high-pass or low-pass properties. The network topology allows for adaption of the network to low and high noise levels by simply adjusting the nearest-neighbour couplings. In the second part of this paper, we compare the previously described information-theoretic requirements on a visual sensory system with biological facts known from the vertebrate retina. The substantial physiological response properties of the vertebrate retina are in agreement with the main features of the infomax filter. Since available experimental data lacks information which is necessary for a more quantitative comparison, we present suggestions for future experiments. Some key anatomical features of the retina of many vertebrates compare well with our two-layered implementation of the infomax filter. The analogy, in particular, concerns the adaption mechanism. To illustrate this point, we summarize some recent experiments which demonstrate that in the retina of some species adaption is based on the release of the neuromodulator dopamine by the interplexiform cells. This causes the horizontal cells to decouple. On the basis of recently gained understanding of the outer plexiform layer of the retina some further hypotheses about the functionality of the retina become obvious and possible future experiments to verify or refute them are suggested. Finally, we discuss the infomax approach from a more general point of view. In particular, we show that redundancy is essential to obtaining noise robustness of an internal representation of the environment as it is produced by a sensory system such as the retina.

Animals↗

PubMed1998

Strategies for problem list implementation in a complex clinical enterprise.

Although the Institute of Medicine states that a patient problem list should have a prominent place in the computer-based patient record, the design and function of the problem list is not a matter of universal agreement. Developer experience with implementation has been inconsistent, in part because of confusion on data standards, uncertain user acceptance of data entry, and minimal rewards for the clinician. I propose that necessary features of the problem list include: 1) clinical focus, 2) codification of problems, 3) support for problem resolution, 4) historicity of problems, 5) support for multiple clinical views, 6) integration of maintenance functions with workflow, 7) support for administrative reporting, and 8) integration with useful clinical tools. I describe the strategies that we employed to meet these goals while implementing the problem list in a computerized patient record serving a large, complex clinical enterprise. I further report the successful achievement of those goals based upon audits six months after implementation.

Diagnosis-Related Groups↗

PubMed2001

The benefit of implementing a heart failure disease management program.

BACKGROUND: To handle the increasing complexity of congestive heart failure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, particularly in terms of beta-blocker use and cost to the health care system. METHODS: After reviewing the literature regarding therapies and management strategies for patients with CHF, we developed the Duke Heart Failure Program. All enrolled patients had 1 of the following: recent CHF hospitalization, ejection fraction less than 20%, or symptoms consistent with New York Heart Association class III or IV. We compared preenrollment and postenrollment medication use and resource utilization. RESULTS: We enrolled 117 patients from July 1998 to April 1999. Mean enrollment time was 4.7 months. beta-Blocker use and dose significantly increased (52% vs 76% for beta-blocker, P<.01; 6% vs 13% of target dose, P<.01). The hospitalization rate decreased (1.5 vs 0 hospitalizations per patient-year, P<.01), while the number of clinic visits increased (4.3 vs 9.8 clinic visits per patient-year, P<.01). The Duke University Health System saved a median of $8571 per patient-year. CONCLUSIONS: Implementing a CHF disease management program was associated with improved CHF medication dosing and with decreased hospitalization for patients with CHF. A CHF disease management program is an effective method for a health care system to care for patients with CHF.

Adrenergic beta-Antagonists↗

PubMed2006

The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors.

BACKGROUND: With increased breast cancer survivor rates among older women, the negative outcomes of breast cancer treatment may linger for years. METHOD: We designed and implemented an oncologist referred, exercise self-management program to increase physical activity and health-related quality of life using a pretest-posttest, single group design. We recruited 34 breast cancer survivors seen for a follow-up oncology visit at two university cancer treatment centers. Women with a mean age of 59.6 years (S.D.=66) comprised the sample. Average time since diagnosed was 3.1 years; 45% had stage I breast cancer and 55% had stage II; 62% received chemotherapy and 59% received a mastectomy. Following a baseline assessment on exercise support, self-efficacy, barriers and benefits; quality of life; and a functional performance test, subjects participated in self-management classes and received telephone support. Participants (n=30) repeated the assessment at 6-months. We compared scores between time periods using t-tests. RESULTS: Older women increased frequency of weekly, moderate physical activities (p<or=0.04), and weekly caloric expenditure (p<or=0.02). Perceived exercise barriers (p<or=0.02), aerobic endurance (p<0.04) and lower body strength (p<0.03) approached significance, and health-related quality of life (p<or=0.001) significantly improved. CONCLUSION: An exercise self-management format referred by an oncologist is efficacious for implementing a lifestyle modification change among older breast cancer survivors.

Breast Neoplasms↗

PubMed2002

The first years of implementation of the Swiss National Environment and Health Action Plan (NEHAP): lessons for environmental health promotion.

The National Environment and Health Action Plans (NEHAPs) are a novel attempt to integrate environmental protection and health promotion in political programmes. Throughout Europe, about 40 NEHAPs have been developed so far. The Swiss NEHAP was among the first to be developed in an industrialised country. We discuss strength and weaknesses of the Swiss NEHAP and draw first conclusions on the development and implementation process of such programmes, illustrated by examples of other European NEHAPs. The strengths of the Swiss NEHAP lie in the formulation of specific targets in selected areas, its approach as a environmental health promotion programme, and its comprehensive evaluation. Weaknesses in most NEHAPs are the lack of involvement of the general public and of the economic sector, and the absence of an implementation strategy along with adequate financing.

Conservation of Natural Resources↗

PubMed2001

[Methods of process analysis, instruments of quality management. Successful implementation of quality projects].

Meaningful experience and knowledge--the prerequisite for the successful implementation of quality projects--are described in terms of their practical importance on the basis of the experience gained with quality management in the municipal hospital at München-Schwabing (HMS). Against the background of the process of quality assurance or PDCA (Plan Do Check Act), the approach to the selection of suitable themes (problem selection), the prioritization of projects, the appropriate composition of the project group, the description of the problem, and the organization of the project, are discussed. The authors describe the implementation of methods of process analysis such as flow diagrams and cause-and-effect diagrams. The importance of evaluation is justified, and pragmatic approaches are presented. The importance of project documentation and essential contents are discussed.

Germany↗

PubMed2006

[Prevention of type 2 diabetes in Germany. Ideas, evidence, implementation].

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, as well as pharmacological preventive strategies reduce the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes, these studies offer a compelling evidence base for the important translation of the research findings into community-based prevention strategies and the development of a national diabetes prevention program. The work group "diabetes prevention" of the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a national program. This comprises a three-step intervention: in a first step individuals at high risk of developing type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes, and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.

Cross-Sectional Studies↗

PubMed2004

[Experiences and difficulties in implementing immunization registries in Saxony-Anhalt].

In the German Federal State of Saxony-Anhalt, the Health Department must be notified of vaccines administered to children <7 years of age including their names. The goal of this mandatory notification is to improve and stabilize the age-appropriate vaccination coverage. However, difficulties have been encountered in implementing mandatory notification. Therefore, the Health Departments of Magdeburg and Halle have launched a model project focusing on analysing and eliminating these problems. Mandatory notification requires parents' approval, endorsement of vaccantors, and availability of human and technicely resources in the Health Department. An enquiry among paediatricians and family doctors in private practice revealed widespread reservations about mandatory notification because of privacy issues related to data and legal protection. Furthermore, family doctors believed that parents disapproved of notification by name. However, a survey among young mothers revealed this not to be the case. Winning young mothers' approval depends largely on the positive attitude of the vaccinators. To implement the mandatory notification of vaccinations to the Health Department, it is necessary to dispel physicians' concerns and to inform young parents about the practical benefits. However, this places high demands on the Health Departments for maintaining immunization registries, communicating with physicians and notifying parents when immunisations are due or late.

Adult↗

PubMed2025

Mixed Methods Findings from a Stepped Wedge Hybrid Implementation Trial of ATTAIN NAV: A Mental Health Family Navigation Intervention for Autistic Youth.

ATTAIN NAV (Access to Tailored Autism Integrated Care through Family Navigation) was delivered by family navigators to promote access to and engagement with mental health services for school-age autistic youth. This study used a mixed method, stepped wedge design to test the effects of family navigation on service and clinical outcomes while gathering information on implementation. Primary care providers from six clinics in California and 56 caregiver-child dyads enrolled in and completed the study. Clinics were randomized to either a technology-enhanced or standard family navigation condition. Caregivers completed assessments at baseline and post about child, family and services outcomes, and a subset participated in a post qualitative interview. Quantitative findings demonstrated improvements in child challenging behavior and parent activation across conditions although these improvements were more pronounced for families in the standard FN condition. At post-intervention, families in the standard FN condition reported higher levels of navigation satisfaction, a shorter time to attend their first mental health appointment, and higher engagement with their navigator. Qualitative findings complemented and expanded the quantitative survey findings. The ATTAIN NAV model of family navigation for autistic children with co-occurring mental health needs demonstrates promising implementation, service, and clinical benefits. Clinical Trials Registration. NCT05344378.

Humans↗

PubMed1995

The implementation of health promotion: a new structural perspective.

Although health promotion has become a critical concept in public health, both research and practical projects in this area are almost devoid of theory. The present article uses a theory of complexity and structure to organize the different elements of health promotion in a new perspective. This perspective involves (1) new ways for looking at patterns of behavioral risk factors and health-related lifestyles. It (2) relates health promotion to policy making. In particular, it (3) focuses on a comprehensive model of the implementation process, revealing the true interrelationship of relevant elements to the concept of health promotion. In this context, it (4) becomes obvious that the reflexivity and recursiveness of scientific analyses are an integral part of the structure of health promotion. Thus, the professional role of the social scientist with regards to the implementation and utilization of scientific knowledge in the field of public health policy will be discussed. Finally, the role of appropriate theory is emphasized as a strategy for improving the practice of health promotion and to further the development of a new public health.

Forecasting↗

PubMed2005

"Painting a picture of the client": implementing the Addiction Severity Index in community treatment programs.

This article discusses the implementation of the Drug Evaluation Network System (DENS) version of the Addiction Severity Index (ASI) among substance abuse treatment providers in Los Angeles County. Thirty-two trained and certified treatment professionals from 14 programs participated in focus group interviews about their use of and experiences with the ASI. All 14 programs were currently administering the ASI at the time of the study. Qualitative interviews revealed variation among the programs in terms of when staff administered the ASI and how they used it in clinical care. Although the ASI creates a comprehensive picture of substance-abusing patients and their functioning, the timing of its administration seems to significantly affect the usefulness of the information. The findings illustrate the importance of practicality, flexibility, and ongoing training for the successful implementation of evidence-based practices.

Adult↗