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From research to practice: one organizational model for promoting research-based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗

Individual social security accounts: issues in assessing administrative feasibility and costs.

Whether to add individual accounts (IAs) to the Social Security system is a highly political issue. But almost lost in the debate so far have been any practical considerations about how to administer such accounts. Any discussion of whether to create individual accounts must also address the basic but critical questions of how they would work: Who would run them? What would they cost? Logistically, are they even possible? This EBRI Issue Brief provides an overview of the most salient administrative issues facing the current Social Security reform debate--issues that challenge proponents to carefully think through how their proposals could be implemented so as to achieve their policy goals. The options and difficulties in administering IAs raise concerns that cut across ideology. The object of this report is neither to dissuade the advocates nor support the critics of individual accounts. Rather, it is to bring practical considerations to a political debate that has largely ignored the pragmatic challenges of whether IAs would be too complex for participants to understand or too difficult for record keepers to administer. The major findings in this analysis include: Adding individual accounts to Social Security could be the largest undertaking in the history of the U.S. financial market, and no system to date has the capacity to administer such a system. The number of workers currently covered by Social Security--the largest single entitlement program in the nation--is at least four times higher than the combined number of all tax-favored employment-based retirement accounts in the United States, which are administered by hundreds of entities. Direct comparisons between employment-based retirement savings plans and Social Security reform are tenuous at best. Social Security covers workers and businesses that are disproportionately excluded from employment-based plans. Because of these differences, a system of individual Social Security accounts would be more difficult to administer than employment-based plans, and total administrative expenses would be larger relative to benefits. Credit-based systems such as the current Social Security program are less difficult to administer than cash-based systems, which must account for every dollar. Inherent in the "privatization" debate is generally the presumption that IA benefits would be based on cash contributions and investment returns. The current credit-based system tolerates small errors in wage reporting, because they rarely affect benefits. But every dollar counts in a cash-based IA system. To ensure that benefits are properly provided, an IA system would require more regulation, oversight, and error reconciliation than the current Social Security program. Social Security individual accounts cannot be administered like 401(k) plans without adding significant employer burdens--especially on small businesses. Under the current wage reporting and tax collection process, it would take at least 7-19 months for every dollar contributed to an individual's account to be sorted out from aggregate payments and credited to his or her IA. This 7-19 month "float period" could result in substantial benefit losses over time. Options for preventing such losses involve difficult trade-offs, such as increased government responsibility, increased complexity, greater employer burdens, and/or investment restrictions for beneficiaries. If legally considered personal property, the IAs of married participants could pose significant administrative challenges. Social Security today must obtain proof of marriage only at the time spousal benefits are claimed. But some IA proposals would require contributions to be split between spouses' individual accounts, requiring records on participants' marital status to be continuously update to ensure that contributions are correctly directed. Also, dealing with claims on individual account contributions in divorce cases could place IA record keepers in the middle o

Aged↗

Update in methodology and conduct of cancer clinical trials.

Many interesting changes are regularly brought into the methodology of cancer clinical trials. This position paper focuses on three topics which are felt to appear as recurrent problems which deserve more attention from the scientific community. RECIST guidelines were published five years ago and have since then been largely implemented and used in clinical trials. Although the criteria were initially designed for screening phase II trials they have been used also in most phase III studies aiming at determining the efficacy of new treatments. Problems have been identified some of which require further clarifications and others deserve further research which is being undertaken. Overall RECIST is well accepted and a revised version is being considered for 2007. Interim analysis is also an important issue revealed recently through many large adjuvant or advanced trials being prematurely discontinued at the time of an interim analysis. In most instances trials were stopped because of evidence of superiority of the investigational treatment over the standard treatment. Premature discontinuation of trial poses a number of challenges addressed in this paper. Finally, the consequences of the implementation of the EU clinical trial directive are being discussed. The conclusions are without equivoque. There is much less academic research conducted in Europe, there is a lot of discrepancy and inconsistency in the implementation of the directive across member states and there is no apparent direct benefit for the patients.

Antineoplastic Agents↗

Community action against asthma: examining the partnership process of a community-based participatory research project.

BACKGROUND: Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. OBJECTIVE: To conduct a process evaluation of the CAAA community-academic partnership. DESIGN: In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. SETTING: Community setting in Detroit, Michigan. PARTICIPANTS: Twenty-three members of the CAAA SC. MEASUREMENTS: Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. MAIN RESULTS: Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to "a different way of doing things" in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CONCLUSIONS: CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.

Asthma↗

Complying with the Occupational Safety and Health Administration's Bloodborne Pathogens Standard: implementing needleless systems and intravenous safety devices.

Preventing the transmission of bloodborne pathogens to healthcare workers has been a mission and a challenge of the healthcare industry for over 20 years. The development of the Occupational Safety and Health Administration Bloodborne Pathogens Standard in 1991 and the passing of the Needlestick Safety Act in 2000 mandated hospitals to develop an Exposure Control Plan to protect workers from these pathogens. Children's Hospital Boston began implementation of a needleless system in 1993. Employees readily accepted these systems into practice, because they were convenient and easy to use. A marked decrease in exposures to bloodborne pathogens naturally followed, which is consistent with the national data. The transition to intravenous (i.v.) safety devices at Children's Hospital began in 2000 and proved to be more of a challenge. First, the clinicians must choose a safety product, which requires developing and implementing a trial plan with potential catheters. This selection process is especially difficult in pediatrics where successful placement of the smallest-gauge catheter, no. 24, is imperative. After choosing an i.v. safety product, successful transition is dependent upon the thoroughness of i.v. safety device training and a commitment by the clinicians to the use of these products. Although the number of needlestick injuries and subsequent transmission of bloodborne pathogens have been further reduced with the use of i.v. safety devices, needlestick injuries still occur. This results from a lack of familiarity with the engineering of the device and therefore poor technique or a failure to activate the safety mechanism. Staff resistance due to loss of expertise with the new device and patient care concerns are additional barriers to the use of these new products. Addressing these obstacles and providing adequate training for all clinicians were required for successful implementation of these i.v. safety devices.

Attitude of Health Personnel↗

Designing a system for managing the performance of mental health managed care: an example from New York State's prepaid mental health plan.

The organization, financing, and delivery of publicly funded behavioral health services are undergoing massive changes nationwide. Managed care principles and practices are being implemented widely and are being relied on increasingly to meet the challenges of containing costs and improving service effectiveness. To meet these goals, comprehensive systems are under development for measuring and reporting outcomes experienced by individuals who received services and for assessing the impact of managed care strategies on the service delivery system. This article presents an example from the Prepaid Mental Health Program in New York State. It highlights the development, implementation, and early experiences with the plan's performance management system for public sector managed behavioral health, a basis for continuous quality improvement activities and information reporting products such as report cards. Policy, administrative, and financial implications are illuminated.

Humans↗

A combined fuzzy-neural network model for non-linear prediction of 3-D rendering workload in grid computing.

Implementation of a commercial application to a grid infrastructure introduces new challenges in managing the quality-of-service (QoS) requirements, most stem from the fact that negotiation on QoS between the user and the service provider should strictly be satisfied. An interesting commercial application with a wide impact on a variety of fields, which can benefit from the computational grid technologies, is three-dimensional (3-D) rendering. In order to implement, however, 3-D rendering to a grid infrastructure, we should develop appropriate scheduling and resource allocation mechanisms so that the negotiated (QoS) requirements are met. Efficient scheduling schemes require modeling and prediction of rendering workload. In this paper workload prediction is addressed based on a combined fuzzy classification and neural network model. Initially, appropriate descriptors are extracted to represent the synthetic world. The descriptors are obtained by parsing RIB formatted files, which provides a general structure for describing computer-generated images. Fuzzy classification is used for organizing rendering descriptor so that a reliable representation is accomplished which increases the prediction accuracy. Neural network performs workload prediction by modeling the nonlinear input-output relationship between rendering descriptors and the respective computational complexity. To increase prediction accuracy, a constructive algorithm is adopted in this paper to train the neural network so that network weights and size are simultaneously estimated. Then, a grid scheduler scheme is proposed to estimate the queuing order that the tasks should be executed and the most appopriate processor assignment so that the demanded QoS are satisfied as much as possible. A fair scheduling policy is considered as the most appropriate. Experimental results on a real grid infrastructure are presented to illustrate the efficiency of the proposed workload prediction--scheduling algorithm compared to other approaches presented in the literature.

Journal Article↗

Managing human resources to improve employee retention.

Managers face increased challenges as the demand for health care services increases while the supply of employees with the requisite skills continues to lag. Employee retention will become more important in the effort to service health care needs. Appropriate human resource management strategies and policies implemented effectively can significantly assist managers in dealing with the employee retention challenges ahead.

Administrative Personnel↗

DKT Memorial Fund v. Agency for International Development, 13 February 1987.

The plaintiffs, domestic and foreign nongovernmental organizations, challenged the lawfulness of the Agency for International Development's implementation of Government policy not to contribute funds to foreign nongovernmental organizations that perform or actively promote abortion as a method of family planning abroad. The Court reversed a lower court decision and held that the plaintiffs had standing to bring their suit. It ruled that the plaintiffs were not attempting to litigate a political question since they did not seek to litigate the political and social wisdom of the policy, but only its legality. It also allowed the plaintiffs to amend their complaint to state that, but for the policy, they would be qualified to receive funds. In a similar case, the United States District Court, S.D. New York, held that AID was acting within its statutory and administrative authority in withholding federal assistance to organizations that perform or actively promote abortions as a method of family planning and that the plaintiffs' constitutional challenge of this policy presented a nonjusticiable political question (Planned Parenthood Federation of America, Inc. vs. Agency for International Development, 29 September 1987, [670 F.Supp. 538]).

Abortion, Induced↗

Innovation in nursing education: a statewide grant initiative.

Meeting the challenges of the nursing shortage appears to be daunting for schools of nursing across the nation as they struggle to meet educational capacity needs with limited resources. A statewide grant program was developed and implemented through legislative initiatives providing opportunities for schools of nursing to respond to the need for innovation in nursing education. This article shares some of the successes and challenges identified through the process of implementing and evaluating this grant program. Insights into the political and regulatory process are provided as a model for other states to consider. Examples of educational strategies that were successful in improving the recruitment and retention of students and faculty are discussed. Nursing and other health care leaders across the nation should look to policy initiatives such as grant programs to infuse innovation into educational programs and to address educational capacity issues compounding the nursing shortage.

Education, Nursing↗

Progress toward poliomyelitis eradication--African Region, 1997.

In 1988, the World Health Assembly established the goal of eradicating poliomyelitis worldwide by 2000. To achieve this goal, the World Health Organization (WHO) promotes the implementation of specific strategies. Eradicating polio from the African continent is one of the remaining major challenges to achieving global eradication by the target date. This report summarizes progress in the African Region of WHO in 1997 with the implementation of polio eradication strategies, and suggests that polio eradication by 2000 remains a feasible target.

Africa↗

A failed fall prevention study in an acute care setting: lessons from the swamp.

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest-post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.

Accidental Falls↗

[Tick bites and borreliosis in children attending forest kindergarten: a challenge for prevention].

AIM: The aim of this study was to analyse the influence of preventive measures on the risk of being bitten by a tick and of suffering from borreliosis in children attending so-called 'forest kindergartens' (nurseries located in forested areas where children spend all-season full-time outdoors), compared to children attending regular kindergartens. In addition, we aimed to analyse sources of information and the risk of being bitten more than once. METHODS: 53 kindergartens (25 forest kindergartens, 28 regular kindergartens) in the state of Baden-Württemberg, Germany participated in this study and protective parental behaviour was recorded. In a prospective cohort study, the numbers of tick bites and cases of borreliosis were recorded monthly (March to October 2004) using a questionnaire. The influence of preventive measures was estimated using multivariate log-binomial regression. RESULTS: Altogether, 1707 children of 'forest kindergartens' (506 children) and regular kindergartens (1201 children) were included. Parental protective behaviour was significantly better in forest kindergartens compared to regular kindergartens. There were no substantial differences between effect estimates after stratification for parental protective behaviour. For children attending a 'forest kindergarten, the adjusted risk ratio of being tick bitten was 2.6 (3.3-3.0) which was only slightly different from the unadjusted risk, ratio. CONCLUSION: Although protective parental behaviour in 'forest kindergarten' children was significantly better compared to regular kindergarten, children in forest kindergartens are at a considerable risk of tick bites and borreliosis. Implementing effective preventive measures against borreliosis represents a public health challenge.

Borrelia↗

How to create awareness and ensure broad dissemination of health informatics standards.

There is a range of organisations with responsibility for information standards development within Australia. These include Standards Australia, which is formally linked to the International Organisation for Standards (ISO), the National Health Information Management Group, which deals with the government sector and several statutory organisations such as the Australian Institute of Health and Welfare and the National Centre for Classification in Health. The different constituencies involved with each of these organisations, the scope of healthcare informatics and the rate of organisational and technological change in the industry present a significant challenge in ensuring that the standard setting process is highly visible, responsive and capable of demonstrating its value through effective implementation. Creating awareness and ensuring broad dissemination of healthcare informatics standards is a key component in meeting this challenge. This can operate at a number of levels from strategic to operational. At the strategic level, it requires active engagement and commitment of the key decision-makers, both political and professional. This may require directly lobbying and promoting the benefits of standardisation to those decision-makers but can be achieved even more effectively by creating industry awareness and demand through carefully targeted presentations on the impact of standards to broader health industry forums. At the tactical level, the standards development medium itself can be used to engage and gain commitment from government, professionals, vendors and the health industry by operating as an inclusive, open and effective process. At the operational level, there is the opportunity for much more efficient use of technology to create awareness of both these processes and their outcomes. The establishment in Australia of a web enabled National Health Information Knowledge base built around ISO standards is one example of the type of development which will assist in the acceleration of awareness of standards and standardisation, which is needed to cope with the increasing demand.

Australia↗

Delphi study robot consenso: Strategies for the implementation of robotic surgery in general surgery in the Spanish hospital network.

INTRODUCTION: The implementation of robotic surgery in public hospitals presents multiple logistical, educational, and organizational challenges. In the absence of unified guidelines, a national consensus is required to optimize its safe and efficient adoption. This study aimed to establish a set of consensus-based and measurable recommendations for the implementation of robotic surgery programs in hospitals within the Spanish National Health System, based on the experience of centres with established robotic programs and intended to serve as guidance for hospitals that are initiating or planning their implementation. METHODS: A national Delphi study was conducted with the participation of robotic surgery experts from 26 public hospitals. The expert panel was composed exclusively of digestive surgeons with experience in robotic surgery. Three iterative rounds of expert panel evaluation were conducted between March 2024 and March 2025. The questions were grouped into five thematic blocks. Consensus was defined as an agreement level of ≥66.7%. Kendall's W coefficient was used to assess concordance. RESULTS: High levels of consensus were achieved on key aspects related to infrastructure, structured training, cost evaluation, and quality assurance mechanisms. Areas of disagreement were also identified, such as the need for a dedicated anaesthesiologist, purchase of accessory instruments during the initial phase, and official accreditation pathways. CONCLUSIONS: This study provides a guideline for developing a national robotic surgery strategy focused on patient safety, program sustainability, and standardized training of surgical teams. These recommendations can guide hospitals at different stages of robotic technology adoption. Given that the consensus was reached from an exclusively surgical perspective, the recommendations focus on patient safety, program sustainability, and standardized training of the surgical team, and should be interpreted in an adaptable manner according to each centre's context, case volume, and available resources.

Cirugía Asistida por Robot↗

Application of reconstruction-based scatter compensation to thallium-201 SPECT: implementations for reduced reconstructed image noise.

Scatter compensation in Tl-201 single photon emission computed tomography (SPECT) presents an interesting challenge because of the multiple emission energies and relatively large proportion of scattered photons. In this paper, we present a simulation study investigating reconstructed image noise levels arising from various implementations of iterative reconstruction-based scatter compensation (RBSC) in Tl-201 SPECT. A two-stage analysis was used to study single and multiple energy window implementations of reconstruction-based scatter compensation, and RBSC was compared to the upper limits on performance for other approaches to handling scatter. In the first stage, singular value decomposition of the system transfer matrix was used to analyze noise levels in a manner independent of the choice of reconstruction algorithm, providing results valid across a wide range of regularizations. In the second stage, the data were reconstructed using maximum-likelihood expectation-maximization, and the noise properties of the resultant images were analyzed. The best RBSC performance was obtained using multiple energy windows, one for each emission photopeak, and RBSC outperformed the upper limit on subtraction-based compensation methods. Implementing RBSC with the correct choice of energy window acquisition scheme is a promising method for performing scatter compensation for Tl-201 SPECT.

Phantoms, Imaging↗

A social marketing approach to changing mental health practices directed at youth and adolescents.

The mental health problems of children are of increasing social concern. Many best practices have been developed but often not implemented. Social marketing has been suggested as an innovative, useful approach to this challenge-along with others in the health care field. However, much confusion exists over what the approach entails, where it has been applied and how it can be adapted to significant social challenges such as changing mental health practices directed at youth and adolescents. This article defines key terms, offers historical perspective and provides a specific approach and set of models to implement an effective social marketing strategy in a range of contexts.

Adolescent↗

Introducing quality management in the community: the VON experience.

How does a national, non-profit, community health organization introduce and implement quality management (QM) throughout its branches? This article traces VON's move from a traditional quality assurance model to a systematic QM approach, focused on customers and on outcomes. Implementing Quality Management in a three-tiered organization (national, provincial and local levels), with boards and staff, is not an easy challenge but is feasible. Effective and creative strategic planning is a necessity. Educational strategies and ideas for implementation are included.

Community Health Nursing↗