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Results for “Implementation science”

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PubMed2000

[Brain death and intensive care medicine. The cultural history of a medical concept].

The paper focuses on the cultural history of brain death in Germany in the second half of the 20th century. It analyzes scientific and public discourses on the relevance of brain death and the importance of medical innovations in intensive care medicine. The paper examines how the public reacted when heart transplantation led to an urgent need for a new definition of death. It will be shown how the concept of brain death was accepted by the public, introduced into clinical routine, and implemented through medical and legal policies. Finally, it will be analyzed why the public consensus on brain death was definitely questioned in the last ten years. An understanding of the use of the concept of brain death by scientists, lawyers, theologians, and the public during the last three decades may help to shed light on the social role of science in modern and late-modern societies.

Brain Death↗

PubMed1990

Non-institutional treatment of chronic pain by field management: an outcome study with comparison group.

Field management, through the use of specially trained field consultants, is a mechanism by which interdisciplinary interventions can be implemented in non-institutional settings. Management of the real environmental determinants (home, work, social) of pain and disability should improve the effectiveness of behaviorally based interventions and make these treatments more accessible. Over a 6 year period, 261 patients having various chronic somatic complaints (e.g., pain, fatigue, gastrointestinal complaints) underwent interdisciplinary outpatient treatment based on medical and behavioral sciences. Comparison of patients having field management with patients receiving office-based treatment found a significantly greater reduction in disability with field management. 84% of field managed patients had a successful outcome as defined by: (a) return to regular work, or (b) reduced limitations on work, exercise, and daily living activities, depending on functional status at assessment. Only 61% of patients with office-based treatment were successful. Compliance, defined as the frequency with which treatment was mutually terminated, was significantly higher with field management. The availability of long-term disability benefits was highly predictive of a poorer outcome. However, field management remained effective for improving functional status regardless of the availability of benefits. Finally, determination of the cost of non-institutional treatment indicated that field management is a cost-effective modality. Implications of these findings for the treatment of disability in chronic pain and other chronic illness syndromes are discussed.

Adolescent↗

PubMed2006

Recurrent outbreaks of cryptosporidiosis associated with calves among students at an educational farm programme, Minnesota, 2003.

Enteric illness outbreaks among middle-/high-school students in consecutive semesters of an educational farm programme were investigated with retrospective cohort studies. During the first outbreak, 31/92 (34%) interviewed students were ill. Risk factors included participating in animal science class (RR 8.1, 95% CI 1.2-55.2) and contact with calves (RR 4.2, 95% CI 1.1-16.2). Stool samples from seven students and two calves yielded Cryptosporidium parvum. Students cared for animals in street clothes and practised poor hand washing. During the second outbreak, 37/81 (46%) interviewed animal science students were ill. Risk factors included having visible manure on hands, and wearing coveralls and boots. Stool samples from seven students and eight calves yielded C. parvum. Student hand washing was still inadequate. Coveralls/boots were cleaned infrequently and removed after hand washing. These outbreaks of cryptosporidiosis resulted from calf contact and inadequate hygiene practices. The failure to adequately implement recommended interventions contributed to the second outbreak.

Adolescent↗

PubMed1984

A few axonal proteins distinguish ventral spinal cord neurons from dorsal root ganglion neurons.

A series of proteins putatively involved in the generation of axonal diversity was identified. Neurons from ventral spinal cord and dorsal root ganglia were grown in a compartmented cell-culture system which offers separate access to cell somas and axons. The proteins synthesized in the neuronal cell somas and subsequently transported into the axons were selectively analyzed by 2-dimensional gel electrophoresis. The patterns of axonal proteins were substantially less complex than those derived from the proteins of neuronal cell bodies. The structural and functional similarity of axons from different neurons was reflected in a high degree of similarity of the gel pattern of the axonal proteins from sensory ganglia and spinal cord neurons. Each axonal type, however, had several proteins that were markedly less abundant or absent in the other. These neuron-population enriched proteins may be involved in the implementation of neuronal diversity. One of the proteins enriched in dorsal root ganglia axons had previously been found to be expressed with decreased abundance when dorsal root ganglia axons were co-cultured with ventral spinal cord cells under conditions in which synapse formation occurs (P. Sonderegger, M. C. Fishman, M. Bokoum, H. C. Bauer, and P.G. Nelson, 1983, Science [Wash. DC], 221:1294-1297). This protein may be a candidate for a role in growth cone functions, specific for neuronal subsets, such as pathfinding and selective axon fasciculation or the initiation of specific synapses. The methodology presented is thus capable of demonstrating patterns of protein synthesis that distinguish different neuronal subsets. The accessibility of these proteins for structural and functional studies may contribute to the elucidation of neuron-specific functions at the molecular level.

Animals↗

PubMed2001

Applying social and behavioral theory as a template in containing and confining VRE.

Infection control professionals play several important roles--surveyors, educators, and ultimately change agents--in the identification and prevention of nosocomial infections in hospitals. The medical and surgical intensive care units (ICUs) in a large inner-city teaching hospital experienced an increased patient colonization rate with vancomycin-resistant enterococcus (VRE). Intervening in this problem required a multifaceted approach to control the spread of VRE and to change behavior by shifting social norms at multiple levels throughout the ICU community. The success of the interventions could be best explained by applying the use of several behavioral science models. The Ecological Model of Behavior Change, the Health Belief Model, and Social Cognitive Theory can be applied and are consistent with the successful interventions. This multifaceted approach to intervening in this problem consists of five levels of influence: (1) intrapersonal or individual factors, (2) interpersonal factors, (3) institutional factors, (4) community factors, and (5) public factors. We implemented educational inservices and developed references, policies, and programs directed at each of the five levels of influence. The Health Belief Model and Social Cognitive Theory were employed for intervention, and behavior change was based on modeling, observational learning, and vicarious reinforcement. Within six months of initial implementation, the number of positive VRE surveillance cultures and positive clinical isolates decreased significantly in both the medical and surgical ICUs. Two years later, there continues to be a marked reduction of VRE.

Behavior↗

PubMed2005

Nursing, midwifery and allied health education programmes in Afghanistan.

BACKGROUND: In 2001, Afghanistan was the centre of the world's attention. By 2002, following 23 years of internal conflict - including Soviet invasion, civil war and Taliban rule, plus 3 years of drought, the country was just beginning the process of re-establishing its internal structures and processes. In the health sector, this included the revival of the Ministry of Health (MOH). The MOH was assisted in its efforts by multiple partners, including the UN, donor and aid agencies, and a variety of non-governmental organizations. The author served as a consultant to the Aga Khan University School of Nursing, in partnership with the World Health Organization and the MOH, as it took on the work of strengthening nursing, midwifery and allied health education programmes for Afghanistan. AIM: This paper will focus on the initial assessment of that sector. It will describe the situation as it existed in 2002, by examining the Kabul Institute of Health Sciences (IHS) and then turn briefly to the current state of affairs. CONCLUSIONS: Despite the uncertainties of daily life in Afghanistan, the country has successfully initiated the reconstruction process. In the health sector, this can be seen in the work done at the Kabul IHS. Progress has been made in a number of areas, most notably in development and implementation of nursing and midwifery curricula. However, no one would deny that much more work is needed.

Afghanistan↗

PubMed1997

Inventory accuracy in 60 days!

Despite great advances in manufacturing technology and management science, thousands of organizations still don't have a handle on basic inventory accuracy. Many companies don't even measure it properly, or at all, and lack corrective action programs to improve it. This article offers an approach that has proven successful a number of times, when companies were quite serious about making improvements. Not only can it be implemented, but also it can likely be implemented within 60 days per area, if properly managed. The hardest part is selling people on the need to improve and then keeping them motivated. The net cost of such a program? Probably less than nothing, since the benefits gained usually far exceed the costs. Improved inventory accuracy can aid in enhancing customer service, determining purchasing and manufacturing priorities, reducing operating costs, and increasing the accuracy of financial records. This article also addresses the gap in contemporary literature regarding accuracy program features for repetitive, JIT, cellular, and process- and project-oriented environments.

Equipment and Supplies↗

PubMed2001

How to launch a community early defibrillation program.

More than 60 emergency services professionals attended an EMS Today 2001 preconference symposium, "How to Champion Public Access Defibrillation in Your Community: Leadership, Art and Science," hosted by AED manufacturer Philips/Heartstream. Their goal: to learn the practicalities of starting and maintaining an early defibrillation program in their communities. The recent increase in research and attention to community early defibrillation programs led Philips/Heartstream to host the symposium, which featured cardiac arrest survivor Diane Jackson, as well as three community early defibrillation program advocates who've implemented early defibrillation programs in their communities. Their advice for kick-starting early defibrillation programs in your community follows.

Cooperative Behavior↗

PubMed1994

Towards a new model of nursing research.

Nursing research is generally located within the paradigm of the social sciences, and therefore reflects the concerns and agenda of social research. In particular, nursing has become embroiled in the ongoing dispute between the advocates of qualitative and quantitative methodologies. However, it is argued in this paper that whereas the aim of social research is to develop knowledge, the aim of nursing research is primarily to advance practice. This paper offers an alternative model of nursing research which categorizes approaches to research not according to the methodology employed but on the extent to which the research process is likely to bring about change. These approaches are termed level 1, level 2 and level 3 research, where level 1 researchers are concerned with generating information for others to conceptualize and implement, while level 3 researchers see their aim as directly bringing about clinical change. Two approaches to level 3 research are suggested, and examples of projects at all three levels are examined. Finally, it is contended that only by adopting an appropriate model of research for a practice-based discipline can nursing address the real issues of relevance to nurses and patients in clinical settings.

Clinical Nursing Research↗

PubMedDate not supplied

Establishing an on-site pharmacy in a community health center to help indigent patients access medications and to improve care.

OBJECTIVES: To describe the establishment of an on-site pharmacy in a community health center (CHC) to improve access to medications for indigent patients, the implementation of pharmaceutical care programs and clinical pharmacy services to improve patient care and therapeutic outcomes, and the development of an ambulatory care site for training pharmacy students. SETTING: Partnership Health Center (PHC), a federally funded CHC in Missoula, Mont. PRACTICE DESCRIPTION: Establishment of an on-site pharmacy and strategies for accessing medications for indigent patients, including participation in the U.S. Public Health Service pricing program, pharmaceutical manufacturers' assistance programs, and drug sampling, are described. The clinical pharmacy, disease management, and pharmaceutical care programs developed at the site to improve medication use and therapeutic outcomes are discussed. Development of an ambulatory care clerkship site at the CHC for training University of Montana pharmacy students is reviewed. PRACTICE INNOVATION: Partnership between PHC and the University of Montana School of Pharmacy and Allied Health Sciences (SPAHS) to establish an on-site pharmacy to help medically indigent patients access medications and to improve care. INTERVENTIONS: Programs to help indigent patients access, adhere, and appropriately use needed medications while decreasing clinic expenditures for medications. MAIN OUTCOME MEASURES: Number of prescriptions dispensed per month, clinic expenditures on medications per month, and number of clinical services and pharmaceutical care programs developed. RESULTS: Between November 1, 1999, and April 30, 2000, the average number of prescriptions filled for PHC clients increased from 219/month to 838/month and the average expenditure per prescription decreased from $16.55/month to $0.51/month. A pharmacist-assisted refill program was implemented. Programs in diabetes, hypertension, dyslipidemia, asthma, anticoagulation, and peptic ulcer disease were developed. CONCLUSION: Establishing an on-site pharmacy in a CHC in collaboration with a school of pharmacy significantly improved indigent patients' access to medications while decreasing clinic expenditures. Pharmaceutical care programs improved therapeutic outcomes, and clinical pharmacy services complemented the clinical activities of other health care providers in managing chronic diseases and resolving drug-related problems. The CHC provided an excellent setting for training pharmacy students in ambulatory care.

Community Health Centers↗

PubMedDate not supplied

Consumer research for development of educational messages for the MyPyramid Food Guidance System.

OBJECTIVE: To assess consumer understanding and use of messages from the original Food Guide Pyramid and potential concepts for a revised Food Guidance System. DESIGN: Focus groups conducted in two phases, in 2002 and 2004. SETTING: Market research facilities in Baltimore, Chicago, and Houston. PARTICIPANTS: Phase I, 178 participants in 18 groups: 6 of general adult consumers, 4 of adults over 60 years of age, 4 of food stamp recipients, and 4 of overweight adults. Phase II, 75 participants in 8 groups: 4 of younger adults and 4 of older adults. PHENOMENON OF INTEREST: Understanding and use of original Pyramid symbol and messages and potential concepts for a revised food guidance system. ANALYSIS: Focus group sessions were audiotaped and transcribed. Content analysis summarized comments into meaningful themes. RESULTS: Key concepts of the original Pyramid were widely understood, but specific knowledge was limited and misunderstandings common, especially related to servings and food group placement. Detailed information about whole grains, types of fats, vegetable subgroups, and physical activity was lacking. CONCLUSIONS AND IMPLICATIONS: While consumers are aware of general concepts about healthy eating, they lack specific knowledge to help them implement recommendations. Educators can help by providing consumers with concrete examples and specific information.

Adult↗

PubMed2001

Nutrition intervention strategies in chronically malnourished regions: preventing endemic goitre in Togo.

Iodine deficiency disorders (IDDs) are an important problem in the world. Some 760 million people suffer from goitre and 1600 million are at risk. In Togo, a small West African country, the prevalence of visible goitre in 6-12-year-old children was 21.6% and 5.3% in two endemic regions in 1999. Goitre is considered endemic as it affects one adult in five. UNICEF-Togo (United Nations Children's Fund) in co-operation with the Togolese government has implemented different programmes with the aim of improving the survival and development of children and women and to defend and promote children's rights. The aim of this paper is to describe the procedures followed and key results of a school-based nutrition education project implemented in Togo to prevent iodine deficiency disorders, by encouraging use of iodised salt.

Child↗

PubMedDate not supplied

A framework for selecting performance measures for opioid treatment programs.

As a result of new federal regulations released in early 2001 that move the monitoring and evaluation of opioid treatment programs from a government regulation to an accreditation model, program staff members are now being challenged to develop performance measurement systems that improve care and service. Using measurement selection criteria is the first step in developing a performance measurement system as a component of an overall quality management (QM) strategy. Opioid treatment programs can "leapfrog" the development of such systems by using lessons learned from the healthcare quality industry. This article reviews performance measurement definitions, proposes performance measurement selection criteria, and makes a business case for Internet automation and accessibility. Performance measurement sets that are appropriate for opioid treatment programs are proposed, followed by a discussion on how performance measurement can be used within a comprehensive QM program. It is hoped that through development, adoption, and implementation of such a performance measurement program, treatment for clients and their families will continuously improve.

Accreditation↗

PubMedDate not supplied

IAIMS: an interview with Dick West. Integrated Advanced Information Management Systems. Interview by Joan S Ash and Frances E Johnson.

Richard T. West, IAIMS (Integrated Advanced Information Management Systems) Program Officer at the National Library of Medicine for 13 years, reflects on the origin, development, effectiveness, and future of IAIMS efforts. He dwells on the changes that have taken place as the concept of IAIMS has evolved from a technology-based to an organization-based level of integration. The role of IAIMS in patient care, education, and research is discussed, along with the role of the librarian in the implementation of IAIMS programs. He sees a need for training for librarians, informaticians, and others in preparation for these efforts and for the development of academic reward systems that encourage them. He expresses a desire for those working in information technology in hospitals to gain a clearer understanding of IAIMS, because the concept fits hospitals as well as academic health science centers. He exhorts informaticians to bring to reality the futuristic fantasies of a new information world.

Computer-Assisted Instruction↗

PubMed2006

HSCL LibQUAL+ 2004: from numbers and graphs to practical application.

The University of Florida Health Science Center Libraries created a task force representing various departments to review data from its 2004 LibQUAL+ survey. This review compared results from the 2002 and 2004 LibQUAL+ surveys, and the data from the Association of Academic Health Science Libraries 2004 cohort. The task force analyzed the key components of the LibQUAL+ survey: Affect of Service, Information Control, Library as Place, and user comments. At the conclusion of this review, the task force made recommendations and suggestions along departmental lines to meet the patrons' needs and expectations. In addition to following the task force recommendations, the Libraries independently implemented several new services and hired additional personnel after the completion of the 2004 survey. Combined, these changes should improve overall library service and increase customer satisfaction. Looking towards the 2006 LibQUAL+ survey, the task force will be convened in advance and will guide the entire process.

Consumer Behavior↗

PubMed2001

Short dementia questionnaire for assessing the severity of cognitive impairment in patients with dementia.

This paper describes the Short Dementia Questionnaire (SDQ), a psychometric test that provides an initial assessment of the severity of cognitive impairment in patients with dementia. This test requires minimal effort on the part of the assessor and places little strain on the patient. For several years now, a preliminary form of the test has been used for large-scale screening of dementia patients in nursing homes within clinical drug trials. This test is short, inexpensive and largely standardized in regard to implementation, even without the usual intensive training. This paper focuses in particular on the structure and implementation of the test. The item and scale parameters relevant for the evaluation of its field of application are presented, and finally, the results of an initial validation study are reported. These results show that the test procedure is a good predictor of severity scores in frequently used, more extensive tests for grading the severity of dementia. (c) 2001 Prous Science. All rights reserved.

Journal Article↗

PubMedDate not supplied

Closing the gap between science and practice: the need for professional leadership.

Major opportunity exists to better align clinical science and clinical practice. To do so will require efforts not only to develop clinical practice guidelines, but to facilitate their application in practice. The American College of Cardiology operates a program to develop and assess the effectiveness of tools that facilitate the application of guidelines in practice. Here we review what we have learned about the process of guideline implementation, lay out the major research questions that need to be addressed, and argue that professional societies play a critical role in moving from guideline development to application.

Cardiology↗

PubMed2005

Effectiveness of school programs in preventing childhood obesity: a multilevel comparison.

OBJECTIVES: In light of the alarming increase in childhood obesity and lack of evidence for the effectiveness of school programs, we studied the effects of school programs in regard to preventing excess body weight. METHODS: In 2003, we surveyed 5200 grade 5 students along with their parents and school principals. We measured height and weight, assessed dietary intake, and collected information on physical and sedentary activities. We compared excess body weight, diet, and physical activity across schools with and without nutrition programs using multilevel regression methods while adjusting for gender and socioeconomic characteristics of parents and residential neighborhoods. RESULTS: Students from schools participating in a coordinated program that incorporated recommendations for school-based healthy eating programs exhibited significantly lower rates of overweight and obesity, had healthier diets, and reported more physical activities than students from schools without nutrition programs. CONCLUSIONS: Our finding that school programs are effective in preventing childhood obesity supports the need for broader implementation of successful programs, which will reduce childhood obesity and, in the longer term, comorbid conditions and health care spending.

Body Height↗