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 1,639 records · Page 91Linked to original sources

PubMed2005

Developing a community science research agenda for building community capacity for effective preventive interventions.

Research has shown that prevention programming can improve community health when implemented well. There are examples of successful prevention in local communities, however many continue to face significant challenges, demonstrating a gap between science and practice. Common strategies within the United States to address this gap are available (e.g., trainings), but lack outcomes. Building community capacity to implement high quality prevention can help communities achieve positive health outcomes, thereby narrowing the gap. While there is ample research on the efficacy of evidence-based programs, there is little on how to improve community capacity to improve prevention quality. In order to narrow the gap, a new model of research-one based in Community Science-is suggested that improves the latest theoretical understanding of community capacity and evaluates technologies designed to enhance it. In this article, we describe this model and suggest a research agenda that can lead to improved outcomes at the local level.

Community Mental Health Services↗

PubMed2003

Estimating biological half-lifes of radionuclides in marine compartments from environmental time-series measurements.

Modelling radionuclide transfers between seawater and marine species on a short time scale basis requires being able to take into account the transfer kinetics. This means (1) to implement the effect of the biological half-lives of radionuclides together with the concentration factor in the calculation of transfers and (2), to get these kinetic parameters for each element and species. Biological half-lives are usually determined from laboratory labelling experiments with the challenge to match natural environmental conditions. The present work proposes a simple model that implements the effect of kinetic parameters in the calculation of transfers. This model is also used to derive the biological half-life and the concentration factor for 137Cs from time-series measurements of environmental concentrations in seawater and in the brown alga Fucus serratus, as an example. These transfer parameters are finally used to predict the Cs activities in Fucus serratus on the English Channel shores.

Cesium Radioisotopes↗

PubMed2005

An in-house course for first assistants (advanced scrub practitioners) in theatres.

It has become commonplace to see theatre practitioners undertaking the role of the first assistant to the surgeon in the absence of medical staff in the operating room (Martin 2004). At Kettering General Hospital we have devised, implemented and are in the process of evaluating a first assistant training package to facilitate a solution to the increasing problems arising from the challenges of the European Working Time Directive.

Health Plan Implementation↗

PubMed2002

Using technology to reduce maternal mortality in low-resource settings: challenges and opportunities.

Technology--consisting of equipment, supplies, procedures, and techniques--can play a central role in the management of pregnancy-related complications. Implementing proven interventions in developing countries and low-resource settings has been difficult, however, because skilled human and financial resources are constrained, and the physical and epidemiological environments are challenging. This article examines the limitations and challenges affecting health technologies in low-resource settings and suggests a framework for characterizing specific technology-based solutions. It also provides examples of pregnancy-related problems in which the introduction of new or modified technologies (drugs for prevention and management of postpartum hemorrhage, infection treatment, manual vacuum aspiration, preeclampsia detection and eclampsia management, partograms, and vacuum extraction) could help save women's lives. The authors call for a more complete assessment of the technology needs associated with pregnancy-related problems in low-resource settings, including evaluating alternative technology-based possibilities, carefully synthesizing and disseminating existing information, and characterizing the nature of current challenges. When accompanied by appropriate provider knowledge and skills, practice guidelines, financing and distribution systems, and community support, technology-based solutions can contribute to a significant reduction in maternal morbidity and mortality around the world.

Developing Countries↗

PubMed2003

Addressing the new competencies for residents' surgical training.

In July 2001 the Accreditation Council for Graduate Medical Education (ACGME) charged U.S. residency training programs to implement a curriculum and evaluation plan covering six competencies. The authors describe the curriculum and evaluation strategy of the first surgical training program developed to meet the competencies, and list each competency and the teaching method and measurement instruments used. Implementation began July 1, 2001, and the program was fully operational on July 1, 2002. Meeting the curriculum challenges required modification of the existing curriculum and the addition of new instructional units. Nine additional evaluation instruments were needed. The largest investment was in planning and implementation, a one-time development cost. Staff workload increased by 252 hours; this is expected to be a continuing annual requirement. Faculty workload increased by two hours per resident and each resident's workload increased by 112 hours per year (2.3 hours per week). The transition was smoother than expected. Faculty and residents' buy-in was crucial. Faculty and residents were alerted to upcoming changes at the beginning of the year in a grand rounds presentation on the ACGME competencies and the approach to meeting requirements. Updates were presented periodically. The authors recommend that residency programs engaged in similar efforts make effective use of instruments developed elsewhere and collaborate with other programs rather than develop everything locally. The program's benefits include time savings and the availability of validity data and norms to inform decision making on residents' and program progress.

Clinical Competence↗

PubMed1996

Implementing a continuous renal replacement therapies program.

Initiating and maintaining a continuous renal replacement therapy (CRRT) program presented more challenges than first anticipated; however, problems remained within the health care team's ability to solve. Here a multidisciplinary group reflects on what was done, should have been done, and remains to be done to offer effective CRRT at this university medical center. All participating members have come to realize that communication and collaboration are necessary to accomplish implementation of a complex program such as CRRT.

Academic Medical Centers↗

PubMed1996

Downsizing of the nation's labor force and a needed social work response.

While employers recognize that downsizings are not cyclical but rather strategic business decisions, there is not sufficient recognition of the importance of these human resources in the profitability and service quality in their organizations. The author highlights the challenge to the social work profession to sensitize management to the needs of their employees, both the released workers and the survivors. The author recommends strategies to sensitize employers to implement processes to humanize the consolidations occurring increasingly in the workforce. An emphasis is placed on the challenges to the social work profession in providing programs and services to America's businesses and employees.

Crisis Intervention↗

PubMed1991

The Healthy Cities Project: a challenge for health education.

The World Health Organization Healthy Cities Project assists participating cities in developing and implementing plans to create health promoting policies, programs, and environmental conditions. The project, which has its origins in the strategy of Health for All by Year 2000, seeks to bring the rhetoric down to earth and ground it in policy and practice. So far the project has been very successful in interesting and involving people at the local level. What began as a small European project in 1986 has become part of a global movement four years later. This movement is based on a recognition of the ecological context of health and the need to reconcile human lifestyles with their environmental and planetary impact. In the process of involving many people from nonmedical sectors in urban health promotion, the continuing relevance of health education to public health is becoming apparent. The challenge to Health Education is to broaden its perspective from the individual and biological, to the social and environmental if it is to play a full part in tackling the ecological crises which confront us.

Global Health↗

PubMed1994

The effects of an undergraduate nursing informatics curriculum on students' knowledge and attitudes.

This paper describes the fourth stage of a process to design, implement and evaluate the nursing informatics courses incorporated into a baccalaureate nursing program. The challenge is to structure the nursing informatics curriculum so as to provide the nursing professional with the basis with which to impact health care delivery. The basic components of the framework are information, technology, and clinical care process. Students in the fourth course worked closely with agency personnel to design, implement and evaluate clinical application projects.

Attitude of Health Personnel↗

PubMed2003

[The psychosocial approach to the planning and implementation of vaccine trials for HIV infection].

The production of an effective vaccine for HIV infection is one of the major challenges for the third millennium public health. Here we review published studies addressing the issue of incentives and barriers influencing the choice to participate in a vaccine trial. Currently available literature clearly indicates the need to include psychosocial dimensions in the preparation and implementation of vaccine trials. The underestimation of participants' satisfaction about information communication may lead to non-adherence and to drop-out from the trials. Proper attention to communication skills of professionals involved in participants' enrollment and follow-up is essential to ensure trial success.

AIDS Vaccines↗

PubMed1996

Overcoming practical challenges in intervention research in occupational health and safety.

In addition to more familiar research issues, intervention research projects in naturalistic settings present the investigator with a number of practical challenges including gaining access to potentially resistant populations, maximizing participation rates in the face of weak incentives for cooperation, getting valid answers to sensitive questions, and meeting ethical obligations when health or legal problems are discovered in the course of study. Generalizable approaches to these challenges are addressed in the context of a retrospective evaluation of the implementation of OSHA's 1984 ethylene oxide standard in Massachusetts hospitals. In the evaluation study, enthusiastic cooperation was secured, a 96% participation rate was realized, sensitive questions were posed successfully, and worker health risks discovered in the course of study received attention without having to wait for the write-up of the study results. Key elements in the study population's receptivity appear to have been (I) the investigator's familiarity with the hazard, its setting, respondent concerns and needs, and (2) reciprocity in the form of providing follow-up consulting services as an integral part of the research process, delivered to each hospital at the conclusion of data collection. Specific techniques used in the study are presented in the hopes of aiding other investigators facing similar practical challenges in occupational health and safety intervention research.

Air Pollutants, Occupational↗

PubMed2004

Applying service-learning through a community-academic partnership: depression screening at a federally funded community health center.

CONTEXT: Increasingly, health care facilities worldwide, particularly those that comprise the safety-net, are finding themselves understaffed and challenged to meet patients' needs. Identifying additional sources of support and resources is critical for facilities to be able to sustain current and develop new initiatives to improve patients' health. APPROACH: We present one community health center's reliance on a partnership with an academic medical/nursing institution to develop and initiate a depression screening and treatment project. Incorporating students to help implement or pilot a needed clinical service for a high prevalence condition presents significant rewards as well as challenges. Nevertheless, an academic-community partnership has the potential to initiate systems change at the clinical level. RESULTS: Using a service-learning modality, medical and nursing students worked with health center providers to initiate a pilot depression screening and treatment program based on the chronic disease model. Implementation of this initiative succeeded in poising the health center for participation in a large, federally supported collaborative on depression in primary care. While students gained insight into some of the challenges faced by safety net providers and their patients, discontinuity in student availability led to uneven pacing in project implementation. CONCLUSION: Curricula that employ a service-learning framework can enable health care facilities world-wide to gain additional resources for needed initiatives. Students' learning experiences can provide an excellent mutually beneficial opportunity as a "jumpstart" for new evidence-based clinical initiatives and demonstration projects. Such programs can help meet the needs of patients while enhancing students' education. However, students can neither make up for staffing shortages nor be expected to maintain programs. In order to be successful for the long term, service-learning projects must skirt the pitfalls of the inherent logistical incompatibilities e.g. schedules and length of commitment, between academic institutions and health care facilities.

Academic Medical Centers↗

PubMed2005

Developing and testing competency levels for laparoscopic skills training.

HYPOTHESIS: Expert levels can be developed for use as training end points for a basic video-trainer skills curriculum, and the levels developed will be suitable for training. DESIGN: Fifty subjects with minimal prior simulator exposure were enrolled using an institutional review board-approved protocol. As a measure of baseline performance, medical students (n = 11) and surgery residents (n = 39) completed 3 trials on each of 5 validated video-trainer tasks. Four board-certified surgeons established as laparoscopic experts (with more than 250 basic and more than 50 advanced cases) performed 11 trials on each of the 5 tasks. The mean score was determined and outliers (>2 SDs) were trimmed; the trimmed mean was used as the competency level. Baseline performance of each subject was compared with the competency level for each task. SETTING: All research was performed in a laparoscopic skills training and simulation laboratory. PARTICIPANTS: Medical students, surgical residents, and board-certified surgeons. MAIN OUTCOME MEASURES: Expert scores based on completion time and the number of subjects achieving these scores at baseline testing. RESULTS: For all tasks combined, the competency level was reached by 6% of subjects by the third trial; 73% of these subjects were chief residents, and none were medical students. CONCLUSIONS: These data suggest that the competency level is suitably challenging for novices but is achievable for subjects with more experience. Implementation of this performance criterion may allow trainees to reliably achieve maximal benefit while minimizing unnecessary training.

Clinical Competence↗

PubMed2006

GENOMIZER: an integrated analysis system for genome-wide association data.

Genome-wide association analysis appears to be a promising way to identify heritable susceptibility factors for complex human disorders. However, the feasibility of large-scale genotyping experiments is currently limited by an incomplete marker coverage of the genome, a restricted understanding of the functional role of given genomic regions, and the small sample sizes used. Thus, genome-wide association analysis will be a screening tool to facilitate subsequent gene discovery rather than a means to completely resolve individual genetic risk profiles. The validation of association findings will continue to rely upon the replication of "leads" in independent samples from either the same or different populations. Even under such pragmatic conditions, the timely analysis of the large data sets in question poses serious technical challenges. We have therefore developed public-domain software, GENOMIZER, that implements the workflow of an association experiment, including data management, single-point and haplotype analysis, "lead" definition, and data visualization. GENOMIZER (www.ikmb.uni-kiel.de/genomizer) comes with a complete user manual, and is open-source software licensed under the GNU Lesser General Public License. We suggest that the use of this software will facilitate the handling and interpretation of the currently emerging genome-wide association data.

Chromosome Mapping↗

PubMed1998

Aggregate exposures under the Food Quality Protection Act: An approach using chlorpyrifos.

The Food Quality Protection Act of 1996 (Public Law 104-170, August 3, 1996), which amended the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Federal Food, Drug, and Cosmetic Act (FFDCA), requires that the EPA evaluate pesticide safety in light of potential aggregate exposures from both nondietary and dietary routes. As with any new legislation, there has been considerable discussion and challenges presented within the regulatory and scientific communities regarding the effective implementation of this act as it relates to the determination of aggregate exposures. This paper describes a novel methodology incorporating personal exposure factors, route-specific exposure measurements, and usage information to characterize potential aggregate exposures to a widely used pesticide, chlorpyrifos. A calendar model framework has been developed to describe potential multipathway exposures to individuals. The model assimilates information regarding the typical use patterns of chlorpyrifos-containing pesticides in concert with quantitative exposure and dose measurements to estimate the probability and magnitude of exposures to members of the U.S. population. Studies measuring 3,5,6-trichloropyridinol, the primary metabolite of chlorpyrifos, in the urine of individuals within the United States show that aggregate exposures derived from this approach are consistent with actual population-based exposures to chlorpyrifos. According to this assessment, potential health risks attributed to exposure to chlorpyrifos are low when compared to relevant toxicological end points.

Animals↗

PubMed1994

Designing long-term clinical trials in affective disorders.

Long-term clinical trials in affective disorders have become increasingly important, but their methodology continues to impose a major challenge. An ideal design can be developed but is difficult to implement. The advantages and disadvantages of different designs (mirror image, double-blind study controlled with placebo, and/or standard and discontinuation studies) are described and compared. Shortcuts in design usually carry a high risk of false-negative findings and result in a waste of resources. An abbreviated version was presented at the European Consensus Conference on Long-term Clinical Trials in Zurich, Switzerland, October 1992.

Clinical Trials as Topic↗

PubMed2005

Organizational systems to support publicly funded tobacco treatment services.

BACKGROUND: Professional societies and government organizations have promoted guidelines and best practices that encourage clinicians to routinely integrate cessation counseling into patient encounters. While research in health maintenance organizations has demonstrated that the development and maintenance of office systems do enable clinicians' smoking-cessation services, little is known about the adoption of system strategies in diverse organizations serving disadvantaged populations. METHODS: Data were collected via face-to-face interviews from November 2001 to October 2002 using a standardized systems assessment checklist at service delivery sites of 83 funded community health service agencies, which included hospitals, community health centers, and other organizations (e.g., substance abuse, mental health, and multiservice). The content of the structured assessment reflected system elements with proven effectiveness that have been included in guidelines and best practices recommendations. Detailed information was collected on the implementation strategies. RESULTS: This study found considerable attention to systems that support cessation services in diverse healthcare organizations, but much remains to be done. There is a wide diversity of implementation strategies employed, with varied degrees of sophistication. CONCLUSIONS: A major challenge is to develop systems capable of providing population-based feedback to, and between, providers, which will enable further quality improvement efforts.

Adolescent↗

PubMed2003

Challenge of conducting trials of neuroprotection in the asphyxiated term infant.

There has been much progress in understanding the pathogenesis of hypoxic-ischemic brain injury in the near-term and term infant. Although gaps in our knowledge base persist, advances over the past two decades have led to the development of specific brain oriented therapies directed at critical events contributing to tissue damage. The primary goal of these interventions is to prevent or attenuate neurologic and developmental sequelae of brain injury. Examples of current potential treatments include modest reductions in brain temperature, receptor antagonists of excitatory neurotransmitters, reductions in O2 free radicals, blockade of inflammatory mediators, and inhibition of apoptotic pathways. At present, some of these treatments have sufficient animal data that demonstrate benefit, to justify moving experiments from the laboratory to the clinical arena. Modest hypothermia represents the neuroprotective intervention that has been investigated in the most complete fashion for the newborn, and there are multiple ongoing clinical trials testing its efficacy. This review will address specific challenges that are pertinent to the evaluation of any neuroprotective therapy implemented shortly after birth. Specific issues to be covered include the therapeutic window, establishing a diagnosis of hypoxic-ischemic encephalopathy, patient selection, characteristics of an effective therapy, safety considerations, appropriate outcome variables, and sample size considerations. Since clinical trials of brain hypothermia are in progress, many of these issues will be addressed from the perspective of this specific intervention.

Animals↗