SEARCH · PubMed Health

Results for “Implementation science”

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 1,657 records · Page 92Linked to original sources

PubMed2003

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↗

PubMed2006

Do mothers understand healthy eating principles for low-birth-weight infants?

OBJECTIVES: To describe feeding patterns and mothers' perceptions of desirable feeding practices in low-birth-weight (LBW) infants after hospital discharge in England and to test for the association of inappropriate practices/perceptions with identifiable demographics. DESIGN: Postal questionnaires from 198 mothers of LBW infants in London, Liverpool and Winchester were analysed regarding infant demographics, mothers' demographics, infant milks used, solid feeding practices and mothers' perceptions of infant feeding practices. RESULTS: At birth, the median weight, independent of gestational age, was 1.80 kg (range 0.6-2.50 kg) and 37.1% of infants received breast milk exclusively; 83.7% were breast-fed at some stage, a practice favoured more by first-time mothers (90.2%) than multiparous mothers (73.4%) (P = 0.004) as well as by mothers of higher social groups (P = 0.019). The median age of solid food introduction was 17 postnatal weeks (range 8-36 weeks); the timing correlated strongly with infant birth weight (P < 0.001). A high-fibre diet and a low-fat diet were incorrectly considered important for their infants by 67.1% and 51.6% of mothers, respectively. Regarding a high-fibre diet as important was associated with being a multiparous mother (P = 0.006), while regarding a low-fat diet as important was associated with low social group (P = 0.018). A quarter of mothers did not consider 'plenty of calories' to be important for their infants, reflecting similar attitudes in 1990 for mothers of term infants; this incorrect attitude exhibited an association with being a first-time mother (P = 0.047). CONCLUSIONS: Infant feeding practices were very variable, showing poor concordance with national and international recommendations for term infants. In selecting foods for their infants, many mothers appeared to be applying principles more appropriate to planning a healthy diet for adults. There is an urgent need to develop and implement evidence-based guidelines for feeding LBW infants after hospital discharge, with special attention given to multiparous mothers as well as mothers from lower social groups.

Adolescent↗

PubMed1988

A stochastic version of the Malthusian Trap Model: consequences for the empirical relationship between economic growth and population growth in LDC's.

A stochastic version of the Malthusian trap model relating the growth rate of income per capita to the population growth rate of a given country is described. This model is applied to the a priori evaluation of the cross-sectional correlation between these 2 growth rates under 2 additional assumptions: 1) the relations in the model at national levels include country-specific and time-invariant random components, and 2) these growth rates are measured with a certain degree of temporal aggregation. It is shown that these 2 assumptions can explain near-0 correlations between the 2 growth rates even if there exist a strongly negative effect of population growth on economic growth. However, it is not clear whether these assumptions fully explain such insignificant correlations. Indeed, the implementation of the model is complicated by the structural shifts which are likely to occur in the equations over the course of the demographic transition.

Demography↗

PubMed1994

Migraine headaches: coping efficacy of guided imagery training.

This study compares the effectiveness of guided imagery, (psychosynthetic approach), and biofeedback in the treatment of migraine headache. Specifically, the volunteer's subjective perception of the efficacy of the treatments is assessed. The subjects were 40 male and female volunteers presenting with migraine headache diagnosis at Sunnybrook Health Sciences Centre in Toronto, Canada. Subjects were randomly assigned to one of the three treatment conditions or to a control group. All subjects attended six sessions of training. Measures were completed pre- and post-treatment. The results did not reveal significant reduction in migraine activity in any of the treatment groups. There were no differences among the groups regarding the intake of medication. Nevertheless the implementation of guided imagery training resulted in subjective reports of improved capacity to cope with the pain and in subjective reports of a reduced perception of the pain itself, although objective measures did not indicate an appreciable change in migraine activity. Findings from the present study do not support either feedback or guided imagery training as more effective in counteracting migraines although subjective reports do favor guided imagery as having a positive influence on the perception of migraine pain. These findings are discussed from the perspective of empowering the sufferers by providing them with a more active role in dealing with the migraine triggering physiology, abandoning the "learned helplessness" typical of chronic pain syndromes. The issue of cost effectiveness is raised and it supports the use of guided imagery versus biofeedback training given the lack of theoretical agreement in the current literature.

Adaptation, Psychological↗

PubMed2003

Household trials with very small samples predict responses to nutrition counseling intervention.

Household trials were conducted to test the acceptability and feasibility of the recommendations to be delivered to the mothers in the context of a randomized intervention implemented in Pelotas, Brazil. A first home visit was paid to assess child health and feeding problems. In a second visit, the mother was encouraged to select one or two recommendations to try out over five days. The last visit was used to assess the mothers' experiences in attempting to implement the recommendations. Nonexclusive breastfeeding, use of the bottle, monotonous diet, and low energy density of foods were the most common problems. The most frequently selected recommendations were those aiming to increase the energy density of foods. Mothers generally reported positive responses to the recommendations. The household trials highlighted the acceptability and feasibility of the planned recommendations and correctly predicted the changes that were successfully implemented by the mothers in the large intervention study.

Adult↗

PubMed2005

Children's healthful eating: from research to practice.

This paper provides a brief overview of some of the challenges facing the world community in promoting the nutrition status of schoolchildren. It begins by describing the main objectives and aims of children's nutrition promotion and then moves to consider the needs and environments of schoolchildren, the purposes of education and food and nutrition promotion, and the domains of schools and teachers. In the second part of the paper the evidence bases for food and nutrition promotion are considered, especially the gaps in current knowledge. This leads to a discussion of useful practice models as well as a case study of a school health promotion program in Australia. The final part of the paper examines some proposals for schoolchildren's food and nutrition policies, which might be implemented in local schools as well as nationally and internationally. The main theme underlying these proposals is that policies must be created and their effectiveness monitored regularly and reported back to schoolteachers, health workers, school communities, and governments.

Adolescent↗

PubMed2004

The Australian government's review of positron emission tomography: evidence-based policy-making in action.

The Commonwealth Government constituted the Medicare Services Advisory Committee (MSAC) to implement its commitment to entrench the principles of evidence-based medicine in Australian clinical practice. With its recent review of positron emission tomography (PETReview), the Commonwealth intervened in an established MSAC process, and sanctioned the stated objective to restrict expenditure on the technology. In our opinion: The evaluation of evidence by PETReview was fundamentally compromised by a failure to meet the terms of reference, poor science, poor process and unique decision-making benchmarks. By accepting the recommendations of PETReview, the Commonwealth is propagating information which is not of the highest quality. The use of inferior-quality information for decision-making by doctors, patients and policy-makers is likely to harm rather than enhance healthcare outcomes.

Australia↗

PubMed1999

[Are principles of evidence-based medicine taken into account in the area of pharmacology?].

Scientific literature published in the early 1980s claimed that only 15% of medical interventions are based on scientific evidence (57). Lately, a number of published articles concluded that ca. 80% of the interventions in family medicine (18, 25) and ca. 60% of those in psychiatry fulfil these criteria (24). Did medical practice change so fundamentally? Hard to believe. But to what extent do physicians practice evidence-based medicine as newer publications also constitute a level of science-based interventions across all medical disciplines of only 21% (17)? This article tries to highlight and discuss which observations can be made regarding the compliance to principles of 'evidence based medicine' in one of the most important field of medical interventions--drug therapy. Taking the submarkets of cardiovascular and respiratory drugs as an example, the authors try to identify and discuss effects and obstacles to implement evidence-based pharmacotherapy, and how the latter might be overcome in the future.

Evidence-Based Medicine↗

PubMed2000

Therapeutic upper endoscopy.

Endoscopy continues to evolve now and in the future with advances in diagnostic and therapeutic procedures. Advances in therapeutic procedures consist of cheaper and more effective instrumentation, the use of novel biologicals for site-specific therapy, and the introduction of bold new approaches such as endoscopic transluminal interventions. The invention and implementation of these changes, however, is dependent on improvements in technology and the creation of an enlightened cadre of endoscopists with the knowledge and ability to be effective translational scientists.

Biocompatible Materials↗

PubMed2001

Point-of-care testing. Impact on medical outcomes.

There is now clear evidence that POCT has a positive benefit on morbidity and mortality. In addition, there are other tangible benefits that may themselves influence morbidity and mortality, e.g., reduced blood sample requirement in pediatrics, reduced length of stay, and greater doctor and patient satisfaction. These benefits accrue from the ability to make decisions and implement the appropriate intervention more quickly. It has also been demonstrated that POCT can facilitate improved patient motivation and satisfaction and thereby compliance with a prescribed disease management strategy. Improvement in health outcome, morbidity, and mortality can only be achieved, however, when the diagnostic and therapeutic interventions operate in concert. A review of the literature on medical outcomes of POCT has demonstrated the complexity of establishing evidence and the paucity of robust literature that exists at the present time. It is hoped, however, that the reader will appreciate how important it is to stress the role of a diagnostic test in decision making, to ensure that decisions are made and that benefits will be achieved. From a more pragmatic standpoint, however, it is hoped the reader will see the potential value of the arguments put forward in favor of implementing POCT when submitting a business case to a funding authority; the fact that the cost of POCT may be greater should not be a deterrent.

Adult↗

PubMed1996

Cognitive evaluation of the user interface and vocabulary of an outpatient information system.

This paper describes an innovative approach to the evaluation of the user interface and vocabulary of a medical information system. The use of video recording for collecting usability data is detailed. The technique employed involves the collection of data consisting of transcripts of physicians as they "think aloud" while interacting with the system, along with a video record of the complete user-computer interaction. Using methods of analysis from cognitive science, the study was able to distinguish the source of physician problems in using the system's interface and in interacting with its controlled medical vocabulary. Analysis of the protocols indicated that all subjects encountered several generic problems, the most common ones indicative of a need for greater consistency in the interface design. Based on this evaluation, parts of the user interface have been re-implemented in an ongoing process of iterative system development.

Ambulatory Care Facilities↗

PubMed1976

The reorganization of a monographic reference collection.

Reference monographs in the Health Sciences Library of the College of Medicine and Dentistry of New Jersey were reorganized recently according to form, in order to enable both librarians and patrons to utilize these materials more efficiently. This reorganization reflects the unique characteristics of reference books as differentiated from the regular monographic collection, since reference materials are frequently consulted for quick "look-ups." A reference category scheme was developed and implemented, based on observations of and comparisons with reference collections of eight medical libraries in the New York metropolitan area. The reorganization enhances the retrievability of materials from this collection.

Book Classification↗

PubMed1998

The influence of CO2 in a space-like environment: study design.

For the operation of manned spacecraft, the removal of CO2 from the cabin atmosphere, produced by its inhabitants, is essential. This is accomplished by chemical absorption in a gas processing unit, a process which requires energy and consumables. Therefore, in terms of resource management, the CO2-level should be kept as high as possible. Otherwise, considering crew health and performance and also the interference with life science experiments, the CO2 load should be as on Earth, close to zero. In order to obtain more information about the permissible CO2 level for future space missions and also to clarify Space Station design criteria, NASA-ESA-DARA have initiated a ground-based simulation study with two different CO2 levels: 0.7% (first campaign) and 1.2% CO2 (second campaign). For this study the deep diving facility of DLR was used to provide atmospheric control and long-term habitation for the test subjects in studying the effect of increased CO2 on physiological and psychological functions. A number of experiments were implemented, which tested selected effects of raised CO2 on humans. Four male subjects stayed in the chamber for 26 d in each campaign, in order to perform the different tests in repeated trials, with the aim of evaluating possible long-term effects. CO2 was controlled by absorption with soda lime, flushing with fresh air and the addition of CO2, if necessary. Essentially, the CO2 produced by the subjects was used to maintain the level at 0.7 and 1.2%, respectively. Basic control of CO2 was carried out in the soda lime container of the Life Support System. In order to maintain the required level, the amount of gas flowing through the soda lime could be adjusted by a remote controlled bypass. With this set-up it was possible to keep CO2 at an average level between 0.67 and 0.73% in the first campaign and between 1.17 and 1.23% in the second campaign. The results of the experiments support the current CO2 limits for space operations, insofar as values around 1% do not impose any severe restrictions to human habitation for at least several weeks, whereas life sciences experiments especially sensitive to CO2 influences have to be carefully evaluated for possible interferences.

Adult↗

PubMed1995

Medicine, practice and guidelines: the uneasy juncture of science and art.

While physicians are often portrayed as scientists, the defining character of medical practice is its being both science and art. Indeed, despite drawing on the ever-expanding knowledge base and range of therapies, medical practice remains fundamentally an interpersonal experience, drawing on the dynamic and rich interaction between practitioner and patient. With the goal of situating clinical practice guidelines in a broader context, we briefly explore models of medicine and the nature of clinical practice. The implications of these for guideline development and implementation are then examined as we present guidelines as an opportunity for enhancing medical practice and increasing both patient and practitioner satisfaction.

Humans↗

PubMedDate not supplied

Evidence-based resources and the role of librarians in developing evidence-based practice curricula.

The implementation of evidence-based practice (EBP) requires acquisition and use of a complex set of skills, including the ability to locate and critically evaluate clinically relevant research literature. In this article, we discuss information resources and tools that may be of value to educators faced with the task of teaching students to search for and evaluate research-based evidence. In addition, we discuss how health sciences librarians, with the use of new models of information instruction and delivery, can work with nursing faculty in developing curricula for training students in EBP.

Computer User Training↗

PubMed2005

First-principle computation of zero-field splittings: application to a high valent Fe(IV)-oxo model of nonheme iron proteins.

We report the computational implementation of a combined spin-density-functional theory and perturbation theory (SDFT-PT) methodology for the accurate calculation of zero-field splittings (ZFS) in complexes of the most diverse nature including metal centers in proteins. We have applied the SDFT-PT methodology to study the cation of the recently synthesized complex [Fe(IV)(O)-(TMC)(NCCH(3))](OTf)(2), [J. Rohde et al., Science 299, 1037 (2003)] which is an important structural and functional analog of high-valent intermediates in catalytic cycles of nonheme iron enzymes. The calculated value (D(Theory)=28.67 cm(-1)) is in excellent agreement with the unusually large ZFS reported by experiment (D(Exp)=29+/-3 cm(-1)). The principal component D(zz) of the ZFS tensor is oriented along the Fe(IV)=oxo bond indicating that the oxo ligand dominates the electronic structure of the complex.

Catalysis↗

PubMed2005

How the national healthcare quality and disparities reports can catalyze quality improvement.

BACKGROUND: The purpose of the National Reports on Healthcare Quality and Disparities is to enhance awareness of quality and health care disparities, track progress, understand variations, and catalyze improvements in health care. OBJECTIVES: The objective of this paper is to propose a model that will facilitate a user's progression from knowledge to action and to show how the reports, its data warehouse, associated products, and Agency for Healthcare Research and Quality resources are integrated and focused on a comprehensive campaign to improve health care quality. DESIGN: The design of the paper is to present a conceptual model and to show how implementation strategies for the reports fit the model. FINDINGS: The authors propose a quality improvement supply chain model to help elucidate the links of the process, corresponding developmental stages that potential users need to master and progress through, and "just-in-time" supply chain inputs at each of the corresponding stages, and populate the model with examples. CONCLUSION: The traditional ways of disseminating knowledge derived from science through reports and conferences are inadequate to the humbling need for vast improvements in the US health care system. Our model suggests the need for a wide variety of information, packaged in a diverse ways, and delivered just in time and on demand. It encourages the alignment of decision makers and researchers, along with information intermediaries and innovation brokers, to make the information production cycle more efficient and effective. Future iterations of the reports will improve relevance, meaning, and distribution of information to facilitate its uptake by potential users.

Adolescent↗

PubMed1999

[Management of DNA banks: ethical concerns].

With the creation of DNA banks, short and long-term studies can be conducted on the DNA of many individuals using stored cells and tissues. These studies allow an analysis of the pathophysiological impact of genetics and help define individual markers predictive of risk. Genome analysis is thus an important advance in medical science, providing essential information for establishing appropriate measures to slow disease development, limit severity or improve safe recovery. The use of genetic results may however have an adverse effect in certain situations if the genetic information collected were deviated from its purely medical purpose under the influence of social, occupational or economic factors. The aim of our study was to analyse the ethical challenges linked to the implementation of DNA banks in France, particularly to see how to maintain the concept of individual protection in biomedical research within the patient-physician relationship in the current context of legal and administrative regulations in France. In this study, we discuss a set of criteria which should be systematically evaluated in information collection and consent procedures prior to blood or tissue procurement for DNA bank purposes.

Biological Specimen Banks↗