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 1,783 records · Page 99Linked to original sources

PubMed1994

Hepatitis B vaccine: a pharmacoeconomic evaluation of its use in the prevention of hepatitis B virus infection.

Worldwide, hepatitis B virus (HBV) infection is a major cause of acute and chronic hepatitis, cirrhosis and hepatocellular cancer. Infants and children are at the greatest risk of becoming chronically infected with HBV, and therefore at the greatest risk of developing long term sequelae. Immunisation against HBV represents an important means of controlling the disease. Hepatitis B vaccines are effective in preventing HBV infection and are well tolerated. In addition, they are suitable for integration into mass neonatal vaccination programmes. While there are considerable economic data concerning hepatitis B vaccination, differing methodologies and end-points present a challenge in reviewing these studies for consistent findings. Immunisation strategies should be implemented in accordance with local area disease incidence and patterns of HBV transmission, and will be influenced by regional budgetary constraints. In conclusion, universal neonatal vaccination is both cost effective and appropriate for control of HBV infection in regions of medium or high endemicity. In low endemicity areas, selective vaccination of high-risk groups is cost effective, but its impact on the incidence of HBV infection will depend on the ability to reach these groups. Expanded vaccination strategies may be appropriate where local conditions prohibit efficient access to high-risk groups.

Adolescent↗

PubMed2003

Lifestyle intervention for the prevention of type 2 diabetes mellitus: putting theory to practice.

Type 2 diabetes mellitus is a serious, growing, and costly public health problem. The disease is chronic and degenerative, and thus primary prevention is desirable. Observational studies have linked type 2 diabetes to specific lifestyle behaviors. Several recent major clinical trials confirm that type 2 diabetes can be delayed or prevented in people at high risk; multicomponent lifestyle modification can reduce the incidence of diabetes up to 58%. The American Diabetes Association has recently recommended that lifestyle interventions to prevent or delay diabetes be delivered to people with prediabetes. Delivery of lifestyle interventions in practice is fraught with challenges, but there are several tools and practical strategies available for the implementation of trial findings.

Clinical Trials as Topic↗

PubMed2005

The European vibration directive.

The European Union adopted a Directive in 2002 on minimum requirements for the health and safety of workers exposed to vibration. This is known as the Physical Agents (Vibration) Directive. It builds on existing general employers' duties to manage risks to health and safety, and introduces exposure action and limit values for both hand-arm vibration and whole-body vibration, setting minimum standards for the control of vibration risks across Europe. New Regulations on Vibration at Work will be introduced in Great Britain on 6 July 2005 to implement the Directive. These Regulations should serve to strengthen the continuing work of the Health and Safety Executive (HSE) to reduce exposures to hand-arm vibration in British industry. Implementation of the Directive for whole-body vibration presents a different challenge and the HSE is currently preparing appropriate guidance to accompany the Regulations. This will form part of an holistic approach to back pain in professional drivers, setting vibration in context with other risk factors, particularly postural concerns and manual handling operations.

European Union↗

PubMed2004

A new approach to control of anemia in "at risk" infants and children around the world. 2004 Ryley-Jeffs memorial lecture.

An estimated 60-80% of the world's population is affected by iron deficiency. It is the most common preventable nutritional deficiency in the world, despite global goals for its reduction. Young children are the highest risk group, particularly during their rapid period of growth. Anemia in infants and young children is known to have a negative impact on motor and socioemotional development and cognitive function. A new intervention, microencapsulated ferrous fumarate Sprinkles, has been developed to treat iron deficiency. The development process took the intervention from the idea stage to the research stage to the implementation stage. Multiple micronutrient Sprinkles are a breakthrough in meeting the global challenge to reduce childhood anemia due to iron and other micronutrient deficiencies. The goal of the Sprinkles project is to reduce the global burden of childhood anemia by promoting healthy weaning practices, by advocating home-fortification strategies to increase the micronutrient content of weaning foods, and by making Sprinkles widely available, particularly in developing countries.

Anemia, Iron-Deficiency↗

PubMed2002

DNA fngerprinting of Mycobacterium tuberculosis: lessons learned and implications for the future.

DNA fingerprinting of Mycobacterium tuberculosis--a relatively new laboratory technique--offers promise as a powerful aid in the prevention and control of tuberculosis (TB). Established in 1996 by the Centers for Disease Control and Prevention (CDC), the National Tuberculosis Genotyping and Surveillance Network was a 5-year prospective, population-based study of DNA fingerprinting conducted from 1996 to 2000. The data from this study suggest multiple molecular epidemiologic and program management uses for DNA fingerprinting in TB public health practice. From these data, we also gain a clearer understanding of the overall diversity of M. tuberculosis strains as well as the presence of endemic strains in the United States. We summarize the key findings and the impact that DNA fingerprinting may have on future approaches to TB control. Although challenges and limitations to the use of DNA fingerprinting exist, the widespread implementation of the technique into routine TB prevention and control practices appears scientifically justified.

Centers for Disease Control and Prevention, U.S.↗

PubMedDate not supplied

Getting evidence into practice: ingredients for change.

Mounting pressure is being exerted to ensure that the delivery of care is evidence-based and clinically effective. However, the challenge this presents to practitioners is complex. The authors propose that successful implementation of evidence into practice is a function of three elements: the nature of the evidence; the context in which the change is to take place; and the way the process is managed. A framework has been developed to represent these factors. For those about to embark on implementation work, this article closes by highlighting a number of key questions for consideration, stimulated by the framework.

Delivery of Health Care↗

PubMed1997

The value of clinical pathways in home care.

Providing cost-effective, high-quality care can pose a challenge in this era of managed care. One agency successfully established and implemented multidisciplinary teams to organize and optimize care. Two case studies compare the nursing process of traditional versus well-managed care and show that clinical pathways can be effective tools to enhance the nursing process in home care.

Cost-Benefit Analysis↗

PubMed1997

Healthcare information system approaches based on middleware concepts.

To meet the challenges for efficient and high-level quality, health care systems must implement the "Shared Care" paradigm of distributed co-operating systems. To this end, both the newly developed and legacy applications must be fully integrated into the care process. These requirements can be fulfilled by information systems based on middleware concepts. In the paper, the middleware approaches HL7, DHE, and CORBA are described. The relevance of those approaches to the healthcare domain is documented. The description presented here is complemented through two other papers in this volume, concentrating on the evaluation of the approaches, and on their security threats and solutions.

Computer Communication Networks↗

PubMed1989

New directions in hospital governance.

This article suggests new directions for hospital governance to meet the demands of a rapidly changing health care environment. Board members must increasingly play roles as risk takers, strategic directors, experts, mentors, and evaluators. Lessons from other industries regarding risk taking, use of expertise, and streamlining decision making must be adapted to meet hospital needs. Recent data suggest that these needs may still differ by hospital ownership despite a convergence in investor-owned and not-for-profit corporate structures. The effectiveness of hospital boards in the future will depend on their ability to: (1) manage a diverse group of stakeholders; (2) involve physicians in the management and governance process; (3) meet the governance needs of multi-institutional systems and hospital restructuring; (4) meet the challenges of diversification and vertical integration; and (5) understand strategy formulation and implementation as interdependent and interrelated processes.

Decision Making, Organizational↗

PubMed1999

Making Internet benefits enrollment work for you.

With all of its promise, the Internet is virtually impossible for a benefits administrator to ignore, but implementing an Internet-enabled benefits administration system is not without its challenges. However, with the proper care and planning, any employer, regardless of size or employee population, can successfully leverage this technology to simplify benefits administration, reduce costs and improve the level of service to plan participants.

Communication↗

PubMed2001

Coordinating a multiple casualty Critical Incident Stress Management (CISM) response within a medical/surgical hospital setting.

The medical/surgical hospital environment presents numerous challenges to a Critical Incident Stress Management (CISM) Team Coordinator responsible for implementing a psychological crisis intervention. Often this person is responsible for managing a response to a large in-house multiple-casualty incident, sometimes involving fatalities. Many mental health professionals have not had the opportunity to work in a medical/surgical healthcare facility and consequently are not familiar with the environment (and agency culture) that exists within these employment settings. This article will review important factors to be considered during the initial assessment of a critical incident in a hospital setting, logistical concerns that are unique to this setting, and the subsequent planning of the Critical Incident Stress Management Team crisis management response.

Crime Victims↗

PubMed2002

Water policy differences between a western democracy and a country in economic transition.

Where environmental policy is concerned Western democracies and transition economies share more similarities than differences. Sound environmental policies require substantial investment. Public-private cooperation can play a major role in the search for solutions, but politicians, environmentalists and academics must act vigorously to ensure that big business does not acquire a final say in the implementation of environmental policy. Lithuania as a transition economy faces major environmental challenges, but international collaboration, including working with the European Union and cross-border cooperation with neighbouring states, is bringing good results. A major unifying factor for the Baltic Sea states is the continuing struggle to purify and protect the Baltic Sea.

Baltic States↗

PubMed2002

Consumerism: automating patient and provider interactions.

Healthcare is essentially an information industry that is seeking to automate its processes and use Internet technology to support its consumers. The healthcare industry understands that, without computerization, it would be nearly impossible to reduce medical errors, analyze the delivery of care, and provide real-time clinical decision support to healthcare providers to support patient care via the Internet. Without progressive steps, use of Internet technology to care for patients will be limited. The only way to meet the information challenges of tomorrow is to begin capitalizing on today's technology and implement the necessary tools now. Most important, healthcare organizations need to adopt a full array of technology to support their consumers in the electronic world of today and tomorrow.

Consumer Advocacy↗

PubMed2003

Managing the cost drivers of medical injectables.

In recent years, the cost increases of medical injectables--pharmaceuticals and apparatus used to treat rare and chronic diseases--have far outstripped the rises in medical costs in general. Health plans have taken notice, and many are designing and implementing new procedures for managing these treatments. The task is complex and challenging, but identifying and addressing the cost drivers and, in particular, creating specialty pharmacy networks, hold the promise of containing the spiraling cost of medical injectables.

Chronic Disease↗

PubMed2003

Making the Health Insurance Flexibility and Accountability (HIFA) waiver work through collaborative governance.

This paper argues that collaborative governance should be an essential component in any HIFA waiver proposal, due to the fact that the health care system is moving away from a federal and hierarchical program design and implementation towards a more local, collaborative approach. As several current collaborative projects demonstrate, collaboration may overcome barriers to health expansion program success, such as stakeholder buy-in, notice, and state access to private health coverage information. Furthermore, collaboration within the context of the HIFA waiver process may maximize the strengths of current collaborations, such as providing: (a) access to greater and more stable funding sources; (b) access to a facilitator that can collect and distribute data; and (c) an avenue for accountability. Multiple challenges in ensuring collaborative governance are reviewed. Ms. Zabawa argues that these challenges are not insurmountable if states adopt a truly collaborative approach to designing and implementing programs under the HIFA waiver; there may be hope in expanding and improving health coverage, since collaboration is the most appropriate mechanism to address the complexity of health system reform.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2004

UME-21 local evaluation initiatives: contributions and challenges.

BACKGROUND AND OBJECTIVES: The 18 medical schools involved in the UME-21 initiative developed innovative curricula and evaluation strategies. While there was significant variation in how schools approached the evaluation process, there were common methodological issues and challenges affecting the reliability of scores and validity of interpretations regarding outcomes. This paper explores these issues and challenges, using experiences from selected UME-21 schools. METHODS: Four evaluation issues and strategies are discussed: instrument development, study design, process evaluation using formative evaluation methods, and qualitative strategies. Within each discussion, examples from a UME-21 school are presented. RESULTS: The four evaluation strategies offered the flexibility to match local evaluation needs with an effective approach to evaluations. CONCLUSIONS/IMPLICATIONS: The school-level evaluation requirements by the UME-21 initiative provided schools the flexibility to design individualized evaluation strategies, yet also encouraged collaboration among evaluators. While this strategy resulted in many successes at the school level, it also served to identify common methodological challenges that can be used as a guide for other schools in implementing and evaluating curricula.

Clinical Clerkship↗

PubMed2004

Ethical decision-making by students in physical and occupational therapy.

The professions of physical therapy (PT) and occupational therapy (OT) progressively have expanded their scope of responsibility, and practitioners often are placed in positions in which ethical decisions must be made. Few studies have reported the level of moral development and the effects of education on ethical decision making in PT or OT students. This research study was designed to determine the impact of the educational programs at the University of New Mexico (UNM) in PT and OT on the moral reasoning of the students as measured by the Defining Issues Test (DIT). The longitudinal design of this study followed two consecutive classes in each program (N = 94; 58 PT students and 36 OT students) from entry until graduation approximately 2 years later. The subjects completed a demographic survey and the DIT on the first day of class and again during their final semester (OT) or at graduation (PT). A factorial analysis of covariance was used to examine the effects of a professional degree program (PT and OT) and time (ENTRY and EXIT), after adjusting for the effects of age. The mean P score for this sample was between 45 and 46, which is within range for college and professional students. There was a significant relationship between age and the P score of the DIT. There were no significant differences between PT and OT students or between the entering and the exiting scores for either group of students. Based on the results of this study, these educational programs do not seem to be facilitating moral development in these students. The baseline level of moral development and the skills that PT and OT students use when making ethical decisions need to be established. Additional research is recommended with a larger sample size, including students in other locations. To optimize clinical practice, students must be taught how to make ethical as well as clinical judgments. Therapists must be capable of functioning in the changing health care environment, now and in the future. If the disciplines of PT and OT expect to graduate students who meet this challenge, the educational programs must take the responsibility for evaluating students and implementing curricula that facilitate ethical decision making.

Adult↗

PubMedDate not supplied

An evaluation of the care provided to patients prescribed controlled substances for chronic nonmalignant pain at an academic family medicine center.

BACKGROUND AND OBJECTIVES: Prescribing medications for chronic nonmalignant pain (CNMP) can be challenging for physicians for many reasons. In 1999, the state of Oregon implemented new guidelines governing the prescription of medications for CNMP. This study assessed the quality of care provided to CNMP patients, including the extent of compliance with the new state requirements 2 years after they were implemented. METHODS: We used telephone records to identify patients who had called for prescription refills between mid 2001 and mid 2002. We then reviewed medical records of those patients to identify those who received refills for opioids or benzodiazepines for treatment of chronic pain. Medical records were evaluated to measure the percentage of records exhibiting documentation of compliance with state prescribing laws and other features indicative of a high standard of care. RESULTS: Ninety seven percent of records included documentation of the diagnosis for which chronic therapy was indicated. Required Material Risk Notification Forms were absent from 100% of charts. Seventy-five percent of records document consultation with a pain specialist or other physician with specialty pertinent to the patient's source of pain. Medication contracts were only present in 39% of records, and documentation of a pain evaluation and functional evaluation was present in 67% and 54% of records, respectively. CONCLUSIONS: Review of medical records in our clinic documented less-than-optimal compliance with state laws regulating prescribing for CNMP and the need for improvement in assessment and care of these patients.

Academic Medical Centers↗