How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

PubMed

OʼRourke, Hannah M; Fraser, Kimberly D

2016-01-01

Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

Making a Difference: Leading and Managing for Quality Improvement in Adult and Community Learning.

ERIC Educational Resources Information Center

Ravenhall, Mark; Kenway, Mike

This guide looks at demands on leaders and managers in adult and community learning (ACL) in the roles and issues they face in the context of quality improvement (QI). It suggests practical approaches for improving the quality of provision for adults. The guide's design builds on current practice toward the desired state of excellence in all…

Empirical Analysis of Green Supply Chain Management Practices in Indian Automobile Industry

NASA Astrophysics Data System (ADS)

Luthra, S.; Garg, D.; Haleem, A.

2014-04-01

Environmental sustainability and green environmental issues have an increasing popularity among researchers and supply chain practitioners. An attempt has been made to identify and empirically analyze green supply chain management (GSCM) practices in Indian automobile industry. Six main GSCM practices (having 37 sub practices) and four expected performance outcomes (having 16 performances) have been identified by implementing GSCM practices from literature review. Questionnaire based survey has been made to validate these practices and performance outcomes. 123 complete questionnaires were collected from Indian automobile organizations and used for empirical analysis of GSCM practices in Indian automobile industry. Descriptive statistics have been used to know current implementation status of GSCM practices in Indian automobile industry and multiple regression analysis has been carried out to know the impact on expected organizational performance outcomes by current GSCM practices adopted by Indian automobile industry. The results of study suggested that environmental, economic, social and operational performances improve with the implementation of GSCM practices. This paper may play an important role to understand various GSCM implementation issues and help practicing managers to improve their performances in the supply chain.

Improving Teacher Education Programs

ERIC Educational Resources Information Center

Harding, Kelly; Parsons, Jim

2011-01-01

In this paper, the authors review current practices in pre-service teacher education. They suggest that radical improvements are possible and that, if practiced, would help mediate many of the pressures young teachers face. To do so, the authors: 1) outline the experiences of young teachers to consider how teachers might thrive in a difficult…

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

Articulating current service development practices: a qualitative analysis of eleven mental health projects

PubMed Central

2014-01-01

Background The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Methods Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Results Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. Conclusions This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial. PMID:24438471

Articulating current service development practices: a qualitative analysis of eleven mental health projects.

PubMed

Jun, Gyuchan Thomas; Morrison, Cecily; Clarkson, P John

2014-01-17

The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

Study of Current Practice and Future Advancements in Blood Management and Effectiveness of a Multimodality Training Program on Improving Transfusion Knowledge, Practice and Outcomes

DTIC Science & Technology

2012-08-01

to trauma, surgery or blood diseases such as anemia, hemophilia or sickle- cell disease. But transfusions carry risks. Current practices are often...Blood Management Topic 4: Diagnosis of Red cell disorders and oxygen carrying capacity Topic 5: Diagnosis of Disorders in homeostasis Topic 6...the Clinical Transfusion Medicine Committee of the AABB. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med

Review article: practical current issues in perioperative patient safety.

PubMed

Eichhorn, John H

2013-02-01

This brief review provides an overview and, importantly, a context perspective of relevant current practical issues in perioperative patient safety. The dramatic improvement in anesthesia patient safety over the last 30 years was not initiated by electronic monitors but, rather, largely by a set of behaviours known as "safety monitoring" that were then made decidedly more effective by extending the human senses through electronic monitoring, for example, capnography and pulse oximetry. In the highly developed world, this current success is threatened by complacency and production pressure. In some areas of the developing/underdeveloped world, the challenge is implementing the components of anesthesia practice that will bring safety improvements to parallel the overall current success, for instance, applying the World Federation of Societies of Anaesthesiologists (WFSA) "International Standards for A Safe Practice of Anaesthesia". Generally, expanding the current success in safety involves many practical issues. System issues involve research, effective reporting mechanisms and analysis/broadcasting of results, perioperative communication (including "speaking up to power"), and checklists. Monitoring issues involve enforcing existing published monitoring standards and also recognizing the risk of danger to the patient from hypoventilation during procedural sedation and from postoperative intravenous pain medications. Issues of clinical care include medication errors in the operating room, cerebral hypoperfusion (especially in the head-up position), dangers of airway management, postoperative residual weakness from muscle relaxants, operating room fires, and risks specific in obstetric anesthesia. Recognition of the issues outlined here and empowerment of all anesthesia professionals, from the most senior professors and administrators to the newest practitioners, should help maintain, solidify, and expand the improvements in anesthesia and perioperative patient safety.

Nutritional screening, assessment and implementation strategies for adults in an Australian acute tertiary hospital: a best practice implementation report.

PubMed

Smith, Louise; Chapman, Amanda; Flowers, Kelli; Wright, Kylie; Chen, Tanghua; O'Connor, Charmaine; Astorga, Cecilia; Francis, Nevenka; Vigh, Gia; Wainwright, Craig

2018-01-01

The project aimed to improve the effectiveness of nutritional screening and assessment practices through clinical audits and the implementation of evidence-based practice recommendations. In the absence of optimal nutrition, health may decline and potentially manifest as adverse health outcomes. In a hospitalized person, poor nutrition may adversely impact on the person's outcome. If the nutritional status can be ascertained, nutritional needs can be addressed and potential risks minimized.The overall purpose of this project was to review and monitor staff compliance with nutritional screening and assessment best practice recommendations ensuring there is timely, relevant and structured nutritional therapeutic practices that support safe, compassionate and person-centered care in adults in a tertiary hospital in South Western Sydney, Australia, in the acute care setting. A baseline retrospective chart audit was conducted and measured against 10 best practice criteria in relation to nutritional screening and assessment practices. This was followed by a facilitated multidisciplinary focus group to identify targeted strategies, implementation of targeted strategies, and a post strategy implementation chart audit.The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRIP) tool, including evidence from other available supporting literature, for promoting change in healthcare practice. The baseline audit revealed deficits between current practice and best practice across the 10 criteria. Barriers for implementation of nutritional screening and assessment best practice criteria were identified by the focus group and an education strategy was implemented. There were improved outcomes across all best practice criteria in the follow-up audit. The baseline audit revealed gaps between current practice and best practice. Through the implementation of a targeted education program and resource package, outcomes improved in the follow up audit. The findings indicated that engagement from multidisciplinary team members and consumers was effective in developing tailored education that improved knowledge of best practice. This was demonstrated by an increase in the percentage of compliance across the 10 criteria, although leaving room for more improvement. A policy has been developed for implementation and future audits are planned to measure whether improved practices have been sustained.

Examination of the current practice of lighting in Virginia : nighttime work zones and improving safety through the development of nighttime lighting specifications : final report.

DOT National Transportation Integrated Search

2017-09-01

This project evaluated current nighttime work zone lighting practices for limited-access highways and primary routes in Virginia through (1) an on-site evaluation of lighting levels in work zones; (2) an illuminance characterization of various commer...

Examination of the current practice of lighting in Virginia : nighttime work zones and improving safety through the development of nighttime lighting specifications : summary report.

DOT National Transportation Integrated Search

2017-09-01

This project evaluated current nighttime work zone lighting practices for limited-access highways and primary routes in Virginia through (1) an on-site evaluation of lighting levels in work zones; (2) an illuminance characterization of various commer...

Birth Control in Clinical Trials

PubMed Central

Stewart, J.; Beyer, B. K.; Chadwick, K.; De Schaepdrijver, L.; Desai, M.; Enright, B.; Foster, W.; Hui, J. Y.; Moffat, G. J.; Tornesi, B.; Van Malderen, K.; Wiesner, L.; Chen, C. L.

2015-01-01

The Health and Environmental Sciences Institute (HESI) Developmental and Reproductive Toxicology Technical Committee sponsored a pharmaceutical industry survey on current industry practices for contraception use during clinical trials. The objectives of the survey were to improve our understanding of the current industry practices for contraception requirements in clinical trials, the governance processes set up to promote consistency and/or compliance with contraception requirements, and the effectiveness of current contraception practices in preventing pregnancies during clinical trials. Opportunities for improvements in current practices were also considered. The survey results from 12 pharmaceutical companies identified significant variability among companies with regard to contraception practices and governance during clinical trials. This variability was due primarily to differences in definitions, areas of scientific uncertainty or misunderstanding, and differences in company approaches to enrollment in clinical trials. The survey also revealed that few companies collected data in a manner that would allow a retrospective understanding of the reasons for failure of birth control during clinical trials. In this article, suggestions are made for topics where regulatory guidance or scientific publications could facilitate best practice. These include provisions for a pragmatic definition of women of childbearing potential, guidance on how animal data can influence the requirements for male and female birth control, evidence-based guidance on birth control and pregnancy testing regimes suitable for low- and high-risk situations, plus practical methods to ascertain the risk of drug-drug interactions with hormonal contraceptives. PMID:27042398

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

Practice Behaviors of Eighth-Grade Instrumental Musicians

ERIC Educational Resources Information Center

Rohwer, Debbie; Polk, Jeremy

2006-01-01

The purposes of the current study were to (1) determine the relationship between the number of practice strategies students could articulate and their performance improvement scores, (2) identify trends in students' 5-minute practice behaviors, and (3) compare students' achievement based on their practice procedures. Participants were 65 eighth…

Professional Learning Communities: Teachers Working Collaboratively for Continuous Improvement

ERIC Educational Resources Information Center

Griffith, Louise Ann

2009-01-01

Current research indicates that a professional learning community (PLC) is an effective means for helping teachers to bridge the gap between research and practice. A PLC is a team of educators systematically working together to improve teaching practice and student learning. This study evaluated the PLC formed by teachers at a public elementary…

Record of Assessment Moderation Practice (RAMP): Survey Software as a Mechanism of Continuous Quality Improvement

ERIC Educational Resources Information Center

Johnson, Genevieve Marie

2015-01-01

In higher education, assessment integrity is pivotal to student learning and satisfaction, and, therefore, a particularly important target of continuous quality improvement. This paper reports on the preliminary development and application of a process of recording and analysing current assessment moderation practices, with the aim of identifying…

Defining Continuous Improvement and Cost Minimization Possibilities through School Choice Experiments

ERIC Educational Resources Information Center

Merrifield, John

2009-01-01

Studies of existing best practices cannot determine whether the current "best" schooling practices could be even better, less costly, or more effective and/or improve at a faster rate, but we can discover a cost effective menu of schooling options and each item's minimum cost through market accountability experiments. This paper describes…

Improved Writing-Conductor Designs For Magnetic Memory

NASA Technical Reports Server (NTRS)

Wu, Jiin-Chuan; Stadler, Henry L.; Katti, Romney R.

1994-01-01

Writing currents reduced to practical levels. Improved conceptual designs for writing conductors in micromagnet/Hall-effect random-access integrated-circuit memory reduces electrical current needed to magnetize micromagnet in each memory cell. Basic concept of micromagnet/Hall-effect random-access memory presented in "Magnetic Analog Random-Access Memory" (NPO-17999).

Current Risk Management Practices in Psychotherapy Supervision.

PubMed

Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee

2017-12-01

Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures. © 2017 American Academy of Psychiatry and the Law.

Forest Practice Rules and cumulative watershed impacts in California

Treesearch

L. M. Reid

1999-01-01

Response to the following questions, "As currently implemented, are existing California forest practice rules effective in preventing cumulative watershed impacts, including flooding?" and "What kind of measures might improve the effectiveness of forest practices rules for avoiding forestry-related cumulative watershed impacts

If I Was Going There I Wouldn't Start from Here: A Critical Commentary on Current Assessment Practice

ERIC Educational Resources Information Center

Price, Margaret; Carroll, Jude; O'Donovan, Berry; Rust, Chris

2011-01-01

Assessment is currently in the spotlight for its poor ratings in student satisfaction surveys and "under performance" in quality reviews. Consequently, a variety of initiatives and projects are being undertaken aimed at improving assessment. However, many of the concepts and theories underpinning assessment practice are complex and interrelated,…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smegal, J.; Lstiburek, J.

There is an increasing market in liquid (or fluid) applied water management barriers for residential applications that could be used in place of tapes and other self-adhering membranes if applied correctly, especially around penetrations in the enclosure. This report discusses current best practices, recommends ways in which the best practices can be improved, and looks at some current laboratory testing and testing standards.

Coordination of care by primary care practices: strategies, lessons and implications.

PubMed

O'Malley, Ann S; Tynan, Ann; Cohen, Genna R; Kemper, Nicole; Davis, Matthew M

2009-04-01

Despite calls from numerous organizations and payers to improve coordination of care, there are few published accounts of how care is coordinated in real-world primary care practices. This study by the Center for Studying Health System Change (HSC) documents strategies that a range of physician practices use to coordinate care for their patients. While there was no single recipe for coordination given the variety of patient, physician, practice and market factors, some cross-cutting lessons were identified, such as the value of a commitment to interpersonal continuity of care as a foundation for coordination. Respondents also identified the importance of system support for the standardization of office processes to foster care coordination. While larger practices may have more resources to invest, many of the innovations described could be scaled to smaller practices. Some coordination strategies resulted in improved efficiency over time for practices, but by and large, physician practices currently pursue these efforts at their own expense. In addition to sharing information on effective strategies among practices, the findings also provide policy makers with a snapshot of the current care coordination landscape and implications for initiatives to improve coordination. Efforts to provide technical support to practices to improve coordination, for example, through medical-home initiatives, need to consider the baseline more typical practices may be starting from and tailor their support to practices ranging widely in size, resources and presence of standardized care processes. If aligned with payment incentives, some of these strategies have the potential to increase quality and satisfaction among patients and providers by helping to move the health care delivery system toward better coordinated care.

Areas for improvement in community optometry: flashes and floaters take priority.

PubMed

Duncan, Eilidh M; Cassie, Heather; Pooley, Janet; Elouafakoui, Paula; Prior, Maria; Gibb, Elizabeth; Ramsay, Craig; Young, Linda

2018-07-01

A common response to rising demand for healthcare is to extend the role of health professionals and the range of their service provision. Community optometry in Scotland is a recent example of this. Within this context of innovation and change there are challenges to ensuring quality in optometry practice. The purpose of this research is to establish what the priorities are for practice improvement within community optometry and to start a programme to inform strategies to improve practice. A four stage study was conducted: (1) a service-driven topic prioritisation exercise to identify priorities for optometry practice improvement; (2) a review of national and international guidance and UK protocols relating to the identified priority topic; (3) a national theory-based survey identifying current practice and the barriers and facilitators to the target behaviour; and (4) the identification of theory-based intervention options to improve practice. The Behaviour Change Wheel approach to behaviour change intervention development and Theoretical Domains Framework (TDF) provided the underlying theoretical framework. Stakeholders identified 'patients presenting with flashes and floaters' as an important priority for practice improvement. The decision about whether or not to refer patients on to secondary care for further examination is the target behaviour. Guidance for optometrists on this topic is lacking. Six TDF domains were related to the decision about whether or not to refer patients with flashes and floaters to secondary care - 'social influences', 'emotion', 'beliefs about capabilities', 'beliefs about consequences', 'behavioural regulation' and 'reinforcement'. This study has examined current practice in relation to the management of patients with flashes and floaters, identified the most salient targets for future strategies to improve optometry practice and highlighted what form these strategies may take. It demonstrates the use of a flexible, theory-informed approach, which can be used to engage with stakeholders and professionals to inform the design and development of efforts to improve practice in a variety of healthcare settings. © 2018 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

Avoiding the "Brick Wall of Awkward": Perspectives of Youth with Autism Spectrum Disorder on Social-Focused Intervention Practices

ERIC Educational Resources Information Center

Bottema-Beutel, Kristen; Mullins, Teagan S.; Harvey, Michelle N.; Gustafson, Jenny R.; Carter, Erik W.

2016-01-01

Many youth with autism spectrum disorder participate in school-based, peer-mediated intervention programs designed to improve their social experiences. However, there is little research discerning how these youth view intervention practices currently represented in the literature, information which could improve the social validity of intervention…

Combining the Best of Two Worlds: A Conceptual Proposal for Evidence-Informed School Improvement

ERIC Educational Resources Information Center

Brown, Chris; Schildkamp, Kim; Hubers, Mireille D.

2017-01-01

Background: Data-based decision-making (DBDM) and research-informed teaching practice (RITP) are key to teacher and school improvement. Currently, however, DBDM and RITP represent two distinct approaches to developing evidence-informed practice (EIP) and do not correspond to the all-encompassing notion of EIP envisaged by many academics and…

Are hospital quality improvement and public accountability compatible?

PubMed

Panzer, R J

1994-07-01

The goals of public accountability and quality improvement are compatible in theory but not necessarily in practice. Both concepts emphasize the customer. However, those working toward these two goals design systems with quite different roles and relationships between the providers and consumers of health care. Superficial interactions obstruct meaningful dialogue about how to build a better system meeting both sets of goals. Current practices of public accountability and quality improvement have fundamentally different paradigms concerning the roles and responsibilities of those who provide and those who consume health care. There are at least three ways to improve the current relationship between public accountability and quality improvement. First, optimizing the design and performance of each effort would be an improvement since the goals are highly compatible. Neither ideal currently meets its own expectations, creating distrust among the proponents of each when reality falls short. Second, the two efforts could be coordinated through joint community-level planning and sharing. Finally and optimally, the two concepts could be made part of the same community-level cooperative system, an approach that offers the greatest opportunity for achieving shared goals.

Development, Implementation, and Evaluation of a Strategic Plan for Improving Physical Plant Management at Southwest Texas Junior College.

ERIC Educational Resources Information Center

Box, Wilford Winston

A study was conducted at Southwest Texas Junior College (STJC) to assess current management practices used by the physical plant maintenance department (PPMD) and to develop a strategic plan for physical plant management. Procedures included an analysis of current management practices and systems that affect physical resources, and periodic and…

Water Management of Noninsulating and Insulating Sheathings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smegal, J.; Lstiburek, J.

2012-04-01

There is an increasing market in liquid (or fluid) applied water management barriers for residential applications that could be used in place of tapes and other self-adhering membranes if applied correctly, especially around penetrations in the enclosure. This report discusses current best practices, recommends ways in which the best practices can be improved, and looks at some current laboratory testing and testing standards.

75 FR 3753 - Tishomingo National Wildlife Refuge, Comprehensive Conservation Plan, Johnston County, OK

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... equivalent to existing restoration practices. Recreational opportunities would continue to be limited to... improved or expanded to accommodate more visitors. Current habitat management practices would continue... management practices would contribute to ongoing monitoring and modification of Refuge resources for years to...

Assessment of training capacity in New Zealand general practices: a stocktake in the lower North Island and South Island.

PubMed

Murton, Samantha A; Pullon, Susan Rh

2017-09-22

General practices are providing clinically-based training for rapidly increasing numbers of medical (and other health professional) trainees. This study investigated capacity and intention of general practices to additionally teach junior doctors (now required to undertake community-based attachments by the New Zealand Medical Council) alongside current trainees in their service. A web-based/telephone survey of all general practices was developed and administered November 2015-April 2016. In the Otago study region (lower North Island, South Island), 463 currently operating practices were identified. (A companion Auckland-based study concurrently investigated the upper North Island.) Of the 280/463 (60%) responding practices, 93% (261/280) were currently taking health professional trainees, with 86% (241/280) taking at least one type of medical trainee. Practices indicate that 14% fewer of them will take undergraduate medical students than previously (199 practices down to 162), but more would take junior doctors (42 up to 79) and GP registrars (129 practices up to 142). Most practices in these regions already contribute to teaching. Practices indicated limitations in accommodating continued increases in numbers of trainees in the current poorly coordinated system. Improved support and training for practices is needed to enable practices to take more trainees of multiple types per practice, both concurrently and sequentially.

Water Use: A Survey

ERIC Educational Resources Information Center

Fleming, Rose Glee; Warden, Jessie

1976-01-01

A survey of Florida State University students showed that their current laundry practices generate energy and water over-consumption. The survey also resulted in some concrete suggestions to the students that would improve their conservation practices. (Author/BP)

Pedagogical Practices in Early Childhood Education and Care in Tanzania: Policy and Practices

ERIC Educational Resources Information Center

Mligo, Ignasia; Mitchell, Linda; Bell, Beverley

2016-01-01

The purpose of this study was to examine current pedagogical practices in early childhood education and care in Tanzania, a reflection from policy and practices to the implementation of Learner-Centred Pedagogy and to put forward possible improvements for the future. In 2005 a new pre-school education curriculum introduced a learner-centred…

E-Learning Instructional Design Practice in American and Australian Institutions

ERIC Educational Resources Information Center

Sadeghi, Sayed Hadi

2017-01-01

This research study provides a comparative understanding of instructional design e-practice in an Australian and an American university. This comparative study identifies information relating to the current status of instructional design e-practice that will be of assistance to Australian universities to improve their existing online programs. The…

Pilot of a Learning Management System to Enhance Counselors' Relational Qualities through Mindfulness-Based Practices

ERIC Educational Resources Information Center

Ballinger, Julie Ann

2013-01-01

Mindfulness-based practices are associated with increased attentional qualities, improved self-focus styles, enhanced empathic understanding, and strengthened self-compassion, making these practices a viable addition to counselor training programs. However, current mindfulness training models are primarily designed for relief of psychological…

A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Area for Improvement

EPA Science Inventory

A systematic review was conducted of health impact assessments (HIAs) from the U.S. to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review was focused on HIAs from the four se...

Is it time for a new practice environment? Part II: an operational approach to determining space needs.

PubMed

Brooks, Larry; Griffin, Tim

2010-01-01

In today's practice of medicine, seeing patients requires space. The amount and type of space a practice needs are based on the volume of patients to be seen, services provided, and the number of providers in the practice. To evaluate whether or not your current practice space effectively houses your practice or if a new building could better support your practice, the amount and type of space the practice needs must be determined. Once this space needs assessment is done, it can be used to evaluate the current practice environment, and if need be develop preliminary drawings to evaluate new space. Both operational flow and the economics of creating the new improved practice (whether it is a renovation of existing space or brand new space) should be compared.

The path to impact of operational research on tuberculosis control policies and practices in Indonesia

PubMed Central

Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U.; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W.; Alisjahbana, Bachti

2016-01-01

Background Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Results Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Conclusions Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored. PMID:26928217

The path to impact of operational research on tuberculosis control policies and practices in Indonesia.

PubMed

Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W; Alisjahbana, Bachti

2016-01-01

Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored.

Calorie postings in chain restaurants in a low-income urban neighborhood: measuring practical utility and policy compliance.

PubMed

Cohn, Elizabeth Gross; Larson, Elaine L; Araujo, Christina; Sawyer, Vanessa; Williams, Olajide

2012-08-01

Current strategies for combating obesity include recent federal legislation mandating calorie count postings in chain restaurants. This study describes the current practice of menu board calorie postings in a low-income urban neighborhood, identifies the extent to which current practice complies with existing policy, and evaluates the practical utility of menu boards to consumers. We conclude that although most postings were legally compliant, they did not demonstrate utility. Menu postings for individual servings are easily understood, but complex math skills are needed to interpret meals designed to serve more than one person. In some items, calories doubled depending on flavor and the calorie posting did not give enough information to make healthier selections. We identified specific strategies to improve practical utility and provide recommendations for policy implementation.

Using quality experts from manufacturing to transform primary care.

PubMed

Steiner, Rose M; Walsworth, David T

2010-01-01

Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality and process improvement. Michigan uses quality experts from the manufacturing industry who are educated regarding the health care environment, which enables them to perform as quality-improvement coaches (QICs) in primary-care practices. In this case study, ninety-six quality experts were trained to coach primary-care practices, with 53 currently assigned to offices, and others assisting as needed. Practice teams and QICs identify gaps in care and office practices with the use of assorted quality-improvement tools. Reports are made monthly to describe clinical and process measures and methods used. Michigan has 33 practices engaged, involving 205 physicians and 40 midlevel providers. The teaming of quality experts from the manufacturing industry with primary-care office providers and staff resulted in office efficiency, improved care provided, and progress toward attainment of a patient-centered medical home (PCMH). Quality experts from manufacturing volunteered to coach for improvements in primary care. The efforts of QICs have been successful. Because the QICs are volunteers, sustainability of the Michigan Improving Performance in Practice program is a challenge.

Yes We Can! Improving Urban Schools through Innovative Educational Reform. Contemporary Perspectives on Access, Equity, and Achievement

ERIC Educational Resources Information Center

Howell, Leanne L., Ed.; Lewis, Chance W., Ed.; Carter, Norvella, Ed.

2011-01-01

Yes We Can: Improving Urban Schools through Innovative Educational Reform is a empirically-based book on urban education reform to not only proclaim that hope is alive for urban schools, but to also produce a body of literature that examines current practices and then offer practical implications for all involved in this arduous task. This book is…

Assessing practice-based learning and improvement.

PubMed

Salzman, David H; Franzen, Douglas S; Leone, Katrina A; Kessler, Chad S

2012-12-01

Assessment of practice-based learning and improvement (PBLI) is a core concept identified in several competency frameworks. This paper summarizes the current state of PBLI assessment as presented at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine. Based on these findings and consensus achieved at the conference, seven recommendations have been identified for future research. © 2012 by the Society for Academic Emergency Medicine.

Missed, Misused, or Mismanaged: Improving Early Detection Systems to Optimize Child Outcomes

ERIC Educational Resources Information Center

Macy, Marisa; Marks, Kevin; Towle, Alexander

2014-01-01

Early detection efforts have been shown to vary greatly in practice, and there is a general lack of systematic accountability built into monitoring early detection effort impact. This article reviews current early detection practices and the drawbacks of these practices, with particular attention given to prevalent issues of mismeasurement,…

Developing and Validating Technological Pedagogical Content Knowledge-Practical (TPACK-Practical) through the Delphi Survey Technique

ERIC Educational Resources Information Center

Yeh, Yi-Fen; Hsu, Ying-Shao; Wu, Hsin-Kai; Hwang, Fu-Kwun; Lin, Tzu-Chiang

2014-01-01

Technological pedagogical content knowledge TPACK refers to the knowledge set that teachers currently use to further improve the quality of their teaching and assist their students in learning. Several TPACK models have been proposed, either for discussing TPACK's possible composition or its practical applications. Considering that…

Improving Mathematical Problem Solving in Grades 4 through 8. IES Practice Guide. NCEE 2012-4055

ERIC Educational Resources Information Center

Woodward, John; Beckmann, Sybilla; Driscoll, Mark; Franke, Megan; Herzig, Patricia; Jitendra, Asha; Koedinger, Kenneth R.; Ogbuehi, Philip

2012-01-01

The Institute of Education Sciences (IES) publishes practice guides in education to bring the best available evidence and expertise to bear on current challenges in education. Authors of practice guides combine their expertise with the findings of rigorous research, when available, to develop specific recommendations for addressing these…

The Relationship of Leadership Qualities to Wisconsin School Superintendent Hiring Practices

ERIC Educational Resources Information Center

VerDuin, Joel A.

2011-01-01

The purpose of this study was to examine the relationship between school board hiring practices and specific leadership behaviors. The current priority of educational leaders is often spoken of in terms of accountability for student achievement. This study considered the priority of educational improvement, and examined hiring practices using five…

Enhancing “usual practice” Treatment Foster Care: Findings from a randomized trial on improving youth outcomes

PubMed Central

Farmer, Elizabeth M.Z.; Burns, Barbara J.; Wagner, H. Ryan; Murray, Maureen; Southerland, Dannia G.

2009-01-01

Objectives This article reports the initial findings from a randomized trial to enhance Treatment Foster Care (TFC) in “usual care” agencies. The intervention, Together Facing the Challenge, was built upon a combination of practice-based elements from a prior descriptive study of TFC and selected elements from Chamberlain’s evidence-based model (MTFC) to fill conspicuous gaps in usual practice. The study was designed to examine whether additional training and consultation to staff and treatment parents improved outcomes for youth. Methods The study was conducted with 247 youth in TFC and their treatment parents from 14 TFC agencies in a southeastern state. Half of the agencies were randomized to the intervention condition and received study-provided training and consultation. Control agencies continued to provide training and treatment as usual. Data for the current analyses come from interviews with treatment parents at baseline, 6, and 12 months. Results Youth in the intervention group showed significant improvement (compared to the youth in the control group) on the three focal domains – symptoms, behaviors, and strengths. Effects were larger for behaviors and symptoms than for strengths. Conclusions This study employs a “hybrid” model to improve practice. It builds upon current practices in existing agencies and infuses additional training and consultation to overcome observed deficits. Such an approach has tremendous potential for moving beyond a singular focus on disseminating evidence-based interventions to a broader view of improving practice in a wide range of agencies. PMID:20513677

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

PubMed

Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K

2014-02-01

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

Actual vs perceived performance debriefing in surgery: practice far from perfect.

PubMed

Ahmed, Maria; Sevdalis, Nick; Vincent, Charles; Arora, Sonal

2013-04-01

Performance feedback or debriefing in surgery is increasingly recognized as an essential means to optimize learning in the operating room (OR). However, there is a lack of evidence regarding the current practice and barriers to debriefing in the OR. Phase 1 consisted of semistructured interviews with surgical trainers and trainees to identify features of an effective debriefing and perceived barriers to debriefing. Phase 2 consisted of ethnographic observations of surgical cases to identify current practice and observed barriers to debriefing. Surgical trainers and trainees identified key features of effective debriefing with regard to the approach and content; however, these were not commonly identified in practice. Culture was recognized as a significant barrier to debriefing across both phases of the study. There is a disparity between what the surgical community views as effective debriefing and actual debriefing practices in the OR. Improvements to the current debriefing culture and practice within the field of surgery should be considered to facilitate learning from clinical practice. Copyright © 2013. Published by Elsevier Inc.

Factors influencing evidence-based practice in prosthetics and orthotics.

PubMed

Andrysek, Jan; Christensen, James; Dupuis, Annie

2011-03-01

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources. The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Cross sectional survey. An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada. A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice. Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice. This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Maternal-Fetal Medicine Physician and Fellow Perceptions of Business in Medicine.

PubMed

Porter, Blake; Iriye, Brian; Ghamsary, Mark

2018-01-01

 Principles of practice management provide a foundation for clinical success and performance improvement. Scant data exist regarding maternal-fetal medicine (MFM) physicians' knowledge of these topics. We hypothesize that physicians enter practice with inadequate education in practice management.  Surveys were emailed to members of the Society for Maternal-Fetal Medicine rating their knowledge and capabilities in practice management topics, and respondents assessed their current institution's business in the medical curriculum.  A total of 325 (14.4%) physicians responded: 63 fellows in training and 262 MFM physician subspecialists. Practicing physicians reported learning most of their knowledge "in practice after fellowship" (85%) or "never at all" (10%). Only 3% of respondents had adequate business education during fellowship, and only 5% felt prepared to teach business principles. However, 85% of those surveyed agreed that this material should be taught during the fellowship. Among MFM subspecialists and fellows in training at institutions with fellowships, 60% reported no current curriculum for practice management, and those with current curricula reported it had "limited" or "no value" (76%).  There is a significant desire for practice management curricula during MFM fellowship, and current training is insufficient. With many MFM physicians ill-prepared to teach these principles, professional education from other financial fields, and standardized education in practice management from current expert sources is needed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Qualitative Phenomenological Study of Students' Perceptions of Classroom Practices and the Affect on Engagement

ERIC Educational Resources Information Center

Baum-Leaman, Rebekah

2013-01-01

Although teachers continue to implement an array of best practices, learners identified as unsuccessful according to criteria may lack engagement to succeed in the current curriculum activities. Even as teachers continue to apply best practices in the classroom, data does not support continued improvement of student engagement and achievement of…

Conceptualizing Mindful Leadership in Schools: How the Practice of Mindfulness Informs the Practice of Leading

ERIC Educational Resources Information Center

Wells, Caryn M.

2015-01-01

This paper advances the conceptual notion of mindfulness for educational leaders. The findings presented acknowledge the current levels of stress that school leaders face and posits that the practice of mindfulness may reduce these stressors while improving the effectiveness of leadership. The author also presents a synthesis of the literature…

NTL Data Management Planning "Greenout" Bingo Self Assessment Tool

DOT National Transportation Integrated Search

2016-08-11

This tool is designed to help assess your current data management practices. Pick a dataset or research project, sit down with your data collection team, and discuss each prompt below. This tool can guide DMP improvement by revealing best practices t...

A synthesis of the "state-of-the-practice for advancing planning and operations integration opportunities within transportation agencies".

DOT National Transportation Integrated Search

2014-12-01

Linking Planning and Operations is vital to improving transportation decision-making and overall : efficiency of transportation systems management. This synthesis summarizes current state of : knowledge and practices in Planning and Operations Integr...

Determination of significance in Ecological Impact Assessment: Past change, current practice and future improvements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Briggs, Sam; Hudson, Malcolm D., E-mail: mdh@soton.ac.uk

2013-01-15

Ecological Impact Assessment (EcIA) is an important tool for conservation and achieving sustainable development. 'Significant' impacts are those which disturb or alter the environment to a measurable degree. Significance is a crucial part of EcIA, our understanding of the concept in practice is vital if it is to be effective as a tool. This study employed three methods to assess how the determination of significance has changed through time, what current practice is, and what would lead to future improvements. Three data streams were collected: interviews with expert stakeholders, a review of 30 Environmental Statements and a broad-scale survey ofmore » the United Kingdom Institute of Ecology and Environmental Management (IEEM) members. The approach taken in the determination of significance has become more standardised and subjectivity has become constrained through a transparent framework. This has largely been driven by a set of guidelines produced by IEEM in 2006. The significance of impacts is now more clearly justified and the accuracy with which it is determined has improved. However, there are limitations to accuracy and effectiveness of the determination of significance. These are the quality of baseline survey data, our scientific understanding of ecological processes and the lack of monitoring and feedback of results. These in turn are restricted by the limited resources available in consultancies. The most notable recommendations for future practice are the implementation of monitoring and the publication of feedback, the creation of a central database for baseline survey data and the streamlining of guidance. - Highlights: Black-Right-Pointing-Pointer The assessment of significance has changed markedly through time. Black-Right-Pointing-Pointer The IEEM guidelines have driven a standardisation of practice. Black-Right-Pointing-Pointer Currently limited by quality of baseline data and scientific understanding. Black-Right-Pointing-Pointer Monitoring and feedback would rapidly improve practice.« less

Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

PubMed

Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O

2016-08-01

This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Good Laboratory Practices of Materials Testing at NASA White Sands Test Facility

NASA Technical Reports Server (NTRS)

Hirsch, David; Williams, James H.

2005-01-01

An approach to good laboratory practices of materials testing at NASA White Sands Test Facility is presented. The contents include: 1) Current approach; 2) Data analysis; and 3) Improvements sought by WSTF to enhance the diagnostic capability of existing methods.

Entrepreneurial Leadership Practices and School Innovativeness

ERIC Educational Resources Information Center

Akmaliah, Zaidatol; Pihie, Lope; Asimiran, Soaib; Bagheri, Afsaneh

2014-01-01

Entrepreneurial leadership, as a distinctive type of leadership required for dealing with challenges and crises of current organizational settings, has increasingly been applied to improve school performance. However, there is limited research on the impact of school leaders' entrepreneurial leadership practices on school innovativeness. The main…

The Business Practices Course: Self-Study Learning Reengineered.

ERIC Educational Resources Information Center

Acovelli, Marianne; Nowakowski, Alan

1994-01-01

Describes an interactive multimedia Business Practices Course, developed to help reengineer point-of-need training for professional development, in which the learner conducts a business review of a company's current operations and makes recommendations to improve productivity and increase customer satisfaction. (six references) (LRW)

Assessing BMP Performance Using Microtox Toxicity Analysis

EPA Science Inventory

Best Management Practices (BMPs) have been shown to be effective in reducing runoff and pollutants from urban areas and thus provide a mechanism to improve downstream water quality. Currently, BMP performance regarding water quality improvement is assessed through measuring each...

Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

PubMed

Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

2013-12-01

The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

The role of MRI in musculoskeletal practice: a clinical perspective

PubMed Central

Dean Deyle, Gail

2011-01-01

This clinical perspective presents an overview of current and potential uses for magnetic resonance imaging (MRI) in musculoskeletal practice. Clinical practice guidelines and current evidence for improved outcomes will help providers determine the situations when an MRI is indicated. The advanced competency standard of examination used by physical therapists will be helpful to prevent overuse of musculoskeletal imaging, reduce diagnostic errors, and provide the appropriate clinical context to pathology revealed on MRI. Physical therapists are diagnostically accurate and appropriately conservative in their use of MRI consistent with evidence-based principles of diagnosis and screening. PMID:22851878

The Journey to Interprofessional Collaborative Practice: Are We There Yet?

PubMed

Golom, Frank D; Schreck, Janet Simon

2018-02-01

Interprofessional collaborative practice (IPCP) is a service delivery approach that seeks to improve health care outcomes and the patient experience while simultaneously decreasing health care costs. The current article reviews the core competencies and current trends associated with IPCP, including challenges faced by health care practitioners when working on interprofessional teams. Several conceptual frameworks and empirically supported interventions from the fields of organizational psychology and organization development are presented to assist health care professionals in transitioning their teams to a more interprofessionally collaborative, team-based model of practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Process Correlation Analysis Model for Process Improvement Identification

PubMed Central

Park, Sooyong

2014-01-01

Software process improvement aims at improving the development process of software systems. It is initiated by process assessment identifying strengths and weaknesses and based on the findings, improvement plans are developed. In general, a process reference model (e.g., CMMI) is used throughout the process of software process improvement as the base. CMMI defines a set of process areas involved in software development and what to be carried out in process areas in terms of goals and practices. Process areas and their elements (goals and practices) are often correlated due to the iterative nature of software development process. However, in the current practice, correlations of process elements are often overlooked in the development of an improvement plan, which diminishes the efficiency of the plan. This is mainly attributed to significant efforts and the lack of required expertise. In this paper, we present a process correlation analysis model that helps identify correlations of process elements from the results of process assessment. This model is defined based on CMMI and empirical data of improvement practices. We evaluate the model using industrial data. PMID:24977170

Process correlation analysis model for process improvement identification.

PubMed

Choi, Su-jin; Kim, Dae-Kyoo; Park, Sooyong

2014-01-01

Software process improvement aims at improving the development process of software systems. It is initiated by process assessment identifying strengths and weaknesses and based on the findings, improvement plans are developed. In general, a process reference model (e.g., CMMI) is used throughout the process of software process improvement as the base. CMMI defines a set of process areas involved in software development and what to be carried out in process areas in terms of goals and practices. Process areas and their elements (goals and practices) are often correlated due to the iterative nature of software development process. However, in the current practice, correlations of process elements are often overlooked in the development of an improvement plan, which diminishes the efficiency of the plan. This is mainly attributed to significant efforts and the lack of required expertise. In this paper, we present a process correlation analysis model that helps identify correlations of process elements from the results of process assessment. This model is defined based on CMMI and empirical data of improvement practices. We evaluate the model using industrial data.

Status of Biology Laboratory and Practical Activities in Some Selected Secondary and Preparatory Schools of Borena Zone, South Ethiopia

ERIC Educational Resources Information Center

Daba, Tolessa Muleta; Anbassa, Baressa; Oda, Bula Kere; Degefa, Itefa

2016-01-01

Science laboratory is a very important resource input for teaching science. Learning science is enhanced and the understanding level is improved when students are engaged in science laboratory for practical experiments. The current study aimed to assess the status of Biology laboratory and practical activities in some selected secondary and…

“More than I Expected”: Perceived Benefits of Yoga Practice among Older Adults at Risk for Cardiovascular Disease

PubMed Central

Alexander, Gina K.; Innes, Kim E.; Selfe, Terry K.; Brown, Cynthia J.

2012-01-01

Objective This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program. Design This study used a constructivist-interpretive approach to naturalistic inquiry. Setting A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study. Intervention The 8-week Iyengar yoga program included two 90-minute yoga classes and five 30-minute home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study. Main Outcome Measures Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process. Results Four broad themes emerged from content analysis: Practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants). Conclusions These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease. PMID:23374201

Fertility preservation in young cancer patients--too little, too late?

PubMed

Robbins, Helen Louise; Zahoor, Arooba; Jones, Kevin

2015-12-01

Fertility is an important concern for many younger women with cancer; however, evidence suggests that these matters are often inadequately addressed, potentially with long-term implications for quality of life. Increased confidence in discussing fertility-related matters and an emphasis on early discussion and referral are needed to improve current practice. Further work is needed to better assess current practice and to explore how barriers to discussion about fertility preservation may be best overcome.

Improving the Quality of Electronic Documentation in Critical Care Nursing

ERIC Educational Resources Information Center

Stevens, Brent

2017-01-01

Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General…

Evaluation of Current Practice for Illumination at Roundabouts : Safety and Illumination of Roundabouts (Phase I)

DOT National Transportation Integrated Search

2016-03-01

This report is for the first phase of a two-phase research program to develop recommended practices for GDOT for lighting rural roundabouts. Phase I of the study was designed to improve our understanding of the relationship between roundabout illumin...

Improving Clinical Practices for Children with Language and Learning Disorders

ERIC Educational Resources Information Center

Kamhi, Alan G.

2014-01-01

Purpose: This lead article of the Clinical Forum addresses some of the gaps that exist between clinical practice and current knowledge about instructional factors that influence learning and language development. Method: Topics reviewed and discussed include principles of learning, generalization, treatment intensity, processing interventions,…

Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

PubMed Central

2013-01-01

Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare. PMID:23617833

Assessing BMP Performance Using Microtox Toxicity Analysis - Rhode Island

EPA Science Inventory

Best Management Practices (BMPs) have been shown to be effective in reducing runoff and pollutants from urban areas and thus provide a mechanism to improve downstream water quality. Currently, BMP performance regarding water quality improvement is assessed through measuring each...

Assessing BMP Performance Using Microtox® Toxicity Analysis

EPA Science Inventory

Best Management Practices (BMPs) have been shown to be effective in reducing runoff and pollutants from urban areas and thus provide a mechanism to improve downstream water quality. Currently, BMP performance regarding water quality improvement is assessed through measuring each...

Worldwide end-of-life practice for patients in ICUs.

PubMed

Wong, Wai-Tat; Phua, Jason; Joynt, Gavin M

2018-04-01

Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.

Creating a Culture of Safety Around Bar-Code Medication Administration: An Evidence-Based Evaluation Framework.

PubMed

Kelly, Kandace; Harrington, Linda; Matos, Pat; Turner, Barbara; Johnson, Constance

2016-01-01

Bar-code medication administration (BCMA) effectiveness is contingent upon compliance with best-practice protocols. We developed a 4-phased BCMA evaluation program to evaluate the degree of integration of current evidence into BCMA policies, procedures, and practices; identify barriers to best-practice BCMA use; and modify BCMA practice in concert with changes to the practice environment. This program provides an infrastructure for frontline nurses to partner with hospital leaders to continually evaluate and improve BCMA using a systematic process.

Harnessing and blending the power of two research networks to improve prevention science and public health practice

PubMed Central

Vanderpool, Robin C.; Brownson, Ross C.; Mays, Glen P.; Crosby, Richard A.; Wyatt, Stephen W.

2015-01-01

Strategic collaborations are essential in moving public health research and practice forward1, particularly in light of escalating fiscal and environmental challenges facing the public health community. This commentary provides background and context for an emerging partnership between two national networks, Prevention Research Centers (PRCs) and Public Health Practice-Based Research Networks (PBRNs), to impact public health practice. Supported by CDC, PRCs are celebrating over 25 years of transdisciplinary applied prevention research grounded in community and stakeholder engagement. Public Health PBRNs, funded by the Robert Wood Johnson Foundation, conduct innovative public health services and systems research with public health agencies and community partners to improve public health decision-making. By utilizing each of the networks’ respective strengths and resources, collaborative ventures between PRCs and Public Health PBRNs can enhance the translation of applied prevention research to evidence-based practice and empirically investigate novel public health practices developed in the field. Three current PRC-Public Health PBRNs projects are highlighted and future research directions are discussed. Improving the interconnectedness of prevention research and public health practice is essential to improve the health of the Nation. PMID:24237918

The SQL Server Database for Non Computer Professional Teaching Reform

ERIC Educational Resources Information Center

Liu, Xiangwei

2012-01-01

A summary of the teaching methods of the non-computer professional SQL Server database, analyzes the current situation of the teaching course. According to non computer professional curriculum teaching characteristic, put forward some teaching reform methods, and put it into practice, improve the students' analysis ability, practice ability and…

Considering the Impact of Preservice Teacher Beliefs on Future Practice

ERIC Educational Resources Information Center

Thomas, Cathy Newman

2014-01-01

Preservice teacher beliefs merit additional attention from special education teacher-educators. Given current policy and reforms aimed at improving outcomes for students with disabilities and increasing the adoption of evidence-based practices, teacher-educators should recognize the barrier that preservice teacher beliefs can pose and consider…

A Statewide Analysis of RNs' Intention To Leave Their Position.

ERIC Educational Resources Information Center

Rambur, Betty; Palumbo, Mary Val; McIntosh, Barbara; Mongeon, Joan

2003-01-01

Secondary analysis of registered nurse work force data from Vermont (n=4,418, 85% response) identified predictors of intention to leave current position. Differences in intention vary by educational attainment, hours worked, gender, practice role, and practice activity. Improving retention will require increased attention to compensation,…

The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families

PubMed Central

Shah, Prakesh S.; McDonald, Sarah D.; Barrett, Jon; Synnes, Anne; Robson, Kate; Foster, Jonathan; Pasquier, Jean-Charles; Joseph, K.S.; Piedboeuf, Bruno; Lacaze-Masmonteil, Thierry; O'Brien, Karel; Shivananda, Sandesh; Chaillet, Nils; Pechlivanoglou, Petros

2018-01-01

Background: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. Methods: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. Interpretation: These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates. PMID:29348260

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mills, G.J.; Brown, G.G.; Waterman, D.D.

The feasibility of prestressing commercial boron/epoxy and graphite/epoxy prepreg material to higher strengths and lower property dispersions is demonstrated. Its practical application as an on-line process for improving quality levels is possible with minor modifications to current experimental practice. The mechanics of the bendstressing method affects a controlled alteration in the fiber defect content to the extent that composite improvements can be achieved approaching the inherent fiber quality with dispersions in properties reduced to the 1 to 2% range. (Author, modified-PL)

Pressure area care: an exploration of Greek nurses' knowledge and practice.

PubMed

Panagiotopoulou, Kalliopi; Kerr, Susan M

2002-11-01

Despite a plethora of information on the prevention of pressure sores, they remain a significant problem in both hospital and community settings. The need to reduce the incidence of pressure sores has been well documented; unfortunately there is little evidence to suggest improvement. The reasons for this lack of improvement have been explored, but the picture remains unclear. While some studies have suggested that nurses have the appropriate knowledge to prevent pressure sores developing (but do not use their knowledge), others suggest that nurses' knowledge of preventive strategies is deficient. In Greece, similarly to the United Kingdom (UK), the incidence of pressure sores is high. There is currently no evidence on Greek nurses' knowledge and practice and therefore no baseline on which to build, in terms of improving practice. The purpose of this study was to explore Greek nurses' knowledge of 'risk factors', 'areas at risk' and 'recommended preventive strategies' in relation to pressure area care. In addition, information was sought on nurses' 'current preventive practice' and any barriers to 'good practice'. The study was exploratory and descriptive, adopting a cross-sectional survey approach. The sample was drawn from the population of nurses working in a military hospital near Athens. The data were collected over a 4-week period in June 2000, using a self-completed questionnaire. Although the knowledge-base of many of the nurses was good in relation to 'risk factors' and 'areas at risk', a significant proportion were unaware that methods such as 'massage' and 'donuts' are no longer recommended. This lack of knowledge influenced practice with these methods commonly being used. In relation to barriers to good practice, a significant proportion of nurses reported that they could not access, read or understand research findings. This has obvious implications for the implementation of evidence-based practice. The results of this study suggest that the knowledge and practice of participants could be improved. It is of particular concern that methods known to be detrimental were in common use. Finally, there is a need to improve the research skills of Greek nurses in order to provide them with the appropriate knowledge to use research findings.

Current State of Overlapping, Concurrent, and Multiple-Room Surgery in Otolaryngology: A National Survey.

PubMed

Cognetti, David M; Nussenbaum, Brian; Brenner, Michael J; Chi, David H; McCormick, Michael E; Venkatraman, Giri; Zhan, Tingting; McKinlay, Alex J

2017-12-01

Objective Multiple-room surgery has gained attention due to reports in the lay press scrutinizing the activity, with hospitals and the government collecting data on current practice. We studied practices and attitudes toward multiple-room surgery in otolaryngology. Methods A survey was developed by members of the Patient Safety and Quality Improvement Committee of the American Academy of Otolaryngology-Head and Neck Surgery. The survey was distributed to members of the Academy and included questions on demographics, current practices, and opinions regarding multiple-room surgery. The survey was designed to capture the spectrum of multidisciplinary, overlapping, and simultaneous/concurrent surgery practices. Data were collected via SurveyMonkey. Results A total of 907 of 9520 members completed the survey. Of the respondents, 40.4% reported performing some form of multiple-room surgery. Multiple-room surgery is more common amongst subspecialists than general otolaryngologists. Most believed that regulations disallowing multiple-room surgery would result in an increase in late starts (73.5%), an increase in the time to schedule surgery (84.5%), a detriment to residency training (63.1%), and no improvement in patient safety (60%.) Discussion Multiple-room surgery is common among responding otolaryngologists. Most respondents consider the practice to serve a role in facilitating access, efficiency, and training. Implications for Practice Due to recent attention placed on multiple-room surgery, institutions are reviewing policies regarding the practice. This survey suggests that policy changes that restrict multiple-room surgery must consider a potential unintended negative impact on patient care and access.

The utah beacon experience: integrating quality improvement, health information technology, and practice facilitation to improve diabetes outcomes in small health care facilities.

PubMed

Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J; North, Christie

2014-01-01

The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010-2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC(3) was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients' diabetes outcomes at 21 participating smaller, independent clinics. Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC(3) helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients' diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC(3) Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC(3) Beacon practices are currently smoothly transitioning to new models of care such as Patient-Centered Medical Homes. Thus, IC(3) Beacon has been instrumental in creating a strong community partnership among various organizations to meet the shared vision of better health and lower costs, and the experience over the last few years has helped the community prepare for the changing health care landscape.

The Utah Beacon Experience: Integrating Quality Improvement, Health Information Technology, and Practice Facilitation to Improve Diabetes Outcomes in Small Health Care Facilities

PubMed Central

Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J.; North, Christie

2014-01-01

Purpose: The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010–2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC3 was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients’ diabetes outcomes at 21 participating smaller, independent clinics. Innovation: Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC3 helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients’ diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Findings: Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC3 Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Conclusion and Discussion: Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC3 Beacon practices are currently smoothly transitioning to new models of care such as Patient-Centered Medical Homes. Thus, IC3 Beacon has been instrumental in creating a strong community partnership among various organizations to meet the shared vision of better health and lower costs, and the experience over the last few years has helped the community prepare for the changing health care landscape. PMID:25848624

Using expert opinion to quantify accuracy and reliability of nondestructive evaluation on bridges : [project brief].

DOT National Transportation Integrated Search

2015-08-01

Research is currently being conducted to improve bridge inspection practices. One potential : improvement is the use of nondestructive testing equipment to supplement visual inspection. To : consider the costs and benefits of this equipment, data abo...

Technology in New York's Classrooms: One Key To Improving Educational Outcomes.

ERIC Educational Resources Information Center

Public Policy Inst., Albany, NY.

This report discusses the potential for computers and other educational technologies to aid in school restructuring in New York State. Issues involved in such a restructuring are examined and include: (1) the need for a common effort in creating a state program; (2) current practices and current realities in the classroom; (3) current uses of such…

Connecting to Collections in Florida: Current Conditions and Critical Needs in Libraries, Archives, and Museums

ERIC Educational Resources Information Center

Jorgensen, Corinne; Marty, Paul F.; Braun, Kathy

2012-01-01

This article presents results from an IMLS-funded project to evaluate the current state of collections in Florida's libraries, archives, and museums, current practices to preserve and conserve these collections, and perceived needs to maintain and improve these collections for future generations. The survey, modeled after the Heritage Health Index…

Current practices for evaluation of resonance disorders in North America.

PubMed

Stelck, Elizabeth Huebert; Boliek, Carol A; Hagler, Paul H; Rieger, Jana M

2011-02-01

Improving treatment outcomes for people with resonance problems (due to velopharyngeal disorders) is a priority for many speech-language pathologists (SLPs), but there exists a limited understanding of the practices SLPs are using to assess and monitor therapeutic effects in this population. The current study was designed to answer the following questions: (1) What are current clinical practices versus best practices for assessing resonance disorders, tracking therapeutic effects, and determining discharge criteria? (2) What assessment practices would SLPs prefer to use with clients who have resonance disorders? (3) What are barriers to SLPs' use of best practices? and (4) What effects do SLP demographics have on clinical practices? Thirty-eight SLPs, specializing in the treatment of resonance disorders, participated in the study. Responses were compared with best practice recommendations derived from the literature. Most clinicians were using low-tech assessment tools, often because they lacked access to high-tech tools. Demographics and training did not affect clinical assessment practices. There is a need to increase the availability of high-tech assessment tools to SLPs practicing in the area of resonance disorders, as consistent use of sophisticated assessment devices would exemplify contemporary thinking about the transfer of knowledge to practice in this area. © Thieme Medical Publishers.

Impact of an Event Reporting System on Resident Complication Reporting in Plastic Surgery Training: Addressing an ACGME and Plastic Surgery Milestone Project Core Competency.

PubMed

Parikh, Rajiv P; Snyder-Warwick, Alison; Naidoo, Sybill; Skolnick, Gary B; Patel, Kamlesh B

2017-11-01

The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program. This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher's exact test was used for binary comparisons. There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001). An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.

Innovation in clinical pharmacy practice and opportunities for academic--practice partnership.

PubMed

Gubbins, Paul O; Micek, Scott T; Badowski, Melissa; Cheng, Judy; Gallagher, Jason; Johnson, Samuel G; Karnes, Jason H; Lyons, Kayley; Moore, Katherine G; Strnad, Kyle

2014-05-01

Clinical pharmacy has a rich history of advancing practice through innovation. These innovations helped to mold clinical pharmacy into a patient-centered discipline recognized for its contributions to improving medication therapy outcomes. However, innovations in clinical pharmacy practice have now waned. In our view, the growth of academic–practice partnerships could reverse this trend and stimulate innovation among the next generation of pioneering clinical pharmacists. Although collaboration facilitates innovation,academic institutions and health care systems/organizations are not taking full advantage of this opportunity. The academic–practice partnership can be optimized by making both partners accountable for the desired outcomes of their collaboration, fostering symbiotic relationships that promote value-added clinical pharmacy services and emphasizing continuous quality improvement in the delivery of these services. Optimizing academic–practice collaboration on a broader scale requires both partners to adopt a culture that provides for dedicated time to pursue innovation, establishes mechanisms to incubate ideas, recognizes where motivation and vision align, and supports the purpose of the partnership. With appropriate leadership and support, a shift in current professional education and training practices, and a commitment to cultivate future innovators, the academic–practice partnership can develop new and innovative practice advancements that will improve patient outcomes.

Improving Injury Prevention Through Health Information Technology

PubMed Central

Haegerich, Tamara M.; Sugerman, David E.; Annest, Joseph L.; Klevens, Joanne; Baldwin, Grant T.

2015-01-01

Health information technology is an emerging area of focus in clinical medicine with the potential to improve injury and violence prevention practice. With injuries being the leading cause of death for Americans aged 1–44 years, greater implementation of evidence-based preventive services, referral to community resources, and real-time surveillance of emerging threats is needed. Through a review of the literature and capturing of current practice in the field, this paper showcases how health information technology applied to injury and violence prevention can lead to strengthened clinical preventive services, more rigorous measurement of clinical outcomes, and improved injury surveillance, potentially resulting in health improvement. PMID:25441230

Centering Pregnancy: practical tips for your practice.

PubMed

DeCesare, Julie Z; Jackson, Jessica R

2015-03-01

With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. To define Centering Pregnancy and practical tips for implementation into both private and academic practices. Evidence was gathered through literature reviews. It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. Practical implementation tips will be offered, with suggestions for negating common implementation barriers.

The Customer Relationship Management in Terms of Business Practice in Slovakia

NASA Astrophysics Data System (ADS)

Urdziková, Jana; Jakábová, Martina; Saniuk, Sebastian

2012-12-01

The aim of the article is to present the results of the research on focus on the customer in relation to the use of customer relationship management in selected business subjects in Slovakia. The main goal of the research is the mapping of current state to ensure the principle of customer orientation and utilizing of CRM in organizations and industrial enterprises in Slovakia. This is the mapping of the current situation of that problem in practical conditions and determines potential opportunities for improvement.

Continuous Manufacturing in Pharmaceutical Process Development and Manufacturing.

PubMed

Burcham, Christopher L; Florence, Alastair J; Johnson, Martin D

2018-06-07

The pharmaceutical industry has found new applications for the use of continuous processing for the manufacture of new therapies currently in development. The transformation has been encouraged by regulatory bodies as well as driven by cost reduction, decreased development cycles, access to new chemistries not practical in batch, improved safety, flexible manufacturing platforms, and improved product quality assurance. The transformation from batch to continuous manufacturing processing is the focus of this review. The review is limited to small, chemically synthesized organic molecules and encompasses the manufacture of both active pharmaceutical ingredients (APIs) and the subsequent drug product. Continuous drug product is currently used in approved processes. A few examples of production of APIs under current good manufacturing practice conditions using continuous processing steps have been published in the past five years, but they are lagging behind continuous drug product with respect to regulatory filings.

Pediatric sepsis.

PubMed

Mathias, Brittany; Mira, Juan C; Larson, Shawn D

2016-06-01

Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72 000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. The definition of pediatric sepsis is currently in a state of evolution, and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated. The current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become a commonplace.

Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital.

PubMed

Mulcahy, Kimberly B; Trigoboff, Eileen; Opler, Lewis; Demler, Tammie Lee

2016-01-01

Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital.

Combustion and fires in low gravity

NASA Technical Reports Server (NTRS)

Friedman, Robert

1994-01-01

Fire safety always receives priority attention in NASA mission designs and operations, with emphasis on fire prevention and material acceptance standards. Recently, interest in spacecraft fire-safety research and development has increased because improved understanding of the significant differences between low-gravity and normal-gravity combustion suggests that present fire-safety techniques may be inadequate or, at best, non-optimal; and the complex and permanent orbital operations in Space Station Freedom demand a higher level of safety standards and practices. This presentation outlines current practices and problems in fire prevention and detection for spacecraft, specifically the Space Station Freedom's fire protection. Also addressed are current practices and problems in fire extinguishment for spacecraft.

Practicing health promotion in primary care -a reflective enquiry.

PubMed

Pati, S; Chauhan, A S; Mahapatra, S; Sinha, R; Pati, S

2017-12-01

Health promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. An exploratory study was planned between the months of January - February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. The study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. We concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

Improving performance in golf: current research and implications from a clinical perspective.

PubMed

Evans, Kerrie; Tuttle, Neil

2015-01-01

Golf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance.

Improving performance in golf: current research and implications from a clinical perspective

PubMed Central

Evans, Kerrie; Tuttle, Neil

2015-01-01

Golf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance. PMID:26537808

Current role challenges in New Zealand aged residential care: the potential consequences for healthcare assistant role expansion.

PubMed

Shannon, Kay; McKenzie-Green, Barbara

2016-01-01

Challenges facing healthcare assistants in aged residential care are a focus of global debate. These challenges involve remuneration, education, skill mix, work conditions and organisational structures. We enter the discussion by acknowledging current work, education and remuneration for healthcare assistants. We then consider the supervisory relationships between registered nurses (RNs), enrolled nurses (ENs) and healthcare assistants, educational levels for RNs, ENs and healthcare assistants, and the interplay between organisation and practice in aged residential care. We suggest that improving work for the healthcare assistant has the potential to lead change in all role levels. Discussion paper. We argue that adjustments to work structures, education and skill advancement of RNs, ENs and healthcare assistants could improve staff working conditions and clarify practice boundaries. The ultimate result is likely to be an improvement to quality of care and the life of residents in aged residential care.

Sound management may sequester methane in grazed rangeland ecosystems

PubMed Central

Wang, Chengjie; Han, Guodong; Wang, Shiping; Zhai, Xiajie; Brown, Joel; Havstad, Kris M.; Ma, Xiuzhi; Wilkes, Andreas; Zhao, Mengli; Tang, Shiming; Zhou, Pei; Jiang, Yuanyuan; Lu, Tingting; Wang, Zhongwu; Li, Zhiguo

2014-01-01

Considering their contribution to global warming, the sources and sinks of methane (CH4) should be accounted when undertaking a greenhouse gas inventory for grazed rangeland ecosystems. The aim of this study was to evaluate the mitigation potential of current ecological management programs implemented in the main rangeland regions of China. The influences of rangeland improvement, utilization and livestock production on CH4 flux/emission were assessed to estimate CH4 reduction potential. Results indicate that the grazed rangeland ecosystem is currently a net source of atmospheric CH4. However, there is potential to convert the ecosystem to a net sink by improving management practices. Previous assessments of capacity for CH4 uptake in grazed rangeland ecosystems have not considered improved livestock management practices and thus underestimated potential for CH4 uptake. Optimal fertilization, rest and light grazing, and intensification of livestock management contribute mitigation potential significantly. PMID:24658176

Sound management may sequester methane in grazed rangeland ecosystems.

PubMed

Wang, Chengjie; Han, Guodong; Wang, Shiping; Zhai, Xiajie; Brown, Joel; Havstad, Kris M; Ma, Xiuzhi; Wilkes, Andreas; Zhao, Mengli; Tang, Shiming; Zhou, Pei; Jiang, Yuanyuan; Lu, Tingting; Wang, Zhongwu; Li, Zhiguo

2014-03-24

Considering their contribution to global warming, the sources and sinks of methane (CH4) should be accounted when undertaking a greenhouse gas inventory for grazed rangeland ecosystems. The aim of this study was to evaluate the mitigation potential of current ecological management programs implemented in the main rangeland regions of China. The influences of rangeland improvement, utilization and livestock production on CH4 flux/emission were assessed to estimate CH4 reduction potential. Results indicate that the grazed rangeland ecosystem is currently a net source of atmospheric CH4. However, there is potential to convert the ecosystem to a net sink by improving management practices. Previous assessments of capacity for CH4 uptake in grazed rangeland ecosystems have not considered improved livestock management practices and thus underestimated potential for CH4 uptake. Optimal fertilization, rest and light grazing, and intensification of livestock management contribute mitigation potential significantly.

Changing academic culture to improve undergraduate STEM education.

PubMed

Suchman, Erica L

2014-12-01

Improving undergraduate science, technology, engineering, and math (STEM) education requires faculty with the skills, resources, and time to create active learning environments that foster student engagement. Current faculty hiring, promotion, and tenure practices at many universities do not measure, reward, nor encourage faculty pursuit of these skills. A cultural change is needed to foster improvement. Published by Elsevier Ltd.

Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

PubMed

Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A

2018-04-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

Leveraging Observation Tools for Instructional Improvement: Exploring Variability in Uptake of Ambitious Instructional Practices

ERIC Educational Resources Information Center

Cohen, Julie; Schuldt, Lorien Chambers; Brown, Lindsay; Grossman, Pamela

2016-01-01

Background/Context: Current efforts to build rigorous teacher evaluation systems has increased interest in standardized classroom observation tools as reliable measures for assessing teaching. However, many argue these instruments can also be used to effect change in classroom practice. This study investigates a model of professional development…

Athletic Trainers' Current Knowledge and Envisioned Use of Foundational Evidence-Based Practice Concepts

ERIC Educational Resources Information Center

Manspeaker, Sarah A.; Hankemeier, Dorice A.

2017-01-01

Context: The Board of Certification (BOC) requires 10 continuing education units (CEUs) in evidence-based practice (EBP) each reporting period. It is unknown whether participation in programming in the Foundations category for CEUs results in improved knowledge of and confidence in EBP. Objective: To examine a continuing professional education…

Internships and Reflective Practice: Informing the Workplace, Informing the Academy. ERIC Digest.

ERIC Educational Resources Information Center

Inkster, Robert

An internship program, created by the English Department at Saint Cloud (Minnesota) State University, is designed to respond to the current need for an improvement in the workplace literacy of many American workers. The internship and concurrent colloquium provide a crucial link between theory and practice, enabling learners to reflect critically…

Developing Leadership for Life: Outcomes from a Collegiate Student-Alumni Mentoring Program

ERIC Educational Resources Information Center

Priest, Kerry L.; Donley, Sarah

2014-01-01

This application brief describes the exploratory assessment of a mentoring program between current students and alumni of a leadership studies minor program. We connect leadership education research and practice in two ways: first, we describe a process of qualitative program evaluation to inform program best practices and improvement. In doing…

Collective Genius: Bridging the Gaps among Research, Innovation and Practice

ERIC Educational Resources Information Center

O'Hair, Mary John

2011-01-01

In this article, the author focuses on bridging the gaps among research, innovation, and practice. First, the author reflects on historical perspectives involving the use of research to improve education and serve the public good. Second, the author explores the current climate as reflected by three national reports highlighting future roles of…

Science for All: Engaging Students with Special Needs in and about Science

ERIC Educational Resources Information Center

Villanueva, Mary Grace; Hand, Brian

2011-01-01

The notion of "science for all" suggests that all students--irrespective of achievement and ability--should engage in opportunities to understand the practice and discourse of science. Improving scientific literacy is an intrinsic goal of science education, yet current instructional practices may not effectively support all students, in…

Improving Teaching and Learning: Three Models to Reshape Educational Practice

ERIC Educational Resources Information Center

Roberson, Sam

2014-01-01

The work of schools is teaching and learning. However, the current educational culture is dominated by three characteristics: (1) the mechanistic view of organization and its practice based on the assembly line model where students progress along a value added conveyor; (2) the predominance of the Essentialist philosophy of education, in which the…

Advancing Kinesiology through Improved Peer Review

ERIC Educational Resources Information Center

Knudson, Duane V.; Morrow, James R., Jr.; Thomas, Jerry R.

2014-01-01

Peer review of scholarship is essential to journal quality, evidence, knowledge advancement, and application of that knowledge in any field. This commentary summarizes recent literature on issues related to peer-review quality and current review practice in kinesiology and provides recommendations to improve peer review in kinesiology journals. We…

Resources for Guidance Program Improvement. Volume 2.

ERIC Educational Resources Information Center

Frenza, Mary C., Comp.; and Others

This guide, for guidance personnel and teachers, is designed to provide ready access to current, practical programs, activities, and references for improving guidance programs. The resources are organized in four sections representing areas of basic concern for guidance personnel. Section 1 presents selected portions of guidance programs from…

Psychotherapy, psychopathology, research and practice: pathways of connections and integration.

PubMed

Castonguay, Louis G

2011-03-01

This paper describes three pathways of connections between different communities of knowledge seekers: integration of psychotherapeutic approaches, integration of psychotherapy and psychopathology, and integration of science and practice. Some of the issues discussed involve the delineation and investigation of common factors (e.g., principles of change), improvement of major forms of psychotherapy, clinical implications of psychopathology research, as well as current and future directions related to practice-research networks. The aim of this paper is to suggest that building bridges across theoretical orientations, scientific fields, professional experiences, and epistemological views may be a fruitful strategy to improve our understanding and the impact of psychotherapy.

Criminal investigations of child abuse: the research behind "best practices".

PubMed

Jones, Lisa M; Cross, Theodore P; Walsh, Wendy A; Simone, Monique

2005-07-01

This article reviews the research relevant to seven practices considered by many to be among the most progressive approaches to criminal child abuse investigations: multidisciplinary team investigations, trained child forensic interviewers, videotaped interviews, specialized forensic medical examiners, victim advocacy programs, improved access to mental health treatment for victims, and Children's Advocacy Centers (CACs). The review finds that despite the popularity of these practices, little outcome research is currently available documenting their success. However, preliminary research supports many of these practices or has influenced their development. Knowledge of this research can assist investigators and policy makers who want to improve the response to victims, understand the effectiveness of particular programs, or identify where assumptions about effectiveness are not empirically supported.

Perioperative hair removal: A review of best practice and a practice improvement opportunity.

PubMed

Spencer, Maureen; Barnden, Marsha; Johnson, Helen Boehm; Fauerbach, Loretta Litz; Graham, Denise; Edmiston, Charles E

2018-06-01

The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.

Prescribers' expectations and barriers to electronic prescribing of controlled substances

PubMed Central

Kim, Meelee; McDonald, Ann; Kreiner, Peter; Kelleher, Stephen J; Blackman, Michael B; Kaufman, Peter N; Carrow, Grant M

2011-01-01

Objective To better understand barriers associated with the adoption and use of electronic prescribing of controlled substances (EPCS), a practice recently established by US Drug Enforcement Administration regulation. Materials and methods Prescribers of controlled substances affiliated with a regional health system were surveyed regarding current electronic prescribing (e-prescribing) activities, current prescribing of controlled substances, and expectations and barriers to the adoption of EPCS. Results 246 prescribers (response rate of 64%) represented a range of medical specialties, with 43.1% of these prescribers current users of e-prescribing for non-controlled substances. Reported issues with controlled substances included errors, pharmacy call-backs, and diversion; most prescribers expected EPCS to address many of these problems, specifically reduce medical errors, improve work flow and efficiency of practice, help identify prescription diversion or misuse, and improve patient treatment management. Prescribers expected, however, that it would be disruptive to practice, and over one-third of respondents reported that carrying a security authentication token at all times would be so burdensome as to discourage adoption. Discussion Although adoption of e-prescribing has been shown to dramatically reduce medication errors, challenges to efficient processes and errors still persist from the perspective of the prescriber, that may interfere with the adoption of EPCS. Most prescribers regarded EPCS security measures as a small or moderate inconvenience (other than carrying a security token), with advantages outweighing the burden. Conclusion Prescribers are optimistic about the potential for EPCS to improve practice, but view certain security measures as a burden and potential barrier. PMID:21946239

Translating Knowledge Into Practice Through an Academic-Practice Partnership for Exploring Barriers That Impact Management of Homebound Patients With Heart Failure.

PubMed

Echevarria, Mercedes

A knowledge translation project involving an academic-practice partnership and guided by action-oriented research was used for exploring barriers that impact management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (practice) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current practice against evidence-based practice recommendations, introduce strategies to "close the gap" between actual practice and the desired practice, develop audit criteria, and reevaluate the impact.

A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from a literature review.

PubMed

Ogrinc, Greg; Headrick, Linda A; Mutha, Sunita; Coleman, Mary T; O'Donnell, Joseph; Miles, Paul V

2003-07-01

To create a framework for teaching the knowledge and skills of practice-based learning and improvement to medical students and residents based on proven, effective strategies. The authors conducted a Medline search of English-language articles published between 1996 and May 2001, using the term "quality improvement" (QI), and cross-matched it with "medical education" and "health professions education." A thematic-synthesis method of review was used to compile the information from the articles. Based on the literature review, an expert panel recommended educational objectives for practice-based learning and improvement. Twenty-seven articles met the inclusion criteria. The majority of studies were conducted in academic medical centers and medical schools and 40% addressed experiential learning of QI. More than 75% were qualitative case reports capturing educational outcomes, and 7% included an experimental study design. The expert panel integrated data from the literature review with the Dreyfus model of professional skill acquisition, the Institute for Healthcare Improvement's (IHI) knowledge domains for improving health care, and the ACGME competencies and generated a framework of core educational objectives about teaching practice-based learning and improvement to medical students and residents. Teaching the knowledge and skills of practice-based learning and improvement to medical students and residents is a necessary and important foundation for improving patient care. The authors present a framework of learning objectives-informed by the literature and synthesized by the expert panel-to assist educational leaders when integrating these objectives into a curriculum. This framework serves as a blueprint to bridge the gap between current knowledge and future practice needs.

Combined motor point associative stimulation (MPAS) and transcranial direct current stimulation (tDCS) improves plateaued manual dexterity performance.

PubMed

Hoseini, Najmeh; Munoz-Rubke, Felipe; Wan, Hsuan-Yu; Block, Hannah J

2016-10-28

Motor point associative stimulation (MPAS) in hand muscles is known to modify motor cortex excitability and improve learning rate, but not plateau of performance, in manual dexterity tasks. Central stimulation of motor cortex, such as transcranial direct current stimulation (tDCS), can have similar effects if accompanied by motor practice, which can be difficult and tiring for patients. Here we asked whether adding tDCS to MPAS could improve manual dexterity in healthy individuals who are already performing at their plateau, with no motor practice during stimulation. We hypothesized that MPAS could provide enough coordinated muscle activity to make motor practice unnecessary, and that this combination of stimulation techniques could yield improvements even in subjects at or near their peak. If so, this approach could have a substantial effect on patients with impaired dexterity, who are far from their peak. MPAS was applied for 30min to two right hand muscles important for manual dexterity. tDCS was simultaneously applied over left sensorimotor cortex. The motor cortex input/output (I/O) curve was assessed with transcranial magnetic stimulation (TMS), and manual dexterity was assessed with the Purdue Pegboard Test. Compared to sham or cathodal tDCS combined with MPAS, anodal tDCS combined with MPAS significantly increased the plateau of manual dexterity. This result suggests that MPAS has the potential to substitute for motor practice in mediating a beneficial effect of tDCS on manual dexterity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Workshop on Agricultural Air Quality: State of the science

NASA Astrophysics Data System (ADS)

Aneja, Viney P.; Blunden, Jessica; Roelle, Paul A.; Schlesinger, William H.; Knighton, Raymond; Niyogi, Dev; Gilliam, Wendell; Jennings, Greg; Duke, Clifford S.

The first Workshop on Agricultural Air Quality: State of the Science was held at the Bolger Center in Potomac, Maryland from 4 to 8 June 2006. This international conference assembled approximately 350 people representing 25 nations from 5 continents, with disciplines ranging from atmospheric chemistry to soil science. The workshop was designed as an open forum in which participants could openly exchange the most current knowledge and learn about numerous international perspectives regarding agricultural air quality. Participants represented many stakeholder groups concerned with the growing need to assess agricultural impacts on the atmosphere and to develop beneficial policies to improve air quality. The workshop focused on identifying methods to improve emissions inventories and best management practices for agriculture. Workshop participants also made recommendations for technological and methodological improvements in current emissions measurement and modeling practices. The workshop commenced with a session on agricultural emissions and was followed by international perspectives from the United States, Europe, Australia, India, and South America. This paper summarizes the findings and issues of the workshop and articulates future research needs. These needs were identified in three general areas: (1) improvement of emissions measurement; (2) development of appropriate emission factors; and (3) implementation of best management practices (BMPs) to minimize negative environmental impacts. Improvements in the appropriate measurements will inform decisions regarding US farming practices. A need was demonstrated for a national/international network to monitor atmospheric emissions from agriculture and their subsequent depositions to surrounding areas. Information collected through such a program may be used to assess model performance and could be critical for evaluating any future regulatory policies or BMPs. The workshop concluded that efforts to maximize benefits and reduce detrimental effects of agricultural production need to transcend disciplinary, geographic, and political boundaries. Also, such efforts should involve natural and social scientists, economists, engineers, business leaders, and decision makers. The workshop came to the conclusion that through these collaborative efforts improvements in air quality from agricultural practices will begin to take effect.

Patient-centred care in general dental practice - a systematic review of the literature

PubMed Central

2014-01-01

Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research. PMID:24902842

76 FR 35864 - Proposed Priority; Special Demonstration Programs-National Technical Assistance Projects To...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... have national significance and improve the performance of State vocational rehabilitation (VR) agencies... that State VR agencies and their partners, need national TA opportunities to improve program management and to keep informed about current effective and promising practices and research in the field of VR...

Communication Is Key: Unpacking "Use of Assessment Results to Improve Student Learning"

ERIC Educational Resources Information Center

Smith, Kristen L.; Good, Megan Rodgers; Sanchez, Elizabeth Hawk; Fulcher, Keston H.

2015-01-01

Although higher education institutions often engage in assessment practices, use of assessment results to improve student learning is rare (Blaich & Wise, 2011). We surmised that this rarity could be partially explained by unclear communication regarding what "use of results" means. The current study qualitatively investigated how…

Surviving Troubled Times: Five Best Practices for Training Solutions

ERIC Educational Resources Information Center

Villachica, Steven W.; Stepich, Donald A.; Rist, Shannon

2011-01-01

The business of training and performance improvement has always been cyclical, with the fortunes of human resource development (HRD) and performance improvement professionals rising and falling with the economic fortunes of the workplace. The current economic downturn and nascent recovery represent an opportunity for HRD and performance…

78 FR 15680 - Information Sharing With Agency Stakeholders: Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

... agriculture. Customer service improvements that make it easier for stakeholders to do business with APHIS... health mission remains firm. In keeping with this commitment, we want to continue to improve our business... opportunities and rethink current business practices, we want to engage our stakeholders in a dialog early in...

Using Performance-Based Pay to Improve the Quality of Teachers

ERIC Educational Resources Information Center

Lavy, Victor

2007-01-01

Tying teachers' pay to their classroom performance should, says Victor Lavy, improve the current educational system both by clarifying teaching goals and by attracting and retaining the most productive teachers. But implementing pay for performance poses many practical challenges, because measuring individual teachers' performance is difficult.…

New Goals and Changed Roles: Re-Visioning Teacher Education.

ERIC Educational Resources Information Center

Hawley, Willis D.

1993-01-01

It is argued that the current agenda for improving teacher education only seeks to improve the present system. A new, radically restructured approach would train teachers to learn from their experiences, communicate clearly, know their subject matter, integrate ideas into practice, apply learning theory and child development principles, and…

School Turnaround Fever: The Paradoxes of a Historical Practice Promoted as a New Reform

ERIC Educational Resources Information Center

Peck, Craig; Reitzug, Ulrich C.

2014-01-01

School "turnaround" has received significant attention recently in education literature and policy action, especially as a means to dramatically improve urban education. In current common education usage, "turnaround" refers to the rapid, significant improvement in the academic achievement of persistently low-achieving schools.…

Geriatrics in family practice residency education: an unmet challenge.

PubMed

Gazewood, John D; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

2003-01-01

The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

A Qualitative Investigation of Practicing Psychologists' Attitudes Toward Research-Informed Practice: Implications for Dissemination Strategies

PubMed Central

Stewart, Rebecca E.; Stirman, Shannon Wiltsey; Chambless, Dianne L.

2012-01-01

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, investigating everyday treatment decisions and attitudes about treatment outcome research and empirically supported treatments (ESTs). Clinicians noted positive aspects about treatment outcome research, such as being interested in what works. However, they had misgivings about the application of controlled research findings to their practices, were skeptical about using manualized protocols, and expressed concern that nonpsychologists would use EST lists to dictate practice. Clinicians reported practicing in an eclectic framework, and many reported including cognitive-behavioral elements in their practice. To improve their practice, they reported valuing clinical experience, peer networks, practitioner-oriented books, and continuing education when it was not too basic. Time and financial barriers concerned nearly all participants. Clinicians suggested they might be interested in ESTs if they could integrate them into their current frameworks, and if resources for learning ESTs were improved. PMID:22654246

Current concepts in platelet transfusion

PubMed Central

Mohanty, Dipika

2009-01-01

This is the era of component therapy. Therefore there is a need for rational use of platelet concentrate. Lot of knowledge has been added recently in the field of platelet specially about the platelet rich plasma and its application in clinical practice. The current review focuses on improvement in preparation of platelet rich plasma, the procedure to make the same more safe and its rational use. Furthermore newer aspects of platelet concentrate use in surgical practice and for regenerative medicine has also been discussed. It also covers some progress and hurdles in preparation of platelet substitutes. PMID:20041092

Sustainability in medicine.

PubMed

George, Ruth; Coffin, Janis; George, Sierra

2013-01-01

Given the current state of the U.S. healthcare system, with increasingly complicated regulations and paperwork and decreasing reimbursements, the question arises: Is it possible to provide safe, high-quality healthcare and reduce costs? Furthermore, is it possible to care for the health of your patients while simultaneously caring for the financial health of your practice and promoting improvement in the overall health of the planet? This article will review some steps currently being taken by various companies and hopefully stimulate ideas for changes you may want to consider for your own practice, hospital, or institution.

1989 Report to Congress: Management of Hazardous Wastes from Educational Institutions

EPA Pesticide Factsheets

Report identifying the statutory and regulatory requirements, examining current hazardous waste management practices, and identifying possible ways for educational institutions to improve hazardous waste management.

How high-performance work systems drive health care value: an examination of leading process improvement strategies.

PubMed

Robbins, Julie; Garman, Andrew N; Song, Paula H; McAlearney, Ann Scheck

2012-01-01

As hospitals focus on increasing health care value, process improvement strategies have proliferated, seemingly faster than the evidence base supporting them. Yet, most process improvement strategies are associated with work practices for which solid evidence does exist. Evaluating improvement strategies in the context of evidence-based work practices can provide guidance about which strategies would work best for a given health care organization. We combined a literature review with analysis of key informant interview data collected from 5 case studies of high-performance work practices (HPWPs) in health care organizations. We explored the link between an evidence-based framework for HPWP use and 3 process improvement strategies: Hardwiring Excellence, Lean/Six Sigma, and Baldrige. We found that each of these process improvement strategies has not only strengths but also important gaps with respect to incorporating HPWPs involving engaging staff, aligning leaders, acquiring and developing talent, and empowering the front line. Given differences among these strategies, our analyses suggest that some may work better than others for individual health care organizations, depending on the organizations' current management systems. In practice, most organizations implementing improvement strategies would benefit from including evidence-based HPWPs to maximize the potential for process improvement strategies to increase value in health care.

Antenatal Breastfeeding Education and Support: Summary and Analysis of 2 Cochrane Publications.

PubMed

Jacobsen, Noelle

Key breastfeeding outcomes identified by the World Health Organization, the United Nations Children's Fund, the American Academy of Pediatrics, and Healthy People 2020 include early initiation, any such feeding at 6 months of age, and exclusivity. Broader themes in the current literature include infants who ever breastfed and overall duration. Healthcare providers need to know what current practices demonstrate effectiveness. A review of 2 Cochrane articles on which interventions impact these selected outcomes does not reveal any significant implications for clinical practice. Scant evidence exists to support any specific support efforts or educational outreach to improve these outcomes. A discussion of potential strategies to consider for future research and clinical practice is put forth.

How Does a School Leader's Role Influence Student Achievements? A Review of Research Findings and Best Practices

ERIC Educational Resources Information Center

Gamage, David; Adams, Don; McCormack, Ann

2009-01-01

Currently, school systems around the globe are focusing on student achievements empowering school leaders along with curriculum and accountability frameworks. This paper focuses on a comprehensive review of literature on the role of school leadership towards improving student achievements based on research findings and best practices. It refers to…

Motor Learning of a Bimanual Task in Children with Unilateral Cerebral Palsy

ERIC Educational Resources Information Center

Hung, Ya-Ching; Gordon, Andrew M.

2013-01-01

Children with unilateral cerebral palsy (CP) have been shown to improve their motor performance with sufficient practice. However, little is known about how they learn goal-oriented tasks. In the current study, 21 children with unilateral CP (age 4-10 years old) and 21 age-matched typically developed children (TDC) practiced a simple bimanual…

Evaluation of Administrators: Issues and Practices. OSSC Bulletin Vol. 19, No. 10.

ERIC Educational Resources Information Center

Wills, Lewis A.

In this review of current practices it is observed that administrators are evaluated for two major purposes--(1) to provide a basis for school districts' decisions at the conclusion of the evaluation period, and (2) to provide feedback on performance to allow administrator improvement. A comparison is made of evaluation material from five school…

Exploration and Practice of Blended Teaching Model Based Flipped Classroom and SPOC in Higher University

ERIC Educational Resources Information Center

Wang, Xin-Hong; Wang, Jing-Ping; Wen, Fu-Ji; Wang, Jun; Tao, Jian-Qing

2016-01-01

SPOC is characterized by improving teaching effectiveness. Currently open teaching mode is the popular trend, which is mainly related to several aspects: how to carry out teaching practice by using MOOC proprietary, high-quality online teaching resources in open education, that is, deep integration of curriculum resources and teaching design. On…

Prevention of DNA contamination during forensic medical examinations in a clinical forensic medical service: A best practice implementation project.

PubMed

Lutz, Tasha

2015-01-01

Contamination of forensic specimens can have significant and detrimental effects on cases presented in court. In 2010 a wrongful conviction in Australia resulted in an inquiry with 25 recommendations to minimize the risk of DNA contamination of forensic specimens. DNA decontamination practices in a clinical forensic medical service currently attempt to comply with these recommendations. Evaluation of these practices has not been undertaken. The aim of this project was to audit the current DNA decontamination practices of forensic medical and nursing examiners in the forensic medical examination process and implement changes based on the audit findings. A re-audit following implementation would be undertaken to identify change and inform further research. The Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice were used as the audit tool in this project. A baseline audit was conducted; analysis of this audit process was then undertaken. Following education and awareness training targeted at clinicians, a re-audit was completed. There were a total of 24 audit criteria; the baseline audit reflected 20 of these criteria had 100% compliance. The remaining 4 audit criteria demonstrated compliance between 65% and 90%. Education and awareness training resulted in improved compliance in 2 of the 4 audit criteria, with the remaining 2 having unchanged compliance. The findings demonstrated that education and raising awareness can improve clinical practice; however there are also external factors outside the control of the clinicians that influence compliance with best practice.

Kinship Care: Improving Practice through Research.

ERIC Educational Resources Information Center

Gleeson, James P., Ed.; Hairston, Creasie Finney, Ed.

Family members have traditionally provided kinship care for each other in times of crisis. Recently, such care has become part of the child welfare system. This edited volume presents several studies designed to identify current knowledge about kinship care as a child welfare service. Presented in five parts, the book summarizes the current state…

Improving colorectal cancer screening: fact and fantasy

NASA Astrophysics Data System (ADS)

Van Dam, Jacques

2008-02-01

Premalignant diseases of the gastrointestinal tract, such as Barrett's esophagus, long-standing ulcerative colitis, and adenomatous polyps, have a significantly increased risk for development of adenocarcinoma, most often through an intermediate stage of dysplasia. Adenocarcinoma of the colon is the second most common cancer in the United States. Because patients with colorectal cancer often present with advanced disease, the outcomes are associated with significant morbidity and mortality. Effective methods of early detection are essential. As non-polypoid dysplasia is not visible using conventional endoscopy, surveillance of patients with Barrett's esophagus and ulcerative colitis is performed via a system in which multiple random biopsies are obtained at prescribed intervals. Sampling error and missed diagnoses occur frequently and render current screening methods inadequate. Also, the examination of a tissue biopsy is time consuming and costly, and significant intra- and inter-observer variation may occur. The newer methods discussed herein demonstrate the potential to solve these problems by early detection of disease with high sensitivity and specificity. Conventional endoscopy is based on the observation of white light reflected off the tissue surface. Subtle changes in color and shadow reveal structural changes. New developments in optical imaging go beyond white light, exploiting other properties of light. Several promising methods will be discussed at this meeting and shall be briefly discussed below. However, few such imaging modalities have arrived at our clinical practice. Some much more practical methods to improve colorectal cancer screening are currently being evaluated for their clinical impact. These methods seek to overcome limitations other than those of detecting dysplasia not visible under white light endoscopy. The current standard practice of colorectal cancer screening utilizes colonoscopy, an uncomfortable, sometimes difficult medical procedure. Efforts to improve the practice of colonoscopy will be described. Another limitation of the current practice is the inability to detect polypoid neoplasia that is hidden from view under white light imaging by the natural folds that occur within the colon. A device to overcome this limitation will also be described. Efforts to improve colorectal cancer screening (and thereby decrease the death rate of this second leading cause of cancer death in the United States) are progressing in many arenas. The researcher, basic or clinical, should maintain an up to date overview of the field and how each new technological advance is likely to have a role in the screening and early detection of colorectal cancer.

[Perception of health and safety risks among workers pathology laboratories].

PubMed

Alvarado-Cabrero, Isabel; Valencia-Cedillo, Raquel

2015-01-01

Health care workers are experiencing increasing numbers of occupational illnesses. Safety practices in anatomical pathology laboratories (APL) are crucial to prevent unnecessary exposures to both chemical and biological agents. The main goal of this study was to determine if pathologists perceptions and actual practice mirror regulatory guidelines. Current available recommendations for APL were reviewed and used to construct an online survey distributed to pathologists. The survey was completed by 121 participants. Eighty-seven (72 %) of respondents reported receiving inadequate safety training. Most pathologists (82 %) were not well-informed about biosafety practices. Sixty-three (52 %) participants felt that the risks of chemical and infectious disease exposures in the APL were low. Most respondents reported having a needle stick or cut (71 %). Eighty-six (71 %) of participants reported musculo skeletal problems. This study indicated that there is a need for improving training in anatomical pathology safety practices in Mexican laboratories as daily practices do not reflected current guidelines.

The development of accurate and high quality radiotherapy treatment delivery

NASA Astrophysics Data System (ADS)

Griffiths, Susan E.

Accurate radiotherapy delivery is required for curing cancer. Historical radiotherapy accuracy studies at Leeds (1983-1991) are discussed in context of when radiographers were not involved in practice design. The seminal research was unique in being led by a radiographer practitioner, and in prospectively studying the accuracy of different techniques within one department. The viability of alignment of treatment beams with marks painted on a patient's skin varied daily, and, using film I showed that the alignment of treatment on anatomy varied. I then led 6 sequential studies with collaborating oncologists. Unique outcomes were in identifying the origins of treatment inaccuracies, implementing and evidencing changes in multi-disciplinary practice, thus improving accuracy and reproducibility generally and achieving accuracy for the pelvis to within current norms. Innovations included: discontinuation of painted skin marks and developing whole-body patient positioning using lasers, tattoos, and standardised supports; unification of set-up conditions through planning and treatment; planning normal tissue margins round target tissue to allow for inaccuracies (1985); improved manual shielding methods, changed equipment usage, its quality assurance and design; influenced the development of portal imaging and image analysis. Consequences and current implications. The research, still cited internationally, contributed to clinical management of lymphoma, and critically underpins contemporary practice. It led to my becoming the first radiographer invited into multi-disciplinary collaborative work, to advise in the first multi-centre clinical trials to consider treatment delivery accuracy, contribute to books written from within other disciplines and inform guidelines for good practice so helping to improve practices, with recent publications. I thus led my profession into research activity. Later work included development of a national staffing formula for radiotherapy Centres, and contributing to the evidence-base for improved National radiotherapy resourcing. I recently researched and developed a textbook (second edition) on quality in treatment delivery.

Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice.

PubMed

Hallas, D; Fernandez, J B; Herman, N G; Moursi, A

2015-01-01

Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice.

Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice

PubMed Central

Hallas, D.; Fernandez, J. B.; Herman, N. G.; Moursi, A.

2015-01-01

Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice. PMID:25653873

Pediatric Sepsis

PubMed Central

Mathias, Brittany; Mira, Juan; Larson, Shawn D.

2016-01-01

Purpose of Review Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72,000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. Recent Findings The definition of pediatric sepsis is currently in a state of evolution and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice. Despite this, it is the speed of diagnosis and the timely implementation of current treatment guidelines that has been shown to improve outcomes. However, adherence to treatment guidelines is currently low and it is only through the implementation of protocols that improved care and outcomes have been demonstrated. Summary Current management of pediatric sepsis is largely based on adaptations from adult sepsis treatment; however, distinct physiology demands more prospective pediatric trials to tailor management to the pediatric population. Adherence to current and emerging practice guidelines will require that protocolized care pathways become commonplace. PMID:26983000

Best practice guidelines for stroke in Cameroon: An innovative and participatory knowledge translation project.

PubMed

Cockburn, Lynn; Fanfon, Timothy N; Bramall, Alexa; Ngole, Eta M; Kuwoh, Pius; Anjonga, Emmanuel; Difang, Brenda M E; Kiani, Shirin; Muso, Petra S; Trivedi, Navjyot; Sama, Julius; Teboh, Sylvian

2014-01-01

Although the adherence to stroke guidelines in high-income countries has been shown to be associated with improved patient outcomes, the research, development and implementation of rehabilitation related guidelines in African countries is lacking. The purpose of this article is to describe how a group of front-line practitioners collaborated with academics and students to develop best practice guidelines (BPG) for the management and rehabilitation of stroke in adult patients in Cameroon. A working group was established and adapted internationally recognised processes for the development of best practice guidelines. The group determined the scope of the guidelines, documented current practices, and critically appraised evidence to develop guidelines relevant to the Cameroon context. The primary result of this project is best practice guidelines which provided an overview of the provision of stroke rehabilitation services in the region, and made 83 practice recommendations to improve these services. We also report on the successes and challenges encountered during the process, and the working group's recommendations aimed at encouraging others to consider similar projects. This project demonstrated that there is interest and capacity for improving stroke rehabilitation practices and for stroke guideline development in Africa.

A National Survey of the Nursing Care of Infants With Prenatal Substance Exposure in Canadian NICUs.

PubMed

Marcellus, Lenora; Loutit, Tara; Cross, Shannon

2015-10-01

Many communities are reporting increases in the number of infants requiring NICU care. Practices continue to vary and there is limited available evidence about nursing care. The purpose of this study was to describe current nursing care practices for infants with prenatal substance exposure in the NICU setting and during transition to the community. Findings from this study were compared with an earlier Canadian survey (by Marcellus in 2002) to identify shifts in clinical nursing practice for this population. This was a cross-sectional descriptive survey design. A 68-item survey composed of multiple-choice and open-ended questions was administered through FluidSurveys online software. A convenience sample of 62 clinical managers or clinical educators in hospitals with active maternal-infant clinical units with 500 deliveries or more annually and/or pediatric hospitals with a separate designated neonatal service (ie, Level 2 and 3 units) was chosen. A greater number of NICUs are using clinical guidelines to support the standardization of quality care. Improvements in nursing practice were identified and these included the consistent use of a withdrawal scoring tool and provision of education for team members in orientation. A decline in routine discharge planning meetings and routine parent teaching plans was discovered. This survey has improved understanding of the current state of nursing care for infants with prenatal substance exposure and their families during this critical time of transition. The purpose of the survey was to compare findings with the 2002 study by Marcellus to identify any improved practices and describe current state nursing care practices in the NICU. Practice changes over the last decade have included keeping mothers and infants together, expanding concepts of the team, integrating programs and services across hospital and community settings, and creating opportunities for NICU teams to learn more about substance use, mental health, violence, and trauma. Focus on discharge planning, parent teaching, and creation and implementation of national/hospital guidelines is essential for consistent evidence-based quality patient care.

Soil biodiversity and human health

NASA Astrophysics Data System (ADS)

Wall, Diana H.; Nielsen, Uffe N.; Six, Johan

2015-12-01

Soil biodiversity is increasingly recognized as providing benefits to human health because it can suppress disease-causing soil organisms and provide clean air, water and food. Poor land-management practices and environmental change are, however, affecting belowground communities globally, and the resulting declines in soil biodiversity reduce and impair these benefits. Importantly, current research indicates that soil biodiversity can be maintained and partially restored if managed sustainably. Promoting the ecological complexity and robustness of soil biodiversity through improved management practices represents an underutilized resource with the ability to improve human health.

Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

PubMed

McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

2013-01-01

In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care.

Investigation of the current requirements engineering practices among software developers at the Universiti Utara Malaysia Information Technology (UUMIT) centre

NASA Astrophysics Data System (ADS)

Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Abdullah, Inam

2016-08-01

Requirements Engineering (RE) is a systemic and integrated process of eliciting, elaborating, negotiating, validating and managing of the requirements of a system in a software development project. UUM has been supported by various systems developed and maintained by the UUM Information Technology (UUMIT) Centre. The aim of this study was to assess the current requirements engineering practices at UUMIT. The main problem that prompted this research is the lack of studies that support software development activities at the UUMIT. The study is geared at helping UUMIT produce quality but time and cost saving software products by implementing cutting edge and state of the art requirements engineering practices. Also, the study contributes to UUM by identifying the activities needed for software development so that the management will be able to allocate budget to provide adequate and precise training for the software developers. Three variables were investigated: Requirement Description, Requirements Development (comprising: Requirements Elicitation, Requirements Analysis and Negotiation, Requirements Validation), and Requirement Management. The results from the study showed that the current practice of requirement engineering in UUMIT is encouraging, but still need further development and improvement because a few RE practices were seldom practiced.

Implementing best practice into the emergency department triage process.

PubMed

Burgess, Luke; Kynoch, Kathryn; Hines, Sonia

2018-05-17

Triage is the process by which emergency departments (EDs) sort patients presenting for medical treatment. The Australasian Triage Scale, validated to measure urgency, answers the question 'This patient should wait for medical assessment and treatment no longer than…' Multiple patients may present within short time frames, and some will have conditions that have outcomes directly related to timeliness of treatment such as stroke, sepsis and myocardial infarction. The safety of patients within the ED is thus directly related to the triage system. This project aimed to compare current triage practice within a metropolitan ED with evidence-based practice guidelines produced by the Australasian College for Emergency Medicine and College of Emergency Nurses Australasia. The clinical audit project was undertaken in an ED in a large metropolitan hospital. Two hundred episodes of triage were audited, 100 in the preimplementation and 100 in the postimplementation phase. Current practice was compared with triage guidelines, barriers to adherence to evidence-based practice identified, and interventions were planned and implemented to address these. The audits of practice focused on five key areas and were assessed against 12 criteria: arrival and triage, documentation, compliance with policy, communication, and triage staff. Overall five criteria showed improvement, with reassessment of patients waiting for treatment, and the time taken for each triage episode achieving the greatest amount of improvement. Four criteria showed no improvement or a decline, and two achieved 100% adherence in both audits. The project sought to undertake a clinical audit of triage practice to evaluate the adherence of practice to evidence-based guidelines. The project has provided strong support for the implementation of a formal nursing role to support the care of waiting room patients, and act as a second triage nurse during periods of high activity. The physical triage environment has been identified as a barrier to optimal adherence to evidence-based practice guidelines. Using effective communication to manage the waiting experience of patients can have positive benefits for both patients and staff.

Big data in pharmacy practice: current use, challenges, and the future.

PubMed

Ma, Carolyn; Smith, Helen Wong; Chu, Cherie; Juarez, Deborah T

2015-01-01

Pharmacy informatics is defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes. The term "big data" has been coined and is often defined in three V's: volume, velocity, and variety. This paper describes three major areas in which pharmacy utilizes big data, including: 1) informed decision making (clinical pathways and clinical practice guidelines); 2) improved care delivery in health care settings such as hospitals and community pharmacy practice settings; and 3) quality performance measurement for the Centers for Medicare and Medicaid and medication management activities such as tracking medication adherence and medication reconciliation.

Big data in pharmacy practice: current use, challenges, and the future

PubMed Central

Ma, Carolyn; Smith, Helen Wong; Chu, Cherie; Juarez, Deborah T

2015-01-01

Pharmacy informatics is defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes. The term “big data” has been coined and is often defined in three V’s: volume, velocity, and variety. This paper describes three major areas in which pharmacy utilizes big data, including: 1) informed decision making (clinical pathways and clinical practice guidelines); 2) improved care delivery in health care settings such as hospitals and community pharmacy practice settings; and 3) quality performance measurement for the Centers for Medicare and Medicaid and medication management activities such as tracking medication adherence and medication reconciliation. PMID:29354523

Figures in clinical trial reports: current practice & scope for improvement.

PubMed

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-11-19

Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

[Regional health systems management: a case study in Rio Grande do Sul, Brazil].

PubMed

Lima, Juliano de Carvalho; Rivera, Francisco Javier Uribe

2006-10-01

This article analyzes the management system in a health district in the State of Rio Grande do Sul, Brazil, through qualitative analysis, using a case study as the methodology and macro-organization theory as the analytical framework. For the current management system in the 6th Health Region, a clear mission statement and wide acceptance by health workers are facilitating factors for the current organizational practices within the health system. Nevertheless, the way health coordinators are currently prioritizing their time has diverted necessary resources from critical problems towards more remedial issues. The 6th Health Region has encouraged social control (or public oversight) in order to improve accountability. However, there is room for improvement in quality assurance management, since there were no well-defined goals, objectives, or accountability. Decentralized consultancy provided to the municipalities and the funding model itself have both promoted decentralization and autonomy, although the strategy requires better regional integration and greater commitment in managerial practices.

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients’ Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda

PubMed Central

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-01-01

This study aimed at analyzing the effect of 5S practice on staff motivation, patients’ waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement. PMID:28299136

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

PubMed

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-03-31

This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

Intermittent auscultation of fetal heart rate during labour - a widely accepted technique for low risk pregnancies: but are the current national guidelines robust and practical?

PubMed

Sholapurkar, S L

2010-01-01

Intermittent auscultation of fetal heart rate is an accepted practice in low risk labours in many countries. National guidelines on intrapartum fetal monitoring were critically reviewed regarding timing and frequency of intermittent auscultation. Hypothetical but plausible examples are presented to illustrate that it may be possible to miss significant fetal distress with strict adherence to current guidelines. Opinion is forwarded that intermittent auscultation should be performed for 60 seconds before and after three contractions over about 10 min every half an hour in the first stage of labour. Reasons are put forward to show how this could be more practical and patient friendly and at the same time could improve detection of fetal distress. The current recommendation of intermittent auscultation every 15 min in the first stage is associated with poor compliance and leads to unnecessary burden, stress and medicolegal liability for birth attendants. Modification of current national guidelines would be desirable.

Mobile phone text messaging to improve knowledge and practice of diabetic foot care in a developing country: Feasibility and outcomes.

PubMed

Hassan, Zeinab M

2017-06-01

To test the feasibility and effectiveness of using mobile phone text messaging to reinforce learning and the practice of diabetic foot care in a developing country. Ongoing learning reinforcement (2-3 times weekly) by text messaging followed an informal class on diabetic foot care in a community clinic setting. Subjects with cell phone access and no history of diabetic foot wounds or current wounds were recruited for participation (N = 225). Foot examinations and pretesting by survey occurred just before patients departed the clinic; the posttest survey and a final foot examination occurred 12 weeks later. The survey included basic demographic items along with items to measure knowledge and current foot care practices. One sample t tests (raw scores) and Wilcoxon signed-rank tests compared knowledge and practice before and after intervention. Initially, a majority of the sample (76%) reported poor levels of foot care. After 12 weeks <1% reported poor foot care practices. Statistical testing showed significant gains in knowledge (by score and level) and nearly unanimous compliance with daily foot examination. Mobile phone text messaging is an economical, feasible, and effective method for educators to improve diabetic self-care, even in a developing country. © 2017 John Wiley & Sons Australia, Ltd.

Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork.

PubMed

Zwarenstein, Merrick; Reeves, Scott

2006-01-01

Knowledge-translation interventions and interprofessional education and collaboration interventions all aim at improving health care processes and outcomes. Knowledge-translation interventions attempt to increase evidence-based practice by a single professional group and thus may fail to take into account barriers from difficulties in interprofessional relations. Interprofessional education and collaboration interventions aim to improve interprofessional relations, which may in turn facilitate the work of knowledge translation and thus evidence-based practice. We summarize systematic review work on the effects of interventions for interprofessional education and collaboration. The current evidence base contains mainly descriptive studies of these interventions. Knowledge is limited regarding the impact on care and outcomes and the extent to which the interventions increase the practice of evidence-based care. Rigorous multimethod research studies are needed to develop and strengthen the current evidence base in this field. We describe a Health Canada-funded randomized trial in which quantitative and qualitative data will be gathered in 20 general internal medicine units located at 5 Toronto, Ontario, teaching hospitals. The project examines the impact of interprofessional education and collaboration interventions on interprofessional relationships, health care processes (including evidence-based practice), and patient outcomes. Routes are suggested by which interprofessional education and collaboration interventions might affect knowledge translation and evidence-based practice.

Applying Best Practices to Florida Local Government Retrofit Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

McIlvaine, J.; Sutherland, K.

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multi-year field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annualmore » energy savings of 15-30% and higher. This report describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the 'current best practices.' A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. Our new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.« less

Existing Whole-House Solutions Case Study: Applying Best Practices to Florida Local Government Retrofit Programs - Central Florida

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multiyear field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annualmore » energy savings of 15%-30% and higher. This case study describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the "current best practices". A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. The new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.« less

Applying Best Practices to Florida Local Government Retrofit Programs, Central Florida (Fact Sheet)

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multi-year field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annualmore » energy savings of 15-30% and higher. This report describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the "current best practices". A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. Our new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.« less

Applying Best Practices to Florida Local Government Retrofit Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

McIlvaine, J.; Sutherland, K.

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multiyear field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annualmore » energy savings of 15%-30% and higher. This report describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the "current best practices". A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. The new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.« less

Quality improvement in childhood obesity management through the maintenance of certification process.

PubMed

Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura

2013-11-01

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.

Improving efficacy of landscape interventions in the (sub) humid Ethiopian highlands by improved understanding of runoff processes

USDA-ARS?s Scientific Manuscript database

Despite millions of dollars invested in soil and water conservation practices and other landscape interventions in the Ethiopian highlands and billions of hours of food-for-work farm labor, sediment concentration in rivers is increasing. Possible ways to reverse the current trend have been investiga...

Educational Technology Training for Higher Education Teachers in China and Some Suggestions for Improving It

ERIC Educational Resources Information Center

Huiyu, Zhang; Yan, Dong; Geng, Chen

2005-01-01

This article describes current practices in educational technology training for higher education teachers in China, using information derived from questionnaires and statistics. It addresses problems identified in questionnaires, such as upgrading and improving training content and training modes, and makes some constructive suggestions for the…

Improving fumigation efficiency by increasing drip-tape number and using low permeability film in raised-bed production systems

USDA-ARS?s Scientific Manuscript database

Drip fumigation is commonly used for controlling soilborne pests in raised-bed strawberry production systems in California. However, the high emission loss and poor pest control indicate that the current fumigation practice with two drip tapes and polyethylene film (PE) covering need to be improved....

Application of tung oil to improve adhesion strength and water resistance of cottonseed meal and protein adhesives on maple veneer

USDA-ARS?s Scientific Manuscript database

Cottonseed meal-based products show promise in serving as environment-friendly wood adhesives. However, their practical utilization is currently limited due to low durability and water resistant properties. In this research, we tested the improvement of adhesion strength and water resistance of cott...

Establishing a Safe School Culture: An Examination of Current Practices in K through 12 Leadership

ERIC Educational Resources Information Center

Kelly, Zanita V.

2016-01-01

School improvement plans and major reform initiatives most often target core academic competencies. They might include strategies to improve the physical safety of school campuses, but they rarely include discussions about creating psychologically safe environments. School safety has garnered national attention in the aftermath of violent high…

Educational Technology Classics: Educational Technology Doesn't Really Exist

ERIC Educational Resources Information Center

Silvern, Leonard C.

2013-01-01

The improvement of a professional group is due, in part, to its ability for introspection and self-evaluation. This is essentially the process of "analyzing" the profession as it currently is practiced, identifying necessary changes and improvements, and "synthesizing" or creating a new image or model of the profession to…

A Whole School Approach: Collaborative Development of School Health Policies, Processes, and Practices

ERIC Educational Resources Information Center

Hunt, Pete; Barrios, Lisa; Telljohann, Susan K.; Mazyck, Donna

2015-01-01

Background: The Whole School, Whole Community, Whole Child (WSCC) model shows the interrelationship between health and learning and the potential for improving educational outcomes by improving health outcomes. However, current descriptions do not explain how to implement the model. Methods: The existing literature, including scientific articles,…

Would a new definition and classification of nocturia and nocturnal polyuria improve our management of patients? ICI-RS 2014.

PubMed

Bosch, J L H Ruud; Everaert, Karel; Weiss, Jeffrey P; Hashim, Hashim; Rahnama'i, M Sajjad; Goessaert, An-Sofie; Aizen, Joshua

2016-02-01

The following is a report of the proceedings of the Nocturia Think Tank sessions of the annual International Consultation on Incontinence-Research Society, which took place September 22-24, 2014 in Bristol, UK. The report is organized into sections pertaining to the main topic of discussion focussing on the question as to whether a new definition and classification of nocturia and nocturnal polyuria would improve the outcome of management in our patients. First, discussions identified theoretical and practical shortcomings of current definitions. Secondly, the utility of several nocturnal polyuria definitions was tested in a real life population in relation to the symptom nocturia, in order to display weaknesses of these definitions. Thirdly, we explored in a clinical population the utility of bladder diary based parameters by asking the question: when nocturia improves, which of these parameters improve most? Based on the above explorations the Think Tank summarized elements of the current definitions that need reconsideration and suggests proposals for further research to reach more practical and more clinically meaningful definitions. © 2015 Wiley Periodicals, Inc.

The Southampton Initiative for Health: a complex intervention to improve the diets and increase the physical activity levels of women and children from disadvantaged communities

PubMed Central

Barker, Mary; Lawrence, Wendy; Baird, Janis; Jarman, Megan; Black, Christina; Barnard, Katharine; Cradock, Sue; Davies, Jenny; Margetts, Barrie; Inskip, Hazel; Cooper, Cyrus

2013-01-01

The ‘Southampton Initiative for Health’ (SIH) is a training intervention with Sure Start Children’s Centre staff designed to improve the diets and physical activity levels of women of child-bearing age. Training aims to help staff to support women in making changes to their lifestyles by improving three skills: reflection on current practice; asking ‘open discovery’ questions; and goal setting. The impact of the training on staff practice is being assessed. A before and after non-randomised controlled trial is being used to evaluate the effectiveness and cost-effectiveness of the intervention in improving women’s diets and increasing their physical activity levels. PMID:20709878

Feedback: an essential element of student learning in clinical practice.

PubMed

Clynes, Mary P; Raftery, Sara E C

2008-11-01

Clinical practice is an essential component of the nursing curriculum. In order for the student to benefit fully from the experience regular performance feedback is required. Feedback should provide the student with information on current practice and offer practical advice for improved performance. The importance of feedback is widely acknowledged however it appears that there is inconsistency in its provision to students. The benefits of feedback include increased student confidence, motivation and self-esteem as well as improved clinical practice. Benefits such as enhanced interpersonal skills and a sense of personal satisfaction also accrue to the supervisor. Barriers to the feedback process are identified as inadequate supervisor training and education, unfavourable ward learning environment and insufficient time spent with students. In addition to the appropriate preparation of the supervisor effective feedback includes an appreciation of the steps of the feedback process, an understanding of the student response to feedback and effective communication skills.

Development of a virtual reality assessment of everyday living skills.

PubMed

Ruse, Stacy A; Davis, Vicki G; Atkins, Alexandra S; Krishnan, K Ranga R; Fox, Kolleen H; Harvey, Philip D; Keefe, Richard S E

2014-04-23

Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes.  Treatment studies aimed at cognitive impairment in patients with schizophrenia not only require demonstration of improvements on cognitive tests, but also evidence that any cognitive changes lead to clinically meaningful improvements.  Measures of "functional capacity" index the extent to which individuals have the potential to perform skills required for real world functioning.  Current data do not support the recommendation of any single instrument for measurement of functional capacity.  The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a novel, interactive gaming based measure of functional capacity that uses a realistic simulated environment to recreate routine activities of daily living. Studies are currently underway to evaluate and establish the VRFCAT's sensitivity, reliability, validity, and practicality. This new measure of functional capacity is practical, relevant, easy to use, and has several features that improve validity and sensitivity of measurement of function in clinical trials of patients with CNS disorders.

Forest genetics research at the University of Michigan

Treesearch

Burton V. Barnes

1970-01-01

The purpose of the research program, as evidenced by results as well as current research and future direction, is to add to the knowledge of the ecology and genetics of forest trees. Although we are interested in the practical gains that are possible and being realized in practical tree improvement, our contribution is in basic studies that stimulate and challenge...

Evaluating educational interventions for information literacy.

PubMed

Stevenson, Paul

2012-03-01

This article considers how information literacy training initiatives delivered by health library services are evaluated. It presents three validated assessment and evaluation models, and using examples from practice, discusses how these can be used to establish the impact of information literacy training and to improve current evaluation practices. HS. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Improving Professional Practice through Practice-Based Research: VaKE (Values "and" Knowledge Education) in University-Based Teacher Education

ERIC Educational Resources Information Center

Weinberger, Alfred; Patry, Jean-Luc; Weyringer, Sieglinde

2016-01-01

Evidence suggests that in the professional education of teachers the moral goals are currently a neglected topic in favor of the subject matter and knowledge. The constructivist instructional approach VaKE (Values "and" Knowledge Education) addresses this problem by combining the moral and epistemic goals through the discussion of moral…

Mobile Assisted Language Learning in University EFL Courses in Japan: Developing Attitudes and Skills for Self-Regulated Learning

ERIC Educational Resources Information Center

Kondo, Mutsumi; Ishikawa, Yasushige; Smith, Craig; Sakamoto, Kishio; Shimomura, Hidenori; Wada, Norihisa

2012-01-01

This paper reports a project in which researchers at universities in Japan explored the use of Mobile Assisted Language Learning (MALL) practices by developing a learning module intended to help improve students' scores on the TOEIC Listening and Reading Tests. MALL practices are currently being developed at universities in Japan because almost…

Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways.

PubMed

Rath, Santosh; Yadav, Lalit; Tewari, Abha; Chantler, Tracey; Woodward, Mark; Kotwal, Prakash; Jain, Anil; Dey, Aparajit; Garg, Bhavuk; Malhotra, Rajesh; Goel, Ashish; Farooque, Kamran; Sharma, Vijay; Webster, Premila; Norton, Robyn

2017-12-01

Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospitals over a 10-week period were recruited. Patients' data were collected at admission, discharge and 30 days post-injury. Eleven key informant interviews and four focus group discussions were conducted with healthcare providers. Descriptive data for key quantitative variables were computed. The qualitative data were analysed and interpreted using a behaviour change wheel framework. A total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identified in the three participating hospitals during the recruitment period and only 85 (63%) were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30% received surgery within 48 h of hospital admission, 95% received surgery within 39 days of hospital admission and two (3%) had died by 30 days of injury. According to the healthcare providers, inadequate resources and overcrowding prevent adequate caring of the hip fracture patients. They unanimously felt the need for protocol-based management of hip fracture in India. The development and implementation of national guidelines and standardized protocols of care for older people with hip fractures in India has the potential to improve both care and patient-related outcomes.

Does appraisal enhance learning, improve practice and encourage continuing professional development? A survey of general practitioners' experiences of appraisal.

PubMed

Finlay, Karen; McLaren, Susan

2009-01-01

Revalidation of the medical profession is under review and a system has been proposed to ensure doctors meet standards of practice and professionalism. The current appraisal system allows clinicians to chart their progress and identify developmental needs in order to improve performance. Appraisal is now an annual compulsory requirement for all doctors. The aim of the study was to investigate the experiences of general practitioners (GPs) of the current appraisal process. The specific objectives were to consider the impact the appraisal process had exerted on their learning, practice and individual continuing professional development (CPD). We employed a cross-sectional design using a postal questionnaire sent to all doctors who work as GPs (n = 385) in West Kent. Questionnaires were returned from 71.7% of doctors (n = 276). The key findings obtained were that 47.5% (n = 131) of doctors stated that taking part in the appraisal process had enhanced their learning, 40.2% (n = 111) felt that the appraisal process had improved their practice and 55.8% (n = 154) stated that the appraisal process had encouraged their CPD. Qualitative findings derived from thematic analysis of open questions revealed that participants viewed the role of the appraiser as respected peer to be vital and there was a need for independence in the appraiser's appointment. The time-consuming nature of the appraisal process was emphasised, with little protected time for preparation of documentation and engagement in CPD. Concerns were expressed about links between appraisal and revalidation. Many doctors considered that the appraisal process had enhanced their learning, improved their practice and encouraged their CPD. A vital, independent role for the appraiser was emphasised as was a need to review the time-consuming nature of the current appraisal process, together with identifying protected time to complete this and CPD engagement. As the role of appraisal within the revalidation process changes it is recognised that ensuring the quality, consistency and nature of appraisal will be essential to maintain the confidence of patients and doctors.

Health information technology adoption in New Zealand optometric practices.

PubMed

Heidarian, Ahmadali; Mason, David

2013-11-01

Health information technology (HIT) has the potential to fundamentally change the practice of optometry and the relationship between optometrists and patients and to improve clinical outcomes. This paper aims to provide data on how health information technology is currently being used in New Zealand optometric practices. Also this paper aims to explore the potential benefits and barriers to the future adoption of health information technology in New Zealand. One hundred and six New Zealand optometrists were surveyed about their current use of health information technology and about potential benefits and barriers. In addition, 12 semi-structured interviews were carried out with leaders of health information technology in New Zealand optometry. The areas of interest were the current and intended use of HIT, the potential benefits of and barriers to using HIT in optometric offices and the level of investment in health information technology. Nearly all optometrists (98.7 per cent) in New Zealand use computers in their practices and 93.4 per cent of them use a computer in their consulting room. The most commonly used clinical assessment technology in optometric practices in New Zealand was automated perimeter (97.1 per cent), followed by a digital fundus/retinal camera (82.6 per cent) and automated lensometer (62.9 per cent). The pachymeter is the technology that most respondents intended to purchase in the next one to five years (42.6 per cent), followed by a scanning laser ophthalmoscope (36.8 per cent) and corneal topographer (32.9 per cent). The main benefits of using health information technology in optometric practices were improving patient perceptions of ‘state of the art’ practice and providing patients with information and digital images to explain the results of assessment. Barriers to the adoption of HIT included the need for frequent technology upgrades, cost, lack of time for implementation, and training. New Zealand optometrists are using HIT broadly in their practices and expect HIT use to increase over time.

High-precision GPS vehicle tracking to improve safety.

DOT National Transportation Integrated Search

2016-09-01

Commercial Global Positioning System (GPS) devices are being used in transportation for applications : including vehicle navigation, traffic monitoring, and tracking commercial and public transit vehicles. The : current state-of-practice technology i...

Effective utility accommodation : final report.

DOT National Transportation Integrated Search

2009-12-08

The report presents research regarding methods to improve project delivery times and minimize construction delays due to utility coordination by conducting a study of the current best practices used by six (6) similar state transportation departments...

Ophthalmology resident selection: current trends in selection criteria and improving the process.

PubMed

Nallasamy, Sudha; Uhler, Tara; Nallasamy, Nambi; Tapino, Paul J; Volpe, Nicholas J

2010-05-01

To document and assess current ophthalmology resident selection practices as well as to initiate discussion on how best to improve the process. Online survey comprising 56 questions. Program directors, chairpersons, or members of the resident selection committee representing 65 United States ophthalmology residency programs accredited by the Accreditation Council on Graduate Medical Education. Study participants completed an online, anonymous survey consisting primarily of multiple choice questions, with single or multiple answers. Ophthalmology resident selection practices were evaluated and included: screening of applications, interview processes, selection factors, and formation of rank lists; recommendations given to applicants; and respondent satisfaction with the current selection process. As a group, survey respondents deemed the following factors most important in resident selection: interview performance (95.4%), clinical course grades (93.9%), letters of recommendation (83.1%), and board scores (80%). Statistical analyses deemed that the best predictors of resident performance are interviews, clinical course grades, recommendation letters, and ophthalmology rotation performance. Ophthalmology resident selection is a relatively subjective process, continuing to rely heavily on cognitive factors. Because these factors are not always indicative of ultimate resident quality, it would be helpful if ophthalmology training programs improved selection practices to discern who most likely will become a successful resident and future ophthalmologist. Long-term studies correlating applicant attributes with residency and postresidency success are needed to recommend guidelines for a more standardized selection process. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Clinical exome sequencing reports: current informatics practice and future opportunities.

PubMed

Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon

2017-11-01

The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

PubMed

Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess

2010-01-01

Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma.

PubMed

Schneider, Carl R; Everett, Alan W; Geelhoed, Elizabeth; Padgett, Cale; Ripley, Scott; Murray, Kevin; Kendall, Peter A; Clifford, Rhonda M

2010-01-01

Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted. A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

The theory, practice, and future of process improvement in general thoracic surgery.

PubMed

Freeman, Richard K

2014-01-01

Process improvement, in its broadest sense, is the analysis of a given set of actions with the aim of elevating quality and reducing costs. The tenets of process improvement have been applied to medicine in increasing frequency for at least the last quarter century including thoracic surgery. This review outlines the theory underlying process improvement, the currently available data sources for process improvement and possible future directions of research. Copyright © 2015 Elsevier Inc. All rights reserved.

Support for school-based obesity prevention efforts: attitudes among administrators at nationally representative samples of US elementary schools.

PubMed

Turner, Lindsey; Slater, Sandy J; Chaloupka, Frank J

2013-08-01

With the continued threat of childhood obesity, many public health intervention efforts focus on school settings. The current study sought to document administrator attitudes regarding obesity and interest in improving relevant school practices (i.e., nutrition and physical activity) in elementary schools. Mail-back surveys were used to gather data from public and private elementary schools during the 2006-2007, 2007-2008, 2008-2009, and 2010-2011 school years. In each year, a different set of items pertaining to administrator attitudes was included. Numbers of responding schools annually ranged from 259 to 336 private schools, and from 578 to 748 public schools. The vast majority of elementary school administrators (>90%) agreed that schools can play a role in addressing childhood obesity, physical education improves a variety of academic outcomes, and they were interested in improving practices at their school. Concern about childhood obesity and perceiving that schools can play a role in addressing obesity were both associated with more interest in improving school practices. However, only one-third of administrators agreed that parents were interested in participating in improving nutrition and physical activity practices, suggesting opportunities for efforts to improve collaboration. Administrators are generally very supportive of school-based efforts to improve nutrition and physical activity practices and see the value in doing so. Given the amount of time children spend in school, schools are an essential venue for efforts to address childhood obesity.

Aligning Practice to Policies: Changing the Culture to Recognize and Reward Teaching at Research Universities

PubMed Central

Dennin, Michael; Schultz, Zachary D.; Feig, Andrew; Finkelstein, Noah; Greenhoot, Andrea Follmer; Hildreth, Michael; Leibovich, Adam K.; Martin, James D.; Moldwin, Mark B.; O’Dowd, Diane K.; Posey, Lynmarie A.; Smith, Tobin L.; Miller, Emily R.

2017-01-01

Recent calls for improvement in undergraduate education within STEM (science, technology, engineering, and mathematics) disciplines are hampered by the methods used to evaluate teaching effectiveness. Faculty members at research universities are commonly assessed and promoted mainly on the basis of research success. To improve the quality of undergraduate teaching across all disciplines, not only STEM fields, requires creating an environment wherein continuous improvement of teaching is valued, assessed, and rewarded at various stages of a faculty member’s career. This requires consistent application of policies that reflect well-established best practices for evaluating teaching at the department, college, and university levels. Evidence shows most teaching evaluation practices do not reflect stated policies, even when the policies specifically espouse teaching as a value. Thus, alignment of practice to policy is a major barrier to establishing a culture in which teaching is valued. Situated in the context of current national efforts to improve undergraduate STEM education, including the Association of American Universities Undergraduate STEM Education Initiative, this essay discusses four guiding principles for aligning practice with stated priorities in formal policies: 1) enhancing the role of deans and chairs; 2) effectively using the hiring process; 3) improving communication; and 4) improving the understanding of teaching as a scholarly activity. In addition, three specific examples of efforts to improve the practice of evaluating teaching are presented as examples: 1) Three Bucket Model of merit review at the University of California, Irvine; (2) Evaluation of Teaching Rubric, University of Kansas; and (3) Teaching Quality Framework, University of Colorado, Boulder. These examples provide flexible criteria to holistically evaluate and improve the quality of teaching across the diverse institutions comprising modern higher education. PMID:29196430

Current trends of balloon laryngoplasty in Thailand.

PubMed

Moungthong, Greetha; Bunbanjerdsuk, Sacarin; Wright, Nida; Sathavornmanee, Thanakrit; Setabutr, Dhave

2017-06-01

To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

Strategies for rehabilitation professionals to move evidence-based knowledge into practice: a systematic review.

PubMed

Menon, Anita; Korner-Bitensky, Nicol; Kastner, Monika; McKibbon, K Ann; Straus, Sharon

2009-11-01

Rehabilitation clinicians need to stay current regarding best practices, especially since adherence to clinical guidelines can significantly improve patient outcomes. However, little is known about the benefits of knowledge translation interventions for these professionals. To examine the effectiveness of single or multi-component knowledge translation interventions for improving knowledge, attitudes, and practice behaviors of rehabilitation clinicians. Systematic review of 7 databases conducted to identify studies evaluating knowledge translation interventions specific to occupational therapists and physical therapists. 12 studies met the eligibility criteria. For physical therapists, participation in an active multi-component knowledge translation intervention resulted in improved evidence-based knowledge and practice behaviors compared with passive dissemination strategies. These gains did not translate into change in clinicians' attitudes towards best practices. For occupational therapists, no studies have examined the use of multi-component interventions; studies of single interventions suggest limited evidence of effectiveness for all outcomes measured. While this review suggests the use of active, multi-component knowledge translation interventions to enhance knowledge and practice behaviors of physical therapists, additional research is needed to understand the impact of these strategies on occupational therapists. Serious research gaps remain regarding which knowledge translation strategies impact positively on patient outcomes.

A tale of four practices.

PubMed

Miller-Day, Michelle; Applequist, Janelle; Zabokrtsky, Keri; Dalton, Alexandra; Kellom, Katherine; Gabbay, Robert; Cronholm, Peter F

2017-09-18

Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

Audiology and speech-language pathology practice in Saudi Arabia.

PubMed

Alanazi, Ahmad A

2017-01-01

Audiology and speech-language pathology (SLP) are relatively new professions in Saudi Arabia. The idea of establishing new audiology and SLP programs in some education facilities has become popular across Saudi Arabia; yet, only four undergraduate and graduate programs are currently available. This study aimed to explore the fields of audiology and SLP in Saudi Arabia, obtain demography of audiologists and Speech-language pathologists (SLPs), understand their current practices, and identify their perspective on what both professions need to improve. A cross-sectional mixed methods study design was used to address the aim of this study. Two online surveys were prepared and distributed to reach a large number of audiologists and SLPs. Both surveys consisted of close- and open-ended questions and primarily focused on three categories demography, audiology or SLP practices, and audiologists' or SLPs' perspective on their professions in Saudi Arabia. A total of 23 audiologists and 37 SLPs completed the surveys (age range = 21-50 years). The majority of respondents were from Riyadh with different academic qualifications and working experiences. Various practices were noticed among audiologists and SLPs who mainly worked in hospitals. Several suggestions regarding the development of audiology and SLP education and practice in Saudi Arabia are discussed. This study provides useful information about audiology and SLP education and practices in Saudi Arabia. Collaborative work between stakeholders to achieve high-quality educational and practical standards is critical. National database, clinical guidelines and policies should be developed, employed, and supervised. Further research is needed to improve education and practice of both professions in Saudi Arabia.

Taking a traditional web site to patient portal technology.

PubMed

Labow, Kimberly

2010-01-01

In this era of consumer-driven healthcare, consumers (your current and potential patients) seek healthcare information on the Internet. If your practice doesn't have a Web site, or has one that's static and uninformative, you won't be found, and the patient will move on to the next practice Web site. Why? Because only the most graphically appealing, informative, and patient-centered Web sites will drive patients to your practice. Patients are demanding improved communication with their physician. A practice Web site is a start, but the adoption of a fully functional, interactive Web site with patient portal solutions will not only improve patient-to-provider relationships but will also give the patient access to your practice from anywhere, at any time of the day. Furthermore, these solutions can help practices increase efficiencies and revenue, while reducing operating costs. With the American Recovery and Reinvestment Act of 2009 and other incentives for healthcare information technology adoption, the time is right for your practice to consider implementing technology that will bring considerable value to your practice and also increase patient satisfaction.

Improvement of widening joint design and construction practices for flexible pavements.

DOT National Transportation Integrated Search

2015-09-01

Few guidelines exist statewide, or even nationwide, for assisting designers in selecting : appropriate roadway widening techniques. Current Florida Department of Transportation : (FDOT) specifications provide a basic framework for widening hot-mix as...

FHWA LTBP Bridge Performance Primer

DOT National Transportation Integrated Search

2014-02-01

This TechBrief defines bridge performance and discusses the importance of measuring performance and current practices for doing so. It identifies key issues to improving performance measures and the role the Long-Term Bridge Performance (LTBP) Progra...

State funding of alcohol safety countermeasure programs

DOT National Transportation Integrated Search

1979-09-01

This study was to analyze current State practices in funding State alcohol highway safety programs. The results were intended to provide guidelines for establishing and improving self-sustaining alcohol safety programs. The literature was reviewed an...

The Baldrige Award for Education: How To Measure and Document Quality Improvement.

ERIC Educational Resources Information Center

Arcaro, Jerome S.

This volume describes in practical terms how schools and colleges can use the Malcolm Baldrige National Quality Award assessment as a tool to document and measure areas of existing quality and to identify areas for improvement. This Award is currently given annually to recognize quality in business companies with plans to expand it to include…

Improving efficacy of landscape interventions in the (sub) humid Ethiopian highlands by improved understanding of runoff processes

USDA-ARS?s Scientific Manuscript database

Despite millions of dollars invested in soil and water conservation practices in the (sub) humid Ethiopian highlands and billions of hours of food-for-work farm labor, sediment concentration in rivers is increasing. This paper reports on the research to reverse the current trend. Based on the unders...

Health impact assessment review: a framework for determining the current state-of science and areas for improvement

EPA Science Inventory

A systematic review is being conducted of health impact assessments (HIAs) from the U.S. The purpose of this review is to obtain a clear picture of how HIAs are being implemented nationally and to identify potential areas for improving the HIA community of practice. The review is...

Early Steps to School Success (ESSS): Examining Pathways Linking Home Visiting and Language Outcomes

ERIC Educational Resources Information Center

Iruka, Iheoma U.; Brown, Deborah; Jerald, Judith; Blitch, Kimberly

2018-01-01

Background: Improving the home environment and parenting practices to support children's early development and learning is a key focus of many. Home visiting is one potential strategy to improve the home environment and parenting; however, more data about current programmatic efforts is needed, especially for children with multiple risks living in…

Outcomes of Teaching Improvement Programs for Faculty. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Ramirez, Jose-Luis

This study explored the impact of teaching improvement programs on university faculty participants in Mexico, as well as the factors that have affected the success of these programs. A total of 80 professors from the University of Sonora in Hermosillo, Mexico, completed a questionnaire on current teaching practices. The group included 40 former…

Exploring Lesson Study as an Improvement Strategy at a High-Stakes Accountability School

ERIC Educational Resources Information Center

Lee, Alice Tae

2012-01-01

This study addressed the problem of chronic low student achievement in language arts at a Program Improvement 5+ school by implementing two cycles of facilitated lesson study. Using action research to facilitate and monitor change in instructional practices at a school that is currently undergoing a teacher-initiated turnaround reform effort, this…

Classroom Walkthroughs: Does Such an Approach to Supervision Contribute to District Improvement?

ERIC Educational Resources Information Center

Fields, Cary

2013-01-01

The purpose of this study was to examine what types of data collection currently exist and what kind of information should be provided through a walkthrough observation process that attempts to enhance teaching practice, contribute to student learning and assist a district's overall improvement planning. In fulfilling this purpose the…

Instructional and Career Guidance in STEM: An Improvement Initiative to Create Opportunities for Female High School Students

ERIC Educational Resources Information Center

Belcher, Aaron Heath

2017-01-01

The purpose of this disquisition is to disseminate an improvement initiative in a public high school that addressed female Science, Technology, Engineering and Math (STEM) disparity in STEM classes. In this high school current instructional and career guidance practices were inadequate in providing female STEM students opportunities to experience…

How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money.

PubMed

Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya

2015-09-21

Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money.

Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

PubMed Central

Cohen, Deborah J.; Dorr, David A.; Knierim, Kyle; DuBard, C. Annette; Hemler, Jennifer R.; Hall, Jennifer D.; Marino, Miguel; Solberg, Leif I.; McConnell, K. John; Nichols, Len M.; Nease, Donald E.; Edwards, Samuel T.; Wu, Winfred Y.; Pham-Singer, Hang; Kho, Abel N.; Phillips, Robert L.; Rasmussen, Luke V.; Duffy, F. Daniel; Balasubramanian, Bijal A.

2018-01-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures. PMID:29608365

Performance Metrics as Formal Structures and through the Lens of Social Mechanisms: When Do They Work and How Do They Influence?

ERIC Educational Resources Information Center

Colyvas, Jeannette A.

2012-01-01

Our current educational environment is subject to persistent calls for accountability, evidence-based practice, and data use for improvement, which largely take the form of performance metrics (PMs). This rapid proliferation of PMs has profoundly influenced the ways in which scholars and practitioners think about their own practices and the larger…

Current clinical research in orthodontics: a perspective.

PubMed

Baumrind, Sheldon

2006-10-01

This essay explores briefly the approach of the Craniofacial Research Instrumentation Laboratory to the systematic and rigorous investigation of the usual outcome of orthodontic treatment in the practices of experienced clinicians. CRIL's goal is to produce a shareable electronic database of reliable, valid, and representative data on clinical practice as an aid in the production of an improved environment for truly evidence-based orthodontic treatment.

Examining Teacher Perceptions of the Relationship between Evaluation Policy and Teacher Practice in a North Carolina School System

ERIC Educational Resources Information Center

Frasier, Amanda Marie Slaten

2017-01-01

Examining the justification for current evaluation policy reveals that such policy rests on two assumptions related to the impact on the work of teachers: (1) evaluations are necessary because teachers need to be rated, sanctioned, or rewarded in order to be motivated to improve their practice; and (2) evaluations yield information that is useful…

Elementary Principal Leadership Practices, Attitudes, and Self-Efficacy about Teacher Evaluation in Title I Urban Schools Making Gains in Student Achievement

ERIC Educational Resources Information Center

Ames, Karen Cohen

2013-01-01

Current school reform efforts aim to improve teaching and learning with emphasis on accountability for student achievement. The success of school reform depends on the motivation and capacities of school leaders. It is important to know what effective leadership practices look like to understand the direct impact to student achievement,…

Working conditions and public health risks in slaughterhouses in western Kenya.

PubMed

Cook, Elizabeth Anne Jessie; de Glanville, William Anson; Thomas, Lian Francesca; Kariuki, Samuel; Bronsvoort, Barend Mark de Clare; Fèvre, Eric Maurice

2017-01-05

Inadequate facilities and hygiene at slaughterhouses can result in contamination of meat and occupational hazards to workers. The objectives of this study were to assess current conditions in slaughterhouses in western Kenya and the knowledge, and practices of the slaughterhouse workers toward hygiene and sanitation. Between February and October 2012 all consenting slaughterhouses in the study area were recruited. A standardised questionnaire relating to facilities and practices in the slaughterhouse was administered to the foreperson at each site. A second questionnaire was used to capture individual slaughterhouse workers' knowledge, practices and recent health events. A total of 738 slaughterhouse workers from 142 slaughterhouses completed questionnaires. Many slaughterhouses had poor infrastructure, 65% (95% CI 63-67%) had a roof, cement floor and walls, 60% (95% CI 57-62%) had a toilet and 20% (95% CI 18-22%) had hand-washing facilities. The meat inspector visited 90% (95% CI 92-95%) of slaughterhouses but antemortem inspection was practiced at only 7% (95% CI 6-8%). Nine percent (95% CI 7-10%) of slaughterhouses slaughtered sick animals. Only half of workers wore personal protective clothing - 53% (95% CI 51-55%) wore protective coats and 49% (95% CI 46-51%) wore rubber boots. Knowledge of zoonotic disease was low with only 31% (95% CI 29-33%) of workers aware that disease could be transmitted from animals. The current working conditions in slaughterhouses in western Kenya are not in line with the recommendations of the Meat Control Act of Kenya. Current facilities and practices may increase occupational exposure to disease or injury and contaminated meat may enter the consumer market. The findings of this study could enable the development of appropriate interventions to minimise public health risks. Initially, improvements need to be made to facilities and practices to improve worker safety and reduce the risk of food contamination. Simultaneously, training programmes should target workers and inspectors to improve awareness of the risks. In addition, education of health care workers should highlight the increased risks of injury and disease in slaughterhouse workers. Finally, enhanced surveillance, targeting slaughterhouse workers could be used to detect disease outbreaks. This "One Health" approach to disease surveillance is likely to benefit workers, producers and consumers.

The potential of ecological theory for building an integrated framework to develop the public health contribution of health visiting.

PubMed

Bryans, Alison; Cornish, Flora; McIntosh, Jean

2009-11-01

In line with recent UK and Scottish policy imperatives, there is increasing pressure for the health visiting service to assume an enhanced role in improving public health. Although health visiting has so far maintained its unique position as a primarily preventive service within the UK health service, its distinctive contribution now appears under threat. The continuing absence of a comprehensive and integrated conceptual basis for practice has a negative impact on the profession's ability to respond to current challenges. Establishing an integrative framework to conceptualise health visiting practice would enable more sensitive, focused and appropriate research, education and evaluation in relation to practice. Work in this area could thus usefully contribute to the future development of the service at a difficult time. Our paper aims to make such a contribution. In support of our conceptual aims, we draw on a study of health visiting practice undertaken within a large conurbation in central Scotland. The study used a mixed method, collaborative approach involving 12 audio-recorded and observed health visitor-client interactions, semi-structured interviews with the 12 HVs and 12 clients, examination of related documentation and workshops with the HV participants. We critically consider prevalent models of health visiting practice and describe the more integrative conceptual approach provided by Bronfenbrenner's ecological, 'person-in-context' framework. The paper subsequently explores relationships between this framework and understandings of need demonstrated by health visitors who participated in our study. Current policy emphasises the need to focus on public health and social inclusion in order to improve health. However, if this policy is to be translated into practice, we must develop a more adequate understanding of how practitioners work effectively with families and individuals in a sensitive and context-specific manner. Bronfenbrenner's framework appears to offer a promising means of building on the current strengths of the health visiting service to further develop a 'person-in-context' approach to health improvement that is mindful of and responsive to multiple, inter-related influences on health. We therefore recommend further research to directly test the utility of this framework.

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

PubMed

Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

1997-01-01

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care

PubMed Central

Williams, Kendal; Brennan, Patrick J.

2010-01-01

Hospital-based comparative effectiveness (CE) centers provide a model that clinical leaders can use to improve evidence-based practice locally. The model is used by integrated health systems outside the US, but is less recognized in the US. Such centers can identify and adapt national evidence-based policies for the local setting, create local evidence-based policies in the absence of national policies, and implement evidence into practice through health information technology (HIT) and quality initiatives. Given the increasing availability of CE evidence and incentives to meaningfully use HIT, the relevance of this model to US practitioners is increasing. This is especially true in the context of healthcare reform, which will likely reduce reimbursements for care deemed unnecessary by published evidence or guidelines. There are challenges to operating hospital-based CE centers, but many of these challenges can be overcome using solutions developed by those currently leading such centers. In conclusion, these centers have the potential to improve the quality, safety and value of care locally, ultimately translating into higher quality and more cost-effective care nationally. To better understand this potential, the current activity and impact of hospital-based CE centers in the US should be rigorously examined. PMID:20697961

Inhibition Plasticity in Older Adults: Practice and Transfer Effects Using a Multiple Task Approach.

PubMed

Wilkinson, Andrea J; Yang, Lixia

2016-01-01

OBJECTIVE. To examine plasticity of inhibition, as indexed by practice effects of inhibition tasks and the associated transfer effects, using a multiple task approach in healthy older adults. METHOD. Forty-eight healthy older adults were evenly assigned to either a practice group or a no-contact control group. All participants completed pretest (2.5 hours) and posttest (2 hours) sessions, with a 2-week interval in between. During the 2-week interval, only the practice group completed six 30-minute practice sessions (three sessions per week for two consecutive weeks) of three lab-based inhibition tasks. RESULTS. All three inhibition tasks demonstrated significant improvement across practice sessions, suggesting practice-induced plasticity. The benefit, however, only transferred to near-near tasks. The results are inconclusive with regard to the near-far and far-far transfer effects. DISCUSSION. This study further extends literature on practice effects of inhibition in older adults by using a multiple task approach. Together with previous work, the current study suggests that older adults are able to improve inhibition performance through practice and transfer the practice gains to tasks that overlap in both target cognitive ability and task structure (i.e., near-near tasks).

Inhibition Plasticity in Older Adults: Practice and Transfer Effects Using a Multiple Task Approach

PubMed Central

Wilkinson, Andrea J.; Yang, Lixia

2016-01-01

Objective. To examine plasticity of inhibition, as indexed by practice effects of inhibition tasks and the associated transfer effects, using a multiple task approach in healthy older adults. Method. Forty-eight healthy older adults were evenly assigned to either a practice group or a no-contact control group. All participants completed pretest (2.5 hours) and posttest (2 hours) sessions, with a 2-week interval in between. During the 2-week interval, only the practice group completed six 30-minute practice sessions (three sessions per week for two consecutive weeks) of three lab-based inhibition tasks. Results. All three inhibition tasks demonstrated significant improvement across practice sessions, suggesting practice-induced plasticity. The benefit, however, only transferred to near-near tasks. The results are inconclusive with regard to the near-far and far-far transfer effects. Discussion. This study further extends literature on practice effects of inhibition in older adults by using a multiple task approach. Together with previous work, the current study suggests that older adults are able to improve inhibition performance through practice and transfer the practice gains to tasks that overlap in both target cognitive ability and task structure (i.e., near-near tasks). PMID:26885407

Nursing Practice Environment and Outcomes for Oncology Nursing

PubMed Central

Shang, Jingjing; Friese, Christopher R.; Wu, Evan; Aiken, Linda H.

2012-01-01

Background It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. Objectives The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. Methods A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. Results Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. Conclusions Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. Implications for Practice Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making. PMID:22751101

Best practices for veterinary toxicologic clinical pathology, with emphasis on the pharmaceutical and biotechnology industries.

PubMed

Tomlinson, Lindsay; Boone, Laura I; Ramaiah, Lila; Penraat, Kelley A; von Beust, Barbara R; Ameri, Mehrdad; Poitout-Belissent, Florence M; Weingand, Kurt; Workman, Heather C; Aulbach, Adam D; Meyer, Dennis J; Brown, Diane E; MacNeill, Amy L; Bolliger, Anne Provencher; Bounous, Denise I

2013-09-01

The purpose of this paper by the Regulatory Affairs Committee (RAC) of the American Society for Veterinary Clinical Pathology (ASVCP) is to review the current regulatory guidances (eg, guidelines) and published recommendations for best practices in veterinary toxicologic clinical pathology, particularly in the pharmaceutical and biotechnology industries, and to utilize the combined experience of ASVCP RAC to provide updated recommendations. Discussion points include (1) instrumentation, validation, and sample collection, (2) routine laboratory variables, (3) cytologic laboratory variables, (4) data interpretation and reporting (including peer review, reference intervals and statistics), and (5) roles and responsibilities of clinical pathologists and laboratory personnel. Revision and improvement of current practices should be in alignment with evolving regulatory guidance documents, new technology, and expanding understanding and utility of clinical pathology. These recommendations provide a contemporary guide for the refinement of veterinary toxicologic clinical pathology best practices. © 2013 American Society for Veterinary Clinical Pathology.

[Progress in methodological characteristics of clinical practice guideline for osteoarthritis].

PubMed

Xing, D; Wang, B; Lin, J H

2017-06-01

At present, several clinical practice guidelines for the treatment of osteoarthritis have been developed by institutes or societies. The ultimate purpose of developing clinical practice guidelines is to formulate the process in the treatment of osteoarthritis effectively. However, the methodologies used in developing clinical practice guidelines may place an influence on the transformation and application of that in treating osteoarthritis. The present study summarized the methodological features of individual clinical practice guideline and presented the tools for quality evaluation of clinical practice guideline. The limitations of current osteoarthritis guidelines of China are also indicated. The review article might help relevant institutions improve the quality in developing guide and clinical transformation.

Understanding stakeholders' perspectives and experiences of general practice accreditation.

PubMed

Debono, Deborah; Greenfield, David; Testa, Luke; Mumford, Virginia; Hogden, Anne; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

2017-07-01

To examine general practice accreditation stakeholders' perspectives and experiences to identify program strengths and areas for improvements. Individual (n=2) and group (n=9) interviews were conducted between September 2011-March 2012 with 52 stakeholders involved in accreditation in Australian general practices. Interviews were recorded, transcribed and thematically analysed. Member checking activities in April 2016 assessed the credibility and currency of the findings in light of current reforms. Overall, participants endorsed the accreditation program but identified several areas of concern. Noted strengths of the program included: program ownership, peer review and collaborative learning; access to Practice Incentives Program payments; and, improvements in safety and quality. Noted limitations in these and other aspects of the program offer potential for improvement: evidence for the impact of accreditation; resource demands; clearer outcome measures; and, specific experiences of accreditation. The effectiveness of accreditation as a strategy to improve safety and quality was shaped by the attitudes and experience of stakeholders. Strengths and weaknesses in the accreditation program influence, and are influenced by, stakeholder engagement and disengagement. After several accreditation cycles, the sector has the opportunity to reflect on, review and improve the process. This will be important if the continued or extended engagement of practices is to be realised to assure the continuation and effectiveness of the accreditation program. Copyright © 2017 Elsevier B.V. All rights reserved.

Figures in clinical trial reports: current practice & scope for improvement

PubMed Central

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-01-01

Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used. PMID:18021449

Mental models of audit and feedback in primary care settings.

PubMed

Hysong, Sylvia J; Smitham, Kristen; SoRelle, Richard; Amspoker, Amber; Hughes, Ashley M; Haidet, Paul

2018-05-30

Audit and feedback has been shown to be instrumental in improving quality of care, particularly in outpatient settings. The mental model individuals and organizations hold regarding audit and feedback can moderate its effectiveness, yet this has received limited study in the quality improvement literature. In this study we sought to uncover patterns in mental models of current feedback practices within high- and low-performing healthcare facilities. We purposively sampled 16 geographically dispersed VA hospitals based on high and low performance on a set of chronic and preventive care measures. We interviewed up to 4 personnel from each location (n = 48) to determine the facility's receptivity to audit and feedback practices. Interview transcripts were analyzed via content and framework analysis to identify emergent themes. We found high variability in the mental models of audit and feedback, which we organized into positive and negative themes. We were unable to associate mental models of audit and feedback with clinical performance due to high variance in facility performance over time. Positive mental models exhibit perceived utility of audit and feedback practices in improving performance; whereas, negative mental models did not. Results speak to the variability of mental models of feedback, highlighting how facilities perceive current audit and feedback practices. Findings are consistent with prior research  in that variability in feedback mental models is associated with lower performance.; Future research should seek to empirically link mental models revealed in this paper to high and low levels of clinical performance.

Diets and Feeding Practices during the First 1000 Days Window in the Phnom Penh and North Eastern Districts of Cambodia.

PubMed

Som, Somphos Vicheth; Prak, Sophonneary; Laillou, Arnaud; Gauthier, Ludovic; Berger, Jacques; Poirot, Etienne; Wieringa, Frank T

2018-04-18

Although several health and development indicators have improved significantly in Cambodia, inadequate breastfeeding and inappropriate complementary feeding practices leave many children at high risk of malnutrition during the early stages of life. In 2014, the prevalence of wasting and stunting among Cambodian children under 5 were 10% and 32%, respectively. Thus, a strong focus on improving feeding practices within the first 1000 days window to reduce child malnutrition prevalence in Cambodia is needed. This cross-sectional study assessed the current feeding practices among of women of reproductive age, pregnant women, lactating women and children less than 24 months living in six districts from Phnom Penh and two rural provinces in the North East of Cambodia. The nutritional status of pregnant women was poor, with 21.4% having a Middle Upper arm circumference below 23 cm. While breastfeeding was predominant within the first 6 months of age in every district, feeding practices of pregnant women and children were a concern, as >70% of the children were not meeting the minimum acceptable diet, and most of the women did not improve their diet during pregnancy. Inadequate nutrition during the first 1000 days is highly prevalent in Cambodia. A comprehensive national Mother, Infant and Young Child Nutrition strategy needs to be developed and operationalized to improve feeding practices of Cambodian women and children.

Diets and Feeding Practices during the First 1000 Days Window in the Phnom Penh and North Eastern Districts of Cambodia

PubMed Central

Som, Somphos Vicheth; Prak, Sophonneary; Laillou, Arnaud; Gauthier, Ludovic; Berger, Jacques; Poirot, Etienne; Wieringa, Frank T.

2018-01-01

Although several health and development indicators have improved significantly in Cambodia, inadequate breastfeeding and inappropriate complementary feeding practices leave many children at high risk of malnutrition during the early stages of life. In 2014, the prevalence of wasting and stunting among Cambodian children under 5 were 10% and 32%, respectively. Thus, a strong focus on improving feeding practices within the first 1000 days window to reduce child malnutrition prevalence in Cambodia is needed. This cross-sectional study assessed the current feeding practices among of women of reproductive age, pregnant women, lactating women and children less than 24 months living in six districts from Phnom Penh and two rural provinces in the North East of Cambodia. The nutritional status of pregnant women was poor, with 21.4% having a Middle Upper arm circumference below 23 cm. While breastfeeding was predominant within the first 6 months of age in every district, feeding practices of pregnant women and children were a concern, as >70% of the children were not meeting the minimum acceptable diet, and most of the women did not improve their diet during pregnancy. Inadequate nutrition during the first 1000 days is highly prevalent in Cambodia. A comprehensive national Mother, Infant and Young Child Nutrition strategy needs to be developed and operationalized to improve feeding practices of Cambodian women and children. PMID:29670006

[T'ai chi in the elderly: practical aspects].

PubMed

Kressig, Reto W; Beauchet, Olivier; Tharicharu, Jai

2003-11-01

New approaches to health promotion for the growing geriatric population are needed. Low to moderately intense exercise programs, such as T'ai Chi seem particularly appropriate for older individuals because of many worthwhile physiological and psychological long-term benefits. T'ai Chi reduces falls and improves postural stability in older adults. It also has a positive impact on muscle strength and cardiovascular fitness and can improve mobility in patients with rheumatoid arthritis. It imparts a sense of well-being and confidence, and can reduce fear of falling in older adults. This article reviews the current medical literature regarding the multiple effects of T'ai Chi. Historical aspects of T'ai Chi and its current adaptation for practice by healthy older adults are presented. Finally, a set of modified exercises is proposed that is based on underlying principles of T'ai Chi and can be applied to patients with mild to moderate cognitive impairment.

Evidence-based integrated environmental solutions for secondary lead smelters: pollution prevention and waste minimization technologies and practices.

PubMed

Genaidy, A M; Sequeira, R; Tolaymat, T; Kohler, J; Rinder, M

2009-05-01

An evidence-based methodology was adopted in this research to establish strategies to increase lead recovery and recycling via a systematic review and critical appraisal of the published literature. In particular, the research examines pollution prevention and waste minimization practices and technologies that meet the following criteria: (a) reduce/recover/recycle the largest quantities of lead currently being disposed of as waste, (b) technically and economically viable, that is, ready to be diffused and easily transferable, and (c) strong industry interest (i.e., industry would consider implementing projects with higher payback periods). The following specific aims are designed to achieve the study objectives: Aim 1 - To describe the recycling process of recovering refined lead from scrap; Aim 2 - To document pollution prevention and waste management technologies and practices adopted by US stakeholders along the trajectory of LAB and lead product life cycle; Aim 3 - To explore improved practices and technologies which are employed by other organizations with an emphasis on the aforementioned criteria; Aim 4 - To demonstrate the economic and environmental costs and benefits of applying improved technologies and practices to existing US smelting operations; and Aim 5 - To evaluate improved environmental technologies and practices using an algorithm that integrates quantitative and qualitative criteria. The process of identifying relevant articles and reports was documented. The description of evidence was presented for current practices and technologies used by US smelters as well as improved practices and technologies. Options for integrated environmental solutions for secondary smelters were introduced and rank ordered on the basis of costs (i.e., capital investment) and benefits (i.e., production increases, energy and flux savings, and reduction of SO(2) and slag). An example was provided to demonstrate the utility of the algorithm by detailing the costs and benefits associated with different combinations of practices and technologies. The evidence-based methodology documented in this research reveals that it is technically and economically feasible to implement integrated environmental solutions to increase lead recovery and recycling among US smelters. The working example presented in this research can be confirmed with US stakeholders and form the basis for implementable solutions in the lead smelter and product industries to help reverse the overall trend of declining life-cycle recycling rates.

Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation.

PubMed

Wilkinson, Dominic; Savulescu, Julian

2012-01-01

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. © 2010 Blackwell Publishing Ltd.

SHOULD WE ALLOW ORGAN DONATION EUTHANASIA? ALTERNATIVES FOR MAXIMIZING THE NUMBER AND QUALITY OF ORGANS FOR TRANSPLANTATION

PubMed Central

Wilkinson, Dominic; Savulescu, Julian

2012-01-01

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. PMID:20459428

Translating research into practice in nursing homes: can we close the gap?

PubMed

Rahman, Anna N; Applebaum, Robert A; Schnelle, John F; Simmons, Sandra F

2012-10-01

A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model. The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.

The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand.

PubMed

Turner, Nikki M; Charania, Nadia A; Chong, Angela; Stewart, Joanna; Taylor, Lynn

2017-01-01

Immunisation coverage rates vary considerably at the local level across New Zealand and challenges remain with effectively translating best available research evidence into public health practice. This study aimed to translate best practices from high performing general practices into strategies to improve childhood immunisation coverage among low performing practices. An intervention study was undertaken of general practices with low immunisation coverage rates and a high percentage of the enrolled population being of Māori ethnicity. Intervention groups received customised action plans and support for a 12 month period while control groups received 'business as usual' support. Structured interviews were conducted with key informants from all participating practices to understand current aspects related to childhood immunisation delivery and surveys were conducted to understand how the intervention worked. Collected data were thematically analysed. Ten sites were randomised to either intervention ( n  = 6) or control group ( n  = 4). Positive aspects of childhood immunisation delivery included high prioritisation at the practice and staff being pro-immunisation and knowledgeable. Key challenges experienced included inaccurate family contact information and discrepancies with referral processes to other providers. Other challenges noted were building rapport with families and vaccine hesitancy. The action plans included various strategies aimed to improve processes at the practice, contact and engagement with parents, and partnership development with local service providers. Creating customised action plans and providing support to providers were considered as helpful approaches when attempting to improve childhood immunisation coverage rates. Our study supports the notion that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies from which to draw from.

The Future of School Breakfast: An Analysis of Evidence-Based Practices to Improve School Breakfast Participation in Washington State

ERIC Educational Resources Information Center

Mosehauer, Katie

2013-01-01

School breakfast is associated with a host of positive outcomes, such as improved health and attendance, reduced behavioral problems, and increased academic achievement. Unfortunately, a majority of Washington students who qualify for free or reduced-price breakfasts do not currently receive one at school, with many students eating no breakfast at…

Short Sighted: How America's Lack of Attention to International Education Studies Impedes Improvement. Policy Brief

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

To future generations, Americans' current educational myopia is likely to appear, at best, a negligent failure to anticipate and meet the needs of the nation and its citizens. And for the sake of those future generations, this brief suggests that the short-sighted practices and parochial policies that have delayed significant improvement in the…

Teacher Education Policies, Practices, and Reform in Scotland: Implications in the Indian Context

ERIC Educational Resources Information Center

Misra, Pradeep Kumar

2015-01-01

India, a country of 1.27 billion, nowadays needs reforms, improvements, and new approaches in teacher education to cater to the demands of changing economy and society. This call to improve teacher education becomes more significant considering the fact that 50% of India's current population is below the age of 25 and over 65% below 35. There are…

Current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination: an expert Delphi survey among dental hygienists

PubMed Central

2017-01-01

Purpose This study aimed to investigate current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination (KDHNLE) through an expert Delphi survey. Methods A Delphi survey was conducted from May through August 2016 in Korea. This Delphi survey included 20 persons representing the field of dental hygiene (7 groups from various dental hygiene-related organizations). The Delphi survey was administered through e-mail as 3 rounds of questionnaire surveys regarding the issues facing the KDHNLE and potential solutions to those challenges. The primary Delphi survey was an open questionnaire. In each round, subjects’ responses were categorized according to the detailed themes of their responses. The minimum value of the content validity ratio of the survey results was determined by the number of panels participating in the Delphi survey. Results Issues facing the KDHNLE were identified from the results of the Delphi survey. The following 4 items had an average importance score of 4.0 or higher and were considered as important by over 85% of the panels: the failure of the practical test to reflect actual clinical settings, the focus of the practical test on dental scaling, the gap between the items evaluated on the national examination and actual practical work, and insufficiency in strengthening the expertise of licensed dental hygienists. The following items were suggested for improvement: more rigorous rater training, adjustment of the difficulty of the licensing examination, the introduction of a specialized dental hygienist system, and more rigorous refresher training for licensed dental hygienists. Conclusion Based on the above results, the KDHNLE should be improved according to the core competencies of dental hygienists, including on-site clinical practice experience. PMID:28900069

Current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination: an expert Delphi survey among dental hygienists.

PubMed

Hwang, Yoon-Sook; Kang, Hyun-Sook; Kim, Soo-Hwa; Moon, Hee-Jung; Lee, Sun-Mi; Jung, Jae-Yeon; Hwang, Su-Jeong; Ha, Jung-Eun

2017-01-01

This study aimed to investigate current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination (KDHNLE) through an expert Delphi survey. A Delphi survey was conducted from May through August 2016 in Korea. This Delphi survey included 20 persons representing the field of dental hygiene (7 groups from various dental hygiene-related organizations). The Delphi survey was administered through e-mail as 3 rounds of questionnaire surveys regarding the issues facing the KDHNLE and potential solutions to those challenges. The primary Delphi survey was an open questionnaire. In each round, subjects' responses were categorized according to the detailed themes of their responses. The minimum value of the content validity ratio of the survey results was determined by the number of panels participating in the Delphi survey. Issues facing the KDHNLE were identified from the results of the Delphi survey. The following 4 items had an average importance score of 4.0 or higher and were considered as important by over 85% of the panels: the failure of the practical test to reflect actual clinical settings, the focus of the practical test on dental scaling, the gap between the items evaluated on the national examination and actual practical work, and insufficiency in strengthening the expertise of licensed dental hygienists. The following items were suggested for improvement: more rigorous rater training, adjustment of the difficulty of the licensing examination, the introduction of a specialized dental hygienist system, and more rigorous refresher training for licensed dental hygienists. Based on the above results, the KDHNLE should be improved according to the core competencies of dental hygienists, including on-site clinical practice experience.

Gearbox Reliability Collaborative Phase 3 Gearbox 2 Test Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Link, H.; Keller, J.; Guo, Y.

2013-04-01

Gearboxes in wind turbines have not been achieving their expected design life even though they commonly meet or exceed the design criteria specified in current design standards. One of the basic premises of the National Renewable Energy Laboratory (NREL) Gearbox Reliability Collaborative (GRC) is that the low gearbox reliability results from the absence of critical elements in the design process or insufficient design tools. Key goals of the GRC are to improve design approaches and analysis tools and to recommend practices and test methods resulting in improved design standards for wind turbine gearboxes that lower the cost of energy (COE)more » through improved reliability. The GRC uses a combined gearbox testing, modeling and analysis approach, along with a database of information from gearbox failures collected from overhauls and investigation of gearbox condition monitoring techniques to improve wind turbine operations and maintenance practices. Testing of Gearbox 2 (GB2) using the two-speed turbine controller that has been used in prior testing. This test series will investigate non-torque loads, high-speed shaft misalignment, and reproduction of field conditions in the dynamometer. This test series will also include vibration testing using an eddy-current brake on the gearbox's high speed shaft.« less

The evolution of a doctor of nursing practice capstone process: programmatic revisions to improve the quality of student projects.

PubMed

Nelson, Joan M; Cook, Paul F; Raterink, Ginger

2013-01-01

The past several years have seen explosive growth in the number of doctor of nursing practice (DNP) degree programs offered by colleges of nursing in the United States. Through a process of trial and error since 2005, the faculty at the University of Colorado, College of Nursing, have revised the course structure and procedures related to the DNP capstone project to improve the quality and usefulness of these student projects. Efforts have focused on educating and involving all nursing faculty in the DNP capstone process, distinguishing between competencies for our PhD and DNP projects, clearly aligning the DNP capstone project with quality improvement methods rather than with research, working with our campus institutional review board to clarify regulatory review requirements for quality improvement studies, developing a review committee to oversee DNP students' projects, and structuring our sequential course requirements to encourage students' professional presentations and publications. Our current capstone process reflects 7 years of iterative work, which we summarize in this article in hopes that it will help institutions currently in the process of developing a DNP program. Copyright © 2013 Elsevier Inc. All rights reserved.

Review article: Paediatric status epilepticus in the pre-hospital setting: An update.

PubMed

Furyk, Jeremy; Watt, Kerriane; Emeto, Theophilus I; Dalziel, Stuart; Bodnar, Daniel; Riney, Kate; Babl, Franz E

2017-08-01

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Report on Financing the New Model of Family Medicine

PubMed Central

Spann, Stephen J.

2004-01-01

PURPOSE To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. METHODS The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. RESULTS The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from $167,457 to $210,288 total annual compensation) for prototypical family physicians who maintain their current number of work hours. Alternatively, physicians could choose to decrease their work hours by 12% and maintain their current compensation. This result is sensitive to physician practice group size. The societal level financial model shows that modifications in the current reimbursement system could lead to further improvements in compensation for family physicians practicing the New Model of care. Reimbursement for e-visits and chronic disease management could further increase total annual compensation to $229,849 for prototypical family physicians maintaining their current number of work hours. The widespread introduction of quality-based physician incentive bonus payments similar to some current programs that have been implemented on a limited basis could further increase total annual compensation up to $254,500. The adoption of a mixed reimbursement model, which would add an annual per-patient fee, a chronic care bonus, and an overall performance bonus to the current reimbursement system, could increase total annual compensation for the prototypical family physician continuing the current number of hours worked to as much as $277,800, a 66% increase above current compensation levels. The cost of transition to the New Model is estimated to range from $23,442 to $90,650 per physician, depending on the assumed magnitude of productivity loss associated with implementing an electronic health record. The financial impact of enhanced use of primary care on the costs of health care in the United States was estimated. If every American used a primary care physician as their usual source of care, health care costs would likely decrease by 5.6%, resulting in national savings of $67 billion dollars per year, with an improvement in the quality of the health care provided. CONCLUSIONS Family physicians could use New Model efficiency to increase compensation or to reduce work time. There are alternative reimbursement methodologies compatible with the New Model that would allow family physicians to share in the health care cost savings achieved as a result of effective and efficient delivery of care. The New Model of care should enhance health care while propelling the US system toward improved performance and results that are satisfying to patients, health care professionals, purchasers, and payers. The New Model needs to be implemented now. Given the recognized need for improvements in the US health care system in the areas of quality, safety, access and costs, there is no reason to delay. PMID:15654084

Report on financing the new model of family medicine.

PubMed

Spann, Stephen J

2004-12-02

To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from 167,457 dollars to 210,288 dollars total annual compensation) for prototypical family physicians who maintain their current number of work hours. Alternatively, physicians could choose to decrease their work hours by 12% and maintain their current compensation. This result is sensitive to physician practice group size. The societal level financial model shows that modifications in the current reimbursement system could lead to further improvements in compensation for family physicians practicing the New Model of care. Reimbursement for e-visits and chronic disease management could further increase total annual compensation to 229,849 dollars for prototypical family physicians maintaining their current number of work hours. The widespread introduction of quality-based physician incentive bonus payments similar to some current programs that have been implemented on a limited basis could further increase total annual compensation up to 254,500 dollars. The adoption of a mixed reimbursement model, which would add an annual per-patient fee, a chronic care bonus, and an overall performance bonus to the current reimbursement system, could increase total annual compensation for the prototypical family physician continuing the current number of hours worked to as much as 277,800 dollars, a 66% increase above current compensation levels. The cost of transition to the New Model is estimated to range from 23,442 dollars to 90,650 dollars per physician, depending on the assumed magnitude of productivity loss associated with implementing an electronic health record. The financial impact of enhanced use of primary care on the costs of health care in the United States was estimated. If every American used a primary care physician as their usual source of care, health care costs would likely decrease by 5.6%, resulting in national savings of 67 billion dollars per year, with an improvement in the quality of the health care provided. Family physicians could use New Model efficiency to increase compensation or to reduce work time. There are alternative reimbursement methodologies compatible with the New Model that would allow family physicians to share in the health care cost savings achieved as a result of effective and efficient delivery of care. The New Model of care should enhance health care while propelling the US system toward improved performance and results that are satisfying to patients, health care professionals, purchasers, and payers. The New Model needs to be implemented now. Given the recognized need for improvements in the US health care system in the areas of quality, safety, access and costs, there is no reason to delay.

Developing an advanced practice nurse-led liver clinic.

PubMed

McAfee, Jean L

2012-01-01

End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.

[Effects of agricultural practices on community structure of arbuscular mycorrhizal fungi in agricultural ecosystem: a review].

PubMed

Sheng, Ping-Ping; Li, Min; Liu, Run-Jin

2011-06-01

Arbuscular mycorrhizal (AM) fungi are rich in diversity in agricultural ecosystem, playing a vital role based on their unique community structure. Host plants and environmental factors have important effects on AM fungal community structure, so do the agricultural practices which deserve to pay attention to. This paper summarized the research advances in the effects of agricultural practices such as irrigation, fertilization, crop rotation, intercropping, tillage, and pesticide application on AM fungal community structure, analyzed the related possible mechanisms, discussed the possible ways in improving AM fungal community structure in agricultural ecosystem, and put forward a set of countermeasures, i.e., improving fertilization system and related integrated techniques, increasing plant diversity in agricultural ecosystem, and inoculating AM fungi, to enhance the AM fungal diversity in agricultural ecosystem. The existing problems in current agricultural practices and further research directions were also proposed.

Reprint Filing: A Profile-Based Solution

PubMed Central

Gass, David A.; Putnam, R. Wayne

1983-01-01

A reprint filing system based on practice profiles can give family physicians easy access to relevant medical information. The use of the ICHPPC classification and some supplemental categories provides a more practical coding mechanism than organ systems, textbook chapter titles or even Index Medicus subject headings. The system can be simply maintained, updated and improved, but users must regularly weed out unused information, and read widely to keep the reprints current. PMID:21283301

Quality assurance and improvement: the Pediatric Regional Anesthesia Network.

PubMed

Polaner, David M; Martin, Lynn D

2012-01-01

Quality assurance and improvement (QA/QI) is a critical activity in medicine. The use of large-scale collaborative databases is increasingly essential to obtain enough reports with which to establish standards of practice and define the incidence of complications and risk/benefit ratios for rare events. Such projects can enhance local QA/QI endeavors by enabling institutions to obtain benchmark data against which to compare their performance and can be used for prospective analyses of inter-institutional differences to determine 'best practice'. The pediatric regional anesthesia network (PRAN) is such a project. The first data cohort is currently being analyzed and offers insight into how such data can be used to detect trends in adverse events and improve care. © 2011 Blackwell Publishing Ltd.

Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

PubMed

Mihalopoulos, Cathrine; Magnus, Anne; Lal, Anita; Dell, Lisa; Forbes, David; Phelps, Andrea

2015-04-01

To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations assessed in the current study are likely to improve the efficiency of the mental health care sector. © The Royal Australian and New Zealand College of Psychiatrists 2014.

[How to improve practices and interventions for work integration of people with schizophrenia in France?].

PubMed

Pachoud, B; Llorca, P M; Azorin, J M; Dubertret, C; de Pierrefeu, I; Gaillard, R; Franck, N

2015-12-01

Getting and keeping a job are not only one of the criteria of recovery from schizophrenia, but are also one of its main means. Indeed, recovery is partly defined by the ability to work. Despite the lack of data in France about employment of people with schizophrenia, it is widely acknowledged that the employment rate of people with schizophrenia remains quite low, and frequently it is only an employment in sheltered workshops, not on the regular work market. International research data show that it is possible to improve significantly this employment rate, with an appropriate support, that is precisely defined by the current researches, and that is quickly spreading in most developed countries. The aim of this paper is to present, on the basis of a broad current literature review, the key predictive factors of the return to work for people with schizophrenia, and the strategies to optimize vocational services. It will appear that there are several ways to improve practices and interventions in France to support work integration. To begin with individual factors of work integration, dependant on each person, the clinical state and the cognitive skills (in a broad sense, including social cognition and metacognition) are to be taken into account, and optimized by means of the association of a finely tuned pharmacological treatment and psychosocial interventions such as cognitive remediation adjusted to the person's specific needs. The other main kind of factors is environmental factors, particularly the kind of vocational support, which turns out to have a major impact not only on job acquisition, but importantly also on job tenure. The most effective vocational services are based on the "Place and train" model, and even more precisely on the Individual Placement and Support (IPS) model, that allows to the majority of people with a severe mental illness (more than 50%) to obtain a competitive employment after 6 to 18 months of individualized support. This approach is now widely recommended as "an evidence-based practice" of rehabilitation. It is important to promote in France the development of this kind of practice, already implemented as an experiment by few militant and involved associations. This development remains in France slow and delayed (compared to the practices in the other European countries) because of the lack of public funding. It implies an evolution of the social and medico-social practices, taking into account current research data, and assessing the outcomes of their practices in order to improve them. The employment specialist (sometimes called also the "job coach") turns out to play a key role, emphasized by current research, implying, among many other tasks, to coordinate the net of people supporting the work integration, including the clinical team, the employer and the colleagues of the workplace. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Environmental improvement of product supply chains: proposed best practice techniques, quantitative indicators and benchmarks of excellence for retailers.

PubMed

Styles, David; Schoenberger, Harald; Galvez-Martos, Jose-Luis

2012-11-15

Retailers are strategically positioned to leverage environmental improvement over product supply chains through actions targeted at suppliers and consumers. Informed by scientific evidence on environmental hotspots and control points across 14 priority product groups, and a review of 25 major European retailers' actions, this paper proposes a framework to guide and assess retailer best practice in supply chain environmental improvement. Commonly used product standards and improvement measures are classified into "basic" or "good" levels of environmental protection. A hierarchy of eight Best Environmental Management Practices (BEMPs) is proposed to systematically identify and improve the most environmentally damaging supply chains across retail assortments. Widespread third party environmental certification is the most transparent and verifiable mechanism of improvement but may not be appropriate for some supply chains. The enforcement of retailer-defined environmental requirements, and supplier improvement programmes based on performance benchmarking and dissemination of better management practices, are alternative BEMPs that may be used in combination with third party certification. Facilitating consumer selection of frontrunner ecological products is a lower priority BEMP owing to the well documented limitations of this approach. From available data, the highest current or credible-target sales shares of products improved according to the highest priority BEMP and environmental protection level were used to derive "benchmarks of excellence" for each of the 14 product groups. The assessment framework is demonstrated through application to three retailers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Methods for Improving Consistency between Statewide and Regional Planning Models.

DOT National Transportation Integrated Search

2017-12-01

Given the difference in scope of statewide and MPO models, inconsistencies between the two levels of modelling are inevitable. There are, however, methods to reduce these inconsistencies. This research provides insight into the current practices of s...

Improving antimicrobial prescribing in Irish primary care through electronic data collection and surveillance: a feasibility study.

PubMed

Galvin, Sandra; Callan, Aoife; Cormican, Martin; Duane, Sinead; Bennett, Kathleen; Murphy, Andrew W; Vellinga, Akke

2015-07-02

The increase in the spread of antimicrobial resistance (AMR) in bacterial pathogens and limited availability of new antimicrobials places immense pressure on general practitioners (GPs) to prescribe appropriately. Currently, electronic antimicrobial prescribing data is not routinely collected from GPs in Ireland for surveillance purposes to assess regional specific fluctuations or trends in antimicrobial prescribing. The current study aimed to address this issue by assessing the feasibility of remotely extracting antimicrobial prescribing data from primary care practices in Ireland, for the purpose of assessing prescribing quality using the European Surveillance of Antimicrobial Consumption (ESAC) drug specific quality indicators. Participating practices (n = 30) uploaded data to the Irish Primary Care Research Network (IPCRN). The IPCRN data extraction facility is integrated within the practice patient management software system and permitted the extraction of anonymised patient prescriptions for a one year period, from October 2012 to October 2013. The quality of antimicrobial prescribing was evaluated using the twelve ESAC drug specific quality indicators using the defined daily dose (DDD) per 1,000 inhabitants per day (DID) methodology. National and European prescribing surveillance data (based on total pharmacy sales) was obtained for a comparative analysis. Antimicrobial prescriptions (n = 57,079) for 27,043 patients were obtained from the thirty study practices for a one year period. On average, study practices prescribed a greater proportion of quinolones (37 % increase), in summer compared with winter months, a variation which was not observed in national and European data. In comparison with national data, study practices prescribed higher proportions of β-lactamase-sensitive penicillins (4.98 % vs. 4.3 %) and a greater use of broad spectrum compared to narrow-spectrum antimicrobials (ratio = 9.98 vs. 6.26) was observed. Study practices exceeded the European mean for prescribing combinations of penicillins, including β-lactamase inhibitors. This research demonstrates the feasibility and potential use of direct data extraction of anonymised practice data directly through the patient management software system. The data extraction methods described can facilitate the provision of routinely collected data for sustained and inclusive surveillance of antimicrobial prescribing. These comparisons may initiate further improvements in antimicrobial prescribing practices by identifying potential areas for improvement.

Promotional communications for influenza vaccination: a systematic review.

PubMed

Macdonald, Laura; Cairns, Georgina; Angus, Kathryn; de Andrade, Marisa

2013-01-01

The authors conducted a systematic review that aimed to map current practice and identify effective practice in promotional communications for seasonal influenza vaccination in Europe. They identified 22 studies from 7 European countries. Included studies were primarily outcome evaluations of communications promoting vaccination to health care workers and elderly adults. Evidence on communications to improve public acceptance was sparse. A range of communication approaches, methods, materials, and channels were used, frequently in combination. All forms of promotional communications have the potential to increase uptake in health care workers and can also improve uptake among patients. There was promising evidence that mass communication methods, delivered as standalone activities or as one component of a communication mix, can improve uptake in target populations. Education for health care workers and improved service delivery are common adjuncts to promotional communications that were associated with effectiveness. The evidence suggests that personalized communications, combined with improved service delivery, might boost rates of uptake among elderly adults. Future development of good practice could be enhanced by more systematic, theory-based intervention design and more detailed reporting of process and outcome evaluations. Vaccine hesitancy is increasingly prevalent; more policy and research to improve public acceptance should therefore be considered.

Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

PubMed

Lea, Emma J; Goldberg, Lynette R; Price, Andrea D; Tierney, Laura T; McInerney, Fran

2017-12-01

To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change. © 2017 John Wiley & Sons Ltd.

The Effects of the Reverse Current Caused by the Series Compensation on the Current Differential Protection

PubMed Central

Tang, Cui; Yin, Xianggen; Qi, Xuanwei; Zhang, Zhe

2014-01-01

The series capacitor compensation is one of the key technologies in the EHV and UHV long distance power transmission lines. This paper analyzes the operation characteristics of the main protection combined with the engineering practice when the transmission line overcompensation due to the series compensation system is modified and analyzes the influence of the transition resistance and the system operation mode on the current differential protection. According to the simulation results, it presents countermeasure on improving the sensitivity of differential current protection. PMID:25247206

Development of a Virtual Reality Assessment of Everyday Living Skills

PubMed Central

Ruse, Stacy A.; Davis, Vicki G.; Atkins, Alexandra S.; Krishnan, K. Ranga R.; Fox, Kolleen H.; Harvey, Philip D.; Keefe, Richard S.E.

2014-01-01

Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes.  Treatment studies aimed at cognitive impairment in patients with schizophrenia not only require demonstration of improvements on cognitive tests, but also evidence that any cognitive changes lead to clinically meaningful improvements.  Measures of “functional capacity” index the extent to which individuals have the potential to perform skills required for real world functioning.  Current data do not support the recommendation of any single instrument for measurement of functional capacity.  The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a novel, interactive gaming based measure of functional capacity that uses a realistic simulated environment to recreate routine activities of daily living. Studies are currently underway to evaluate and establish the VRFCAT’s sensitivity, reliability, validity, and practicality. This new measure of functional capacity is practical, relevant, easy to use, and has several features that improve validity and sensitivity of measurement of function in clinical trials of patients with CNS disorders. PMID:24798174

Improving opioid safety practices in primary care: protocol for the development and evaluation of a multifaceted, theory-informed pilot intervention for healthcare providers

PubMed Central

Leece, Pamela; Buchman, Daniel Z; Hamilton, Michael; Timmings, Caitlyn; Shantharam, Yalnee; Moore, Julia; Furlan, Andrea D

2017-01-01

Introduction In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed. Methods and analysis Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method. Ethics and dissemination The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement indicators to monitor opioid prescribing. Additionally, the methods and approach used in this study could be adapted for other opioid guidelines, or applied to other areas of preventive healthcare and clinical guideline implementation processes. PMID:28446522

Physical and Chemical Implications of Mid-Winter Pumping of Trunda Lakes - North Slope, Alaska

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hinzman, Larry D.; Lilly, Michael R.; Kane, Douglas L.

2005-09-30

Tundra lakes on the North Slope, Alaska, are an important resource for energy development and petroleum field operations. A majority of exploration activities, pipeline maintenance, and restoration activities take place on winter ice roads that depend on water availability at key times of the winter operating season. These same lakes provide important fisheries and ecosystem functions. In particular, overwintering habitat for fish is one important management concern. This study focused on the evaluation of winter water use in the current field operating areas to provide a better understanding of the current water use practices. It found that under the currentmore » water use practices, there were no measurable negative effects of winter pumping on the lakes studied and current water use management practices were appropriately conservative. The study did find many areas where improvements in the understanding of tundra lake hydrology and water usage would benefit industry, management agencies, and the protection of fisheries and ecosystems.« less

Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

PubMed

Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

2015-01-01

Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics.

A review of the International Atomic Energy Agency (IAEA) international standards for tissue banks.

PubMed

Morales Pedraza, Jorge; Lobo Gajiwala, Astrid; Martinez Pardo, María Esther

2012-03-01

The IAEA International Standards for Tissue Banks published in 2003 were based on the Standards then currently in use in the USA and the European Union, among others, and reflect the best practices associated with the operation of a tissue bank. They cover legal, ethical and regulatory controls as well as requirements and procedures from donor selection and tissue retrieval to processing and distribution of finished tissue for clinical use. The application of these standards allows tissue banks to operate with the current good tissue practice, thereby providing grafts of high quality that satisfy the national and international demand for safe and biologically useful grafts. The objective of this article is to review the IAEA Standards and recommend new topics that could improve the current version.

GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network.

PubMed

Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian

2012-01-01

This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.

Flying Lessons for Clinicians: Developing System 2 Practice.

PubMed

Gregoire, Jerome N; Alfes, Celeste M; Reimer, Andrew P; Terhaar, Mary F

There is a long history of adopting lessons learned from aviation to improve health care practice. Two of the major practices that have successfully transferred include using a checklist and simulation. Training and simulation technology is currently underdeveloped for nurses and health care providers entering critical care transport. This article describes a pedagogical approach adopted from aviation to develop a new simulation platform and program of research to develop the science of critical care transport nursing education. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

The Practice of Respect in the ICU.

PubMed

Brown, Samuel M; Azoulay, Elie; Benoit, Dominique; Butler, Terri Payne; Folcarelli, Patricia; Geller, Gail; Rozenblum, Ronen; Sands, Ken; Sokol-Hessner, Lauge; Talmor, Daniel; Turner, Kathleen; Howell, Michael D

2018-06-01

Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.

Learning leadership skills in practice through quality improvement.

PubMed

Gamble, James; Vaux, Emma

2014-02-01

The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

Embedding technology into inter-professional best practices in home safety evaluation.

PubMed

Burns, Suzanne Perea; Pickens, Noralyn Davel

2017-08-01

To explore inter-professional home evaluators' perspectives and needs for building useful and acceptable decision-support tools for the field of home modifications. Twenty semi-structured interviews were conducted with a range of home modification professionals from different regions of the United States. The interview transcripts were analyzed with a qualitative, descriptive, perspective approach. Technology supports current best practice and has potential to inform decision making through features that could enhance home evaluation processes, quality, efficiency and inter-professional communication. Technological advances with app design have created numerous opportunities for the field of home modifications. Integrating technology and inter-professional best practices will improve home safety evaluation and intervention development to meet client-centred and societal needs. Implications for rehabilitation Understanding home evaluators technology needs for home safety evaluations contributes to the development of app-based assessments. Integrating inter-professional perspectives of best practice and technological needs in an app for home assessments improves processes. Novice and expert home evaluators would benefit from decision support systems embedded in app-based assessments. Adoption of app-based assessment would improve efficiency while remaining client-centred.

Role of Leadership in Narrowing the Gap between Science and Practice: Improving Treatment Outcomes at the Systems Level.

PubMed

Saeed, Sy Atezaz; Bloch, Richard M; Silver, Stuart

2015-09-01

It's been well documented that health care does not reliably transfer what we know from science into clinical practice. As a result, Americans do not always receive the care suggested by the scientific evidence. Despite the best intentions of a dedicated and skilled healthcare workforce, this can often lead to poor clinical outcomes. As research and technology rapidly advance, this gap between science and practice appears to be widening. There is an increasing public concern about a lack of access to appropriate treatment, pervasiveness of unsafe practices, and wasteful uses of precious health care resources leading to suboptimum treatment outcomes. Leadership has a critical role in creating and sustaining the environment that supports health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Leadership has some responsibility to improve outcomes by insuring effective use of evidence-based treatment guidelines; measurement-based care; knowledge and skills management; care coordination; and information technologies. This paper addresses leadership issues in these components of a system's ability to improve treatment outcomes.

Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home

PubMed Central

Bleser, William K.; Miller-Day, Michelle; Naughton, Dana; Bricker, Patricia L.; Cronholm, Peter F.; Gabbay, Robert A.

2014-01-01

PURPOSE The current model of primary care in the United States limits physicians’ ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg’s conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement. METHODS Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small- to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software. RESULTS We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment. CONCLUSION Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg’s conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process. PMID:24445102

A Pilot Study of the Effectiveness of Augmented Reality to Enhance the Use of Remote Labs in Electrical Engineering Education

NASA Astrophysics Data System (ADS)

Mejías Borrero, A.; Andújar Márquez, J. M.

2012-10-01

Lab practices are an essential part of teaching in Engineering. However, traditional laboratory lessons developed in classroom labs (CL) must be adapted to teaching and learning strategies that go far beyond the common concept of e-learning, in the sense that completely virtualized distance education disconnects teachers and students from the real world, which can generate specific problems in laboratory classes. Current proposals of virtual labs (VL) and remote labs (RL) do not either cover new needs properly or contribute remarkable improvement to traditional labs—except that they favor distance training. Therefore, online teaching and learning in lab practices demand a further step beyond current VL and RL. This paper poses a new reality and new teaching/learning concepts in the field of lab practices in engineering. The developed augmented reality-based lab system (augmented remote lab, ARL) enables teachers and students to work remotely (Internet/intranet) in current CL, including virtual elements which interact with real ones. An educational experience was conducted to assess the developed ARL with the participation of a group of 10 teachers and another group of 20 students. Both groups have completed lab practices of the contents in the subjects Digital Systems and Robotics and Industrial Automation, which belong to the second year of the new degree in Electronic Engineering (adapted to the European Space for Higher Education). The labs were carried out by means of three different possibilities: CL, VL and ARL. After completion, both groups were asked to fill in some questionnaires aimed at measuring the improvement contributed by ARL relative to CL and VL. Except in some specific questions, the opinion of teachers and students was rather similar and positive regarding the use and possibilities of ARL. Although the results are still preliminary and need further study, seems to conclude that ARL remarkably improves the possibilities of current VL and RL. Furthermore, ARL can be concluded to allow further possibilities when used online than traditional laboratory lessons completed in CL.

Within-session and one-week practice effects on a motor task in amnestic mild cognitive impairment.

PubMed

Schaefer, Sydney Y; Duff, Kevin

2017-06-01

Practice effects on neuropsychological tests, which are improvements in test scores due to repeated exposure to testing materials, are robust in healthy elders, but muted in older adults with cognitive disorders. Conversely, few studies have investigated practice effects on motor tasks involving procedural memory, particularly across test-retest periods exceeding 24 hours. The current study examined one-week practice effects on a novel upper extremity motor task in 54 older adults with amnestic mild cognitive impairment. Results indicate that these individuals with primary memory deficits did improve on this motor task within a brief training session as well as across one week. These practice effects were unrelated to demographic characteristics or global cognition. One-week practice effects were, however, negatively related to delayed memory function, with larger practice effects being associated with poorer delayed memory and potentially better visuospatial ability. The presence of longer term practice effects on a procedural motor task not only has implications for how longitudinal assessments with similar measures involving implicit memory might be interpreted, but may also inform future rehabilitative strategies for patients with more severe declarative memory deficits.

The primacy of basics in advanced life support.

PubMed

Chamberlain, Douglas; Frenneaux, Michael; Fletcher, David

2009-06-01

The standards required for optimal effect of chest compressions and the degree to which most practice falls short of ideal have not been widely appreciated. This review highlights some of the important data now available and offers a haemodynamic explanation that broadens current concepts. New techniques have permitted a detailed examination of how compressions are performed in practice. The implications of recent experimental work adds a new imperative to the need for improvement. In addition to highlighting the need for improved training and audit, the greater understanding of mechanisms in resuscitation suggest that guidelines for management of adult cardiac arrest of presumed cardiac origin need further revision and simplification.

Modifying physician behavior to improve cost-efficiency in safety-net ambulatory settings.

PubMed

Borkowski, Nancy; Gumus, Gulcin; Deckard, Gloria J

2013-01-01

Change interventions in one form or another are viewed as important tools to reduce variation in medical services, reduce costs, and improve quality of care. With the current focus on efficient resource use, the successful design and implementation of change strategies are of utmost importance for health care managers. We present a case study in which macro and micro level change strategies were used to modify primary care physicians' practice patterns of prescribing diagnostic services in a safety-net's ambulatory clinics. The findings suggest that health care managers using evidence-based strategies can create a practice environment that reduces barriers and facilitates change.

Child development in the NANDA-I and International Classification for Nursing Practices Nursing Classifications*.

PubMed

de Souza, Juliana Martins; Veríssimo, Maria De La Ó Ramallo

2013-02-01

Identify and analyze the NANDA-I diagnoses and the focus terms of the International Classification for Nursing Practices (ICNP) related to child development. Literature, reflections about clinical experience, and a model case. DATA SYNTHESE: The current diagnoses proposed by NANDA-I and the ICNP focus terms do not encompass the extent of the child development phenomenon. It is necessary studying the child development concept to improve the definition of the ICNP focus terms and the accuracy of NANDA-I diagnoses. Discussing the nursing classifications can improve their understanding and use. © 2012, The Authors. International Journal of Nursing Knowledge © 2012, NANDA International.

Evaluation of the cost-effectiveness of illumination as a safety treatment at rural intersections.

DOT National Transportation Integrated Search

2016-09-01

This research study seeks to improve current understanding of the relationship between rural intersection safety and different illumination levels. It uses three parallel studies: a survey of rural intersection illumination practices among US state d...

Applying instructional design practices to evaluate and improve the roadway characteristics inventory (RCI) training curriculum.

DOT National Transportation Integrated Search

2010-07-01

The Transportation Statistics Office (TranStat) of the Florida Department of Transportation (FDOT) provides training for district data collection technicians in both office- and field-based Roadway Characteristics Inventory (RCI) methods. The current...

Improving the effectiveness of traffic monitoring based on wireless location technology.

DOT National Transportation Integrated Search

2004-01-01

A fundamental requirement for effectively monitoring and operating transportation facilities is reliable, accurate data on traffic flow. The current state of the practice is to use networks of point detectors to gather information on traffic flow at ...

Options for improving the coordination of transportation and land use planning in Virginia.

DOT National Transportation Integrated Search

2004-01-01

Virginia's 2003 General Assembly directed the Secretary of Transportation to (1) assess best practices used by other states to coordinate transportation and land use planning, (2) review current state efforts to provide technical assistance to local ...

Effectiveness study of UNL's crack routing device (CRD) - phase II.

DOT National Transportation Integrated Search

2016-12-31

This project evaluated the crack routing device (CRD) for effectiveness in improving current crack-cutting : practices and for possible adoption as a standard in the Nebraska Department of Roads (NDOR). To enact these : evaluations of CRD, the resear...

Effectiveness study of UNL's pneumatic crack/joint preparation device.

DOT National Transportation Integrated Search

2014-03-01

The aim of this project was to evaluate the effectiveness of the crack cleaning device (CCD) for improving the current crack/joint preparation practices and for possible adoption as a standard in Nebraska Department of Roads (NDOR). Through the colla...

Using Satellite Data to Unpack Causes of Yield Gaps in India's Wheat Belt

NASA Astrophysics Data System (ADS)

Jain, M.; Singh, B.; Srivastava, A.; Malik, R. K.; McDonald, A.; Lobell, D. B.

2016-12-01

India will face significant food security challenges in the coming decades due to climate change, natural resource degradation, and population growth. Yields of wheat, one of India's staple crops, are already stagnating and will be significantly impacted by warming temperatures. Despite these challenges, wheat yields can be enhanced by implementing improved management in regions with existing yield gaps. To identify the magnitude and causes of current yield gaps, we produced 30 m resolution yield maps across India's main wheat belt, the Indo-Gangetic Plains (IGP), from 2000 to 2015. Yield maps were derived using a new method that translates satellite vegetation indices to yield estimates using crop model simulations, bypassing the need for ground calibration data that rarely exist in smallholder systems. We find that yields can be increased by 5% on average and up to 16% in the eastern IGP by improving management to current best practices within a given district. However, if policies and technologies are put in place to improve management to current best practices in Punjab, the highest yielding state, yields can be increased by 29% in the eastern IGP. Considering which factors most influence wheat yields, we find that later sow dates and warmer temperatures are most associated with low yields across the IGP. This suggests that strategies that reduce the negative effects of heat stress, like earlier sowing and planting heat-tolerant wheat varieties, are critical to India's current and future food security.

The cost-effectiveness of changes to the care pathway used to identify depression and provide treatment amongst people with diabetes in England: a model-based economic evaluation.

PubMed

Kearns, Ben; Rafia, R; Leaviss, J; Preston, L; Brazier, J E; Palmer, S; Ara, R

2017-01-24

Diabetes is associated with premature death and a number of serious complications. The presence of comorbid depression makes these outcomes more likely and results in increased healthcare costs. The aim of this work was to assess the health economic outcomes associated with having both diabetes and depression, and assess the cost-effectiveness of potential policy changes to improve the care pathway: improved opportunistic screening for depression, collaborative care for depression treatment, and the combination of both. A mathematical model of the care pathways experienced by people diagnosed with type-2 diabetes in England was developed. Both an NHS perspective and wider social benefits were considered. Evidence was taken from the published literature, identified via scoping and targeted searches. Compared with current practice, all three policies reduced both the time spent with depression and the number of diabetes-related complications experienced. The policies were associated with an improvement in quality of life, but with an increase in health care costs. In an incremental analysis, collaborative care dominated improved opportunistic screening. The incremental cost-effectiveness ratio (ICER) for collaborative care compared with current practice was £10,798 per QALY. Compared to collaborative care, the combined policy had an ICER of £68,017 per QALY. Policies targeted at identifying and treating depression early in patients with diabetes may lead to reductions in diabetes related complications and depression, which in turn increase life expectancy and improve health-related quality of life. Implementing collaborative care was cost-effective based on current national guidance in England.

Team deliberate practice in medicine and related domains: a consideration of the issues.

PubMed

Harris, Kevin R; Eccles, David W; Shatzer, John H

2017-03-01

A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental "model" of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.

Changes to nurses' practice environment over time.

PubMed

Roche, Michael A; Duffield, Christine; Friedman, Sarah; Twigg, Di; Dimitrelis, Sofia; Rowbotham, Samantha

2016-07-01

To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Positive nurse practice environments have been linked to nurse retention and care quality outcomes. The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Managers need to apply existing evidence to improve nurse practice environments and manage instability. © 2016 John Wiley & Sons Ltd.

Breaking up is hard to do: lessons learned from a pharma-free practice transformation.

PubMed

Evans, David; Hartung, Daniel M; Beasley, Denise; Fagnan, Lyle J

2013-01-01

Academic medical centers are examining relationships with the pharmaceutical industry and making changes to limit interactions. Most doctors, however, practice outside of academic institutions and see pharmaceutical detailers and accept drug samples and gifts. Little guidance for practicing physicians exists about transforming practices to become pharma-free. Consideration must be given to the impact on practice culture, staff views, and patient needs. A small private practice, setting out to transform into a pharma-free clinic, used a practice transformation process that examined the industry presence in the clinic, educated the doctors on potential conflicts of interest, and improved practice flow. Staff were given the opportunity to share concerns, and their issues were acknowledged. Educational interventions were developed to help providers keep current. Finally, efforts were made to educate patients about the policy. The clinic recorded the degree to which it was detailed. Loss of gifts, keeping current with new drugs, and managing without samples were noted concerns. Policy change champions developed strategies to address concerns. A shift in practice culture to a pharma-free clinic is achievable and maintainable over time. Barriers to success can be identified and overcome with attention given to careful gathering of information, staff input, and stakeholder education.

Performance measures for improving the prevention of venous thromboembolism: achievement in clinical practice.

PubMed

Wilson, Kenneth C; Merli, Geno J

2011-10-01

Venous thromboembolism (VTE) is a common complication during and after hospitalization for acute medical illness or surgery. Despite the existence of evidence-based guidelines for VTE prevention, real-world prescribing practices are frequently suboptimal. Specific performance measures relating to VTE prevention and treatment have been developed by US health care organizations to increase adherence with best-practice recommendations and ultimately reduce the number of preventable VTE events. Two measures developed by the Surgical Care Improvement Project have been endorsed by the National Quality Forum (NQF) and focus on VTE prevention. In addition, six measures have been developed recently by The Joint Commission in collaboration with the NQF; three measures relate to VTE prevention and three focus on treatment. To attain widespread achievement of these performance goals, it is essential to raise awareness of their existence and specifications. It is also imperative that hospitals develop and implement effective VTE protocols. The use of multiple, active strategies, such as computer decision support systems with regular audit and feedback, may be particularly valuable approaches to improve current practices within an integrated quality improvement program. During practical implementation of VTE protocols at Norton Healthcare (Kentucky's largest healthcare system), strong leadership, physician engagement, and caregiver accountability were identified as key factors influencing the process. As such, more hospitals may be able to increase adherence with guidelines, improve achievement of quality goals, and help to reduce the substantial burden associated with avoidable VTE.

[Medical confidentiality for minors].

PubMed

Peyrebrune, Cécile; Génot-Pok, Isabelle

2009-12-20

The new statutory provisions on the care of minors have given a legal framework for primary healthcare professionals. They clarify the rights of minors and their general application to improve the quality of the healthcare system. They are valuable and relevant tools for general practitioners in their day to day practice, and they help improve the medical care of minors, currently considered as a real public health problem.

Reflection: moving from a mandatory ritual to meaningful professional development.

PubMed

Murdoch-Eaton, Deborah; Sandars, John

2014-03-01

Reflection has become established as a key principle underpinning maintenance of standards within professional education and practice. A requirement to evidence reflection within performance review is intended to develop a transformative approach to practice, identify developmental goals, and ultimately, improve healthcare. However, some applications have taken an excessively instrumental approach to the evidencing of reflection, and while they have provided useful templates or framing devices for recording individualistic reflective practice, they potentially have distorted the original intentions. This article revisits the educational theory underpinning the importance of reflection for enhancing performance and considers how to enhance its value within current paediatric practice.

Role of practice-based research networks in comparative effectiveness research.

PubMed

Hartung, Daniel M; Guise, Jeanne-Marie; Fagnan, Lyle J; Davis, Melinda M; Stange, Kurt C

2012-01-01

Comparative effectiveness research fundamentally reorients how clinical evidence is generated and used with the goal of providing actionable information to decision-makers. To achieve this, it is vital that decision-makers and the research enterprise are engaged from research inception, to evidence generation and translation. Practice-based research networks are affiliated clinicians in diverse communities with the goal of conducting research to improve care. Practice-based research networks have the potential to advance all phases of the comparative effectiveness research cycle. The aim of this paper is to explore current and potential roles of practice-based research networks in conducting comparative effectiveness research.

Role of practice-based research networks in comparative effectiveness research

PubMed Central

Hartung, Daniel M; Guise, Jeanne-Marie; Fagnan, Lyle J; Davis, Melinda M; Stange, Kurt C

2012-01-01

Comparative effectiveness research fundamentally reorients how clinical evidence is generated and used with the goal of providing actionable information to decision-makers. To achieve this, it is vital that decision-makers and the research enterprise are engaged from research inception, to evidence generation and translation. Practice-based research networks are affiliated clinicians in diverse communities with the goal of conducting research to improve care. Practice-based research networks have the potential to advance all phases of the comparative effectiveness research cycle. The aim of this paper is to explore current and potential roles of practice-based research networks in conducting comparative effectiveness research. PMID:23105964

Cancer Screening Practices among Physicians Serving Chinese Immigrants

PubMed Central

Aragones, Abraham; Trinh-Shevrin, Chau; Gany, Francesca

2012-01-01

Chinese immigrants in the United States are broadly affected by cancer health disparities. We examined the cancer screening attitudes and practices of physicians serving Chinese immigrants in the New York City (NYC) area by mailing a cancer screening survey, based on current guidelines, to a random sample of physicians serving this population. Fifty three physicians (44%) completed the survey. Seventy-two percent reported following the guidelines for breast cancer, 35% for cervical cancer screening, and 45% for all colorectal cancer screening tests. Sixty-eight percent of physicians were satisfied with their current rates of cancer screening with their Chinese immigrant patient population. Physicians serving the Chinese community in NYC follow cancer screening guidelines inadequately. Cancer screening rates in this population could likely be increased by interventions that target physicians and improve awareness of guidelines and recommended best practices. PMID:19202247

[Practice guideline neuroendocrine tumors - AWMF-Reg. 021-27].

PubMed

2018-06-01

This guideline was created for the first time and is intended as a practical aid for the diagnosis and therapy of neuroendocrine tumors. The aim is to represent the current state of science, promote the recognition of the disease and improve the treatment of patients. The guideline was created under the leadership of the DGVS and with participation of neighbouring scientific societies. © Georg Thieme Verlag KG Stuttgart · New York.

A comparative analysis of the dissemination of best practice measures for key populations.

PubMed

Lundy, Jennifer; Santangelo, Jennifer; Rogers, Patrick; Kuehn, Lynn; Christensen, Sharon; Bournique, Judy; Mekhjian, Hagop; Kamal, Jyoti

2008-11-06

In collaboration with the department of Quality and Operations Improvement, Clinical Applications and the Information Warehouse, we have leveraged available Information Warehouse data to build a Best Practice Compliance Measurement Dashboard. This tool combines information from our operating room charting system, our order entry system and coding information from the patient billing and management system to provide 'previous day', data on a patients current course of treatment.

An update on dental imaging.

PubMed

Whaites, E; Brown, J

1998-08-22

This paper reviews recent advances and current trends in dental radiology. Developments in the design of dental x-ray equipment which improve both radiation hygiene and image quality are described. Also discussed are new features which broaden the scope of intra-oral and panoramic radiological diagnosis in the general dental practice setting. The article concludes with the main recommendations from the latest guidelines on quality standards for radiography, selection criteria and quality assurance in general practice.

"Best practice" in inflammatory bowel disease: an international survey and audit.

PubMed

Van Der Eijk, Ingrid; Verheggen, Frank W.; Russel, Maurice G.; Buckley, Martin; Katsanos, Kostas; Munkholm, Pia; Engdahl, Ingemar; Politi, Patrizia; Odes, Selwyn; Fossen, Jan; Stockbrügger, Reinhold W.

2004-04-01

Background: An observational study was conducted at eight university and four district hospitals in eight countries collaborating in clinical and epidemiological research in inflammatory bowel disease (IBD) to compare European health care facilities and to define current "best practice" with regard to IBD. Methods: The approach used in this multi-national survey was unique. Existing quality norms, developed for total hospital care by a specialized organization, were restricted to IBD-specific care and adapted to the frame of reference of the study group. In each center, these norms were surveyed by means of questionnaires and professional audits in all participating centers. The collected data were reported to the center, compared to data from other hospitals, and used to benchmark. Group consensus was reached with regard to defining current "best practice". Results: The observations in each center involved patient-oriented processes, technical and patient safety, and quality of the medical standard. Several findings could be directly implemented to improve IBD care in another hospital (benchmarks). These included a confidential relationship between health care worker(s) and patients, and availability of patient data. Conclusions: The observed benchmarks, in combination with other subjectively chosen "positive" procedures, have been defined as current "best practice in IBD", representing practical guidelines towards better quality of care in IBD.

Improving the nutrition and screen time environment through self-assessment in family childcare homes in Nebraska.

PubMed

Dev, Dipti A; Williams, Natalie; Iruka, Iheoma; Garcia, Aileen S; Guo, Yage; Patwardhan, Irina; Cummings, Katrina; Rida, Zainab; Hulse, Emily; Sedani, Ami

2018-06-01

To determine if family childcare homes (FCCH) in Nebraska meet best practices for nutrition and screen time, and if focusing on nutrition and screen time policies and practices improves the FCCH environment. A pre-post evaluation was conducted using the Go Nutrition and Physical Activity Self-Assessment for Childcare (Go NAP SACC). FCCH in Nebraska, USA. FCCH enrolled in the Child and Adult Care Food Program (CACFP; n 208) participated in a pre-post evaluation using Go NAP SACC. At baseline, all FCCH met the minimum childcare standards for fifty-four of fifty-six practices in nutrition and screen time. After the intervention, FCCH demonstrated significant improvement in fourteen of the forty-four Child Nutrition items and eleven of the twelve Screen Time items. However, FCCH providers did not meet best practices at post-intervention. Lowest scores were found in serving meals family-style, promoting visible support for healthy eating, planned nutrition education and written policy on child nutrition. For screen time, lowest scores were reported on the availability of television, offering families education on screen time and having a written policy on screen time. FCCH in Nebraska were able to strengthen their policies and practices after utilizing Go NAP SACC. Continued professional development and participation in targeted interventions may assist programmes in sustaining improved practices and policies. Considering the varying standards and policies surrounding FCCH, future studies comparing the current findings with childcare centres and non-CACFP programmes are warranted.

Florida Initiative for Quality Cancer Care: improvements on colorectal cancer quality of care indicators during a 3-year interval.

PubMed

Siegel, Erin M; Jacobsen, Paul B; Lee, Ji-Hyun; Malafa, Mokenge; Fulp, William; Fletcher, Michelle; Smith, Jesusa Corazon R; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-Terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Philip; Markham, Merry-Jennifer; Shibata, David

2014-01-01

The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥ 12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and improving the quality of cancer care at a regional level. Copyright © 2014. Published by Elsevier Inc.

Project ECHO: A Telementoring Network Model for Continuing Professional Development.

PubMed

Arora, Sanjeev; Kalishman, Summers G; Thornton, Karla A; Komaromy, Miriam S; Katzman, Joanna G; Struminger, Bruce B; Rayburn, William F

2017-01-01

A major challenge with current systems of CME is the inability to translate the explosive growth in health care knowledge into daily practice. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network designed for continuing professional development (CPD) and improving patient outcomes. The purpose of this article was to describe how the model has complied with recommendations from several authoritative reports about redesigning and enhancing CPD. This model links primary care clinicians through a knowledge network with an interprofessional team of specialists from an academic medical center who provide telementoring and ongoing education enabling community clinicians to treat patients with a variety of complex conditions. Knowledge and skills are shared during weekly condition-specific videoconferences. The model exemplifies learning as described in the seven levels of CPD by Moore (participation, satisfaction, learning, competence, performance, patient, and community health). The model is also aligned with recommendations from four national reports intended to redesign knowledge transfer in improving health care. Efforts in learning sessions focus on information that is relevant to practice, focus on evidence, education methodology, tailoring of recommendations to individual needs and community resources, and interprofessionalism. Project ECHO serves as a telementoring network model of CPD that aligns with current best practice recommendations for CME. This transformative initiative has the potential to serve as a leading model for larger scale CPD, nationally and globally, to enhance access to care, improve quality, and reduce cost.

Perinatal pathology: practice suggestions for limited-resource settings.

PubMed

Roberts, Drucilla J

2013-06-01

The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

Why primary care practices should become digital health information hubs for their patients.

PubMed

Baird, Aaron; Nowak, Samantha

2014-11-25

Two interesting health care trends are currently occurring: 1) patient-facing technologies, such as personal health records, patient portals, and mobile health apps, are being adopted at rapid rates, and 2) primary care, which includes family practice, is being promoted as essential to reducing health care costs and improving health care outcomes. While these trends are notable and commendable, both remain subject to significant fragmentation and incentive misalignments, which has resulted in significant data coordination and value generation challenges. In particular, patient-facing technologies designed to increase care coordination, often fall prey to the very digital fragmentation issues they are supposed to overcome. Additionally, primary care providers are treating patients that may have considerable health information histories, but generating a single view of such multi-source data is nearly impossible. We contribute to this debate by proposing that primary care practices become digital health information hubs for their patients. Such hubs would offer health data coordination in a medically professional setting with the benefits of expert, trustworthy advice coupled with active patient engagement. We acknowledge challenges including: costs, information quality and provenance, willingness-to-share information and records, willingness-to-use (by both providers and patients), primary care scope creep, and determinations of technical and process effectiveness. Even with such potential challenges, we strongly believe that more debate is needed on this topic prior to full implementation of various health information technology incentives and reform programs currently being designed and enacted throughout the world. Ultimately, if we do not provide a meaningful way for the full spectrum of health information to be used by both providers and patients, especially early in the health care continuum, effectively improving health outcomes may remain elusive. We view the primary care practice as a central component of digital information coordination, especially when considering the current challenges of digital health information fragmentation. Given these fragmentation issues and the emphasis on primary care as central to improving health and lower overall health care costs, we suggest that primary care practices should embrace their evolving role and should seek to become digital health information hubs for their patients.

Oncology nurses and the experience of participation in an evidence-based practice project.

PubMed

Fridman, Mary; Frederickson, Keville

2014-07-01

To illuminate the experiences of oncology nurses who participated in an evidence-based practice (EBP) project in an institution with an EBP organizational structure. A descriptive phenomenologic approach and in-depth interviews with each participant. An oncology-focused academic medical center with an established organizational infrastructure for EBP. 12 RNs working in an oncology setting who participated in an EBP project. Descriptive, qualitative phenomenologic approach through use of interviews and analysis of interview text. Four essential themes (i.e., support, challenges, evolution, and empowerment) and 11 subthemes emerged that reflected nurses' professional and personal growth, as well as the creation of a culture of EBP in the workplace. The participants described the EBP project as a positive, empowering personal and professional evolutionary experience with supports and challenges that resulted in improvements in patient care. To the authors' knowledge, the current study is the first qualitative study to demonstrate improved nursing outcomes (e.g., professional growth, improved nursing performance) and nurses' perception of improved patient outcomes (e.g., ongoing healthcare collaboration, evidence-based changes in practice).

Teaching evidence-based social work in foundation practice courses: learning from pedagogical choices of allied fields.

PubMed

Traube, Dorian E; Pohle, Cara E; Barley, Melissa

2012-01-01

The field of social work is attuned to the need to incorporate evidence-based practice education into masters-level curriculum. One question remaining is how to integrate evidence-based practice in the foundation practice courses. Integration of evidence-based practice across the foundation-level curriculum coincides with the Council on Social Work Education's mandate that student's engage in research-informed practice and practice-informed research. Through a discussion of definitions, criticisms, and pedagogy across the allied fields of medicine, nursing, and social work the authors address the current status of evidence-based practice curriculum in foundation-level education. The authors incorporate the lessons learned from allied fields and a Masters of Social Work student's analyses of their experience of evidence-based practice learning to propose an adult-learner model to improve evidence-based practice pedagogy in Social Work.

Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

PubMed Central

Verdun di Cantogno, Elisabetta; Russell, Susan; Snow, Tom

2011-01-01

Background: All established disease-modifying drugs for multiple sclerosis require parenteral administration, which can cause difficulties for some patients, sometimes leading to suboptimal adherence. A new electronic autoinjection device has been designed to address these issues. Methods: Patients with relapsing multiple sclerosis currently receiving subcutaneous or intramuscular interferon beta-1a, interferon beta-1b, or glatiramer acetate completed an online questionnaire (July 4–25, 2008) that surveyed current injection practices, experiences with current injection methods, and impressions and appeal of the new device. Results: In total, 422 patients completed the survey, of whom 44% used autoinjectors, 43% prefilled syringes, and 13% syringes and vials; overall, 66% currently self-injected. Physical and psychological barriers to self-injection included difficulty with injections, needle phobia, and concerns over correct injection technique. Only 40% of respondents were “very satisfied” with their current injection method. The new electronic autoinjector was rated as “very appealing” by 65% of patients. The benefits of the new device included the ability to customize injection settings and to review dosing history. Conclusion: New technologies may help patients overcome physical and psychological barriers to self-injection. The combination of a reliable and flexible autoinjection device with dose-monitoring technology may improve communication between health care professionals and patients, and improve treatment adherence. PMID:21573048

Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings.

PubMed

Ostroff, Jamie S; Li, Yuelin; Shelley, Donna R

2014-02-21

Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. NCT01615237.

Assessing diabetes practices in clinical settings: precursor to building community partnerships around disease management.

PubMed

Prochaska, John D; Mier, Nelda; Bolin, Jane N; Hora, Kerrie L; Clark, Heather R; Ory, Marcia G

2009-12-01

Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process.

The future of education and training in dental technology: designing a dental curriculum that facilitates teamwork across the oral health professions.

PubMed

Evans, J; Henderson, A; Johnson, N

2010-03-13

Teamwork is essential for the provision of contemporary, high quality oral health care. Teamwork skills need to be taught and learnt and therefore ought to be one of the core competencies in all dental education programmes: dentistry, oral health therapy, dental technology and dental assisting. Currently, lack of opportunities for collaborative learning and practice within educational establishments, and in the practising professions, hamper the development of effective teamwork. For students across oral health care, learning 'together' requires positive action for teamwork skills to be developed. Interprofessional curricula need to be formally developed, based on evidence from the wider education literature that demonstrates how to maximise the engagements needed for teamwork in practice. Rigorous study of interprofessional education within dentistry and oral health is in its infancy. Anecdotal evidence indicates that dental technology students who experience an interprofessional curriculum are better prepared for collaborative practice. Formalised interprofessional education is posited as an effective strategy to improve interactions among oral health professionals leading to improved patient care. This paper reviews the extant literature and describes the approach currently being trialled at Griffith University.

A proposal for improving sustainability practice through the implementations of reuse and recycle technique in Malaysian construction industry

NASA Astrophysics Data System (ADS)

Osman, Wan Nadzri; Nawi, Mohd Nasrun Mohd; Saad, Rohaizah; Anuar, Herman Shah; Ibrahim, Siti Halipah

2016-08-01

Construction and demolition waste is often seen as the major contributor to the solid waste stream that is going to landfill, hence, making it the area of focus for improvement. In the construction industry, reuse and recycle principles have been promoted in order to reduce waste and protect the environment. Construction and demolition waste including demolished concrete, bricks and masonry, wood and other materials such as dry wall, glass, insulation, roofing, wire, pipe, rock and soil constitute a significant component of the total waste. Without proper reuse and recycle policies, these construction and demolition wastes would quickly fill all the remaining landfill space, which has already been growing in scarce around this region. Based on the feedback received, on average, a third of respondents said they currently have a lotto benefit from the use of reduce and reuse. In addition, they also agreed that the existing policies help and support the min carrying out the reduce and reuse practices. Respondents also agreed that other stakeholders in the construction industry currently have an excellent awareness in term of implementation of the reduce and reuse in their practices.

Clinical guidelines and practice: in search of the truth.

PubMed

Kereiakes, Dean J; Antman, Elliott M

2006-09-19

Data from randomized clinical trials, non-randomized studies, and registries, as well as expert panel consensus are appropriately weighted and woven into the context of clinical practice guidelines. Recent guidelines for the care of patients with ischemic heart disease have emphasized both risk stratification and early coronary angiography with revascularization of patients with high-risk indicators. Advances in our understanding of the pathogenesis of acute coronary syndromes and the dynamics of therapeutic innovation (improvement in catheter-based technologies and adjunctive pharmacotherapy) mandate the timely update and revision of practice guidelines. We believe that the weight of evidence remains clearly in support of an early invasive treatment strategy based on risk stratification. Arguments regarding treatment strategy (invasive vs. conservative) are misguided, and greater focus should be placed on improving the treatment-risk paradox demonstrated in clinical practice as well as on strategies to enhance current guideline compliance and utilization. Interest exists in establishing regional centers of excellence for care of patients with acute ischemic heart disease, analogous to the regionalized approach already established for patients with trauma or stroke. This approach is supported by data that demonstrate an inverse relationship between both institutional and operator procedural volumes and mortality, as well as by existing constraints in resources such as specialized nurses and subspecialty-trained physicians. It is appropriate at this time to briefly review specific aspects of the American College of Cardiology/American Heart Association practice guidelines and the current process of care for acute ischemic heart disease.

Reading, Writing, and Publishing Digital Text.

ERIC Educational Resources Information Center

Boone, Randall; Higgins, Kyle

2003-01-01

This article explores current state-of-the-art technologies available for reading, writing, and publishing, including electronic books (ebooks), electronic libraries, and electronic journals. Instructional design, best practices for improving reading skills using ebooks, and copyright issues are discussed. Vignettes offer a positive scenario for…

Immunization Services for Adolescents within Comprehensive School Health Programs.

ERIC Educational Resources Information Center

Vernon, Mary E.; Bryan, Gloria; Hunt, Pete; Allensworth, Diane; Bradley, Beverly

1997-01-01

Discusses school health services, adolescent immunization, current school immunization practices, and support for school-based immunization programs. Children and adolescents can receive preventive health services, including immunizations and monitoring of immunization levels. Expanding school health services could improve the immunization levels…

IMPROVED EQUIPMENT CLEANING IN COATED AND LAMINATED SUBSTRATE MANUFACTURING FACILITIES (PHASE I)

EPA Science Inventory

The report gives results of a Phase I study to characterize current equipment cleaning practices in the coated and laminated substrate manufacturing industry, to identify alternative cleaning technologies, and to identify demonstrable technologies and estimate their emissions imp...

Studying Innovation Technologies in Modern Education

ERIC Educational Resources Information Center

Stukalenko, Nina M.; Zhakhina, Bariya B.; Kukubaeva, Asiya K.; Smagulova, Nurgul K.; Kazhibaeva, Gulden K.

2016-01-01

In modern society, innovation technologies expand to almost every field of human activity, including such wide field as education. Due to integrating innovation technologies into the educational process practice, this phenomenon gained special significance within improvement and modernization of the established educational system. Currently, the…

Using Wise Interventions to Motivate Deliberate Practice

PubMed Central

Eskreis-Winkler, Lauren; Shulman, Elizabeth P.; Young, Victoria; Tsukayama, Eli; Brunwasser, Steven M.; Duckworth, Angela L.

2015-01-01

Deliberate practice leads to world-class excellence across domains. In the current investigation, we examined whether psychologically “wise” interventions targeting expectancies and values—stock antecedents of ordinary effortful behaviors—could motivate non-experts to engage in deliberate practice and improve their achievement. As a preliminary, we developed and validated a novel task measure of deliberate practice and confirmed its association with (a) expectancy-value beliefs and (b) achievement in the non-expert setting (Study 1). Next, across four longitudinal, randomized-controlled, field experiments, we intervened. Among lower-achievers, wise deliberate practice interventions improved math performance for fifth and sixth graders (Study 2), end-of-semester grades for undergraduates (Study 3), and end-of-quarter grades for sixth graders (Study 4); the same pattern of results emerged in end-of-quarter grades for seventh graders (Study 5). Following the intervention, expectancy-value beliefs and deliberate practice improved for one month (Study 4), but not four (Study 5). Treatment proved beneficial over and above two control conditions, one that taught standard study skills (Studies 2 and 3), and one that discussed deep interests, generalized motivation, and high achievement (Studies 4 and 5). Collectively, these findings provide preliminary support for the heretofore untested hypothesis that deliberate practice submits to the same laws that govern typical forms of effortful behavior, and that wise interventions that tap into these laws can spur short-term gains in adaptive beliefs, deliberate practice, and objectively-measured achievement. PMID:27762575

The pediatric orthopaedics workforce demands, needs, and resources.

PubMed

Schwend, Richard M

2009-01-01

The Pediatric Orthopaedic Society of North America Practice Management Committee evaluated current and future pediatric orthopaedic workforce needs. The resulting informational article summarizes its findings and makes recommendations for improvement of our workforce. Whereas policy decisions are often in the hands of the government with its emphasis on access and cost containment, the area that we can control, the quality of our workforce should be our primary effort. Specific recommendations include the prospective collection of accurate workforce data, increasing the interest of residents and students to enter our specialty, assisting members to improve practice efficiencies and assuming leadership in the musculoskeletal education of our primary care colleagues. We expect that by improving our workforce and professional work environment, we can make a difference for our young patients and for the society.

Measuring Infant and Young Child Complementary Feeding Practices: Indicators, Current Practice, and Research Gaps.

PubMed

Ruel, Marie T

2017-01-01

The publication of the WHO Infant and Young Child Feeding (IYCF) indicators in 2008 equipped the nutrition and broader development community with an invaluable tool for measuring, documenting, and advocating for faster progress in improving these practices in low- and middle-income countries (LMICs). The indicators, with 5 of them focusing on complementary feeding (CF) practices, were originally designed for population level assessment, targeting, monitoring, and evaluation. This chapter takes stock of where we are with the existing CF indicators: it reviews how the indicators have been used, what we have learned, and what their strengths and limitations are, and it suggests a way forward. We find that the indicators have been used extensively for population level assessments and country comparisons, and to track progress. They have also been adopted by researchers in program impact evaluations and in research seeking to understand the determinants and consequences of poor CF practices for child growth and development outcomes. In addition to generating a wealth of knowledge and unveiling the severity of the global problem of poor CF practices in LMICs, the indicators have been an invaluable tool to raise awareness and call for urgent action on improving CF practices at scale. The indicators have strengths and limitations, which are summarized in this chapter. Although enormous progress has been achieved since the indicators were released in 2008, we feel it is time to reflect and revisit the CF indicators, improve them, develop new ones, and promote their appropriate use. Better indicators are critically important to stimulate action and investments in improving CF practices at scale. © 2017 Nestec Ltd., Vevey/S. Karger AG, Basel.

The maturing of the quality improvement paradigm in the SEL

NASA Technical Reports Server (NTRS)

Basili, Victor R.

1993-01-01

The Software Engineering Laboratory uses a paradigm for improving the software process and product, called the quality improvement paradigm. This paradigm has evolved over the past 18 years, along with our software development processes and product. Since 1976, when we first began the SEL, we have learned a great deal about improving the software process and product, making a great many mistakes along the way. Quality improvement paradigm, as it is currently defined, can be broken up into six steps: characterize the current project and its environment with respect to the appropriate models and metrics; set the quantifiable goals for successful project performance and improvement; choose the appropriate process model and supporting methods and tools for this project; execute the processes, construct the products, and collect, validate, and analyze the data to provide real-time feedback for corrective action; analyze the data to evaluate the current practices, determine problems, record findings, and make recommendations for future project improvements; and package the experience gained in the form of updated and refined models and other forms of structured knowledge gained from this and prior projects and save it in an experience base to be reused on future projects.

Current Best Practices for Sexual and Gender Minorities in Hospice and Palliative Care Settings.

PubMed

Maingi, Shail; Bagabag, Arthur E; O'Mahony, Sean

2018-05-01

Although several publications document the health care disparities experienced by sexual and gender minorities (SGMs), including lesbian, gay, bisexual, and transgender (LGBT) individuals,1e4 less is known about the experiences and outcomes for SGM families and individuals in hospice and palliative care (HPC) settings. This article provides a brief overview of issues pertaining to SGMs in HPC settings, highlighting gaps in knowledge and research. Current and best practices for SGM individuals and their families in HPC settings are described, as are recommendations for improving the quality of such care. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Rational Selection and Use of Antimicrobials in Patients with Burn Injuries.

PubMed

Hill, David M; Sinclair, Scott E; Hickerson, William L

2017-07-01

Caring for patients with burn injuries is challenging secondary to the acute disease process, chronic comorbidities, and underrepresentation in evidence-based literature. Much current practice relies on extrapolation of guidance from different patient populations and wide variations in universal practices. Identifying infections or sepsis in this hypermetabolic population is imperfect and often leads to overprescribing of antimicrobials, suboptimal dosing, and multidrug resistance. An understanding of pharmacokinetics and pharmacodynamics may aid optimization of dosing regimens to better attain treatment targets. This article provides an overview of the current status of burn infection and attempts recommendations for consideration to improve universally accepted care. Copyright © 2017 Elsevier Inc. All rights reserved.

Establishing CASA as an evidence-based practice.

PubMed

Lawson, Jennifer; Berrick, Jill Duerr

2013-01-01

In this article the authors examine the evidentiary status of the Court Appointed Special Advocates (CASA) program through a review of current research findings and a critical analysis of the study methodologies used to produce those findings. Due to the equivocal research findings and widespread methodological weaknesses (most notably selection bias) in the literature base, it is determined that there is not currently enough evidence to establish CASA as an evidence-based practice. In spite of the challenges to the feasibility of such research, a future research agenda is suggested that calls for the execution of large randomized controlled trials in order to produce findings that will inform a deeper understanding of CASA effectiveness in improving child outcomes.

Current best practice in the management of Turner syndrome

PubMed Central

Shankar, Roopa Kanakatti; Backeljauw, Philippe F.

2017-01-01

Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population. PMID:29344338

Designing nursing excellence through a National Quality Forum nurse scholar program.

PubMed

Neumann, Julie A; Brady-Schluttner, Katherine A; Attlesey-Pries, Jacqueline M; Twedell, Diane M

2010-01-01

Closing the knowledge gap for current practicing nurses in the Institute of Medicine (IOM) core competencies is critical to providing safe patient care. The National Quality Forum (NQF) nurse scholar program is one organization's journey to close the gap in the IOM core competencies in a large teaching organization. The NQF nurse scholar program is positioned to provide a plan to assist current nurses to accelerate their learning about quality improvement, evidence-based practice, and informatics, 3 of the core competencies identified by the IOM, and focus on application of skills to NQF nurse-sensitive measures. Curriculum outline, educational methodologies, administrative processes, and aims of the project are discussed.

Education on fluid management and encouraging critical thinking skills.

PubMed

Dale, Willette

2012-01-01

The unit is currently utilizing hematocrit-based blood volume monitoring on each patient, resulting in improved monitoring in patients achieving their target weight. The nurses expressed confidence in their understanding of the use of hematocrit-based blood volume monitoring. This learning experience provided a vivid look at the importance of fluid management in nephrology nursing. This area should always be included in nephrology nurse competencies and represented in a way that it ignites critical thinking within the nursing professional. It is the responsibility of a professional nurse to stay current in evidence-based practice and continuing education. Professional pride stimulates nephrology nurses to seek new learning experiences to enhance their practice.

Applying principles from safety science to improve child protection.

PubMed

Cull, Michael J; Rzepnicki, Tina L; O'Day, Kathryn; Epstein, Richard A

2013-01-01

Child Protective Services Agencies (CPSAs) share many characteristics with other organizations operating in high-risk, high-profile industries. Over the past 50 years, industries as diverse as aviation, nuclear power, and healthcare have applied principles from safety science to improve practice. The current paper describes the rationale, characteristics, and challenges of applying concepts from the safety culture literature to CPSAs. Preliminary efforts to apply key principles aimed at improving child safety and well-being in two states are also presented.

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units.

PubMed

Day, T; Wainwright, S P; Wilson-Barnett, J

2001-09-01

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.

Preventing nipple trauma in lactating women in the University Hospital of the University of Sao Paulo: a best practice implementation project.

PubMed

Shimoda, Gilcéria Tochika; Soares, Alda Valeria Neves; Aragaki, Ilva Marico Mizumoto; McArthur, Alexa

2015-03-12

Nipple trauma in lactating women is an important issue in facilitating successful breastfeeding. Evidence suggests that early postnatal education on the positioning and attachment technique, early observation of mothers and correcting breastfeeding techniques at an early stage may reduce nipple trauma. The aim of this project was to improve breastfeeding practice and thereby reduce nipple trauma in lactating women in a public hospital in Sao Paulo. More specifically the objectives of this project were: firstly, to assess the current practice in nurses' assistance concerning the prevention of nipple trauma; secondly, to adapt and trial a Breastfeeding Assessment Form to observe and educate the lactating mother during the early post-natal period; and thirdly, to assess the impact of introducing the assessment strategy on breastfeeding and nipple trauma rates. The Joanna Briggs Institute Practical Application of Clinical Evidence System online tool was utilized for this project. A clinical audit was conducted to assess compliance with best practice in nursing assistance concerning the prevention of nipple trauma. The project concluded with a second audit, which assessed the change in practice following the implementation of strategies to improve practice. The project was successful in that there was an improvement across all of the audit criteria following the introduction of the strategy to promote best practice. Criterion 1, concerning nursing staff knowledge, improved in compliance by 73%. Criterion 2 and 4, concerning women's knowledge about prevention and management of nipple trauma, improved by 53% and 55% respectively. Breastfeeding assessment improved by 26% from baseline to follow-up audit. Moreover, an improvement in women's satisfaction and exclusive breastfeeding rates was observed; however, nipple trauma rates did not decrease. This implementation project had great impact on both nursing staff as well as lactating women's knowledge of preventing and managing nipple trauma. It also enhanced women's satisfaction with breastfeeding and exclusive breastfeeding rates. Further research is required into other aspects involved with the onset of nipple trauma. The Joanna Briggs Institute.

Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK.

PubMed

Valentine, W J; Curtis, B H; Pollock, R F; Van Brunt, K; Paczkowski, R; Brändle, M; Boye, K S; Kendall, D M

2015-07-01

The aim of the analysis was to investigate whether insulin intensification, based on the use of intensive insulin regimens as recommended by the current standard of care in routine clinical practice, would be cost-effective for patients with type 2 diabetes in the UK. Clinical data were derived from a retrospective analysis of 3185 patients with type 2 diabetes on basal insulin in The Health Improvement Network (THIN) general practice database. In total, 48% (614 patients) intensified insulin therapy, defined by adding bolus or premix insulin to a basal regimen, which was associated with a reduction in HbA1c and an increase in body mass index. Projections of clinical outcomes and costs (2011 GBP) over patients' lifetimes were made using a recently validated type 2 diabetes model. Immediate insulin intensification was associated with improvements in life expectancy, quality-adjusted life expectancy and time to onset of complications versus no intensification or delaying intensification by 2, 4, 6, or 8 years. Direct costs were higher with the insulin intensification strategy (due to the acquisition costs of insulin). Incremental cost-effectiveness ratios for insulin intensification were GBP 32,560, GBP 35,187, GBP 40,006, GBP 48,187 and GBP 55,431 per QALY gained versus delaying intensification 2, 4, 6 and 8 years, and no intensification, respectively. Although associated with improved clinical outcomes, insulin intensification as practiced in the UK has a relatively high cost per QALY and may not lead to cost-effective outcomes for patients with type 2 diabetes as currently defined by UK cost-effectiveness thresholds. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Partnering with patients to promote holistic diabetes management: changing paradigms.

PubMed

Lorenzo, Lenora

2013-07-01

To provide a review of best practice for clinical management of diabetes mellitus (DM) for nurse practitioners (NPs) and accelerate incorporation of key findings into current practice. A search was conducted in Pub Med, Ovid, CINAHL, and Cochrane's Database of Systematic Reviews. There are many challenges for DM care identified in the current health system. There is a great need to change care paradigms to engage patients in partnership for enhanced management and self-management in DM. A review of the best practice evidence revealed numerous models of care, strategies, and tools available to enhance diabetes care and promote health and well-being. The primary focus of this article is to engage NP clinicians to incorporate new strategies to augment management and improve clinical outcomes. Incorporation of best practice for DM management may accelerate the paradigm shift to more patient-focused care. Engaged, informed, and activated patients along with clinicians working in partnerships may enhance clinical outcomes. ©2013 The Author ©2013 American Association of Nurse Practitioners.

Current management practices and interventions prioritised as part of a nationwide mastitis control plan

PubMed Central

Bradley, A. J.; Breen, J. E.; Hudson, C. D.; Green, M. J.

2016-01-01

The objectives of this study were to report performance and management data taken from a sample of UK dairy farms that have participated in the Agriculture and Horticulture Development Board Dairy Mastitis Control Plan (DMCP) and to identify important mastitis prevention practices that are not currently widely implemented. A total of 234 UK dairy herds were included in the study from which farm management and udder health data were collected. Herds were grouped according to their mastitis epidemiology and could be classed as (i) environmental dry period (EDP) (i.e. environmental pathogen with majority of infections being acquired during the dry period), (ii) environmental lactation (EL), (iii) contagious dry period (CDP) or (iv) contagious lactation (CL). The results of this study showed that many mastitis-related management practices that are generally considered to be important were not widely performed. A better understanding of those practices not widely adopted by UK dairy farmers at present may aid practitioners in identifying and overcoming potential barriers to improved mastitis control. PMID:26966249

Are electronic medical records helpful for care coordination? Experiences of physician practices.

PubMed

O'Malley, Ann S; Grossman, Joy M; Cohen, Genna R; Kemper, Nicole M; Pham, Hoangmai H

2010-03-01

Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-around practices have created to address new coordination challenges. Semi-structured telephone interviews in 12 randomly selected communities. Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). There is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

Sharing and re-use of phylogenetic trees (and associated data) to facilitate synthesis.

PubMed

Stoltzfus, Arlin; O'Meara, Brian; Whitacre, Jamie; Mounce, Ross; Gillespie, Emily L; Kumar, Sudhir; Rosauer, Dan F; Vos, Rutger A

2012-10-22

Recently, various evolution-related journals adopted policies to encourage or require archiving of phylogenetic trees and associated data. Such attention to practices that promote sharing of data reflects rapidly improving information technology, and rapidly expanding potential to use this technology to aggregate and link data from previously published research. Nevertheless, little is known about current practices, or best practices, for publishing trees and associated data so as to promote re-use. Here we summarize results of an ongoing analysis of current practices for archiving phylogenetic trees and associated data, current practices of re-use, and current barriers to re-use. We find that the technical infrastructure is available to support rudimentary archiving, but the frequency of archiving is low. Currently, most phylogenetic knowledge is not easily re-used due to a lack of archiving, lack of awareness of best practices, and lack of community-wide standards for formatting data, naming entities, and annotating data. Most attempts at data re-use seem to end in disappointment. Nevertheless, we find many positive examples of data re-use, particularly those that involve customized species trees generated by grafting to, and pruning from, a much larger tree. The technologies and practices that facilitate data re-use can catalyze synthetic and integrative research. However, success will require engagement from various stakeholders including individual scientists who produce or consume shareable data, publishers, policy-makers, technology developers and resource-providers. The critical challenges for facilitating re-use of phylogenetic trees and associated data, we suggest, include: a broader commitment to public archiving; more extensive use of globally meaningful identifiers; development of user-friendly technology for annotating, submitting, searching, and retrieving data and their metadata; and development of a minimum reporting standard (MIAPA) indicating which kinds of data and metadata are most important for a re-useable phylogenetic record.

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions

PubMed Central

2017-01-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy. PMID:29209469

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

PubMed

Nantha, Yogarabindranath Swarna

2017-11-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

Patient safety in phlebology: The ACP Phlebology Safety Checklist.

PubMed

Collares, Felipe Birchal; Sonde, Mehru; Harper, Kenneth; Armitage, Michael; Neuhardt, Diana L; Fronek, Helane S

2018-05-01

Objectives To assess the current use of safety checklists among the American College of Phlebology (ACP) members and their interest in implementing a checklist supported by the ACP on their clinical practices; and to develop a phlebology safety checklist. Method Online surveys were sent to ACP members, and a phlebology safety checklist was developed by a multispecialty team through the ACP Leadership Academy. Results Forty-seven percent of respondents are using a safety checklist in their practices; 23% think that a phlebology safety checklist would interfere or disrupt workflow; 79% answered that a phlebology safety checklist could improve procedure outcomes or prevent complications; and 85% would be interested in implementing a phlebology safety checklist approved by the ACP. Conclusion A phlebology safety checklist was developed with the intent to increase awareness on patient safety and improve outcome in phlebology practice.

Vocational rehabilitation: facilitating evidence based practice through participatory action research.

PubMed

Maciver, Donald; Prior, Susan; Forsyth, Kirsty; Walsh, Mike; Meiklejohn, Allison; Irvine, Linda; Pentland, Duncan

2013-04-01

Improving vocational rehabilitation in line with the current evidence base is an area of considerable interest. Aims To describe the strategies used by a multidisciplinary team in the initial stages of a participatory action research (PAR) approach to improving a vocational rehabilitation service. A literature review and PAR process were completed. One hundred and fifteen participants engaged in multifaceted data collection and analysis, building consensus around key principles for a new vocational rehabilitation service. A synthesis of our literature review and PAR process was developed into a set of principles for practice which we plan to implement across the service. We have developed methodologies in interdisciplinary collaborations spanning statutory and non-statutory services. We have developed a set of principles for practice and detailed plans for implementation are being drawn up to inform provision in the future.

Public service quality improvements: a case for exemption from IRB review of public administration research.

PubMed

Jordan, Sara R

2014-01-01

Should the exemption from Institutional Review Board (IRB) evaluations currently in place for quality improvements research be extended to public administration research that addresses questions of improving the quality of public service delivery? As a means to both reduce the level of disdain held by a group of social science researchers for IRBs and to reduce the cost of review for minimal risk studies, I argue here that much of the current public administration research should also be exempted from normal processes of review by IRBs on the basis of their similarity to Quality Improvements (QI) research, a category of studies already granted exemption. This argument dovetails provisions currently in place for studies of public service and public benefit, but reframes these exemptions in the language of "quality improvements," which may be a more comfortable language for IRBs concerned to demonstrate compliance for review of all fields. To expedite this argument into the practices of IRBs, I included a checklist that researchers could use to self-identify their studies as QI, not research as such.

Holding up a mirror: changing obstetric practice through criterion-based clinical audit in developing countries.

PubMed

Wagaarachchi, P T; Graham, W J; Penney, G C; McCaw-Binns, A; Yeboah Antwi, K; Hall, M H

2001-08-01

The objective of the study described is to assess the feasibility and effectiveness of using a criterion-based clinical audit to measure and improve the quality of obstetric care at the district hospital level in developing countries. The focus is on the management of five life-threatening obstetric complications--hemorrhage, eclampsia, genital tract infection, obstructed labor and uterine rupture was audited using a "before and after" design. The five steps of the audit cycle were followed: establish criteria of good quality care; measure current practice (Review I); feedback findings and set targets; take action to change practice; and re-evaluate practice (Review II). Systematic literature review, panel discussions and pilot work led to the development of 31 audit criteria. Review I included 555 life-threatening complications occurring over 66 hospital-months; Review II included 342 complications over 42 hospital-months. Many common areas for improvement were identified across the four hospitals. Agreed mechanisms for achieving these improvements included clinical protocols, reviews of staffing, and training workshops. Some aspects of clinical monitoring, drug use and record keeping improved significantly between Reviews I and II. Criterion-based clinical audit in four typical district hospitals in Ghana and Jamaica is a feasible and acceptable method for quality assurance and appears to have improved the management of life-threatening obstetric complications.

Assessing and Treating Pain in Hospices: Current State of Evidence-Based Practices

PubMed Central

Herr, Keela; Titler, Marita; Fine, Perry; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen

2010-01-01

The aim of this article is to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index (CPPI), a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of the those key evidence-based practices (EBPs) that were applicable to their situation. When examining individual practices, the majority of patients had their pain assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps including: additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the Pain Treatment Plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by pain medication increases (15.8%); monitoring of analgesic- induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both non-pharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices. PMID:20471542

Where we are now and how we can improve: a qualitative study of practitioners' perspectives on providing ART adherence support in Romania.

PubMed

Dima, Alexandra Lelia; Linn, Annemiek J; Schweitzer, Ana-Maria

2016-01-01

Supporting medication adherence is a priority in HIV care worldwide as low adherence threatens the effectiveness of antiretroviral treatment (ART). While evidence on adherence causes and consequences has steadily accumulated, investigating current practice and relevant determinants of practitioners' behaviors has only recently been highlighted as essential for developing effective and sustainable interventions. In Romania, ART adherence is low despite universal access to HIV care, and improving support services is a priority. We report a qualitative exploration of practitioners' experiences and views on ART adherence support, guided by current behavioral theory. Semi-structured interviews were performed with 10 practitioners from six HIV centers, aiming for maximum variation sampling on professional experience, location, and organization type. Questions addressed practitioners' views and experiences on assessing patients' adherence behaviors and determinants, content and format of adherence support, and perceived influences on their capacity to deliver support. Verbatim transcripts were analyzed via template analysis. Results show that adherence support is provided in Romania by trained psychologists in multidisciplinary teams that operate flexibly and perform multiple HIV care activities. Assessment of adherence behaviors and determinants is primarily interview-based, and practitioners use mostly psychotherapeutic techniques and theories with a degree of intervention tailoring. Practitioners' descriptions covered a broad range of common determinants and behavior change techniques, but showed limited use of behavioral theory. Participants also described difficulties to cope with limited resources, and lack of support for managing practical and emotional challenges. Several opportunities for improvement were identified, such as standardizing patient profiling and intervention delivery, conceptualizing and recording active intervention content based on behavioral theory, and actively monitoring intervention effectiveness. This qualitative inquiry provided valuable information for improving adherence support in this clinical context. Understanding practitioners' perspectives based on behavioral theory-informed analyses can help intervention developers increase intervention fidelity by integrating current practice information in program design.

Role of Large Clinical Datasets From Physiologic Monitors in Improving the Safety of Clinical Alarm Systems and Methodological Considerations: A Case From Philips Monitors.

PubMed

Sowan, Azizeh Khaled; Reed, Charles Calhoun; Staggers, Nancy

2016-09-30

Large datasets of the audit log of modern physiologic monitoring devices have rarely been used for predictive modeling, capturing unsafe practices, or guiding initiatives on alarm systems safety. This paper (1) describes a large clinical dataset using the audit log of the physiologic monitors, (2) discusses benefits and challenges of using the audit log in identifying the most important alarm signals and improving the safety of clinical alarm systems, and (3) provides suggestions for presenting alarm data and improving the audit log of the physiologic monitors. At a 20-bed transplant cardiac intensive care unit, alarm data recorded via the audit log of bedside monitors were retrieved from the server of the central station monitor. Benefits of the audit log are many. They include easily retrievable data at no cost, complete alarm records, easy capture of inconsistent and unsafe practices, and easy identification of bedside monitors missed from a unit change of alarm settings adjustments. Challenges in analyzing the audit log are related to the time-consuming processes of data cleaning and analysis, and limited storage and retrieval capabilities of the monitors. The audit log is a function of current capabilities of the physiologic monitoring systems, monitor's configuration, and alarm management practices by clinicians. Despite current challenges in data retrieval and analysis, large digitalized clinical datasets hold great promise in performance, safety, and quality improvement. Vendors, clinicians, researchers, and professional organizations should work closely to identify the most useful format and type of clinical data to expand medical devices' log capacity.

Interprofessional primary care team meetings: a qualitative approach comparing observations with personal opinions.

PubMed

van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia; Daniëls, Ramon; Lenzen, Stephanie Anna; van der Weijden, Trudy; Beurskens, Anna

2017-02-01

The number of people with multiple chronic conditions requiring primary care services increases. Professionals from different disciplines collaborate and coordinate care to deal with the complex health care needs. There is lack of information on current practices regarding interprofessional team (IPT) meetings. This study aimed to improve our understanding of the process of interprofessional collaboration in primary care team meetings in the Netherlands by observing the current practice and exploring personal opinions. Qualitative study involving observations of team meetings and interviews with participants. Eight different IPT meetings (n = 8) in different primary care practices were observed by means of video recordings. Experiences were explored by conducting individual semi-structured interviews (n = 60) with participants (i.e. health care professionals from different disciplines) of the observed team meetings. The data were analysed by means of content analysis. Most participants expressed favourable opinions about their team meetings. However, observations showed that team meetings were more or less hectic, and lacked a clear structure and team coordinator or leader. There appears to be a discrepancy between findings from observations and interviews. From the interviews, four main themes were extracted: (1) Team structure and composition, (2) Patient-centredness, (3) Interaction and (4) Attitude and motivation. IPT meetings could benefit from improvements in structure, patient-centredness and leadership by the chairpersons. Given the discrepancy between observations and interviews, it would appear useful to improve team members' awareness of aspects that could be improved before training them in dealing with specific challenges. © The Author 2016. Published by Oxford University Press.

Improved work zone design guidelines and enhanced model of travel delays in work zones : Phase I, portability and scalability of interarrival and service time probability distribution functions for different locations in Ohio and the establishment of impr

DOT National Transportation Integrated Search

2006-01-01

The project focuses on two major issues - the improvement of current work zone design practices and an analysis of : vehicle interarrival time (IAT) and speed distributions for the development of a digital computer simulation model for : queues and t...

Machine learning and deep analytics for biocomputing: call for better explainability.

PubMed

Petkovic, Dragutin; Kobzik, Lester; Re, Christopher

2018-01-01

The goals of this workshop are to discuss challenges in explainability of current Machine Leaning and Deep Analytics (MLDA) used in biocomputing and to start the discussion on ways to improve it. We define explainability in MLDA as easy to use information explaining why and how the MLDA approach made its decisions. We believe that much greater effort is needed to address the issue of MLDA explainability because of: 1) the ever increasing use and dependence on MLDA in biocomputing including the need for increased adoption by non-MLD experts; 2) the diversity, complexity and scale of biocomputing data and MLDA algorithms; 3) the emerging importance of MLDA-based decisions in patient care, in daily research, as well as in the development of new costly medical procedures and drugs. This workshop aims to: a) analyze and challenge the current level of explainability of MLDA methods and practices in biocomputing; b) explore benefits of improvements in this area; and c) provide useful and practical guidance to the biocomputing community on how to address these challenges and how to develop improvements. The workshop format is designed to encourage a lively discussion with panelists to first motivate and understand the problem and then to define next steps and solutions needed to improve MLDA explainability.

Utilizing hot electrons

DOE PAGES

Nozik, Arthur J.

2018-03-01

In current solar cells, any photon energy exceeding the semiconductor bandgap is lost before being collected, limiting the cell performance. Hot carrier solar cells could avoid these losses. Now, a detailed experimental study and analysis shows that this strategy could lead to an improvement of the photoconversion efficiency in practice.

Utilizing hot electrons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nozik, Arthur J.

In current solar cells, any photon energy exceeding the semiconductor bandgap is lost before being collected, limiting the cell performance. Hot carrier solar cells could avoid these losses. Now, a detailed experimental study and analysis shows that this strategy could lead to an improvement of the photoconversion efficiency in practice.

CONSIDERATION IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

For the past three decades, municipalities in the United States have successfully addressed pollution in the watershed by collecting and treating their wastewater. Currently, all municipalities provide secondary level treatment, and in some cases tertiary treatment, and industri...

The Future of Principal Evaluation

ERIC Educational Resources Information Center

Clifford, Matthew; Ross, Steven

2012-01-01

The need to improve the quality of principal evaluation systems is long overdue. Although states and districts generally require principal evaluations, research and experience tell that many state and district evaluations do not reflect current standards and practices for principals, and that evaluation is not systematically administered. When…

The Dynamic Difference: Montessori's Legacy for the New Century.

ERIC Educational Resources Information Center

Loeffler, Margaret Howard

2000-01-01

Maintains that Montessori education must regain its dynamism by recognizing barriers that separate Montessori from mainstream educational thinking and entering into meaningful dialog with other educators. Suggests ways to improve understanding of Montessori's basic principles and practices and their current relevance, including defining core…

Fever management in the emergency department of the Children's Hospital of Fudan University: a best practice implementation project.

PubMed

Hu, Fei; Zhang, Jiayan; Shi, Shupeng; Zhou, Zhang

2016-09-01

Febrile illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. It is very important that healthcare professionals know how to recognize fever, assess children with fever, treat children with fever and role of nurses and parents. This paper outlines a best practice implementation project on the management of fever in children in an emergency department. To audit current practice of fever management for children in an emergency department and to implement strategies to standardize pediatric fever management based on evidence-based practice guidelines. We used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice to examine compliance with fever management criteria based on the best available evidence before and after the implementation of strategies to spread the use of evidence-based practice protocols. We found significant improvements in pediatric fever management as measured by the knowledge scores of parents (54.5-83.7) and nurses (67.6-90.3). This suggested a need for continuous education. We found a noticeable improvement in compliance across all the five criteria; using correct methods to measure temperature (86-98%), staff education (0-100%), parents education (0-100%), using assessment tools (0-100%) and observed management (0-98%). This best practice implementation project demonstrated the use of effective strategies to standardize the protocol for fever management, implement assessment tool, develop multimedia materials, deliver continuous staff education and update nursing documentation and patient education pamphlets to ensure best practice is delivered by nurses to improve patient outcomes.

Solid health care waste management status at health care centers in the West Bank - Palestinian Territory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Al-Khatib, Issam A.; Sato, Chikashi

Health care waste is considered a major public health hazard. The objective of this study was to assess health care waste management (HCWM) practices currently employed at health care centers (HCCs) in the West Bank - Palestinian Territory. Survey data on solid health care waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7 m{sup 3} (288.1 tons) of SHCW are generated monthly by the HCCs in the West Bank. This study concluded that: (i) current HCWM practices do not meet HCWM standards recommended by the World Health Organization (WHO) or adapted by developedmore » countries, and (ii) immediate attention should be directed towards improvement of HCWM facilities and development of effective legislation. To improve the HCWM in the West Bank, a national policy should be implemented, comprising a comprehensive plan of action and providing environmentally sound and reliable technological measures.« less

Reconstruction and systemization of the methodologies for strategic environmental assessment in Taiwan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liou, M.-L.; Yeh, S.-C.; Yu, Y.-H.

2006-03-15

This paper discusses the current SEA procedures and assessment methodologies, aiming to propose strategies that can lead to effective improvement in a newly industrialized Asian country, Taiwan. Institutional and practical problems with regard to the regulations and tools of SEA in Taiwan are compared to those in other countries. According to the research results, it is suggested that extra evaluation processes should be incorporated into the current assessment procedures to improve their scientific validity and integrity. Moreover, it is also suggested that the sustainability appraisal approaches be included in the SEA framework. In this phase, revised evaluation indicators associated withmore » corresponding targets can be the first attempt for modifying the SEA system. It is believed that these can promote the operability in practice and also lead the whole assessment procedures to a direction closer to sustainable development. The trails that Taiwan has followed can help other countries that are going to adopt SEA to find a more effective and efficient way to follow.« less

Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association.

PubMed

Cheng, Adam; Nadkarni, Vinay M; Mancini, Mary Beth; Hunt, Elizabeth A; Sinz, Elizabeth H; Merchant, Raina M; Donoghue, Aaron; Duff, Jonathan P; Eppich, Walter; Auerbach, Marc; Bigham, Blair L; Blewer, Audrey L; Chan, Paul S; Bhanji, Farhan

2018-06-21

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest. © 2018 American Heart Association, Inc.

Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body's Urge to Push.

PubMed

DiFranco, Joyce T; Curl, Marilyn

2014-01-01

Women in the United States are still giving birth in the supine position and are restricted in how long they can push and encouraged to push forcefully by their caregivers. Research does not support these activities. There is discussion about current research and suggestions on how to improve the quality of the birth experience. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions," published in The Journal of Perinatal Education, 16(3), 2007.

Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy

PubMed Central

Newhouse, Robin P.; Spring, Bonnie

2010-01-01

Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform. PMID:21074648

Constructing high-quality bounding volume hierarchies for N-body computation using the acceptance volume heuristic

NASA Astrophysics Data System (ADS)

Olsson, O.

2018-01-01

We present a novel heuristic derived from a probabilistic cost model for approximate N-body simulations. We show that this new heuristic can be used to guide tree construction towards higher quality trees with improved performance over current N-body codes. This represents an important step beyond the current practice of using spatial partitioning for N-body simulations, and enables adoption of a range of state-of-the-art algorithms developed for computer graphics applications to yield further improvements in N-body simulation performance. We outline directions for further developments and review the most promising such algorithms.

Practices of traditional birth attendants in Sierra Leone and perceptions by mothers and health professionals familiar with their care.

PubMed

Dorwie, Florence M; Pacquiao, Dula F

2014-01-01

Describe practices of traditional birth attendants (TBAs) in assisting women in childbirth and the perceptions of TBAs by mothers and health professionals familiar with their work. Qualitative design using focus groups conducted in urban and rural settings in Sierra Leone. Separate audiotaped focus groups conducted for each group of participants lasting between 45 and 90 minutes. Purposive sample of 20 TBAs, 20 mothers, and 10 health professionals who met the following criteria: (a) at least 18 years of age, (b) TBAs currently practicing, (c) mothers who delivered at least one child assisted by a TBA, and (d) health professionals currently practicing in the hospital and familiar with TBA practices. TBAs are valued by mothers, health professionals, and the community because they provide accessible and affordable care to mothers who may otherwise have no access to health services. TBAs need training, supervision, and resources for effective referral of mothers. Systemic problems in the health care system create enormous barriers to effective care for mothers and children independent of TBA practices that contribute to high maternal and infant mortality rates. The study findings have implications on broad public policy in improving maternal and child health in the country.

Global trends in critical values practices and their harmonization.

PubMed

Kost, Gerald J; Hale, Kristin N

2011-02-01

The objectives of this article were 1) to identify current trends in critical values practices in North America, Europe, and other regions; 2) to describe progress toward harmonization of critical limits; and 3) to synthesize strategies that will encourage global consensus. Critical limits are described in national surveys. Critical value practices are guided by federal statutes, The Joint Commission regulations, and accreditation requirements in the US; by provincial healthcare agencies in Canada; by thought leaders and ISO EN 15189:2007 in Europe; and in SE Asia, mostly by ad hoc policies lacking statutory grip. Review of databases, literature, websites, federal statutes, litigation, official policies, current affairs, and accreditation agency requirements. Practical strategies will accelerate harmonization of critical values practices, as follows: a) continue national and international survey comparisons; b) clarify age, ethnic, and subject dependencies; c) standardize qualitative and quantitative decision levels for urgent clinician notification; d) monitor compliance and timeliness for safety; and e) alert high frequencies of critical values related to adverse events. New expectations and communication technologies present opportunities for enhanced performance using wireless closed-loop reporting with recipient acknowledgment to reduce phone calls and improve efficiency. Hospitals worldwide can benefit from developing consensus for critical values practices.

[General practitioners' opinion and attitude towards DMPs and the change in practice routines to implement the DMP "diabetes mellitus type 2"].

PubMed

Miksch, Antje; Trieschmann, Johanna; Ose, Dominik; Rölz, Andreas; Heiderhoff, Marc; Szecsenyi, Joachim

2011-01-01

Effective implementation of disease management programmes (DMPs) in primary care practices often requires changes in practice workflows and responsibilities and acceptance by the parties involved. Within the ELSID study (evaluation study of the DMP diabetes mellitus type 2) the physicians' attitudes toward DMPs were obtained and an optimised implementation of DMPs was developed by conducting a quality management cycle with primary care practice teams. The aim was to investigate which practice workflows will have to be changed and what kind of barriers to implement these changes are perceived. In 78 primary care practices of the two German federal states of Rheinland-Pfalz and Sachsen-Anhalt a quality management cycle was conducted using a structured analysis of the current state of DMP workflows and the need for improvement identified. Subsequently, an optimised workflow was developed and targets were agreed upon. After 6 months, the study team called to inquire about the current state of implementation and, if appropriate, actual barriers to change. After 6 months, 71 practices had been interviewed by phone. 64 of them (90.1%) had agreed on at least one target (e.g., to purchase new instrumentation, to regularly discuss feedback reports, to set up a patient registry). On average three targets had been formulated, and 2 out of 3 had been implemented in the meantime. In most cases lack of time was given as the reason for non-implementation. The majority of surveyed practices perceived some need for improvement. But sufficient resources (time, staff and money) are required to ensure efficient implementation of DMPs in primary care practices and their integration with routine processes. A redefinition of responsibilities for DMPs will strengthen the role of medical assistants and promote high-quality implementation of these programmes. Copyright © 2010. Published by Elsevier GmbH.

Simulator Network Project Report: A tool for improvement of teaching materials and targeted resource usage in Skills Labs

PubMed Central

Damanakis, Alexander; Blaum, Wolf E.; Stosch, Christoph; Lauener, Hansjörg; Richter, Sabine; Schnabel, Kai P.

2013-01-01

During the last decade, medical education in the German-speaking world has been striving to become more practice-oriented. This is currently being achieved in many schools through the implementation of simulation-based instruction in Skills Labs. Simulators are thus an essential part of this type of medical training, and their acquisition and operation by a Skills Lab require a large outlay of resources. Therefore, the Practical Skills Committee of the Medical Education Society (GMA) introduced a new project, which aims to improve the flow of information between the Skills Labs and enable a transparent assessment of the simulators via an online database (the Simulator Network). PMID:23467581

Quality management for the international transport of laboratory animals.

PubMed

Leary, Steven L

2008-01-01

Increased collaboration between investigators at different institutions has increased the number of laboratory animals being transported. The current system of laws and regulations governing animal shipments is inconsistent and government agencies often have areas of overlapping regulatory management. Furthermore, the lack of industry-wide shipping standards and good practices contributes to confusion among those responsible for shipment. One answer to these quality control issues would be the establishment of independent, industry-regulated 'good practices' for animal transport, similar to those used in laboratories for experimental design. These good practices could be based on the existing International Air Transport Association Live Animals Regulations, with contributions from representatives of the specialties involved. Additionally, quality control under the current system of patchwork regulations could be improved if each institution, both academic and commercial, would designate a single point of contact to follow each shipment from start to finish.

Using quality and safety education for nurses to guide clinical teaching on a new dedicated education unit.

PubMed

McKown, Terri; McKeon, Leslie; McKown, Leslie; Webb, Sherry

2011-12-01

Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.

Practice Skill Development Through the Use of Human Patient Simulation

PubMed Central

2011-01-01

Human patient simulation (HPS) is used in health care education to enhance the transition from classroom learning to competent performance. It has been used frequently in nursing and medical schools and less often in pharmacy and other allied health professions. HPS is used to improve the development of pharmacy practice skills such as physical assessment, pharmacotherapy plan development, and monitoring plans. Engaging multiple health care disciplines in simulations enables participants to practice teamwork and communication skills that are essential in preventing errors and events of harm to patients. This article reviews current literature and use of simulation in pharmacy curricula for the development, enhancement, and assessment of pharmacy practice skills. PMID:22171116

ESIP Information Quality Cluster (IQC)

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K.; Peng, Ge; Moroni, David F.

2016-01-01

The Information Quality Cluster (IQC) within the Federation of Earth Science Information Partners (ESIP) was initially formed in 2011 and has evolved significantly over time. The current objectives of the IQC are to: 1. Actively evaluate community data quality best practices and standards; 2. Improve capture, description, discovery, and usability of information about data quality in Earth science data products; 3. Ensure producers of data products are aware of standards and best practices for conveying data quality, and data providers distributors intermediaries establish, improve and evolve mechanisms to assist users in discovering and understanding data quality information; and 4. Consistently provide guidance to data managers and stewards on how best to implement data quality standards and best practices to ensure and improve maturity of their data products. The activities of the IQC include: 1. Identification of additional needs for consistently capturing, describing, and conveying quality information through use case studies with broad and diverse applications; 2. Establishing and providing community-wide guidance on roles and responsibilities of key players and stakeholders including users and management; 3. Prototyping of conveying quality information to users in a more consistent, transparent, and digestible manner; 4. Establishing a baseline of standards and best practices for data quality; 5. Evaluating recommendations from NASA's DQWG in a broader context and proposing possible implementations; and 6. Engaging data providers, data managers, and data user communities as resources to improve our standards and best practices. Following the principles of openness of the ESIP Federation, IQC invites all individuals interested in improving capture, description, discovery, and usability of information about data quality in Earth science data products to participate in its activities.

A systematic review of best practices in teaching ophthalmology to medical students.

PubMed

Succar, Tony; Grigg, John; Beaver, Hilary A; Lee, Andrew G

2016-01-01

Ophthalmic medical student education is a cornerstone to improving eye health care globally. We review the current state of the literature, listing barriers to potential best practices for undergraduate ophthalmology teaching and learning within medical curricula. We describe recent advances and pedagogical approaches in ophthalmic education and propose specific recommendations for further improvements and research. Future research should concentrate on developing teaching and learning innovations that may result in a more time- and resource-effective models for interactive and integrated learning. As well as demonstrating that a competency-based approach results not just in better eye health, but also improvements in patient care, education, and medical care in general. By optimizing teaching available through improved evidence-based education, the ultimate goal is to increase medical students' knowledge and produce graduates who are highly trained in eye examination skills, resulting in improved patient eye care through timely diagnosis, referrals, and treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

The Practice Integration Profile: Rationale, development, method, and research.

PubMed

Macchi, C R; Kessler, Rodger; Auxier, Andrea; Hitt, Juvena R; Mullin, Daniel; van Eeghen, Constance; Littenberg, Benjamin

2016-12-01

Insufficient knowledge exists regarding how to measure the presence and degree of integrated care. Prior estimates of integration levels are neither grounded in theory nor psychometrically validated. They provide scant guidance to inform improvement activities, compare integration efforts, discriminate among practices by degree of integration, measure the effect of integration on quadruple aim outcomes, or address the needs of clinicians, regulators, and policymakers seeking new models of health care delivery and funding. We describe the development of the Practice Integration Profile (PIP), a novel instrument designed to measure levels of integrated behavioral health care within a primary care clinic. The PIP draws upon the Agency for Health care Research & Quality's (AHRQ) Lexicon of Collaborative Care which provides theoretic justification for a paradigm case of collaborative care. We used the key clauses of the Lexicon to derive domains of integration and generate measures corresponding to those key clauses. After reviewing currently used methods for identifying collaborative care, or integration, and identifying the need to improve on them, we describe a national collaboration to describe and evaluate the PIP. We also describe its potential use in practice improvement, research, responsiveness to multiple stakeholder needs, and other future directions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Use of Neural Response Telemetry for Pediatric Cochlear Implants: Current Practice.

PubMed

Almosnino, Galit; Anne, Samantha; Schwartz, Seth R

2018-06-01

Evaluate usage trends of neural response telemetry (NRT) in cochlear implant centers across the nation and assess reported benefits of intraoperative NRT for pediatric cochlear implant recipients. Survey. All US cochlear implant centers (n = 110). A 15-question multiple-choice survey was distributed electronically to all centers. The survey captured demographic information of all centers, practice patterns surrounding the use of NRT, and the extent to which intraoperative NRT is of benefit. Thirty-two invited participants (29%) completed the survey. A majority of participants reported practicing in an academic center (66%), followed by a hospital setting (19%) and private practice (16%). Seventy-two percent of survey participants reported using NRT for pediatric cochlear implant recipients. Sixty-three percent felt it improved the ability to program at initial activation, and 50% of participants felt that NRT improves satisfaction at initial activation. This study suggests that a majority of surgeons use intraoperative NRT for pediatric cochlear implantation as an additional measure to ensure appropriate electrode placement and improve device activation. Larger studies are needed to better establish the relationship between intraoperative NRT and postoperative outcomes and justify the additional costs associated with intraoperative NRT.

Key elements of high-quality practice organisation in primary health care: a systematic review.

PubMed

Crossland, Lisa; Janamian, Tina; Jackson, Claire L

2014-08-04

To identify elements that are integral to high-quality practice and determine considerations relating to high-quality practice organisation in primary care. A narrative systematic review of published and grey literature. Electronic databases (PubMed, CINAHL, the Cochrane Library, Embase, Emerald Insight, PsycInfo, the Primary Health Care Research and Information Service website, Google Scholar) were searched in November 2013 and used to identify articles published in English from 2002 to 2013. Reference lists of included articles were searched for relevant unpublished articles and reports. Data were configured at the study level to allow for the inclusion of findings from a broad range of study types. Ten elements were most often included in the existing organisational assessment tools. A further three elements were identified from an inductive thematic analysis of descriptive articles, and were noted as important considerations in effective quality improvement in primary care settings. Although there are some validated tools available to primary care that identify and build quality, most are single-strategy approaches developed outside health care settings. There are currently no validated organisational improvement tools, designed specifically for primary health care, which combine all elements of practice improvement and whose use does not require extensive external facilitation.

Retrieval practice improves memory in multiple sclerosis: clinical application of the testing effect.

PubMed

Sumowski, James F; Chiaravalloti, Nancy; Deluca, John

2010-03-01

The testing effect is a robust cognitive phenomenon by which memory retrieval on a test improves subsequent recall more than restudying. Also known as retrieval practice, the testing effect has been studied almost exclusively in healthy undergraduates. The current study investigated whether retrieval practice during testing leads to better delayed recall than restudy among persons with multiple sclerosis (MS), a neurologic disease associated with memory dysfunction. In a within-subjects design, 32 persons with MS and 16 demographically matched healthy controls (HC) studied 48 verbal paired associates (VPA) divided across 3 learning conditions: massed restudy (MR), spaced restudy (SR), and spaced testing (ST). Delayed VPA cued recall was measured after 45 min. There was a large main effect of learning condition (etap2 = .54, p < .001) such that both MS and HC participants produced better delayed recall for VPAs learned through ST relative to MR and SR; and SR relative to MR. This same pattern was observed for MS participants with objective memory impairment (n = 16), thereby providing the first evidence that retrieval practice improves memory more than restudy among persons with neurologically based memory impairment. Copyright 2010 APA, all rights reserved

Physicians' Preferences for Communication of Pharmacist-Provided Medication Therapy Management in Community Pharmacy.

PubMed

Guthrie, Kendall D; Stoner, Steven C; Hartwig, D Matthew; May, Justin R; Nicolaus, Sara E; Schramm, Andrew M; DiDonato, Kristen L

2017-02-01

(1) To identify physicians' preferences in regard to pharmacist-provided medication therapy management (MTM) communication in the community pharmacy setting; (2) to identify physicians' perceived barriers to communicating with a pharmacist regarding MTM; and (3) to determine whether Missouri physicians feel MTM is beneficial for their patients. A cross-sectional prospective survey study of 2021 family and general practice physicians registered with MO HealthNet, Missouri's Medicaid program. The majority (52.8%) of physicians preferred MTM data to be communicated via fax. Most physicians who provided care to patients in long-term care (LTC) facilities (81.0%) preferred to be contacted at their practice location as opposed to the LTC facility. The greatest barriers to communication were lack of time and inefficient communication practices. Improved/enhanced communication was the most common suggestion for improvement in the MTM process. Approximately 67% of respondents reported MTM as beneficial or somewhat beneficial for their patients. Survey respondents saw value in the MTM services offered by pharmacists. However, pharmacists should use the identified preferences and barriers to improve their currently utilized communication practices in hopes of increasing acceptance of recommendations. Ultimately, this may assist MTM providers in working collaboratively with patients' physicians.

Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries.

PubMed

Bitton, Asaf; Ratcliffe, Hannah L; Veillard, Jeremy H; Kress, Daniel H; Barkley, Shannon; Kimball, Meredith; Secci, Federica; Wong, Ethan; Basu, Lopa; Taylor, Chelsea; Bayona, Jaime; Wang, Hong; Lagomarsino, Gina; Hirschhorn, Lisa R

2017-05-01

Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators ("Vital Signs"). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.

Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: a randomized controlled trial.

PubMed

Palter, Vanessa N; Grantcharov, Teodor P

2014-03-01

The purpose of this study was to investigate whether individualized deliberate practice on a virtual reality (VR) simulator results in improved technical performance in the operating room. Training on VR simulators has been shown to improve technical performance in the operating room (OR). Currently described VR curricula consist of trainees practicing the same tasks until expert proficiency is reached. It has yet to be investigated whether the individualized deliberate practice, where curricula tasks vary depending on prior levels of technical proficiency, would translate into the OR. This single-blinded prospective trial randomized 16 novice surgical residents to a deliberate practice (DP) group and a conventional residency training group. Both groups performed a laparoscopic cholecystectomy in the OR that was video-recorded. Technical performance of DP group residents in the OR was assessed using 3 validated assessment tools. A score of less than 60% on any component of the assessment tool resulted in the trainee practicing a specific task on the VR simulator. The DP group practiced on the simulator as per their individualized schedule. Both groups then performed another laparoscopic cholecystectomy. A blinded expert assessed the OR recordings using a validated global rating scale. Although both groups had similar technical abilities preintervention [DP: median score, 13.5 (9.3-15.0); control: median score, 14.5 (9.3-17.8); P = 0.45], the DP residents had a superior technical performance postintervention [DP: median score, 17.0 (15.3-18.5); control: median score, 12.5 (7.5-14.0); P = 0.03]. Of 8 DP residents, 6 practiced 5 basic VR tasks (median 1 trial to pass), and 7 of 8 practiced 2 advanced tasks (median 4 trials to pass). A curriculum of deliberate individualized practice on a VR simulator improves technical performance in the OR. This has implications to greatly improve the feasibility of implementing simulation-based curricula in residency training programs, rather then having them being limited to research protocols.

Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial

PubMed Central

Fitzmaurice, David A; Jowett, Sue; Mant, Jonathon; Murray, Ellen T; Holder, Roger; Raftery, J P; Bryan, S; Davies, Michael; Lip, Gregory Y H; Allan, T F

2007-01-01

Objectives To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening. Design Multicentred cluster randomised controlled trial, with subsidiary trial embedded within the intervention arm. Setting 50 primary care centres in England, with further individual randomisation of patients in the intervention practices. Participants 14 802 patients aged 65 or over in 25 intervention and 25 control practices. Interventions Patients in intervention practices were randomly allocated to systematic screening (invitation for electrocardiography) or opportunistic screening (pulse taking and invitation for electrocardiography if the pulse was irregular). Screening took place over 12 months in each practice from October 2001 to February 2003. No active screening took place in control practices. Main outcome measure Newly identified atrial fibrillation. Results The detection rate of new cases of atrial fibrillation was 1.63% a year in the intervention practices and 1.04% in control practices (difference 0.59%, 95% confidence interval 0.20% to 0.98%). Systematic and opportunistic screening detected similar numbers of new cases (1.62% v 1.64%, difference 0.02%, −0.5% to 0.5%). Conclusion Active screening for atrial fibrillation detects additional cases over current practice. The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography. Trial registration Current Controlled Trials ISRCTN19633732. PMID:17673732

ICU nurses' oral-care practices and the current best evidence.

PubMed

DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

2009-01-01

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all ICU nurses to introduce and use evidence-based, oral-care protocols. Practicing ICU nurses in this survey were often not adhering to the latest evidence-based practice and therefore need to be educated and encouraged to do so in order to improve patient care.

Improving medical students’ knowledge of genetic disease: a review of current and emerging pedagogical practices

PubMed Central

Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

2015-01-01

Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student’s critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

The promise and peril of chemical probes

PubMed Central

Arrowsmith, Cheryl H; Audia, James E; Austin, Christopher; Baell, Jonathan; Bennett, Jonathan; Blagg, Julian; Bountra, Chas; Brennan, Paul E; Brown, Peter J; Bunnage, Mark E; Buser-Doepner, Carolyn; Campbell, Robert M; Carter, Adrian J; Cohen, Philip; Copeland, Robert A; Cravatt, Ben; Dahlin, Jayme L; Dhanak, Dashyant; Frederiksen, Mathias; Frye, Stephen V; Gray, Nathanael; Grimshaw, Charles E; Hepworth, David; Howe, Trevor; Huber, Kilian V M; Jin, Jian; Knapp, Stefan; Kotz, Joanne D; Kruger, Ryan G; Lowe, Derek; Mader, Mary M; Marsden, Brian; Mueller-Fahrnow, Anke; Müller, Susanne; O'Hagan, Ronan C; Overington, John P; Owen, Dafydd R; Rosenberg, Saul H; Ross, Ruth; Roth, Bryan; Schapira, Matthieu; Schreiber, Stuart L; Shoichet, Brian; Sundström, Michael; Superti-Furga, Giulio; Taunton, Jack; Toledo-Sherman, Leticia; Walpole, Chris; Walters, Michael A; Willson, Timothy M; Workman, Paul; Young, Robert N; Zuercher, William J

2016-01-01

Chemical probes are powerful reagents with increasing impacts on biomedical research. However, probes of poor quality or that are used incorrectly generate misleading results. To help address these shortcomings, we will create a community-driven wiki resource to improve quality and convey current best practice. PMID:26196764

Lessons from Enlightened Corporations.

ERIC Educational Resources Information Center

Blankstein, Alan M.

1992-01-01

The formula for improving U.S. schools can be found in the philosophy that helped transform Japanese industry and in Deming's 14 principles, emulated by many corporations. Deming's arguments against appraising individual performance through quotas or numerical goals call into question schools' current grading and merit pay practices. (12…

Current status of practical applications: Probiotics in dairy cattle

USDA-ARS?s Scientific Manuscript database

The gastrointestinal microbial population of dairy cattle is dense and diverse, and can be utilized to reduce pathogenic bacterial populations as well as improve animal productivity and environmental impacts. Because of the nature of the dairy industry, probiotic products have been widely used to e...

Promoting Entrepreneurship Studies in the Community College Setting.

ERIC Educational Resources Information Center

Watts, Karen Southall

This document examines the current promotional methods used by North Carolina community colleges to advance entrepreneurship education and identifies practical strategies for improving promotional efforts and outcomes. The observations, interviews, and anecdotal information presented in the paper are based on the author's three years of community…

Characterizing body temperature and activity changes at the onset of estrus in replacement gilts

USDA-ARS?s Scientific Manuscript database

Accurate estrus detection can improve sow conception rates and increase swine production efficiency. Unfortunately, current estrus detection practices based on individual animal behavior may be inefficient due to large sow populations at commercial farms and the associated labor required. Therefore,...

Transit Marketing : Review of the State-of-the-Art and a Handbook of Current Practice

DOT National Transportation Integrated Search

1985-04-01

Over the past decade, marketing has been given increased emphasis as a way to improve both transit rideship and productivity. While there is near universal agreement among transit managers that some level of marketing is necessary, there is far from ...

Collaboration in Cultural Heritage Digitisation in East Asia

ERIC Educational Resources Information Center

Lee, Hyuk-Jin

2010-01-01

Purpose: The purpose of this paper is to review the current status of collaboration in cultural heritage preservation in East Asia, including digital projects, and to suggest practical improvements based on a cultural structuralism perspective. Design/methodology/approach: Through exploratory research, the paper addresses aspects for successful…

Adaptation, Evaluation and Inclusion

ERIC Educational Resources Information Center

Basson, R.

2011-01-01

In this article I reflect on a recent development currently shaping programme evaluation as field, which makes the case for evaluators facilitating evaluation training evaluees to self-evaluate and improve the programmes they teach. Fetterman argues persuasively that the practice was incipient in the field and required formalization and acceptance…

Educational Resource Management: An International Perspective

ERIC Educational Resources Information Center

Glover, Derek; Levacic, Rosalind

2007-01-01

This book offers practical guidance on management of financial and real resources in schools and college, and critically evaluates current tensions involved in the area of educational resource management. It is essential reading for educational leaders who wish to improve the effectiveness, efficiency and equity of their resource utilisation…

Student Complainants--Vexatious or Vulnerable?

ERIC Educational Resources Information Center

Millward, Christine V.

2016-01-01

In December 2014, the Office of the Independent Adjudicator (OIA) introduced the "Good practice framework for handling complaints and academic appeals" which will inform external judgement on each university's approach to conflict management from the current academic year 2015-2016. The framework aims to improve the complaint process for…

The brave new world of older patients: preparing general practice training for an ageing population.

PubMed

Bonney, Andrew; Phillipson, Lyn; Jones, Sandra C; Hall, Julie; Sharma, Rashmi

2015-11-01

Develop and pilot test evidence-based resources for general practice training practices to enhance older patients' (65+ years) interactions with General Practice Registrars (GPRs). In Australia, general practice trainees, referred to as GPRs, see fewer older patients and patients with chronic conditions than doctors who have completed their specialist GP training. This reduces learning opportunities for GPRs in the management of these important patient groups. Therefore, developing effective strategies to improve GPR-older patient interaction is critical to primary care training, to meet the current and future needs of an ageing population. Adopting a social marketing approach, GPR practice resources were developed to address knowledge and attitudinal barriers at the practice and patient level to improve older patient comfort, and willingness to engage, with GPR care. Two focus groups with older patients (n=18) and interviews with staff of training practices (n=12) were utilised to pre-test resources. Amended resources were pilot tested and evaluated in a naturalistic GPR training practice setting using a structured patient questionnaire (n=44). Pilot evaluation suggests improved comfort and willingness of older patients to interact with GPRs. In all, 54% of survey participants indicated they would be more likely to make an appointment with a Registrar in the future as a result of exposure to the resources. In all, 40% of patients would feel comfortable having a GPR manage a complex or chronic condition, which compares favourably with 28% of similarly aged patients in previous research. The use of tailored, engaging and informative GPR resources for older patients and practice staff may be an important contributor to addressing the growing problem of ensuring GPRs are adequately engaged in treating older patients. The adoption of a social marketing framework was instrumental in enhancing the acceptance and effectiveness of this intervention.

Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

PubMed

Choma, Kim; McKeever, Amy E

2015-02-01

The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.

Dissemination 2.0: closing the gap between knowledge and practice with new media and marketing.

PubMed

Bernhardt, Jay M; Mays, Darren; Kreuter, Matthew W

2011-01-01

Despite substantial investments in public health and clinical research at the national level, and significant advancements in these areas of science, few evidence-based programs and services are rapidly implemented in health care or public health practice as a result of failures of dissemination. A significant gap in current processes to disseminate and implement effective programs relates to the lack of systems and infrastructure to facilitate distribution of scientific research products to potential end users, including clinicians and other practitioners. In this article, the authors assert that Web 2.0 technologies can be leveraged to enhance dissemination efforts and increase the implementation of evidence-based programs and services in everyday practice. The authors describe the research-to-practice delivery process and highlight gaps in the supply chain necessary to translate research findings into evidence-based practice. The authors critically evaluate the 4 most prominent strategies currently used to promote dissemination and implementation of research evidence in practice, and they detail how each can be improved by leveraging Web 2.0 technologies to enhance dissemination of research evidence. Last, the authors provide examples and suggestions for capitalizing on Web 2.0 technologies to enhance dissemination efforts and ensure that evidence-based research products reach intended end users and are implemented in clinical practice.

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

PubMed

Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q

2018-06-01

The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

Integrating Climate Change Adaptation into Disaster Risk Reduction in Urban Contexts: Perceptions and Practice

PubMed Central

Rivera, Claudia

2014-01-01

This paper analyses the perceptions of disaster risk reduction (DRR) practitioners concerning the on-going integration of climate change adaptation (CCA) into their practices in urban contexts in Nicaragua. Understanding their perceptions is important as this will provide information on how this integration can be improved. Exploring the perceptions of practitioners in Nicaragua is important as the country has a long history of disasters, and practitioners have been developing the current DRR planning framework for more than a decade. The analysis is based on semi-structured interviews designed to collect information about practitioners’ understanding of: (a) CCA, (b) the current level of integration of CCA into DRR and urban planning, (c) the opportunities and constraints of this integration, and (d) the potential to adapt cities to climate change. The results revealed that practitioners’ perception is that the integration of CCA into their practice is at an early stage, and that they need to improve their understanding of CCA in terms of a development issue. Three main constraints on improved integration were identified: (a) a recognized lack of understanding of CCA, (b) insufficient guidance on how to integrate it, and (c) the limited opportunities to integrate it into urban planning due to a lack of instruments and capacity in this field. Three opportunities were also identified: (a) practitioners’ awareness of the need to integrate CCA into their practices, (b) the robust structure of the DRR planning framework in the country, which provides a suitable channel for facilitating integration, and (c) the fact that CCA is receiving more attention and financial and technical support from the international community. PMID:24475365

National continuous surveys on internal quality control for HbA1c in 306 clinical laboratories of China from 2012 to 2016: Continual improvement.

PubMed

Li, Tingting; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

2017-09-01

This study aimed to evaluate whether the quality performance of clinical laboratories in China has been greatly improved and whether Internal Quality Control (IQC) practice of HbA1c has also been changed since National Center for Clinical Laboratories (NCCL) of China organized laboratories to report IQC data for HbA1c in 2012. Internal Quality Control information of 306 External Quality Assessment (EQA) participant laboratories which kept reporting IQC data in February from 2012 to 2016 were collected by Web-based EQA system. Then percentages of laboratories meeting four different imprecision specifications for current coefficient of variations (CVs) of HbA1c measurements were calculated. Finally, we comprehensively analyzed analytical systems and IQC practice of HbA1c measurements. The current CVs of HbA1c tests have decreased significantly from 2012 to 2016. And percentages of laboratories meeting four imprecision specifications for CVs all showed the increasing tendency year by year. As for analytical system, 52.1% (159/306) laboratories changed their systems with the change in principle of assay. And many laboratories began to use cation exchange high-performance liquid chromatography (CE-HPLC) instead of Immunoturbidimetry, because CE-HPLC owed a lower intra-laboratory CVs. The data of IQC practice, such as IQC rules and frequency, also showed significant variability among years with overall tendency of meeting requirements. The imprecision performance of HbA1c tests has been improved in these 5 years with the change in IQC practice, but it is still disappointing in China. Therefore, laboratories should actively find existing problems and take action to promote performance of HbA1c measurements. © 2016 Wiley Periodicals, Inc.

Management of testosterone therapy in adolescents and young men with hypogonadism: are we following adult clinical practice guidelines?

PubMed

Nahata, Leena; Yu, Richard N; Bhasin, Shalender; Cohen, Laurie E

2015-05-01

Male hypogonadism is a common disorder that is associated with low bone density, poor muscle mass, anemia, and sexual dysfunction. The Endocrine Society recently published a Clinical Practice Guideline for testosterone therapy in androgen-deficient men. Because treatment is frequently initiated in adolescence, the goal of this quality improvement initiative was to assess whether pediatric endocrinologists at a large tertiary care center follow these guidelines and to identify opportunities for improvement. We performed a retrospective chart review at Boston Children's Hospital. Inclusion criteria were as follows: current age ≥16 years, diagnosis of hypogonadism, and testosterone replacement therapy. Data were collected about current age, age at treatment initiation, diagnoses, pre- and on-treatment testosterone levels, route of testosterone administration and dose, bone density, hematocrit levels, and adherence with therapy. Fifty-nine patients were included. Fourteen (24%) were prescribed lower testosterone doses than those recommended in the Clinical Practice Guideline. Seven (12%) had no pre-treatment testosterone levels, and 10 (17%) had no on-treatment levels. In 49 patients with on-treatment testosterone levels, 36 had at least one value that was lower than the adult reference range. Ten (28%) of the 36 men with low testosterone levels had no dose adjustments. Thirty-seven (63%) of the 59 patients had no dual-energy X-ray absorptiometry scans, and 18 (31%) did not have hematocrit levels. Pediatric endocrinologists in this review did not consistently follow the Clinical Practice Guideline for testosterone therapy in hypogonadal adult males. Strategies that improve adherence to guidelines could help maximize the benefits of therapy and minimize treatment-associated risks.

GUIDANCE ON SELECTING AGE GROUPS FOR ...

EPA Pesticide Factsheets

This guidance document provides a set of early-lifestage age groups for Environmental Protection Agency scientists to consider when assessing children’s exposure to environmental contaminants and the resultant potential dose. These recommended age groups are based on current understanding of differences in behavior and physiology which may impact exposures in children. A consistent set of early-life age groups, supported by an underlying scientific rationale, is expected to improve Agency exposure and risk assessments for children by increasing the consistency and comparability of risk assessments across the Agency; by improving accuracy and transparency in assessments for those cases where current practice might too broadly combine behaviorally and physiologically disparate age groups; and by fostering a consistent approach to future exposure surveys and monitoring efforts to generate improved exposure factors for children. see description

Improving low-wage, midsized employers' health promotion practices: a randomized controlled trial.

PubMed

Hannon, Peggy A; Harris, Jeffrey R; Sopher, Carrie J; Kuniyuki, Alan; Ghosh, Donetta L; Henderson, Shelly; Martin, Diane P; Weaver, Marcia R; Williams, Barbara; Albano, Denise L; Meischke, Hendrika; Diehr, Paula; Lichiello, Patricia; Hammerback, Kristen E; Parks, Malcolm R; Forehand, Mark

2012-08-01

The Guide to Community Preventive Services (Community Guide) offers evidence-based intervention strategies to prevent chronic disease. The American Cancer Society (ACS) and the University of Washington Health Promotion Research Center co-developed ACS Workplace Solutions (WPS) to improve workplaces' implementation of Community Guide strategies. To test the effectiveness of WPS for midsized employers in low-wage industries. Two-arm RCT; workplaces were randomized to receive WPS during the study (intervention group) or at the end of the study (delayed control group). Forty-eight midsized employers (100-999 workers) in King County WA. WPS provides employers one-on-one consulting with an ACS interventionist via three meetings at the workplace. The interventionist recommends best practices to adopt based on the workplace's current practices, provides implementation toolkits for the best practices the employer chooses to adopt, conducts a follow-up visit at 6 months, and provides technical assistance. Employers' implementation of 16 best practices (in the categories of insurance benefits, health-related policies, programs, tracking, and health communications) at baseline (June 2007-June 2008) and 15-month follow-up (October 2008-December 2009). Data were analyzed in 2010-2011. Intervention employers demonstrated greater improvement from baseline than control employers in two of the five best-practice categories; implementing policies (baseline scores: 39% program, 43% control; follow-up scores: 49% program, 45% control; p=0.013) and communications (baseline scores: 42% program, 44% control; follow-up scores: 76% program, 55% control; p=0.007). Total best-practice implementation improvement did not differ between study groups (baseline scores: 32% intervention, 37% control; follow-up scores: 39% intervention, 42% control; p=0.328). WPS improved employers' health-related policies and communications but did not improve insurance benefits design, programs, or tracking. Many employers were unable to modify insurance benefits and reported that the time and costs of implementing best practices were major barriers. This study is registered at clinicaltrials.gov NCT00452816. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Clinical Practices in Collegiate Concussion Management.

PubMed

Baugh, Christine M; Kroshus, Emily; Stamm, Julie M; Daneshvar, Daniel H; Pepin, Michael J; Meehan, William P

2016-06-01

In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Descriptive epidemiology study. An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included shorter return-to-play time at Division I schools than Division III schools (9.13 vs 10.31 days, respectively) and more frequently referring concussed athletes to a physician within 24 hours of diagnosis at Division I schools. Concussion management at many colleges in the United States incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multimodal baseline and postinjury examination will elevate the concussion care provided to college athletes and better align with best practice guidance. © 2016 The Author(s).

Prevention of venous thromboembolism in long term care: results of a multicenter educational intervention using clinical practice guidelines: part 2 of 2 (an AMDA Foundation project).

PubMed

Dharmarajan, T S; Nanda, Aman; Agarwal, Bikash; Agnihotri, Parag; Doxsie, G L; Gokula, Murthy; Javaheri, Ashkan; Kanagala, M; Lebelt, Anna S; Madireddy, Prasuna; Mahapatra, Sourya; Murakonda, P; Muthavarapu, S Ram Rao; Patel, Mennakshi; Patterson, Christopher; Soch, Kathleen; Troncales, Anna; Yaokim, Kamal; Kroft, Robin; Norkus, Edward P

2012-03-01

Implementation of prophylaxis for venous thomboembolism (VTE) through risk assessment based on clinical practice guidelines (CPGs) is variably adopted in long term care facilities (LTCF). Current guidelines recommend venous thromboembolism prophylaxis (VTE-P) following risk assessment, individualized to patient status. In LTCF, differing comorbidity, life-expectancy, ethical, and quality-of-life issues may warrant a unique approach. This article examines VTE-P practices in LTCF before and after educational intervention to bring practice patterns consistent with CPGs. Phase 1 (preceding article in this issue) identified current practice to assess risk and implement VTE-P (17 geographically diverse LTCFs, 3260 total beds). Phase 2 (educational intervention using CPGs) and Phase 3 (outcomes) reexamined VTE-P at the same 17 centers. The frequency of indications for VTE-P and contraindications to anticoagulation were similar during Phases 1 and 3 (all P > .05). In Phase 3, use of aspirin alone decreased more than 50% (P < .0005), whereas use of compression devices increased (P < .0005). Regression models predicted no relationship between any indication or contraindication and VTE-P in Phase 1 (all P > .05) but identified significant relationships between indication and contraindications and VTE-P in Phase 3 (P = .022 to P < .0005), suggesting adequate understanding of current CPGs following education as the basis for improved VTE-P. The study confirms the presence of significant comorbidity in LTC residents, many with indications for VTE-P, some with contraindications for anticoagulation. Following educational intervention, more residents received VTE-P, influenced by risk-benefit ratio favoring treatment. These findings suggest that even a modest educational intervention significantly improves provider knowledge pertinent to risk assessment consistent with CPG and more appropriate VTE-P. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Improvements in safety and recovery following cystectomy: reassessing the role of pre-operative bowel preparation and interventions to speed return of post-operative bowel function.

PubMed

Zaid, Harras B; Kaffenberger, Samuel D; Chang, Sam S

2013-04-01

For radical cystectomy, historical practice trends have favored the use of preoperative bowel preparations to reduce complications, including surgical site infections, ileus, and anastomotic leaks. However, emerging data has questioned this practice. Postoperative cystectomy care also remains in flux, as new pharmacologic agents that may potentiate earlier return of bowel function are studied. We review the current literature with regards to preoperative and postoperative cystectomy bowel management.

[The quality of epidemiological research on pediatric refractive error and amblyopia in China needs to be improved].

PubMed

He, M G

2017-01-11

Over the past decade, great progress has been made in the clinical and epidemiological studies on refractive error and amblyopia in children with research findings published in international peer reviewed journals. This article reviews some of the essential publications so that the research findings could be learnt extensively, understood critically and objectively, and applied effectively to clinical practice. We aim to address the current limitations and shed light on clinical practice. (Chin J Ophthalmol, 2017, 53: 3-6) .

Developing and Implementing Health and Sustainability Guidelines for Institutional Food Service123

PubMed Central

Kimmons, Joel; Jones, Sonya; McPeak, Holly H.; Bowden, Brian

2012-01-01

Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability. PMID:22585909

Developing and implementing health and sustainability guidelines for institutional food service.

PubMed

Kimmons, Joel; Jones, Sonya; McPeak, Holly H; Bowden, Brian

2012-05-01

Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.

From Cat's Cradle to Beat the Reaper: Getting Evidence-Based Treatments into Practice In Spite of Ourselves

PubMed Central

Sorensen, James L.

2011-01-01

Kurt Vonnegut was one of the most influential novelists of the late 20th Century. His wry views of people and organizations are applicable to the today's efforts to use science to improve the effectiveness of substance use treatment programs. His 1963 book, Cat's Cradle pointed to the potentially disastrous consequences of the development of science for science's sake. Moving to more current viewpoints, in 2009 the young writer and medical doctor Josh Bazell published Beat the Reaper, a novel that discusses modern medical care and pharmaceutical treatments with sarcasm and wit. Currently we are witnessing many developments to incorporate evidence-based practices into addiction treatment, ranging from Institute of Medicine overviews to the organization the Substance Abuse and Mental Health Services Administration, fielding the National Registry of National Registry of Evidence-based Programs and Practices for preventing and treating substance abuse and mental health disorders, legislative initiatives, efforts to upgrade the treatment workforce and, most recently, health care reform. There are signs that these and other efforts are upgrading the effectiveness of treatments for addiction. Yet the checks and balances of every effort to create change make for a field that shows halting and peripatetic development. “Top-down” reforms are watered down by “bottom-up” approaches, and vice-versa. Several concrete steps can be taken to improve the magnitude and speed of change in the field. We cannot change human nature, but we can improve addiction treatment. PMID:21330063

[Challenges in geriatric rehabilitation: the development of an integrated care pathway].

PubMed

Everink, Irma Helga Johanna; van Haastregt, Jolanda C M; Kempen, Gertrudis I J M; Dielis, Leen M J; Maessen, José M C; Schols, Jos M G A

2015-04-01

Coordination and continuity of care within geriatric rehabilitation is challenging. To tackle these challenges, an integrated care pathway within geriatric rehabilitation care (hospital, geriatric rehabilitation and follow-up care in the home situation) has been developed. The aim of this article is to expound the process of developing the integrated care pathway, and to describe and discuss the results of this process (which is the integrated care pathway). Developing the integrated care pathway was done by the guidance of the first four steps of the theoretical framework for implementation of change from Grol and Wensing: (1) development of a specific proposal for change in practice; (2) analysis of current care practice; (3) analysis of the target group and setting; and (4) development and selection of interventions/strategies for change. The organizations involved in geriatric rehabilitation argued that the integrated care pathway should focus on improving the process of care, including transfer of patients, handovers and communication between care organizations. Current practice, barriers and incentives for change were analyzed through literature research, expert consultation, and interviews with the involved caregivers and by establishing working groups of health care professionals, patients and informal caregivers. This resulted in valuable proposals for improvement of the care process, which were gathered and combined in the integrated care pathway. The integrated care pathway entails agreements on (a) the triage process in the hospital; (b) active engagement of patients and informal caregivers in the care process; (c) timely and high quality handovers; and (d) improved communication between caregivers.

Development of quality measures for monitoring and improving care in gastroenterology.

PubMed

Germansky, Katharine A; Leffler, Daniel A

2011-06-01

Over the past decade, most quality assurance (QA) efforts in gastroenterology have been aimed at endoscopy. Endoscopic quality improvement was the rational area to begin QA work in gastroenterology due to the relatively acute nature of complications and the high volume of procedures performed. While endoscopy is currently the focus of most quality assurance (QA) measures in gastroenterology, more recent efforts have begun to address clinical gastroenterology practices both in the outpatient and inpatient settings. Clinical outpatient and inpatient gastroenterology is laden with areas where standardization could benefit patient care. While data and experience in clinical gastroenterology QA is relatively limited, it is clear that inconsistent use of guidelines and practice variations in gastroenterology can lead to lower quality care. In this review, we review a variety of areas in clinical gastroenterology where existing guidelines and published data suggest both the need and practicality of active QA measures. Copyright © 2011 Elsevier Ltd. All rights reserved.

Opportunities for improving management of advanced chronic kidney disease.

PubMed

Patwardhan, Meenal B; Matchar, David B; Samsa, Gregory P; Haley, William E

2008-01-01

Evidence suggests that management of advanced chronic kidney disease affects patient outcomes. To identify clinical areas that demand attention from a quality improvement perspective, we sought to examine the extent of conformance to an advanced chronic kidney disease guideline in a range of practices. A total of 237 patient medical records were abstracted from 4 primary care providers and 4 nephrology private practices across the country. In the practices studied, management of advanced chronic kidney disease patients was suboptimal for patients managed by primary care providers as well as those managed by nephrologists (overall conformance 27% and 42%, respectively), specifically for anemia, bone disease, and timing for renal replacement therapy. The current exercise (in conjunction with a literature search and focused and individual interviews with providers and patients) offered valuable information that was used to develop a toolkit for optimizing management of advanced chronic kidney disease.

Practical outpatient pharmacotherapy for alcohol use disorder

PubMed Central

Kim, Youngjung; Hack, Laura M; Ahn, Elizabeth S

2018-01-01

Alcohol use disorder (AUD) is commonly encountered in clinical practice. A combination of psychosocial intervention and pharmacotherapy is the cornerstone of AUD treatment. Despite their efficacy, safety and cost-effectiveness, clinicians are reluctant to prescribe medications to treat individuals with AUD. Given the high rate of relapse with psychosocial intervention alone, increasing patient access to this underutilized treatment has the potential to improve clinical outcome in this difficult-to-treat population. Herein, we provide practical pharmacotherapy strategies to improve treatment outcome for AUD. We review the efficacy and side effects of both on- and off-label agents with a particular focus on clinical applicability. Recommendations are supported by findings from randomized controlled trials (RCT) and meta-analyses selected to be representative, where possible, of current treatment guidelines. The goal of this paper is to help readers use pharmacotherapy with greater confidence when treating patients with AUD. PMID:29445407

Supporting self-care in general practice

PubMed Central

Greaves, Colin J; Campbell, John L

2007-01-01

There is both a clear need and a political will to improve self-care in long-term conditions: demand for self-care support interventions is rising. This article discusses current approaches to supporting self-care in primary care, evidence in favour of self-care support, and issues for GPs to consider in planning self-care support systems. In planning care pathways, important choices need to be made about whether to use individual or group-based approaches and what intensity of intervention is appropriate to match patient needs. Investment may also be needed in both health professional competences and practice systems to optimise their ability to support patient self-care. Self-care support is a key approach for the future of UK health care. Practices that are well trained and well organised to support self-care will respond better to the complex challenges of achieving improvements in the outcomes of long-term conditions. PMID:17925140

The relationship among the resiliency practices in supply chain, financial performance, and competitive advantage in manufacturing firms in Indonesia and Sierra Leone

NASA Astrophysics Data System (ADS)

Musa, I.; Nyoman Pujawan, I.

2018-04-01

Current supply chain management (SCM) has become a potentially treasured way of safeguarding competitive advantage and improving organizational performance since competition is no longer between organizations, but among supply chains. This research conceptualizes and develops four resiliency practices (Flexibility, Redundancy, Collaboration and Agility) and tests the relationships between organizations’ financial performance and competitive advantage in manufacturing firms. The study involves manufacturing firms in Indonesia and Sierra Leone. The study used stratified random sampling to pick a sample size of 95 manufacturing firms, which represented different industrial sectors. The respondents were mainly managers of different manufacturing companies. The relationships proposed in the conceptual framework were tested using correlation analysis. The results indicate that higher levels of resilience practices in manufacturing firms can lead to enhanced competitive advantage and improved financial performance.

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

PubMed Central

Teoh, M; Clark, C H; Wood, K; Whitaker, S; Nisbet, A

2011-01-01

Volumetric modulated arc therapy (VMAT) is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT). The clinical worldwide use of VMAT is increasing significantly. Currently the majority of published data on VMAT are limited to planning and feasibility studies, although there is emerging clinical outcome data in several tumour sites. This article aims to discuss the current use of VMAT techniques in practice and review the available data from planning and clinical outcome studies in various tumour sites including prostate, pelvis (lower gastrointestinal, gynaecological), head and neck, thoracic, central nervous system, breast and other tumour sites. PMID:22011829

Current status for gastrointestinal nematode diagnosis in small ruminants: where are we and where are we going?

PubMed

Preston, Sarah Jane Margaret; Sandeman, Mark; Gonzalez, Jorge; Piedrafita, David

2014-01-01

Gastrointestinal nematode (GIN) parasites pose a significant economic burden particularly in small ruminant production systems. Anthelmintic resistance is a serious concern to the effective control of GIN parasites and has fuelled the focus to design and promote sustainable control of practices of parasite control. Many facets of sustainable GIN parasite control programs rely on the ability to diagnose infection both qualitatively and quantitatively. Diagnostics are required to determine anthelmintic efficacies, for targeted treatment programs and selection of animals for parasite resistant breeding. This review describes much of the research investigated to date to improve the current diagnostic for the above practices which is based on counting the number of parasite eggs in faeces.

The Basic Structure of Community Early Intervention Programs for Children with Autism: Provider Descriptions

PubMed Central

Stahmer, Aubyn C.

2007-01-01

Autism researchers have identified a set of common effective practice elements for early intervention (EI) (e.g., intensive programming). The current study examined the reported about use of common elements of effective interventions in community EI settings. Eighty EI providers reported about their programs. The majority of participants reported using common effective elements, however, the depth and quality of the use of these elements was highly variable. Taking community program structure into account in future research will facilitate the development of methodologies, which immediately fit into the context of community programming rather than requiring program adaptation for use in the real world. Recommendations for using current community program structure to improve use of evidence-based practices are discussed. PMID:17086438

Implementing and maintaining a researchable database from electronic medical records: a perspective from an academic family medicine department.

PubMed

Stewart, Moira; Thind, Amardeep; Terry, Amanda L; Chevendra, Vijaya; Marshall, J Neil

2009-11-01

Electronic medical records (EMRs) are posited as a tool for improving practice, policy and research in primary healthcare. This paper describes the Deliver Primary Healthcare Information (DELPHI) Project at the Department of Family Medicine at the University of Western Ontario, focusing on its development, current status and research potential in order to share experiences with researchers in similar contexts. The project progressed through four stages: (a) participant recruitment, (b) EMR software modification and implementation, (c) database creation and (d) data quality assessment. Currently, the DELPHI database holds more than two years of high-quality, de-identified data from 10 practices, with 30,000 patients and nearly a quarter of a million encounters.

Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation.

PubMed

Ratwani, Raj; Fairbanks, Terry; Savage, Erica; Adams, Katie; Wittie, Michael; Boone, Edna; Hayden, Andrew; Barnes, Janey; Hettinger, Zach; Gettinger, Andrew

2016-11-16

Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.

Characteristics of health impact assessments reported in Australia and New Zealand 2005–2009

PubMed Central

Haigh, Fiona; Harris, Elizabeth; Chok, Harrison NG; Baum, Fran; Harris-Roxas, Ben; Kemp, Lynn; Spickett, Jeff; Keleher, Helen; Morgan, Richard; Harris, Mark; Wendel, Arthur M; Dannenberg, Andrew L

2013-01-01

Abstract Objective : To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009. Methods : We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study's inclusion criteria to identify characteristics and appraise the quality of the reports. Results : Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision-making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate. Conclusion : This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed. Implications: There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries. PMID:24892152

Patterns of cultural consensus and intracultural diversity in Ghanaian complementary feeding practices.

PubMed

Kalra, Nikhila; Pelto, Gretel; Tawiah, Charlotte; Zobrist, Stephanie; Milani, Peiman; Manu, Grace; Laar, Amos; Parker, Megan

2018-01-01

Designing effective interventions to improve infant and young child (IYC) feeding requires knowledge about determinants of current practices, including cultural factors. Current approaches to obtaining and using research on culture tend to assume cultural homogeneity within a population. The purpose of this study was to examine the extent of cultural consensus (homogeneity) in communities where interventions to improve IYC feeding practices are needed to address undernutrition during the period of complementary feeding. A second, related objective was to identify the nature of intracultural variation, if such variation was evident. Selected protocols from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were administered to samples of key informants and caregivers in a peri-urban and a rural area in Brong-Ahafo, Ghana. Cultural domain analysis techniques (free listing, caregiver assessment of culturally significant dimensions, and food ratings on these dimensions), as well as open-ended questions with exploratory probing, were used to obtain data on beliefs and related practices. Results reveal generally high cultural consensus on the 5 dimensions that were assessed (healthiness, appeal, child acceptance, convenience, and modernity) for caregiver decisions and on their ratings of individual foods. However, thematic analysis of caregiver narratives indicates that the meanings and content of the constructs connoted by the dimensions differed widely among individual mothers. These findings suggest that research on cultural factors that affect IYC practices, particularly cultural beliefs, should consider the nature and extent of cultural consensus and intracultural diversity, rather than assuming cultural homogeneity. © 2017 John Wiley & Sons Ltd.

Physician professionalism and accountability: the role of collaborative improvement networks.

PubMed

Miles, Paul V; Conway, Patrick H; Pawlson, L Gregory

2013-06-01

The medical profession is facing an imperative to deliver more patient-centered care, improve quality, and reduce unnecessary costs and waste. With significant unexplained variation in resource use and outcomes, even physicians and health care organizations with "the best" reputations cannot assume they always deliver the best care possible. Going forward, physicians will need to demonstrate professionalism and accountability in a different way: to their peers, to society in general, and to individual patients. The new accountability includes quality and clinical outcomes but also resource utilization, appropriateness and patient-centeredness of recommended care, and the responsibility to help improve systems of care. The pediatric collaborative improvement network model represents an important framework for helping transform health care. For individual physicians, participation in a multisite network offers the opportunity to demonstrate accountability by measuring and improving care as part of an approach that addresses the problems of small sample size, attribution, and unnecessary variation in care by pooling patients from individual practices and requiring standardization of care to participate. For patients and families, the model helps ensure that they are likely to receive the current best evidence-based recommendation. Finally, this model aligns with payers' goals of purchasing value-based care, rewarding quality and improvement, and reducing unnecessary variation around current best evidenced-based, effective, and efficient care. In addition, within the profession, the American Board of Pediatrics recognizes participation in a multisite quality improvement network as one of the most rigorous and meaningful approaches for a diplomate to meet practice performance maintenance of certification requirements.

Improving opioid safety practices in primary care: protocol for the development and evaluation of a multifaceted, theory-informed pilot intervention for healthcare providers.

PubMed

Leece, Pamela; Buchman, Daniel Z; Hamilton, Michael; Timmings, Caitlyn; Shantharam, Yalnee; Moore, Julia; Furlan, Andrea D

2017-04-26

In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed. Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method. The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement indicators to monitor opioid prescribing. Additionally, the methods and approach used in this study could be adapted for other opioid guidelines, or applied to other areas of preventive healthcare and clinical guideline implementation processes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Plant Metabolomics: An Indispensable System Biology Tool for Plant Science

PubMed Central

Hong, Jun; Yang, Litao; Zhang, Dabing; Shi, Jianxin

2016-01-01

As genomes of many plant species have been sequenced, demand for functional genomics has dramatically accelerated the improvement of other omics including metabolomics. Despite a large amount of metabolites still remaining to be identified, metabolomics has contributed significantly not only to the understanding of plant physiology and biology from the view of small chemical molecules that reflect the end point of biological activities, but also in past decades to the attempts to improve plant behavior under both normal and stressed conditions. Hereby, we summarize the current knowledge on the genetic and biochemical mechanisms underlying plant growth, development, and stress responses, focusing further on the contributions of metabolomics to practical applications in crop quality improvement and food safety assessment, as well as plant metabolic engineering. We also highlight the current challenges and future perspectives in this inspiring area, with the aim to stimulate further studies leading to better crop improvement of yield and quality. PMID:27258266

Plant Metabolomics: An Indispensable System Biology Tool for Plant Science.

PubMed

Hong, Jun; Yang, Litao; Zhang, Dabing; Shi, Jianxin

2016-06-01

As genomes of many plant species have been sequenced, demand for functional genomics has dramatically accelerated the improvement of other omics including metabolomics. Despite a large amount of metabolites still remaining to be identified, metabolomics has contributed significantly not only to the understanding of plant physiology and biology from the view of small chemical molecules that reflect the end point of biological activities, but also in past decades to the attempts to improve plant behavior under both normal and stressed conditions. Hereby, we summarize the current knowledge on the genetic and biochemical mechanisms underlying plant growth, development, and stress responses, focusing further on the contributions of metabolomics to practical applications in crop quality improvement and food safety assessment, as well as plant metabolic engineering. We also highlight the current challenges and future perspectives in this inspiring area, with the aim to stimulate further studies leading to better crop improvement of yield and quality.

The effects of a spiritual learning program on improving spiritual health and clinical practice stress among nursing students.

PubMed

Hsiao, Ya-Chu; Chiang, Hui-Ying; Lee, Hsiang-Chun; Chen, Su-Hui

2012-12-01

Numerous studies have indicated an association between spirituality and health outcomes. However, little information is available about interventions that have been shown to enhance spiritual health and decrease stress. This study examined the effects of a spiritual learning program (SLP) on nursing student-perceived spiritual health and clinical practice stress. A convenience sample of nursing students currently enrolled at a nursing school in northern Taiwan were recruited to participate in this quasiexperimental study as participants to experimental and control groups via simple random sampling. Results from a spiritual health scale and a perceived clinical practice stress scale, together with the score for clinical nursing practice, were compared between the groups. Baseline data were collected from all participants. The experimental group participated in 8 weeks of 50-minute per week SLP, which included lectures, discussion, reflection, and spiritual practices. A second data set was collected from all participants after the intervention. A third data set was collected after all participants had performed 4 weeks of nursing clinical practice. Participants were all women. Average age was 19.4 years (SD = 1.3 years). Generalized estimating equation analysis showed SLP to have a significant short-term effect on improving the total score for spiritual health (p < .01). Significantly greater improvement in clinical practice stress scores was also seen in the experimental group as compared with the control group (all p < .05). The experimental group obtained a higher score of the final clinical practice than the control group (t = 3.771, p < .001). The SLP may encourage participants to see stressors as meaningful events that are connected to individual life purposes. The program developed in this study may be used to improve spiritual health and reduce stress in nursing students' clinical practice. This SLP may be referenced when designing similar spirituality-related courses and applied to nursing student counseling.

Genome-wide prediction models that incorporate de novo GWAS are a powerful new tool for tropical rice improvement

USDA-ARS?s Scientific Manuscript database

To address the multiple challenges to food security posed by global climate change, population growth and rising incomes, plant breeders are developing new crop varieties that can enhance both agricultural productivity and environmental sustainability. Current breeding practices, however, are unable...

Study of recidivism rates among drivers administratively sanctioned by the New Jersey motor vehicle commission : final report, December 2009.

DOT National Transportation Integrated Search

2009-12-01

The purpose of this study was to examine the current state of practice related to driver improvement countermeasures : used in the United States and to assess the effectiveness of New Jerseys negligent driver interventions. As part of the : study,...

Origins of Teachers' Selection of Aversive Interventions.

ERIC Educational Resources Information Center

Lee, Steven W.; Weis, Glenna

This study was designed to replicate and improve upon Kaplan's 1992 study of the possible link between teachers' past experiences and use of aversive disciplinary strategies. The current study examines the possible effect of past home and school experience on both preservice and practicing teachers' choices of intervention. The first study…

Online Faculty Development and Assessment System (OFDAS)

ERIC Educational Resources Information Center

Villar, Luis M.; Alegre, Olga M.

2006-01-01

The rapid growth of online learning has led to the development of faculty inservice evaluation models focused on quality improvement of degree programs. Based on current "best practices" of student online assessment, the Online Faculty Development and Assessment System (OFDAS), created at the Canary Islands, was designed to serve the…

Nurses' Spirituality Improves Caring Behavior

ERIC Educational Resources Information Center

Bakar, Abu; Nursalam; Adriani, Merryana; Kusnanto; Qomariah, Siti Nur; Hidayati, Laily; Pratiwi, Ika Nur; Ni'mah, Lailatun

2017-01-01

Caring is a behavior of giving holistic assistance to individuals. In fact, this important behavior still has not routinely performed in current nursing practice. Personality and sipirituality are important factors in forming one's caring behavior. Spirituality is a passion or impulse to perform noble action. The objective of this study was to…

Improving efficacy of landscape interventions in the (semi) humid Ethiopian Highlands

USDA-ARS?s Scientific Manuscript database

Despite millions of dollars invested in soil and water conservation practices and other landscape interventions in Ethiopian highlands and billions of hours of food-for-work farm labor, sediment concentration in rivers is increasing. Possible ways to reverse the current trend has been investigated b...

Concepts and Measurements for Manpower and Occupational Analysis.

ERIC Educational Resources Information Center

Scoville, James G.

This volume contains information on occupational data and their uses, jobs-theories, case studies, and improved data bases. A survey was made of current applications of occupational information data and conceptual bases and practical shortcomings of the more frequently used classification systems. In addition, an economic theory was developed to…

Distributed Learning Environment: Major Functions, Implementation, and Continuous Improvement.

ERIC Educational Resources Information Center

Converso, Judith A.; Schaffer, Scott P.; Guerra, Ingrid J.

The content of this paper is based on a development plan currently in design for the U.S. Navy in conjunction with the Learning Systems Institute at Florida State University. Leading research (literature review) references and case study ("best practice") references are presented as supporting evidence for the results-oriented…

Improved Sampling Method Reduces Isokinetic Sampling Errors.

ERIC Educational Resources Information Center

Karels, Gale G.

The particulate sampling system currently in use by the Bay Area Air Pollution Control District, San Francisco, California is described in this presentation for the 12th Conference on Methods in Air Pollution and Industrial Hygiene Studies, University of Southern California, April, 1971. The method represents a practical, inexpensive tool that can…

Education for Public Service.

ERIC Educational Resources Information Center

New England Board of Higher Education, Wellesley, MA.

Issues in the improvement of training for fire fighters and officer personnel were taken up in ten symposium papers. Session 1 covered legal and other constraints that affect what a fire fighter should know; and current practices in volunteer, rural, and municipal fire fighter training in the United States. Papers from the other sessions dealt…

Implementing a UDL Framework: A Study of Current Personnel Preparation Practices

ERIC Educational Resources Information Center

Scott, LaRon A.; Thoma, Colleen A.; Puglia, Lauren; Temple, Peter; D'Aguilar, Allison

2017-01-01

Young adults with intellectual disability (ID) continue to experience the least successful postschool outcomes among transition-aged youth (Sanford et al., 2011). Experts disagree on the most effective approach to improve outcomes such as employment, postsecondary education, and community living. In 2015, the National Goals Conference brought…

Recommendations to Improve Space Projection Models and University Space Usage

ERIC Educational Resources Information Center

Stigall, Sam W.

2007-01-01

In today"s economy, public university administrators need to reflect on current practices for reporting and projecting space requirements to government entities as the cost of constructing new facilities or renovating space rises while income from legislative appropriations diminishes. As stewards of public buildings and funds, institutions…

A Web-Based Learning System for Software Test Professionals

ERIC Educational Resources Information Center

Wang, Minhong; Jia, Haiyang; Sugumaran, V.; Ran, Weijia; Liao, Jian

2011-01-01

Fierce competition, globalization, and technology innovation have forced software companies to search for new ways to improve competitive advantage. Web-based learning is increasingly being used by software companies as an emergent approach for enhancing the skills of knowledge workers. However, the current practice of Web-based learning is…

Improving Lives through Evidence-Based Practice

ERIC Educational Resources Information Center

Young Exceptional Children, 2008

2008-01-01

Tess is a joyful eight-year old girl with epilepsy, frontal lobe dysfunction, and dyspraxia, as well as delays in language, fine motor, and gross motor skills. However, despite her disabilities, Tess happily embraces life. With assistance from a few support professionals, Tess currently functions successfully in a regular education second grade…

Disseminating Educational Research with IT.

ERIC Educational Resources Information Center

Davis, Niki

Teachers and researchers need to use the research produced in education to improve their practice. However, the current modes of dissemination through journals and papers are often written for the expert community. The Telematics Centre at the University of Exeter (United Kingdom), School of Education provides creative solutions for the effective…

Curriculum and Instruction: Reactions.

ERIC Educational Resources Information Center

Passow, A. Harry

The papers presented at this conference review current research on effective educational practices for low-achieving students and identify those that might be applied to programs funded under Chapter 1 of the Education Consolidation and Improvement Act of 1981. A function assumed by several conference participants was to act as reactor to papers…

A Lens on Learning: Early Vision Screening Can Set Children on the Path to Achievement.

ERIC Educational Resources Information Center

Black, Susan

2002-01-01

Discusses student learning difficulties linked to visual disorders such as dyslexia and amblyopia, problems associated with current school vision-screening procedures, and recommendations to improve preschool and in-school vision-screening practices with an emphasis on early, regular, and comprehensive eye examinations. (PKP)

The Wisdom of Scientific Inquiry on Education

ERIC Educational Resources Information Center

Glass, Gene V.

1972-01-01

Under current conditions evaluative research based on curriculum products of master teachers using basic knowledge from the social and natural sciences is more likely to contribute to the improvement of educational practice than is an attempt to build theories of teaching based upon rapidly changing philosophy and technique. (AL)

Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33.

ERIC Educational Resources Information Center

Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

This TIP on the best practice guidelines for treatment of substance abuse provides basic knowledge for practitioners, educators, and paraprofessionals about the nature and treatment of stimulant use disorders. More specifically, it reviews what is currently known about treating the medical, psychiatric, and substance abuse/dependence problems…

Rethinking Postgraduate Education in Geography: International Perspectives on Improving Practice

ERIC Educational Resources Information Center

Monk, Janice; Foote, Kenneth; Solem, Michael

2012-01-01

This symposium brings together multi-national assessments of the current state of and challenges facing postgraduate education in geography. Contributors from Europe, Australia, South Africa and the USA identify ways in which restructuring of educational systems and wider political contexts affect programmes within the field. While highlighting…

Networks: A Route to Improving Performance in Manufacturing SMEs

ERIC Educational Resources Information Center

Coleman, J.

2003-01-01

Perceived as important contributors to economic growth, network and cluster groups are currently receiving much attention. The same may be said of SMEs. But practical and theoretical perspectives indicate that SMEs, and particularly the owner-managers, place little value on networks and have only limited networking resources. Consequently, they do…

Personal Name Identification in the Practice of Digital Repositories

ERIC Educational Resources Information Center

Xia, Jingfeng

2006-01-01

Purpose: To propose improvements to the identification of authors' names in digital repositories. Design/methodology/approach: Analysis of current name authorities in digital resources, particularly in digital repositories, and analysis of some features of existing repository applications. Findings: This paper finds that the variations of authors'…

Prototype development and demonstration for response, emergency staging, communications, uniform management, and evacuation (R.E.S.C.U.M.E.) : information broker framework analysis.

DOT National Transportation Integrated Search

2015-03-01

Through the Dynamic Mobility Applications (DMA) Program, U.S. DOT desires to improve current operational practices and transform management of future surface transportation systems. The DMA program is designed to enhance deployment of emerging techno...

Four Pillars for Improving the Quality of Safety-Critical Software-Reliant Systems

DTIC Science & Technology

2013-04-01

Studies of safety-critical software-reliant systems developed using the current practices of build-then-test show that requirements and architecture ... design defects make up approximately 70% of all defects, many system level related to operational quality attributes, and 80% of these defects are

Pushing Buttons: A Sociomaterial Exploration of the Distributed Lecture

ERIC Educational Resources Information Center

MacLeod, Anna; Cameron, Paula; Kits, Olga; Fournier, Cathy

2017-01-01

Current research on telepresence tends to engage a celebratory, taken-for-granted view of technology as a vehicle for improved communication and a mere backdrop against which communication unfolds. However, a growing body of literature interrogates the neutrality of technological environments in education. This paper considers the practice of…

Preparing Tomorrow's Teachers: The Field Experience. Teacher Education Yearbook IV.

ERIC Educational Resources Information Center

McIntyre, D. John, Ed.; Byrd, David M., Ed.

This yearbook provides educators with current research and practical guidelines for improving the education of teacher candidates and beginning teachers. The book has four sections, each on a particular topic and containing an overview and a response (reflections and implications). The first section focuses on contexts for effective field…

WETLANDS AND WATER QUALITY TRADING: REVIEW OF CURRENT SCIENCE AND ECONOMIC PRACTICES WITH SELECTED CASE STUDIES

EPA Science Inventory

The study evaluates the technical, economic, and administrative aspects of establishing water quality trading (WQT) programs where the nutrient removal capacity of wetlands is used to improve water quality. WQT is a potentially viable approach for wastewater dischargers to cost-e...

Three In-Course Assessment Reforms to Improve Higher Education Learning Outcomes

ERIC Educational Resources Information Center

Sadler, D. Royce

2016-01-01

A current international concern is that, for too large a proportion of graduates, their higher order cognitive and practical capabilities are below acceptable levels. The constituent courses of academic programmes are the most logical sites for developing these capabilities. Contributing to patchy attainment are deficiencies in three particular…

Human growth hormone treatment: synthesis of literature on product delivery systems and administration practices.

PubMed

Bhosle, Monali; Klingman, David; Aagren, Mark; Wisniewski, Tami; Lee, Won Chan

2011-01-01

To synthesize current literature on recombinant human growth hormone (rhGH) use and to identify areas of research that have received little to no attention in light of administration practice and patient perception/behavior. Relevant articles for a systematic review were identified through PubMed. A total of 43 articles were identified: 9 (15.9%) studies on product administration practices and 34 (84.1%) on patient behavior patterns. Patients primarily preferred simple, convenient, and easy-to-use delivery devices. However, literature addressing the effect of convenient product administration practices on treatment outcomes using real-world patient/caregiver data is lacking. Better understanding of real-world product administration practices will help nurses identify areas of improvement in patient education and training. © 2010, Wiley Periodicals, Inc.

Science in the schoolhouse: an uninvited guest.

PubMed

Landrum, Timothy J; Tankersley, Melody

2004-01-01

Science and scientific thinking have not made a substantial impact on educational practice. In this discussion, we examine the relationship between science and education and delineate four reasons for characterizing science as an uninvited guest in schools: (a) Science is not highly regarded in society; (b) good science and bad science are often mistaken for one another; (c) the amount of current data is overwhelming; and (d) science is not easy for those who practice it (researchers), those who translate it (teacher educators), or those who consume it (teachers). We suggest several strategies to improve this relationship, including promoting standards of educational practice, emphasizing the role of teacher educators as translators of the research base into classroom practice, and linking student outcomes with the use of effective instructional practices.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature.

PubMed

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James Sa

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

PubMed Central

Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James SA

2018-01-01

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don’ts) when setting up MDT-driven cancer care. PMID:29403284

Aligning Practice to Policies: Changing the Culture to Recognize and Reward Teaching at Research Universities.

PubMed

Dennin, Michael; Schultz, Zachary D; Feig, Andrew; Finkelstein, Noah; Greenhoot, Andrea Follmer; Hildreth, Michael; Leibovich, Adam K; Martin, James D; Moldwin, Mark B; O'Dowd, Diane K; Posey, Lynmarie A; Smith, Tobin L; Miller, Emily R

2017-01-01

Recent calls for improvement in undergraduate education within STEM (science, technology, engineering, and mathematics) disciplines are hampered by the methods used to evaluate teaching effectiveness. Faculty members at research universities are commonly assessed and promoted mainly on the basis of research success. To improve the quality of undergraduate teaching across all disciplines, not only STEM fields, requires creating an environment wherein continuous improvement of teaching is valued, assessed, and rewarded at various stages of a faculty member's career. This requires consistent application of policies that reflect well-established best practices for evaluating teaching at the department, college, and university levels. Evidence shows most teaching evaluation practices do not reflect stated policies, even when the policies specifically espouse teaching as a value. Thus, alignment of practice to policy is a major barrier to establishing a culture in which teaching is valued. Situated in the context of current national efforts to improve undergraduate STEM education, including the Association of American Universities Undergraduate STEM Education Initiative, this essay discusses four guiding principles for aligning practice with stated priorities in formal policies: 1) enhancing the role of deans and chairs; 2) effectively using the hiring process; 3) improving communication; and 4) improving the understanding of teaching as a scholarly activity. In addition, three specific examples of efforts to improve the practice of evaluating teaching are presented as examples: 1) Three Bucket Model of merit review at the University of California, Irvine; (2) Evaluation of Teaching Rubric, University of Kansas; and (3) Teaching Quality Framework, University of Colorado, Boulder. These examples provide flexible criteria to holistically evaluate and improve the quality of teaching across the diverse institutions comprising modern higher education. © 2017 M. Dennin et al. CBE—Life Sciences Education © 2017 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Current Status and Future Suggestions for Improving the Pharm. D Curriculum towards Clinical Pharmacy Practice in Pakistan

PubMed Central

Malhi, Saima Mahmood; Ajmal, Kiran; Shamim, Sumbul; Ata, Saniya; Farooq, Salman; Sharib, Syed Muhammad; Muntaha, Sidrat-ul

2017-01-01

Objectives & Background: Good curriculum is reflected as the backbone for standard universities to develop competitive professionals having great potential. Pharmacy education in Pakistan has gone through the same developmental stages as in other countries, but is still striving for improvement. In the present study, we want (i) to know the opinion on whether the current pharmacy curriculum requires any improvement in order to meet the training needs of pharmacy professionals regarding clinical knowledge and pharmacy practice; and (ii) to present some humble suggestions to decision-making authorities in order to improve it with respect to patient-focused programs (PFP). Methods: The study was conducted in two sessions. In first session, a questionnaire was distributed to pharmacy students of eight public/private sector universities of Karachi (N = 354) offering Pharm. D degrees. The second session dealt with the pharmacy teachers, deans, and practicing pharmacists in health care facilities (who are in any ways also related to academia), in order to take their opinions on and suggestions for the development of a better Pharm. D curriculum (N = 135). Results: Our results showed that 75.2% of respondents agree that the Pharm. D curriculum does not meet the international standards of practice, and 88.4% of respondents support the addition of more clinical aspects than industrial ones, as Pharm. D could be both clinically and industrially oriented, according to the needs of the Pakistani people. Furthermore, 80.2% of respondents are of the view that an apprenticeship should be included in last two years, while 88.4% demand a ‘paid residency program’ to facilitate the hospital, clinical and compounding areas of pharmacy. In addition, we also received a number of verbal suggestions for improving the Pharm. D curriculum being followed in Pakistan. Discussion & Conclusions: We conclude that our Pharm. D curriculum needs additions in terms of clinical practice by providing residencies and electives in health care settings. Accordingly, the need for a clinically oriented curriculum is highlighted in Pakistan, keeping in mind the continuing importance of the industrial viewpoint. Various studies have criticized the pharmacy curriculum in Pakistan in the past. Conversely, we suggest some changes in the curriculum, as change is always needed for a better tomorrow. PMID:28970458

Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes.

PubMed

Fromer, Len

2011-01-01

Current primary care patterns for chronic obstructive pulmonary disease (COPD) focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosa, Josianne Claudia Sales, E-mail: jcsrosa@usp.br; Sánchez, Luis E., E-mail: lsanchez@usp.br

Considering ecosystem services (ES) could foster innovation and improve environmental and social impact assessment (ESIA) practice, but is the potential being fulfilled? In order to investigate how ES have been treated in recent international practice, three questions are asked: (i) were the tasks of an ES analysis carried out? (ii) how is such analysis integrated with other analysis presented in the ESIA? (iii) does ES analysis result in additional or improved mitigation or enhancement measures? These research questions were unfolded into 15 auxiliary questions for reviewing five ESIA reports prepared for mining, hydroelectric and transportation infrastructure projects in Africa, Asiamore » and South America. All cases incorporated ES into ESIA to meet a requirement of the International Finance Corporation's Performance Standards on Environmental and Social Sustainability. It was found that: (i) in only three cases most tasks recommended by current guidance were adopted (ii) all reports feature a dedicated ES chapter or section, but in three of them no evidence was found that the ES analysis was integrated within impact assessment (iii) in the two ESIAs that followed guidance, ES analysis resulted in specific mitigation measures. Few evidence was found that the ES concept is improving current ESIA practice. Key challenges are: (i) integrating ES analysis in such a way that it does not duplicate other analysis; (ii) adequately characterizing the beneficiaries of ES; and (iii) quantifying ES supply for impact prediction. - Highlights: • Incorporating ecosystem services analysis in impact assessment can improve results. • Additional impacts and mitigation were identified. • Challenges include developing appropriate indicators for impact prediction. • A key challenge is integrating the concept in such a way that it does not duplicate other analysis.« less

Creating Next Generation Teacher Preparation Programs to Support Implementation of the Next Generation Science Standards and Common Core State Standards in K-12 Schools: An Opportunity for the Earth and Space Sciences

NASA Astrophysics Data System (ADS)

Geary, E. E.; Egger, A. E.; Julin, S.; Ronca, R.; Vokos, S.; Ebert, E.; Clark-Blickenstaff, J.; Nollmeyer, G.

2015-12-01

A consortium of two and four year Washington State Colleges and Universities in partnership with Washington's Office of the Superintendent of Public Instruction (OSPI), the Teachers of Teachers of Science, and Teachers of Teachers of Mathematics, and other key stakeholders, is currently working to improve science and mathematics learning for all Washington State students by creating a new vision for STEM teacher preparation in Washington State aligned with the Next Generation Science Standards (NGSS) and the Common Core State Standards (CCSS) in Mathematics and Language Arts. Specific objectives include: (1) strengthening elementary and secondary STEM Teacher Preparation courses and curricula, (2) alignment of STEM teacher preparation programs across Washington State with the NGSS and CCSS, (3) development of action plans to support implementation of STEM Teacher Preparation program improvement at Higher Education Institutions (HEIs) across the state, (4) stronger collaborations between HEIs, K-12 schools, government agencies, Non-Governmental Organizations, and STEM businesses, involved in the preparation of preservice STEM teachers, (5) new teacher endorsements in Computer Science and Engineering, and (6) development of a proto-type model for rapid, adaptable, and continuous improvement of STEM teacher preparation programs. A 2015 NGSS gap analysis of teacher preparation programs across Washington State indicates relatively good alignment of courses and curricula with NGSS Disciplinary Core Ideas and Scientific practices, but minimal alignment with NGSS Engineering practices and Cross Cutting Concepts. Likewise, Computer Science and Sustainability ideas and practices are not well represented in current courses and curricula. During the coming year teams of STEM faculty, education faculty and administrators will work collaboratively to develop unique action plans for aligning and improving STEM teacher preparation courses and curricula at their institutions.

Scoping the role and education needs of practice nurses in London.

PubMed

Procter, Susan; Griffiths, Lauren; Fanning, Agnes; Wallman, Lizzie; Loveday, Heather P

2017-07-01

Aims To identify education priorities for practice nursing across eight London Clinical Commissioning Groups (CCGs); to identify the education, training, development and support needs of practice nurses in undertaking current and future roles. The education needs of practice nurses have long been recognised but their employment status means that accessing education requires the support of their GP employer. This study scopes the educational requirements of the practice nurse workforce and working with educational providers and commissioners describes a coherent educational pathway for practice nurses. A survey of practice nurses to scope their educational attainment needs was undertaken. Focus groups were carried out which identified the education, training, development and support needs of practice nurses to fulfil current and future roles. Findings A total of 272 respondents completed the survey. Practice nurses took part in three focus groups (n=34) and one workshop (n=39). Findings from this research indicate a practice nurse workforce which lacked career progression, role autonomy or a coherent educational framework. Practice nurses recognised the strength of their role in building relationship-centred care with patients over an extended period of time. They valued this aspect of their role and would welcome opportunities to develop this to benefit patients. This paper demonstrates an appetite for more advanced education among practice nurses, a leadership role by the CCGs in working across the whole system to address the education needs of practice nurses, and a willingness on the part of National Health Service education commissioners to commission education which meets the education needs of the practice nurse workforce. Evidence is still required, however, to inform the scope of the practice nurse role within an integrated system of care and to identify the impact of practice nursing on improving health outcomes and care of local populations.

Interprofessionalism: Educating to meet patient needs.

PubMed

Kirch, Darrell G; Ast, Cori

2015-01-01

Interprofessional teams in health care are showing promise in achieving the triple aim-providing better care for the individual patient, reducing costs, and improving population health. To complement current changes in health care delivery in the United States, there is a growing consensus among health professions educators that students should be trained in interprofessional models prior to entering clinical practice. Current interprofessional education (IPE) efforts in anatomy education are producing positive results in enhancing professional respect, collaboration, and teamwork among health professions students. In spite of existing structural and cultural barriers to IPE, health professions educators must continue to lead and grow IPE efforts as a critical component to improving the health of our nation. © 2014 American Association of Anatomists.

Evaluating an online pharmaceutical education system for pharmacy interns in critical care settings.

PubMed

Yeh, Yu-Ting; Chen, Hsiang-Yin; Cheng, Kuei-Ju; Hou, Ssu-An; Yen, Yu-Hsuan; Liu, Chien-Tsai

2014-02-01

Incorporating electronic learning (eLearning) system into professional experimental programs such as pharmacy internships is a challenge. However, none of the current systems can fully support the unique needs of clinical pharmacy internship. In this study we enhanced a commercial eLearning system for clinical pharmacy internship (The Clinical Pharmacy Internship eLearning System, CPIES). The KAP questionnaire was used to evaluate the performance of group A with the traditional teaching model and group B with the CPIES teaching model. The CPIES teaching model showed significant improvement in interns' knowledge and practice (p = 0.002 and 0.031, respectively). The traditional teaching model only demonstrated significant improvement in practice (p = 0.011). Moreover, professionalism, such as attitudes on cooperating with other health professionals, is developed by learning from a good mentor. The on-line teaching and traditional teaching methods should undoubtedly be blended in a complete teaching model in order to improve learners' professional knowledge, facilitate correct attitude, and influence good practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Use it or Lose it? Wii Brain Exercise Practice and Reading for Domain Knowledge

PubMed Central

Ackerman, Phillip L.; Kanfer, Ruth; Calderwood, Charles

2010-01-01

We investigated the training effects and transfer effects associated with two approaches to cognitive activities (so-called “brain training”) that might mitigate age-related cognitive decline. A sample of 78 adults between the ages of 50 and 71 completed 20, one-hour training sessions with the Wii Big Brain Academy software over the course of one month, and in a second month, completed 20, one-hour reading sessions with articles on four different current topics (order of assignment was counterbalanced for the participants). An extensive battery of cognitive and perceptual speed ability measures was administered before and after each month of cognitive training activities, along with a battery of domain-knowledge tests. Results indicated substantial improvements on the Wii tasks, somewhat less improvement on the domain-knowledge tests, and practice-related improvements on 6 of the 10 ability tests. However, there was no significant transfer-of-training from either the Wii practice or the reading tasks to measures of cognitive and perceptual speed abilities. Implications for these findings are discussed in terms of adult intellectual development and maintenance. PMID:20822257

Three Collaborative Models for Scaling Up Evidence-Based Practices

PubMed Central

Roberts, Rosemarie; Jones, Helen; Marsenich, Lynne; Sosna, Todd; Price, Joseph M.

2015-01-01

The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed. PMID:21484449

The present status and future growth of maintenance in US manufacturing: results from a pilot survey.

PubMed

Jin, Xiaoning; Siegel, David; Weiss, Brian A; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented.

The present status and future growth of maintenance in US manufacturing: results from a pilot survey

PubMed Central

Jin, Xiaoning; Siegel, David; Weiss, Brian A.; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

2016-01-01

A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented. PMID:27525253

Understanding physical activity promotion in physiotherapy practice: A qualitative study.

PubMed

Lowe, Anna; Littlewood, Chris; McLean, Sionnadh

2018-06-01

Physical inactivity is a major public health issue and healthcare professionals are encouraged to promote physical activity during routine patient contacts in order to reduce non-communicable diseases and enhance individuals' quality of life. Little is known about physical activity promotion in physiotherapy practice in the UK. The aim of this study was to better understand physiotherapists' experience of physical activity promotion in clinical practice. A qualitative study was undertaken comprising 12 telephone interviews with participants using a quota sampling approach. The qualitative data was analysed using a thematic analysis approach and written up according to COREQ guidelines. Four themes were identified (1) Current physiotherapy practice (2) Barriers to, and facilitators of physical activity promotion, (3) Exercise or physical activity? and (4) Functional restoration versus general wellbeing. Physiotherapists use routine clinical contacts to discuss physical activity. However, brief interventions are not consistently used and no common framework to guide physical activity promotion was identified. Approaches appear to be inconsistent and informal and focus largely on short-term restoration of function rather than health promotion. There is scope to improve practice in line with current guidance to maximise potential impact on inactivity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Working Memory Underpins Cognitive Development, Learning, and Education

PubMed Central

Cowan, Nelson

2014-01-01

Working memory is the retention of a small amount of information in a readily accessible form. It facilitates planning, comprehension, reasoning, and problem-solving. I examine the historical roots and conceptual development of the concept and the theoretical and practical implications of current debates about working memory mechanisms. Then I explore the nature of cognitive developmental improvements in working memory, the role of working memory in learning, and some potential implications of working memory and its development for the education of children and adults. The use of working memory is quite ubiquitous in human thought, but the best way to improve education using what we know about working memory is still controversial. I hope to provide some directions for research and educational practice. PMID:25346585

Rethinking McKeown: The Relationship Between Public Health and Social Change

PubMed Central

Szreter, Simon

2002-01-01

Thomas McKeown was a rhetorically powerful critic, from the inside, of the medical profession's mid-20th-century love affair with curative and scientific medicine. He emphasized instead the importance of economic growth, rising living standards, and improved nutrition as the primary sources of most historical improvements in the health of developed nations. This interpretation failed to emphasize the simultaneous historical importance of an accompanying redistributive social philosophy and practical politics, which has characterized the public health movement from its 19th-century origins. Consequently, the current generation of public health practitioners are having to reconstruct such a politics and practice following its virtual dismantlement during the last 2 decades of the 20th century. PMID:11988434

Advanced Technologies to Improve Closure of Life Support Systems

NASA Technical Reports Server (NTRS)

Barta, Daniel J.

2016-01-01

As NASA looks beyond the International Space Station toward long-duration, deep space missions away from Earth, the current practice of supplying consumables and spares will not be practical nor affordable. New approaches are sought for life support and habitation systems that will reduce dependency on Earth and increase mission sustainability. To reduce launch mass, further closure of Environmental Control and Life Support Systems (ECLSS) beyond the current capability of the ISS will be required. Areas of particular interest include achieving higher degrees of recycling within Atmosphere Revitalization, Water Recovery and Waste Management Systems. NASA is currently investigating advanced carbon dioxide reduction processes that surpass the level of oxygen recovery available from the Sabatier Carbon Dioxide Reduction Assembly (CRA) on the ISS. Candidate technologies will potentially improve the recovery of oxygen from about 50% (for the CRA) to as much as 100% for technologies who's end product is solid carbon. Improving the efficiency of water recycling and recovery can be achieved by the addition of advanced technologies to recover water from brines and solid wastes. Bioregenerative technologies may be utilized for water reclaimation and also for the production of food. Use of higher plants will simultaneously benefit atmosphere revitalization and water recovery through photosynthesis and transpiration. The level at which bioregenerative technologies are utilized will depend on their comparative requirements for spacecraft resources including mass, power, volume, heat rejection, crew time and reliability. Planetary protection requirements will need to be considered for missions to other solar system bodies.

Collaborative Practice Model: Improving the Delivery of Bad News.

PubMed

Bowman, Pamela N; Slusser, Kim; Allen, Deborah

2018-02-01

Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. This model for delivering bad news can be easily adapted to meet the needs of other clinical units.
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Conference on "Multidisciplinary approaches to nutritional problems". Symposium on "Performance, exercise and health". Practical aspects of nutrition in performance.

PubMed

Gilbert, Nicky

2009-02-01

The importance of nutrition in sport has been recognised since the ancient Olympians, and its role in improving both health and sports performance has widespread acceptance. However, in sporting circles nutritional knowledge, beliefs and practices are extremely varied. Within any sporting organisation the sports dietitian or nutritionist must be able to work with athletes, their family, coaches and other support staff to develop and monitor realistic and practical strategies that work best for each performer, contributing to a positive and sustained outcome on performance. The present review examines the practical application of current key issues in performance nutrition, highlighting the advantages of early intervention in youth development and comprehensive and integrated nutrition services.

Mutilating Procedures, Management Practices, and Housing Conditions That May Affect the Welfare of Farm Animals: Implications for Welfare Research.

PubMed

Nordquist, Rebecca E; van der Staay, Franz Josef; van Eerdenburg, Frank J C M; Velkers, Francisca C; Fijn, Lisa; Arndt, Saskia S

2017-02-21

A number of mutilating procedures, such as dehorning in cattle and goats and beak trimming in laying hens, are common in farm animal husbandry systems in an attempt to prevent or solve problems, such as injuries from horns or feather pecking. These procedures and other practices, such as early maternal separation, overcrowding, and barren housing conditions, raise concerns about animal welfare. Efforts to ensure or improve animal welfare involve adapting the animal to its environment, i.e., by selective breeding (e.g., by selecting "robust" animals) adapting the environment to the animal (e.g., by developing social housing systems in which aggressive encounters are reduced to a minimum), or both. We propose adapting the environment to the animals by improving management practices and housing conditions, and by abandoning mutilating procedures. This approach requires the active involvement of all stakeholders: veterinarians and animal scientists, the industrial farming sector, the food processing and supply chain, and consumers of animal-derived products. Although scientific evidence about the welfare effects of current practices in farming such as mutilating procedures, management practices, and housing conditions is steadily growing, the gain in knowledge needs a boost through more scientific research. Considering the huge number of animals whose welfare is affected, all possible effort must be made to improve their welfare as quickly as possible in order to ban welfare-compromising procedures and practices as soon as possible.

Security Personnel Practices and Policies in U.S. Hospitals: Findings From a National Survey.

PubMed

Schoenfisch, Ashley L; Pompeii, Lisa A

2016-06-27

Concerns of violence in hospitals warrant examination of current hospital security practices. Cross-sectional survey data were collected from members of a health care security and safety association to examine the type of personnel serving as security in hospitals, their policies and practices related to training and weapon/restraint tool carrying/use, and the broader context in which security personnel work to maintain staff and patient safety, with an emphasis on workplace violence prevention and mitigation. Data pertaining to 340 hospitals suggest security personnel were typically non-sworn officers directly employed (72%) by hospitals. Available tools included handcuffs (96%), batons (56%), oleoresin capsicum products (e.g., pepper spray; 52%), hand guns (52%), conducted electrical weapons (e.g., TASERs®; 47%), and K9 units (12%). Current workplace violence prevention policy components, as well as recommendations to improve hospital security practices, aligned with Occupational Safety and Health Administration guidelines. Comprehensive efforts to address the safety and effectiveness of hospital security personnel should consider security personnel's relationships with other hospital work groups and hospitals' focus on patients' safety and satisfaction. © 2016 The Author(s).

The national sports safety in secondary schools benchmark (N4SB) study: defining athletic training practice characteristics.

PubMed

McLeod, Tamara C Valovich; Bliven, Kellie C Huxel; Lam, Kenneth C; Bay, R Curtis; Valier, Alison R Snyder; Parsons, John T

2013-01-01

Increased rates of sport participation and sport-related injury have led to greater emphasis on and attention to medical care of student-athletes in the secondary school setting. Access to athletic training services is seen as a critical factor for delivering adequate injury prevention and medical care to student-athletes. However, few data are available regarding practice characteristics of athletic trainers (ATs) in this setting. To characterize the practices of secondary school athletic trainers (ATs). Descriptive study. Web-based survey. A total of 17 558 ATs with current National Athletic Trainers' Association membership were identified for survey distribution. Of these, 4232 ATs indicated that they practiced in the secondary school setting, and 4045 completed some part of the survey. A Web-based survey was used to obtain demographic information about ATs and their secondary schools and characteristics of athletic training practice. Descriptive data regarding the athletic trainer's personal characteristics, secondary school characteristics, and practice patterns are reported as percentages and frequencies. Most respondents were in the early stages of their careers and relatively new to the secondary school practice setting. Nearly two-thirds (62.4%; n = 2522) of respondents had 10 or fewer years of experience as secondary school ATs, 52% (n = 2132) had been certified for 10 or fewer years, and 53.4% (n = 2164) had 10 or fewer years of experience in any practice setting. The majority of respondents (85%) worked in public schools with enrollment of 1000 to 1999 (35.5%) and with football (95.5%). More than half of respondents were employed directly by their school. Most respondents (50.6%) reported an athletic training budget of less than $4000. The majority of ATs performed evaluations (87.5%) on-site all of the time, with a smaller percentage providing treatments (73.3%) or rehabilitation (47.4%) services all of the time. This is the first study to describe secondary school athletic training that reflects national practice trends. To improve the quality of athletic training care and to support and improve current working conditions, the profession must examine how its members practice on a day-to-day basis.

Trout Creek, Oregon Watershed Assessment; Findings, Condition Evaluation and Action Opportunities, 2002 Technical Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Runyon, John

The purpose of the assessment is to characterize historical and current watershed conditions in the Trout Creek Watershed. Information from the assessment is used to evaluate opportunities for improvements in watershed conditions, with particular reference to improvements in the aquatic environment. Existing information was used, to the extent practicable, to complete this work. The assessment will aid the Trout Creek Watershed Council in identifying opportunities and priorities for watershed restoration projects.

UTILIZATION OF ACUTE CARE NURSE PRACTITIONERS TO COMBAT PHYSICIAN SHORTAGES IN THE MILITARY TRAUMA SYSTEM: WORKING TOWARDS IMPROVED OUTCOMES

DTIC Science & Technology

2016-10-01

MILITARY TRAUMA SYSTEM: WORKING TOWARDS IMPROVED OUTCOMES by April J. Dunlevy, Maj, USAF, NC A Research Report Submitted to the Faculty In...developed to aid in efforts to provide safe , effective and efficient care. One barrier to this goal is the current national shortage of physician...healthcare system. 5 Preface I have been working in healthcare for 24 years, practicing in both civilian and military facilities