Operational research as implementation science: definitions, challenges and research priorities.

PubMed

Monks, Thomas

2016-06-06

Operational research (OR) is the discipline of using models, either quantitative or qualitative, to aid decision-making in complex implementation problems. The methods of OR have been used in healthcare since the 1950s in diverse areas such as emergency medicine and the interface between acute and community care; hospital performance; scheduling and management of patient home visits; scheduling of patient appointments; and many other complex implementation problems of an operational or logistical nature. To date, there has been limited debate about the role that operational research should take within implementation science. I detail three such roles for OR all grounded in upfront system thinking: structuring implementation problems, prospective evaluation of improvement interventions, and strategic reconfiguration. Case studies from mental health, emergency medicine, and stroke care are used to illustrate each role. I then describe the challenges for applied OR within implementation science at the organisational, interventional, and disciplinary levels. Two key challenges include the difficulty faced in achieving a position of mutual understanding between implementation scientists and research users and a stark lack of evaluation of OR interventions. To address these challenges, I propose a research agenda to evaluate applied OR through the lens of implementation science, the liberation of OR from the specialist research and consultancy environment, and co-design of models with service users. Operational research is a mature discipline that has developed a significant volume of methodology to improve health services. OR offers implementation scientists the opportunity to do more upfront system thinking before committing resources or taking risks. OR has three roles within implementation science: structuring an implementation problem, prospective evaluation of implementation problems, and a tool for strategic reconfiguration of health services. Challenges facing OR as implementation science include limited evidence and evaluation of impact, limited service user involvement, a lack of managerial awareness, effective communication between research users and OR modellers, and availability of healthcare data. To progress the science, a focus is needed in three key areas: evaluation of OR interventions, embedding the knowledge of OR in health services, and educating OR modellers about the aims and benefits of service user involvement.

Challenges of standardized continuous quality improvement programs in community pharmacies: the case of SafetyNET-Rx.

PubMed

Boyle, Todd A; MacKinnon, Neil J; Mahaffey, Thomas; Duggan, Kellie; Dow, Natalie

2012-01-01

Research on continuous quality improvement (CQI) in community pharmacies lags in comparison to service, manufacturing, and various health care sectors. As a result, very little is known about the challenges community pharmacies face when implementing CQI programs in general, let alone the challenges of implementing a standardized and technologically sophisticated one. This research identifies the initial challenges of implementing a standardized CQI program in community pharmacies and how such challenges were addressed by pharmacy staff. Through qualitative interviews, a multisite study of the SafetyNET-Rx CQI program involving community pharmacies in Nova Scotia, Canada, was performed to identify such challenges. Interviews were conducted with the CQI facilitator (ie, staff pharmacist or technician) in 55 community pharmacies that adopted the SafetyNET-Rx program. Of these 55 pharmacies, 25 were part of large national corporate chains, 22 were part of banner chains, and 8 were independent pharmacies. A total of 10 different corporate chains and banners were represented among the 55 pharmacies. Thematic content analysis using well-established coding procedures was used to explore the interview data and elicit the key challenges faced. Six major challenges were identified, specifically finding time to report, having all pharmacy staff involved in quality-related event (QRE) reporting, reporting apprehensiveness, changing staff relationships, meeting to discuss QREs, and accepting the online technology. Challenges were addressed in a number of ways including developing a manual-online hybrid reporting system, managers paying staff to meet after hours, and pharmacy managers showing visible commitment to QRE reporting and learning. This research identifies key challenges to implementing CQI programs in community pharmacies and also provides a starting point for future research relating to how the challenges of QRE reporting and learning in community pharmacies change over time. Copyright © 2012 Elsevier Inc. All rights reserved.

Tailored combination prevention packages and PrEP for young key populations

PubMed Central

Pettifor, Audrey; Nguyen, Nadia L; Celum, Connie; Cowan, Frances M; Go, Vivian; Hightow-Weidman, Lisa

2015-01-01

Introduction Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations. Objective In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages. Methods We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular. Results and discussion Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations’ practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure. Conclusions Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission. PMID:25724507

Experiences from the implementation of a biosafety system in Slovenia.

PubMed

Milavec, Mojca; Racman, Darja Stanic

2007-09-01

The development and implementation of an effective national biosafety system is important for several key reasons: to ensure safe access to products of modern biotechnology, to build public confidence, to encourage the growth of domestic modern biotechnology, and to comply with international standards and agreements. There is no single best approach in the development and implementation of a national biosafety system and each country is faced with unique challenges. Slovenia is a small country and a new EU Member State. However, it has developed and implemented an efficient national biosafety system. The key elements of this system are administrative procedure, risk assessment, enforcement, and public participation and information.

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom

PubMed Central

Devlin, Alison M; McGee-Lennon, Marilyn; O’Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O’Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan

2016-01-01

Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. PMID:26254480

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom.

PubMed

Devlin, Alison M; McGee-Lennon, Marilyn; O'Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O'Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan; Mair, Frances S

2016-01-01

To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Curriculum Leadership: Development and Implementation

ERIC Educational Resources Information Center

Glatthorn, Allan A.; Boschee, Floyd; Whitehead, Bruce M.

2005-01-01

This book is a resource written for educational leaders who want to successfully restructure and enhance curriculum in schools today. It provides innovative and successful curriculum ideas, including reflective case studies, "Keys to Leadership" sections, curriculum tips, and "Challenge" sections with key issues and questions in every chapter.…

Progress and challenges: implementation and use of health information technology among critical-access hospitals.

PubMed

Gabriel, Meghan Hufstader; Jones, Emily B; Samy, Leila; King, Jennifer

2014-07-01

Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied. Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system. Project HOPE—The People-to-People Health Foundation, Inc.

The Efficacy of Multidimensional Constraint Keys in Database Query Performance

ERIC Educational Resources Information Center

Cardwell, Leslie K.

2012-01-01

This work is intended to introduce a database design method to resolve the two-dimensional complexities inherent in the relational data model and its resulting performance challenges through abstract multidimensional constructs. A multidimensional constraint is derived and utilized to implement an indexed Multidimensional Key (MK) to abstract a…

"Now" We Have an App for That

ERIC Educational Resources Information Center

Schaen, Richard J.; Hayden, Garry; Zydney, Janet M.

2016-01-01

The best Science, Technology, Engineering, and Mathematics (STEM) design challenges are student centered, with students themselves making the key decisions. But with young children who are still learning basic academic and social skills, implementing projects where they truly take the lead can be quite challenging. To give students at one…

Examining implementation of a patient activation and self-management intervention within the context of an effectiveness trial.

PubMed

Ault-Brutus, Andrea; Lee, Catherine; Singer, Sara; Allen, Michele; Alegría, Margarita

2014-11-01

This qualitative study examines factors important for delivering a patient activation/self-management intervention in 13 mental health clinics within the context of an effectiveness trial to inform understanding of real-world implementation. Eighteen key personnel were interviewed about the following factors relative to the intervention and its delivery: alignment with organization values/patient needs; buy-in/support from leaders and providers; roles played by leaders and key personnel; and availability of organizational resources. Where supportive, these factors facilitated the delivery of the intervention; elsewhere, they presented as impediments. Findings from this study could help anticipate challenges to implementation that could be examined in a full-scale implementation study.

Secure Cryptographic Key Management System (CKMS) Considerations for Smart Grid Devices

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

Abercrombie, Robert K; Sheldon, Frederick T; Aldridge, Hal

2011-01-01

In this paper, we examine some unique challenges associated with key management in the Smart Grid and concomitant research initiatives: 1) effectively model security requirements and their implementations, and 2) manage keys and key distribution for very large scale deployments such as Smart Meters over a long period of performance. This will set the stage to: 3) develop innovative, low cost methods to protect keying material, and 4) provide high assurance authentication services. We will present our perspective on key management and will discuss some key issues within the life cycle of a cryptographic key designed to achieve the following:more » 1) control systems designed, installed, operated, and maintained to survive an intentional cyber assault with no loss of critical function, and 2) widespread implementation of methods for secure communication between remote access devices and control centers that are scalable and cost-effective to deploy.« less

Future perspectives on nonmedical prescribing

PubMed Central

Stewart, Derek; Jebara, Tesnime; Cunningham, Scott; Awaisu, Ahmed; Pallivalapila, Abdulrouf; MacLure, Katie

2017-01-01

Many countries have implemented nonmedical prescribing (NMP) and many others are scoping prescribing practices with a view to developing NMP. This paper provides a future perspective on NMP in light of findings of an umbrella review of aspects of NMP. This is followed by coverage of the Scottish Government strategy of pharmacist prescribing and finally, consideration of two key challenges. The review identified seven systematic reviews of influences on prescribing decision-making, processes of prescribing, and barriers and facilitators to implementation. Decision making was reported as complex with many, and often conflicting, influences. Facilitators of NMP included perceived improved patient care and professional autonomy, while barriers included lack of defined roles and resource pressures. Three systematic reviews explored patient outcomes that were noted to be equivalent or better to physician prescribing. In particular, a Cochrane review of 46 studies of clinical, patient-reported, and resource-use outcomes of NMP compared with medical prescribing showed positive intervention-group effects. Despite positive findings, authors highlighted high bias, poor definition and description of ‘prescribing’ and the ‘prescribing process’ and difficulty in separating NMP effects from the contributions of other healthcare team members. While evidence of benefit and safety is essential to inform practice, for NMP to be implemented and sustained on a large scale, there needs to be clear commitment at the highest level. The approach being taken by the Scottish Government to pharmacist prescribing implementation may inform developments in other professions and countries. The vision is that by 2023, all pharmacists providing pharmaceutical care will be pharmacist-independent prescribers. There are, however, challenges to implementing NMP into working practice; two key challenges are the need for sustainable models of care and evaluation research. These challenges could be met by considering the theoretical basis for implementation, and robust and rigorous evaluation. PMID:28607668

Using the Consolidated Framework for Implementation Research to implement and evaluate national surgical planning

PubMed Central

Saluja, Saurabh; Silverstein, Allison; Mukhopadhyay, Swagoto; Lin, Yihan; Raykar, Nakul; Keshavjee, Salmaan; Samad, Lubna; Meara, John G

2017-01-01

The Lancet Commission on Global Surgery defined six surgical indicators and a framework for a national surgical plan that aimed to incorporate surgical care as a part of global public health. Multiple countries have since begun national surgical planning; each faces unique challenges in doing so. Implementation science can be used to more systematically explain this heterogeneous process, guide implementation efforts and ultimately evaluate progress. We describe our intervention using the Consolidated Framework for Implementation Research. This framework requires identifying characteristics of the intervention, the individuals involved, the inner and outer setting of the intervention, and finally describing implementation processes. By hosting a consultative symposium with clinicians and policy makers from around the world, we are able to specify key aspects of each element of this framework. We define our intervention as the incorporation of surgical care into public health planning, identify local champions as the key individuals involved, and describe elements of the inner and outer settings. Ultimately we describe top-down and bottom-up models that are distinct implementation processes. With the Consolidated Framework for Implementation Research, we are able to identify specific strategic models that can be used by implementers in various settings. While the integration of surgical care into public health throughout the world may seem like an insurmountable challenge, this work adds to a growing effort that seeks to find a way forward. PMID:29225930

Seafood traceability: current needs, available tools, and biotechnological challenges for origin certification.

PubMed

Leal, Miguel Costa; Pimentel, Tânia; Ricardo, Fernando; Rosa, Rui; Calado, Ricardo

2015-06-01

Market globalization and recurring food safety alerts have resulted in a growing consumer awareness of the need for food traceability. This is particularly relevant for seafood due to its perishable nature and importance as a key protein source for the population of the world. Here, we provide an overview of the current needs for seafood origin traceability, along with the limitations and challenges for its implementation. We focus on geochemical, biochemical, and molecular tools and how they should be optimized to be implemented globally and to address our societal needs. We suggest that seafood traceability is key to enforcing food safety regulations and fisheries control, combat fraud, and fulfill present and future expectations of conscientious producers, consumers, and authorities. Copyright © 2015 Elsevier Ltd. All rights reserved.

Design and implementation of a secure wireless mote-based medical sensor network.

PubMed

Malasri, Kriangsiri; Wang, Lan

2009-01-01

A medical sensor network can wirelessly monitor vital signs of humans, making it useful for long-term health care without sacrificing patient comfort and mobility. For such a network to be viable, its design must protect data privacy and authenticity given that medical data are highly sensitive. We identify the unique security challenges of such a sensor network and propose a set of resource-efficient mechanisms to address these challenges. Our solution includes (1) a novel two-tier scheme for verifying the authenticity of patient data, (2) a secure key agreement protocol to set up shared keys between sensor nodes and base stations, and (3) symmetric encryption/decryption for protecting data confidentiality and integrity. We have implemented the proposed mechanisms on a wireless mote platform, and our results confirm their feasibility.

Every Child Matters: Every Challenge Met?

ERIC Educational Resources Information Center

Straker, Katherine; Foster, Rob

2009-01-01

This article explores the impact of the Every Child Matters agenda on a group of multi-agency professionals with regard to a number of key issues--such as leadership, multi-agency collaboration, and individual practice. One of the main challenges concerning the successful implementation of the ECM agenda is to ensure that effective training is…

Seventh-Day Adventist Teachers' Perceptions of Inclusion Classrooms and Identification of Challenges to Their Implementation

ERIC Educational Resources Information Center

Sargeant, Marcel A. A.; Berkner, Donna

2015-01-01

This qualitative study investigated the perceptions and challenges of Seventh-day Adventist teachers towards inclusion classrooms in the United States. For this study, 17 participants were interviewed using two 12-item interview protocols. The analysis of the teachers' responses revealed five key perceptions. First, teachers have positive…

Building Geography's New Frontier: Implementing the Australian Curriculum Geography

ERIC Educational Resources Information Center

Purnell, Ken

2013-01-01

The introduction of Geography as a compulsory learning area from Foundation year, such as Kindergarten, to Year 8 in Australia provides new opportunities for learning and teaching. Opportunities, in part, will be driven by challenges associated with the introduction of this learning area. Key challenges are about variability: in take-up of the…

Translation of tobacco policy into practice in disadvantaged and marginalized subpopulations: a study of challenges and opportunities in remote Australian Indigenous communities

PubMed Central

2012-01-01

Background In Australia generally, smoking prevalence more than halved after 1980 and recently commenced to decline among Australia's disadvantaged Indigenous peoples. However, in some remote Indigenous Australian communities in the Northern Territory (NT), extremely high rates of up to 83% have not changed over the past 25 years. The World Health Organisation has called for public health and political leadership to address a global tobacco epidemic. For Indigenous Australians, unprecedented policies aim to overcome disadvantage and close the 'health gap' with reducing tobacco use the top priority. This study identifies challenges and opportunities to implementing these important new tobacco initiatives in remote Indigenous communities. Methods: With little empirical evidence available, we interviewed 82 key stakeholders across the NT representing operational- and management-level service providers, local Indigenous and non-Indigenous participants to identify challenges and opportunities for translating new policies into successful tobacco interventions. Data were analysed using qualitative approaches to identify emergent themes. Results The 20 emergent themes were classified using counts of occasions each theme occurred in the transcribed data as challenge or opportunity. The 'smoke-free policies' theme occurred most frequently as opportunity but infrequently as challenge while 'health workforce capacity' occurred most frequently as challenge but less frequently as opportunity, suggesting that policy implementation is constrained by lack of a skilled workforce. 'Smoking cessation support' occurred frequently as opportunity but also frequently as challenge suggesting that support for individuals requires additional input and attention. Conclusions These results from interviews with local and operational-level participants indicate that current tobacco policies in Australia targeting Indigenous smoking are sound and comprehensive. However, for remote Indigenous Australian communities, local and operational-level participants' views point to an 'implementation gap'. Their views should be heard because they are in a position to provide practical recommendations for effective policy implementation faithful to its design, thereby translating sound policy into meaningful action. Some recommendations may also find a place in culturally diverse low- and middle-income countries. Key words: tobacco policy implementation, challenges, opportunities, remote Indigenous Australian communities. PMID:22839197

Cultural Challenges in Adapting Lesson Study to a Philippines Setting

ERIC Educational Resources Information Center

Ebaeguin, Marlon; Stephens, Max

2014-01-01

Promising improved student and teacher learning, Japanese lesson study has attracted many international educators to try to implement it in their own contexts. However, a simple transference model of implementation is likely to meet difficulties. Key determinants of any adaptation will be differences between existing conventions of pedagogy and of…

Dynamic Sustainability: Practitioners' Perspectives on Housing First Implementation Challenges and Model Fidelity Over Time

ERIC Educational Resources Information Center

Stergiopoulos, Vicky; Zerger, Suzanne; Jeyaratnam, Jeyagobi; Connelly, Jolynn; Kruk, Katherine; O'Campo, Patricia; Hwang, Stephen

2016-01-01

Objectives: Although Housing First (HF) is a popular evidence-based intervention for persons experiencing homelessness and mental illness, research exploring its sustainability over time is scant. This mixed methods study captures practitioners' perspectives on key shifts in implementation of Housing First in a large urban center, and factors…

A Case Study of Multimethod Evaluation of Complex School Mental Health Promotion and Prevention: The Mindmatters Evaluation Suite

ERIC Educational Resources Information Center

Rowling, Louise; Mason, Jo

2005-01-01

There are a number of challenges and debates surrounding the implementation of mental health interventions in schools. These include recognising the complexity of influencing factors and the interdependency of key components; the critical importance of monitoring school-based implementation in particular contexts; employing multimethod evaluation…

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Perceptions of Yoga Therapy Embedded in Two Inpatient Rehabilitation Hospitals: Agency Perspectives

PubMed Central

Van Puymbroeck, Marieke; Miller, Kristine K.; Dickes, Lori A.; Schmid, Arlene A.

2015-01-01

Inpatient medical rehabilitation has maintained a typical medical-model focus and structure for many years. However, as integrative therapies, such as yoga therapy, emerge as treatments which can enhance the physical and mental health of its participants, it is important to determine if they can be easily implemented into the traditional rehabilitation structure and milieu. Therefore, the purpose of this study was to examine the perceptions of key agency personnel on the feasibility and utility of yoga therapy implemented in inpatient rehabilitation. This study reports the results of focus groups and an individual interview with key stakeholders (administrators and rehabilitation therapists) from two rehabilitation hospitals following the implementation of yoga therapy. Results focused on several key themes: feasibility from the therapist and administrator perspectives, challenges to implementation, and utility and benefit. Overall, the implementation and integration of yoga therapy were positive; however, some programmatic and policy and organizational considerations remain. Implications for practice and future research are provided. PMID:26491457

Examining Implementation of a Patient Activation and Self-management Intervention Within the Context of an Effectiveness Trial

PubMed Central

Lee, Catherine; Singer, Sara; Allen, Michele; Alegría, Margarita

2014-01-01

This qualitative study examines factors important for delivering a patient activation/self-management intervention in 13 mental health clinics within the context of an effectiveness trial to inform understanding of real-world implementation. Eighteen key personnel were interviewed about the following factors relative to the intervention and its delivery: alignment with organization values/patient needs; buy-in/support from leaders and providers; roles played by leaders and key personnel; and availability of organizational resources. Where supportive, these factors facilitated the delivery of the intervention; elsewhere, they presented as impediments. Findings from this study could help anticipate challenges to implementation that could be examined in a full-scale implementation study. PMID:24202066

Current Challenges for HTCMC Aero-Propulsion Components

NASA Technical Reports Server (NTRS)

DiCarlo, James A.; Bansal, Narottam P.

2007-01-01

In comparison to the best metallic materials, HTCMC aero-propulsion engine components offer the opportunity of reduced weight and higher temperature operation, with corresponding improvements in engine cooling requirements, emissions, thrust, and specific fuel consumption. Although much progress has been made in the development of advanced HTCMC constituent materials and processes, major challenges still remain for their implementation into these components. The objectives of this presentation are to briefly review (1) potential HTCMC aero-propulsion components and their generic material performance requirements, (2) recent progress at NASA and elsewhere concerning advanced constituents and processes for meeting these requirements, (3) key HTCMC component implementation challenges that are currently being encountered, and (4) on-going activities within the new NASA Fundamental Aeronautics Program that are addressing these challenges.

Qualitative analysis of the dynamics of policy design and implementation in hospital funding reform.

PubMed

Palmer, Karen S; Brown, Adalsteinn D; Evans, Jenna M; Marani, Husayn; Russell, Kirstie K; Martin, Danielle; Ivers, Noah M

2018-01-01

As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model. We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy); Adoption Supporters (organizations and individuals supporting adoption of QBPs); and Hospital Implementers (those responsible for QBP implementation in hospitals). Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data. Five main findings emerged from our research: (1) Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s) for hospital funding reform; (2) Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3) Perception of the primary goal(s) of the policy reform continues to vary within and across all levels of key informants; (4) Four years into implementation, the QBP funding mechanism remains misunderstood; and (5) Ongoing differences in understanding of QBP goals and funding mechanism have created challenges with implementation and difficulties in measuring success. Policy drift and policy layering affected both the goal and the mechanism of action of hospital funding reform. Lack of early specification in both policy goals and hospital funding mechanism exposed the reform to reactive changes that did not reflect initial intentions. Several challenges further exacerbated implementation of complex hospital funding reforms, including a prolonged implementation schedule, turnover of key staff, and inconsistent messaging over time. These factors altered the trajectory of the hospital funding reforms and created confusion amongst those responsible for implementation. Enacting changes to hospital funding policy through a process that is transparent, collaborative, and intentional may increase the likelihood of achieving intended effects.

Meshfree and efficient modeling of swimming cells

NASA Astrophysics Data System (ADS)

Gallagher, Meurig T.; Smith, David J.

2018-05-01

Locomotion in Stokes flow is an intensively studied problem because it describes important biological phenomena such as the motility of many species' sperm, bacteria, algae, and protozoa. Numerical computations can be challenging, particularly in three dimensions, due to the presence of moving boundaries and complex geometries; methods which combine ease of implementation and computational efficiency are therefore needed. A recently proposed method to discretize the regularized Stokeslet boundary integral equation without the need for a connected mesh is applied to the inertialess locomotion problem in Stokes flow. The mathematical formulation and key aspects of the computational implementation in matlab® or GNU Octave are described, followed by numerical experiments with biflagellate algae and multiple uniflagellate sperm swimming between no-slip surfaces, for which both swimming trajectories and flow fields are calculated. These computational experiments required minutes of time on modest hardware; an extensible implementation is provided in a GitHub repository. The nearest-neighbor discretization dramatically improves convergence and robustness, a key challenge in extending the regularized Stokeslet method to complicated three-dimensional biological fluid problems.

Editorial: Challenges and solutions in GW calculations for complex systems

NASA Astrophysics Data System (ADS)

Giustino, F.; Umari, P.; Rubio, A.

2012-09-01

We report key advances in the area of GW calculations, review the available software implementations and define standardization criteria to render the comparison between GW calculations from different codes meaningful, and identify future major challenges in the area of quasiparticle calculations. This Topical Issue should be a reference point for further developments in the field.

The Extent to Which Collaborative Teams of Educators Link the Results of Functional Assessment to Function-Based Interventions

ERIC Educational Resources Information Center

de Courcy-Bower, Laurie

2010-01-01

A promising approach to addressing challenging behavior in schools is to develop and implement "function-based interventions" (Dunlap et al., 2006; Hanley, Iwata, & McCord, 2003). Function-based interventions are individualized interventions in which five key outcomes of functional assessment (i.e., identification of challenging behavior,…

Design and Implementation of a Secure Wireless Mote-Based Medical Sensor Network

PubMed Central

Malasri, Kriangsiri; Wang, Lan

2009-01-01

A medical sensor network can wirelessly monitor vital signs of humans, making it useful for long-term health care without sacrificing patient comfort and mobility. For such a network to be viable, its design must protect data privacy and authenticity given that medical data are highly sensitive. We identify the unique security challenges of such a sensor network and propose a set of resource-efficient mechanisms to address these challenges. Our solution includes (1) a novel two-tier scheme for verifying the authenticity of patient data, (2) a secure key agreement protocol to set up shared keys between sensor nodes and base stations, and (3) symmetric encryption/decryption for protecting data confidentiality and integrity. We have implemented the proposed mechanisms on a wireless mote platform, and our results confirm their feasibility. PMID:22454585

Why and How Do Nursing Homes Implement Culture Change Practices? Insights from Qualitative Interviews in a Mixed Methods Study

PubMed Central

Shield, Renée R.; Looze, Jessica; Tyler, Denise; Lepore, Michael; Miller, Susan C.

2015-01-01

Objective To understand the process of instituting culture change (CC) practices in nursing homes (NHs). Methods NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail. Results The themes include: 1) Reasons for implementing CC practices vary; 2) NH approaches to implementing CC practices are diverse; 3) NHs consider resident mix in deciding to implement practices; 4) NHAs note benefits and few implementation costs of implementing CC practices; 5) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; 6) Education and communication efforts are vital ways to institute change; and 7) NHA and other staff leadership is key to implementing changes. Discussion Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations. PMID:24652888

Overview of a multi-stakeholder dialogue around Shared Services for Health: the Digital Health Opportunity in Bangladesh.

PubMed

Ashraf, Sania; Moore, Carolyn; Gupta, Vaibhav; Chowdhury, Anir; Azad, Abul K; Singh, Neelu; Hagan, David; Labrique, Alain B

2015-12-09

National level policymaking and implementation includes multiple stakeholders with varied interests and priorities. Multi-stakeholder dialogues (MSDs) can facilitate consensus building through collective identification of challenges, recognition of shared goals and interests, and creation of solution pathways. This can shape joint planning and implementation for long-term efficiency in health and other sectors. Scaling up the effective use of information and communication technologies (ICTs) requires cohesive strategic planning towards a shared goal. In Bangladesh, the government and partners convened an MSD in March 2015 to increase stakeholder engagement in policymaking and implementation of a national ICT or electronic or mobile health (eHealth or mHealth) strategy, which seeks to incorporate ICTs into the national health system, aligning with the Digital Bangladesh Vision 2021. Relevant stakeholders were identified and key priorities and challenges were mapped through key informant interviews. An MSD was conducted with key stakeholders in Dhaka, Bangladesh. The MSD included presentations, group option generation, agreement and prioritization of barriers to scaling up ICTs. The MSD approach to building consensus on key priorities highlights the value of dialogue and collaboration with relevant stakeholders to encourage country ownership of nationwide efforts such as ICT scale-up. This MSD showed the dynamic context in which stakeholders operate, including those from academia, donors and foundations, healthcare professionals, associations, multilateral organizations, non-governmental organizations, partner countries and the private sector. Through this MSD, participants improved understanding of each other's contributions and interests, identified existing relationships, and agreed on policy and implementation gaps that needed to be filled. Collaboration among stakeholders in ICT efforts and research can promote a cohesive approach to scaling up, as well as improve policymaking by integrating interests and feedback of different key cross sectoral actors. MSDs can align stakeholders to identify challenges and solution pathways, and lead to coordinated action and accountability for resources and results. In addition, the MSD template and approach has been useful to guide ICT scale up in Bangladesh and could be replicated in other contexts to facilitate multi-constituency, multi-sector collaboration.

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration

PubMed Central

Sullivan, Jennifer L.; Adjognon, Omonyêlé L.; Engle, Ryann L.; Shin, Marlena H.; Afable, Melissa K.; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

2018-01-01

Background: From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. Purpose: The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Methodology: Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. Results: The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. Discussion: This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Implications: Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges. PMID:28125459

Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration.

PubMed

Sullivan, Jennifer L; Adjognon, Omonyêlé L; Engle, Ryann L; Shin, Marlena H; Afable, Melissa K; Rudin, Whitney; White, Bert; Shay, Kenneth; Lukas, Carol VanDeusen

From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs. The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced. Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded. The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources. This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support). Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.

Web Services Security - Implementation and Evaluation Issues

NASA Astrophysics Data System (ADS)

Pimenidis, Elias; Georgiadis, Christos K.; Bako, Peter; Zorkadis, Vassilis

Web services development is a key theme in the utilization the commercial exploitation of the semantic web. Paramount to the development and offering of such services is the issue of security features and they way these are applied in instituting trust amongst participants and recipients of the service. Implementing such security features is a major challenge to developers as they need to balance these with performance and interoperability requirements. Being able to evaluate the level of security offered is a desirable feature for any prospective participant. The authors attempt to address the issues of security requirements and evaluation criteria, while they discuss the challenges of security implementation through a simple web service application case.

Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program.

PubMed

Dennis, Sarah; Hetherington, Sharon A; Borodzicz, Jerrad A; Hermiz, Oshana; Zwar, Nicholas A

2015-04-01

Community-based programs to address physical activity and diet are seen as a valuable strategy to reduce risk factors for chronic disease. Community partnerships are important for successful local implementation of these programs but little is published to describe the challenges of developing partnerships to implement health promotion programs. The aim of this study was to explore the experiences and opinions of key stakeholders on the development and maintenance of partnerships during their implementation of the HEAL™ program. Semi-structured interviews with key stakeholders involved in implementation of HEAL™ in four local government areas. The interviews were transcribed verbatim and analysed thematically. Partnerships were vital to the success of the local implementation. Successful partnerships occurred where the program met the needs of the partnering organisation, or could be adapted to do so. Partnerships took time to develop and were often dependent on key people. Partnering with organisations that had a strong influence in the community could strengthen existing relationships and success. In remote areas partnerships took longer to develop because of fewer opportunities to meet face to face and workforce shortages and this has implications for program funding in these areas. Partnerships are important for the successful implementation of community preventive health programs. They take time to develop, are dependent on the needs of the stakeholders and are facilitated by stable leadership. SO WHAT?: An understanding of the role of partnerships in the implementation of community health programs is important to inform several aspects of program delivery, including flexibility in funding arrangements to allow effective and mutually beneficial partnerships to develop before the implementation phase of the program. It is important that policy makers have an understanding of the time it takes for partnerships to develop and to take this into consideration when programs are funded and implemented in the community.

Securing resource constraints embedded devices using elliptic curve cryptography

NASA Astrophysics Data System (ADS)

Tam, Tony; Alfasi, Mohamed; Mozumdar, Mohammad

2014-06-01

The use of smart embedded device has been growing rapidly in recent time because of miniaturization of sensors and platforms. Securing data from these embedded devices is now become one of the core challenges both in industry and research community. Being embedded, these devices have tight constraints on resources such as power, computation, memory, etc. Hence it is very difficult to implement traditional Public Key Cryptography (PKC) into these resource constrained embedded devices. Moreover, most of the public key security protocols requires both public and private key to be generated together. In contrast with this, Identity Based Encryption (IBE), a public key cryptography protocol, allows a public key to be generated from an arbitrary string and the corresponding private key to be generated later on demand. While IBE has been actively studied and widely applied in cryptography research, conventional IBE primitives are also computationally demanding and cannot be efficiently implemented on embedded system. Simplified version of the identity based encryption has proven its competence in being robust and also satisfies tight budget of the embedded platform. In this paper, we describe the choice of several parameters for implementing lightweight IBE in resource constrained embedded sensor nodes. Our implementation of IBE is built using elliptic curve cryptography (ECC).

Implementing Multisector Nutrition Programs in Ethiopia and Nepal: Challenges and Opportunities From a Stakeholder Perspective.

PubMed

Kennedy, Eileen; Fekadu, Habtamu; Ghosh, Shibani; Baral, Kedar; Davis, Dale; Sapkota, Diplav; Webb, Patrick

2016-12-01

Effective governance is essential for effective nutrition program implementation. There are additional challenges in launching multisector plans to enhance nutritional status. The present study compares the challenges and opportunities in Ethiopia and Nepal in designing and implementing a multisector plan for nutrition. A semi-quantitative questionnaire with open-ended questions was used to solicit information from senior national-level policy officials and other key stakeholders. The nature of the major nutrition problems in each country was similar; these include malnutrition (particularly stunting), food insecurity, and micronutrient malnutrition. The main challenges identified included the need for more specificity in the roles of agencies/individuals in program implementation, more effective mechanisms for linking national to subnational officials, methods for creating awareness of the plans, and a dedicated line item in the budgets of each agency. The level of enthusiasm was high in both countries. Respondents in both countries highlighted the need to identify a "champion" at the highest level who would keep the momentum for the respective plans alive. © The Author(s) 2016.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.

PubMed

Mupara, Lucia U; Lubbe, Johanna C

2016-01-01

Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

Federal Aviation Administration : challenges in modernizing the agency

DOT National Transportation Integrated Search

2000-02-01

FAA's efforts to implement initiatives in five key areas-air traffic control modernization, procurement and personnel reform, aviation safety, aviation and computer security, and financial management-have met with limited success. For example, FAA ha...

Overcoming Challenges in School-Wide Survey Administration.

PubMed

Rasberry, Catherine N; Rose, India; Kroupa, Elizabeth; Hebert, Andrew; Geller, Amanda; Morris, Elana; Lesesne, Catherine A

2018-01-01

School-based surveys provide a useful method for gathering data from youth. Existing literature offers many examples of data collection through school-based surveys, and a small subset of literature describes methodological approaches or general recommendations for health promotion professionals seeking to conduct school-based data collection. Much less is available on real-life logistical challenges (e.g., minimizing disruption in the school day) and corresponding solutions. In this article, we fill that literature gap by offering practical considerations for the administration of school-based surveys. The protocol and practical considerations outlined in the article are based on a survey conducted with 11,681 students from seven large, urban public high schools in the southeast United States. We outline our protocol for implementing a school-based survey that was conducted with all students school-wide, and we describe six types of key challenges faced in conducting the survey: consent procedures, scheduling, locating students within the schools, teacher failure to administer the survey, improper administration of the survey, and minimizing disruption. For each challenge, we offer our key lessons learned and associated recommendations for successfully implementing school-based surveys, and we provide relevant tools for practitioners planning to conduct their own surveys in schools.

Concept Mapping of PMTCT Implementation Challenges and Solutions Across 6 sub-Saharan African Countries in the NIH-PEPFAR PMTCT Implementation Science Alliance.

PubMed

Aarons, Gregory A; Sommerfeld, David H; Chi, Benjamin H; Ezeanolue, Echezona E; Sturke, Rachel; Guay, Laura; Siberry, George K

2016-08-01

Although tremendous gains have been made to reduce mother-to-child HIV transmission (MTCT) globally, evidence-based practice implementation remains inconsistent in sub-Saharan Africa. We sought to identify the key domains for effective prevention of MTCT (PMTCT) implementation, using a participatory mixed-methods approach. Participants were members of the NIH-PEPFAR PMTCT Implementation Science Alliance (ISA), a platform of researchers, public-health practitioners, policymakers, and donors supported through NIH/PEPFAR. We used concept mapping to identify priority areas for PMTCT implementation science. Participants responded to the focus question: "In your experience, what factors have facilitated or hindered implementation of PMTCT interventions?" Responses were consolidated into discrete statements, grouped together based on similarity, and rated for importance, changeability, and extent to which ISA participation enhanced the capacity to influence/change the factor. Using multidimensional scaling and cluster analysis, we identified 12 key domains of PMTCT implementation. Two domains (Governmental Commitment and Data Measurement & Collection) were consistently ranked at or near the top for overall importance, perceived changeability, and enhanced ability to address through ISA participation. Through a stakeholder-based, participatory approach, we identified key domains for that should be considered for future PMTCT implementation research in sub-Saharan Africa.

Key issues and challenges in developing a pedagogical intervention in the simulation skills center--an action research study.

PubMed

Reierson, Inger Åse; Hvidsten, Anne; Wighus, Marianne; Brungot, Solvor; Bjørk, Ida Torunn

2013-07-01

Simulation skills centers (SSC) are considered important learning arenas for preparing and qualifying nursing students. Limited clinical placements and claims of diminished learning opportunities raise concerns that newly educated nurses lack proficiency in many psychomotor skills. Accordingly, there is an increased focus on learning in the SSC. However, it has been questioned if the pedagogical underpinning of teaching and learning in the SSC is missing or unclear. At a bachelor nursing education in Norway, there was a desire to change practice and enhance learning in the SSC by systematic use of The Model of Practical Skill Performance (Bjørk and Kirkevold, 2000). A participatory action research design was chosen. A pedagogical intervention was developed and implemented in 2010 in a cohort of eighty-seven first year bachelor nursing students during their basic nursing skill course. The intervention is shortly described. This article reports key issues and challenges that emerged during development of the new intervention. Data to inform the study were collected via thorough meeting minutes and the project leader's logbook, and analyzed using fieldnotes analysis. Six key issues and challenges were identified. These are presented and discussed consecutively in light of their importance for development and implementation of the new intervention. Copyright © 2013 Elsevier Ltd. All rights reserved.

Challenges associated with the implementation of the nursing process: A systematic review.

PubMed

Zamanzadeh, Vahid; Valizadeh, Leila; Tabrizi, Faranak Jabbarzadeh; Behshid, Mojghan; Lotfi, Mojghan

2015-01-01

Nursing process is a scientific approach in the provision of qualified nursing cares. However, in practice, the implementation of this process is faced with numerous challenges. With the knowledge of the challenges associated with the implementation of the nursing process, the nursing processes can be developed appropriately. Due to the lack of comprehensive information on this subject, the current study was carried out to assess the key challenges associated with the implementation of the nursing process. To achieve and review related studies on this field, databases of Iran medix, SID, Magiran, PUBMED, Google scholar, and Proquest were assessed using the main keywords of nursing process and nursing process systematic review. The articles were retrieved in three steps including searching by keywords, review of the proceedings based on inclusion criteria, and final retrieval and assessment of available full texts. Systematic assessment of the articles showed different challenges in implementation of the nursing process. Intangible understanding of the concept of nursing process, different views of the process, lack of knowledge and awareness among nurses related to the execution of process, supports of managing systems, and problems related to recording the nursing process were the main challenges that were extracted from review of literature. On systematically reviewing the literature, intangible understanding of the concept of nursing process has been identified as the main challenge in nursing process. To achieve the best strategy to minimize the challenge, in addition to preparing facilitators for implementation of nursing process, intangible understanding of the concept of nursing process, different views of the process, and forming teams of experts in nursing education are recommended for internalizing the nursing process among nurses.

Challenges associated with the implementation of the nursing process: A systematic review

PubMed Central

Zamanzadeh, Vahid; Valizadeh, Leila; Tabrizi, Faranak Jabbarzadeh; Behshid, Mojghan; Lotfi, Mojghan

2015-01-01

Background: Nursing process is a scientific approach in the provision of qualified nursing cares. However, in practice, the implementation of this process is faced with numerous challenges. With the knowledge of the challenges associated with the implementation of the nursing process, the nursing processes can be developed appropriately. Due to the lack of comprehensive information on this subject, the current study was carried out to assess the key challenges associated with the implementation of the nursing process. Materials and Methods: To achieve and review related studies on this field, databases of Iran medix, SID, Magiran, PUBMED, Google scholar, and Proquest were assessed using the main keywords of nursing process and nursing process systematic review. The articles were retrieved in three steps including searching by keywords, review of the proceedings based on inclusion criteria, and final retrieval and assessment of available full texts. Results: Systematic assessment of the articles showed different challenges in implementation of the nursing process. Intangible understanding of the concept of nursing process, different views of the process, lack of knowledge and awareness among nurses related to the execution of process, supports of managing systems, and problems related to recording the nursing process were the main challenges that were extracted from review of literature. Conclusions: On systematically reviewing the literature, intangible understanding of the concept of nursing process has been identified as the main challenge in nursing process. To achieve the best strategy to minimize the challenge, in addition to preparing facilitators for implementation of nursing process, intangible understanding of the concept of nursing process, different views of the process, and forming teams of experts in nursing education are recommended for internalizing the nursing process among nurses. PMID:26257793

Health care financing in Asia: key issues and challenges.

PubMed

Kwon, Soonman

2011-09-01

This article examines the major elements of health care financing such as financial risk protection, resource generation, resource pooling, and purchasing and payment; provides key lessons; and discusses the challenges for health care financing systems of Asian countries. With the exception of Japan, Korea, Taiwan, and Thailand, most health care systems of Asia provide very limited financial risk protection. The role of public prepaid schemes such as tax and social health insurance is minimal, and out-of-pocket payment is a major source of financing. The large informal sector is a major challenge to the extension of population coverage in many low-income countries of Asia, which must seek the optimal mix of tax subsidy and health insurance for universal coverage. Implementation of effective payment systems to control the behavior of health care providers is also a key factor in the success of health care financing reform in Asia.

Global-to-local policy transfer in the introduction of new molecular tuberculosis diagnostics in South Africa.

PubMed

Colvin, C J; Leon, N; Wills, C; van Niekerk, M; Bissell, K; Naidoo, P

2015-11-01

Lack of innovation in diagnostics has contributed to tuberculosis (TB) remaining a global health challenge. It is critical to understand how new diagnostic technologies are translated into policies and how these are implemented. To examine policy transfer for two rapid molecular diagnostic tests, GenoType(®) MDRTBplus and Xpert(®) MTB/RIF, to understand policy development, uptake and implementation in South Africa. A policy transfer analysis framework integrating the key dimensions of policy transfer into one coherent model was used. Two phases of key informant interviews were undertaken with a wide range of stakeholders. Both tests were developed through innovative partnerships and responded to urgent public health needs. GenoType was introduced through a process that was more inclusive than that for Xpert. National policy and planning processes were opaque for both tests. Their implementation, maintenance and expansion suffered from poor communication and coordination, insufficient attention to resource implications, technical challenges and a lack of broader health systems thinking. Our analysis identified the risks and benefits of partnerships for technological innovation, the complex intersections between global and national actors and the impact of health systems on policy transfer, and the risks of rescue- and technology-focused thinking in addressing public health challenges.

Qualitative analysis of the dynamics of policy design and implementation in hospital funding reform

PubMed Central

Brown, Adalsteinn D.; Evans, Jenna M.; Marani, Husayn; Russell, Kirstie K.; Martin, Danielle; Ivers, Noah M.

2018-01-01

Background As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model. Methods We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy); Adoption Supporters (organizations and individuals supporting adoption of QBPs); and Hospital Implementers (those responsible for QBP implementation in hospitals). Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data. Results Five main findings emerged from our research: (1) Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s) for hospital funding reform; (2) Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3) Perception of the primary goal(s) of the policy reform continues to vary within and across all levels of key informants; (4) Four years into implementation, the QBP funding mechanism remains misunderstood; and (5) Ongoing differences in understanding of QBP goals and funding mechanism have created challenges with implementation and difficulties in measuring success. Conclusions Policy drift and policy layering affected both the goal and the mechanism of action of hospital funding reform. Lack of early specification in both policy goals and hospital funding mechanism exposed the reform to reactive changes that did not reflect initial intentions. Several challenges further exacerbated implementation of complex hospital funding reforms, including a prolonged implementation schedule, turnover of key staff, and inconsistent messaging over time. These factors altered the trajectory of the hospital funding reforms and created confusion amongst those responsible for implementation. Enacting changes to hospital funding policy through a process that is transparent, collaborative, and intentional may increase the likelihood of achieving intended effects. PMID:29373587

Dissemination and implementation of evidence based, mental health interventions in post conflict, low resource settings

PubMed Central

Tol, Wietse; Jordans, Mark; Zangana, Goran Sabir; Amin, Ahmed Mohammed; Bolton, Paul; Bass, Judith; Bonilla-Escobar, Fransisco Javier; Thornicroft, Graham

2014-01-01

The burden of mental health problems in (post)conflict low- and middle-income countries (LMIC) is substantial. Despite growing evidence for the effectiveness of selected mental health programs in conflict-affected LMIC and growing policy support, actual uptake and implementation have been slow. A key direction for future research, and a new frontier within science and practice, is Dissemination and Implementation (DI) which directly addresses the movement of evidence-based, effective health care approaches from experimental settings into routine use. This paper outlines some key implementation challenges, and strategies to address these, while implementing evidence-based treatments in conflict-affected LMIC based on the authors’ collective experiences. Dissemination and implementation evaluation and research in conflict settings is an essential new research direction. Future DI work in LMIC should include: 1) defining concepts and developing measurement tools, 2) the measurement of DI outcomes for all programming, and 3) the systematic evaluation of specific implementation strategies. PMID:28316559

Caution Ahead: Research Challenges of a Randomized Controlled Trial Implemented to Improve Breast Cancer Treatment at Safety-Net Hospitals.

PubMed

Bickell, Nina A; Shah, Ajay; Castaldi, Maria; Lewis, Theophilus; Sickles, Alan; Arora, Shalini; Clarke, Kevin; Kemeny, Margaret; Srinivasan, Anitha; Fei, Kezhen; Franco, Rebeca; Parides, Michael; Pappas, Peter; McAlearney, Ann Scheck

2018-03-01

To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs). We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool's usefulness. We conducted intention-to-treat and pre- and poststudy analyses to assess the T&F tool and implementation effectiveness, respectively. Between the study start and intervention implementation, several hospitals reorganized care delivery and 49% of patients scheduled to undergo breast cancer surgery were ineligible because they already were in contact with an oncologist. One high-volume hospital closed. Despite randomization of hospitals, intervention (INT) hospitals had fewer white patients (5% v 16%; P = .0005), and more underuse (28% v 15%; P = .002) compared with usual care (UC) hospitals. Over time, INT hospitals with poorer follow-up significantly reduced underuse compared with UC hospitals (INT hospitals, from 33% to 9%, P = .001 v UC hospitals, from 15% to 11%, P = .5). There was no difference in underuse (9% at INT hospitals, 11% at UC hospitals; P = .8). Hospitals with better follow-up (odds ratio, 0.85; 95% CI, 0.73 to 0.98) had less underuse. In settings with poor follow-up and tracking approaches, key informants found the tool useful. The rapidly changing delivery landscape posed significant challenges to this implementation research. A T&F tool did not significantly reduce adjuvant underuse but may help reduce underuse in SNHs with poor follow-up capabilities. Inability to discern T&F effectiveness is likely due to encountered challenges that inform lessons for future implementation research.

Foundational Report Series: Advanced Distribution Management Systems for Grid Modernization, Implementation Strategy for a Distribution Management System

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

Singh, Ravindra; Reilly, James T.; Wang, Jianhui

Electric distribution utilities encounter many challenges to successful deployment of Distribution Management Systems (DMSs). The key challenges are documented in this report, along with suggestions for overcoming them. This report offers a recommended list of activities for implementing a DMS. It takes a strategic approach to implementing DMS from a project management perspective. The project management strategy covers DMS planning, procurement, design, building, testing, Installation, commissioning, and system integration issues and solutions. It identifies the risks that are associated with implementation and suggests strategies for utilities to use to mitigate them or avoid them altogether. Attention is given to commonmore » barriers to successful DMS implementation. This report begins with an overview of the implementation strategy for a DMS and proceeds to put forward a basic approach for procuring hardware and software for a DMS; designing the interfaces with external corporate computing systems such as EMS, GIS, OMS, and AMI; and implementing a complete solution.« less

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PubMed Central

Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-01-01

Abstract Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. PMID:28369396

Legal Challenges and Pitfalls for Start-up Companies - 48 Common Questions and Answers.

PubMed

Staehelin, Matthias

2014-12-01

Transforming a business idea into reality requires a legal implementation plan. The following 48 questions and answers address key issues that typically arise in start-up situations. Early planning can help avoid costly mistakes.

Implementing the No Child Left Behind Act: Using Student Engagement to Improve Adolescent Literacy. NCREL Quick Key 10 Action Guide

ERIC Educational Resources Information Center

Learning Point Associates / North Central Regional Educational Laboratory (NCREL), 2005

2005-01-01

Literacy instruction does not end with reading success in early grades. As students move to middle and high school, new challenges emerge that can affect literacy achievement. Even for students who achieve early reading and writing success, the literacy demands of middle and high school can pose substantial challenges. Older students must be able…

Writing implementation research grant proposals: ten key ingredients

PubMed Central

2012-01-01

Background All investigators seeking funding to conduct implementation research face the challenges of preparing a high-quality proposal and demonstrating their capacity to conduct the proposed study. Applicants need to demonstrate the progressive nature of their research agenda and their ability to build cumulatively upon the literature and their own preliminary studies. Because implementation science is an emerging field involving complex and multilevel processes, many investigators may not feel equipped to write competitive proposals, and this concern is pronounced among early stage implementation researchers. Discussion This article addresses the challenges of preparing grant applications that succeed in the emerging field of dissemination and implementation. We summarize ten ingredients that are important in implementation research grants. For each, we provide examples of how preliminary data, background literature, and narrative detail in the application can strengthen the application. Summary Every investigator struggles with the challenge of fitting into a page-limited application the research background, methodological detail, and information that can convey the project’s feasibility and likelihood of success. While no application can include a high level of detail about every ingredient, addressing the ten ingredients summarized in this article can help assure reviewers of the significance, feasibility, and impact of the proposed research. PMID:23062065

Dollars and sense: Mitigating budget risk for ICD-10.

PubMed

Newell, Lucy Mancini; DeSilva, Joseph J

2013-02-01

The extended deadline for ICD-10 implementation is time that should not be wasted. Healthcare leaders should keep three things in mind: CFOs should approach the effort knowing the costs of ICD-10 implementation will be high and spread over multiple budget years. Training, productivity, and contractual issues are among key areas that will be challenged by ICD-10 implementation. Healthcare finance leaders should work to improve cash-on-hand and cash reserves prior to the ICD-10 deadline to ensure liquidity post-compliance.

A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.

PubMed

Janamian, Tina; Jackson, Claire L; Glasson, Nicola; Nicholson, Caroline

2014-08-04

To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. Systematic review of peer-reviewed literature. PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012. Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model. One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness. Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance. This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana

PubMed Central

Mupara, Lucia U.; Lubbe, Johanna C.

2016-01-01

Background Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. Design A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. Results The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. Conclusions The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana. PMID:26899774

CAGE IIIA Distributed Simulation Design Methodology

DTIC Science & Technology

2014-05-01

2 VHF Very High Frequency VLC Video LAN Codec – an Open-source cross-platform multimedia player and framework VM Virtual Machine VOIP Voice Over...Implementing Defence Experimentation (GUIDEx). The key challenges for this methodology are with understanding how to: • design it o define the...operation and to be available in the other nation’s simulations. The challenge for the CAGE campaign of experiments is to continue to build upon this

Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease.

PubMed

Cahalin, Lawrence P; Kaminsky, Leonard; Lavie, Carl J; Briggs, Paige; Cahalin, Brendan L; Myers, Jonathan; Forman, Daniel E; Patel, Mahesh J; Pinkstaff, Sherry O; Arena, Ross

2015-01-01

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs. Copyright © 2015 Elsevier Inc. All rights reserved.

Implementation of Prolonged Exposure in the Army: Is Consultation Necessary for Effective Dissemination

DTIC Science & Technology

2015-10-01

study team implemented various efforts to re-educate providers regarding the goal of the study, including holding individual provider meetings...of these changes was developed in direct response to the challenges faced at Ft. Carson, but these changes required IRB approval, resulting in...constitutes a key step towards the ultimate goal of increased access to evidence-based treatment among soldiers suffering from PTSD and related

Functional Land Management: Bridging the Think-Do-Gap using a multi-stakeholder science policy interface.

PubMed

O'Sullivan, Lilian; Wall, David; Creamer, Rachel; Bampa, Francesca; Schulte, Rogier P O

2018-03-01

Functional Land Management (FLM) is proposed as an integrator for sustainability policies and assesses the functional capacity of the soil and land to deliver primary productivity, water purification and regulation, carbon cycling and storage, habitat for biodiversity and recycling of nutrients. This paper presents the catchment challenge as a method to bridge the gap between science, stakeholders and policy for the effective management of soils to deliver these functions. Two challenges were completed by a wide range of stakeholders focused around a physical catchment model-(1) to design an optimised catchment based on soil function targets, (2) identify gaps to implementation of the proposed design. In challenge 1, a high level of consensus between different stakeholders emerged on soil and management measures to be implemented to achieve soil function targets. Key gaps including knowledge, a mix of market and voluntary incentives and mandatory measures were identified in challenge 2.

The Complexities of Implementing Cluster Supply Chain - Case Study of JCH

NASA Astrophysics Data System (ADS)

Xue, Xiao; Zhang, Jibiao; Wang, Yang

As a new type of management pattern, "cluster supply chain" (CSC) can help SMEs to face the global challenges through all kinds of collaboration. However, a major challenge in implementing CSC is the gap between theory and practice in the field. In an effort to provide a better understanding of this emerging phenomenon, this paper presents the implementation process of CSC in the context of JingCheng Mechanical & Electrical Holding co., ltd.(JCH) as a case study. The cast study of JCH suggests that the key problems in the practice of cluster supply chain: How do small firms use cluster supply chain? Only after we clarify the problem, the actual construction and operation of cluster supply chain does show successful results as it should be.

From Theory to Practice: One Agency's Experience with Implementing an Evidence-Based Model.

PubMed

Murray, Maureen; Culver, Tom; Farmer, Betsy; Jackson, Leslie Ann; Rixon, Brian

2014-07-01

As evidence-based practice is becoming integrated into children's mental health services as a means of improving outcomes for children and youth with severe behavioral and emotional problems, therapeutic foster care (TFC) which is a specialized treatment program for such youth, is one of few community-based programs considered to be evidence-based. "Together Facing the Challenge" (TFTC) which was developed as a component of a randomized trial of TFC has been identified as an evidence-based model. We describe the experiences reported by one of the agencies that participated in our study and how they have incorporated TFTC into their on-going practice. They highlight key implementation strategies, challenges faced, and lessons learned as they moved forward towards full implementation of TFTC throughout their agency.

Evidence-Based Practice: The Psychology of EBP Implementation.

PubMed

Rousseau, Denise M; Gunia, Brian C

2016-01-01

Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation.

Energy-Efficient Implementation of ECDH Key Exchange for Wireless Sensor Networks

NASA Astrophysics Data System (ADS)

Lederer, Christian; Mader, Roland; Koschuch, Manuel; Großschädl, Johann; Szekely, Alexander; Tillich, Stefan

Wireless Sensor Networks (WSNs) are playing a vital role in an ever-growing number of applications ranging from environmental surveillance over medical monitoring to home automation. Since WSNs are often deployed in unattended or even hostile environments, they can be subject to various malicious attacks, including the manipulation and capture of nodes. The establishment of a shared secret key between two or more individual nodes is one of the most important security services needed to guarantee the proper functioning of a sensor network. Despite some recent advances in this field, the efficient implementation of cryptographic key establishment for WSNs remains a challenge due to the resource constraints of small sensor nodes such as the MICAz mote. In this paper we present a lightweight implementation of the elliptic curve Diffie-Hellman (ECDH) key exchange for ZigBee-compliant sensor nodes equipped with an ATmega128 processor running the TinyOS operating system. Our implementation uses a 192-bit prime field specified by the NIST as underlying algebraic structure and requires only 5.20 ·106 clock cycles to compute a scalar multiplication if the base point is fixed and known a priori. A scalar multiplication using a random base point takes about 12.33 ·106 cycles. Our results show that a full ECDH key exchange between two MICAz motes consumes an energy of 57.33 mJ (including radio communication), which is significantly better than most previously reported ECDH implementations on comparable platforms.

From a "perfect storm" to "smooth sailing": policymaker perspectives on implementation and sustainment of an evidence-based practice in two states.

PubMed

Willging, Cathleen E; Green, Amy E; Gunderson, Lara; Chaffin, Mark; Aarons, Gregory A

2015-02-01

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems. © The Author(s) 2014.

From a “Perfect Storm” to “Smooth Sailing”: Policymaker Perspectives on Implementation and Sustainment of an Evidence-Based Practice in Two States

PubMed Central

Willging, Cathleen E.; Green, Amy E.; Gunderson, Lara; Chaffin, Mark; Aarons, Gregory A.

2015-01-01

Policymakers shape implementation and sustainment of evidence-based practices (EBPs), whether they are developing or responding to legislation and policies or negotiating public sector resource constraints. As part of a large mixed-method study, we conducted qualitative interviews with 24 policymakers involved in delivery of the same EBP in two U.S. states. We analyzed transcripts via open and focused coding techniques to identify the commonality, diversity, and complexity of implementation challenges; approaches to overcoming those challenges; and the importance of system-level contextual factors in ensuring successful implementation. Key findings centered on building support and leadership for EBPs; funding and contractual strategies; partnering with stakeholders; tackling challenges via proactive planning and problem solving; and the political, legal, and systemic pressures affecting EBP longevity. The policymaker perspectives offer guidance on nurturing system and organizational practice environments to achieve positive outcomes and for optimally addressing macro-level influences that bear upon the instantiation of EBPs in public sector child welfare systems. PMID:25125232

Unpacking the concept of land degradation neutrality and addressing its operation through the Rio Conventions.

PubMed

Akhtar-Schuster, Mariam; Stringer, Lindsay C; Erlewein, Alexander; Metternicht, Graciela; Minelli, Sara; Safriel, Uriel; Sommer, Stefan

2017-06-15

The world's commitment towards land degradation neutrality (LDN) became enshrined in various international agreements and decisions throughout the year 2015. The challenge now becomes one of addressing its operation, in order to achieve these new policy goals and targets by the year 2030. Advancing LDN demands attention to what the concept seeks to achieve, as well as unravelling the perspectives of the key multi-lateral environmental agreements through which progress can be made. The three Rio Conventions (the UN Convention to Combat Desertification (UNCCD), the UN Framework Convention on Climate Change (UNFCCC) and the Convention on Biological Diversity (CBD)) all play key roles in shaping the international LDN governance and implementation context. Their different but related foci create a number of challenges and opportunities for advancing LDN. In this paper we critically analyze the literature to elucidate potential challenges and opportunities in moving LDN towards implementation, considering the mandates and objectives of all three Rio Conventions. We first unpack the concept of LDN's aspirations. We highlight the importance of the definitions and terminology used, and the relationships between those definitions, terms and the actors using them, as well as their implications in framing the range of policy actions and synergies that could benefit progress towards multiple Sustainable Development Goals. We then examine the LDN pilot project spearheaded by the UNCCD to identify key lessons for LDN implementation. Synthesizing these lessons, we present a portfolio of blended interventions that seeks to address the aspirations of the UNCCD, UNFCCC and CBD in the LDN space, identifying synergistic options for national actions to move towards LDN. Overall, our analysis provides insights in advancing LDN from its current position as a policy target, towards synergetic action. Copyright © 2016 Elsevier Ltd. All rights reserved.

E-learning policies, practices and challenges in two Norwegian organizations.

PubMed

Welle-Strand, Anne; Thune, Taran

2003-05-01

This article reports a pilot study on the uses of technology to enable learning within a formal educational setting in a higher education institution and within a corporation. These two Norwegian cases were selected due to their commitment to technology-enabled learning, as expressed in policy and strategy documents. The aim was to investigate the commitment and actual use of information and communications technology (ICT) for learning as well as what key actors think are the major challenges for successful large scale implementation of ICT for learning. The findings indicate that there is insufficient follow-up on e-learning policies and that there is a general lack of strategic direction and leadership in this area. The key challenges respondents highlight relate to the need for a systematic and pedagogical approach to e-learning in which three equally important considerations must be balanced: organization, pedagogy and technology. Key perspectives of a coherent pedagogical and organizational framework for planning e-learning are discussed.

Smokefree implementation in Colombia: Monitoring, outside funding, and business support.

PubMed

Uang, Randy; Crosbie, Eric; Glantz, Stanton A

2017-01-01

To analyze successful national smokefree policy implementation in Colombia, a middle income country. Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. Colombia's Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners' association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries.

Strengthening TB infection control in specialized health facilities in Romania--using a participatory approach.

PubMed

Turusbekova, N; Popa, C; Dragos, M; van der Werf, M J; Dinca, I

2016-02-01

In 2012, the tuberculosis (TB) notification rate among Romanian TB facility doctors and nurses was 7.2 times higher than in the general population. This indicates that transmission is ongoing inside TB facilities and that TB infection control measures are insufficient. To help prevent nosocomial TB transmission a project was implemented that aimed at providing nationwide tailor-made technical assistance in TB infection control (TB-IC) in TB treatment facilities, including the development of TB infection control plans. The objective of the present article is to describe the implementation of the project and to discuss successes and challenges. The project was an implementation study using two methods of evaluation: (1) a cross sectional questionnaire study; and (2) collection of information, during the training, on challenges related to infection control and to the project implementation. The project team developed a TB facility infection control (TB-IC) plan template, together with the Romanian experts. The template was discussed and agreed upon with the experts at a meeting and thereafter distributed by email to all TB facilities. Afterwards, a training of trainers (TOT) seminar was organized which included the provision of information about different training methods, as well as information about TB-IC. The TOT was followed by training for key TB-IC providers. Information about use of the TB-IC template was gathered through a self-administered questionnaire sent to all participants of the expert meeting and the training (42 people). Additionally, non-systematized discussions were held on broader challenges in TB-IC implementation during the training. Within the project 42 key TB-IC service providers were trained in TB-IC, including 9 who were trained at a TOT seminar. The trainees were specialists working at the national level, such as country TB coordinators, or at the TB facility level: TB doctors, epidemiologists, laboratory specialists and maintenance engineers. Out of 42 key TB-IC service providers who were trained, only eighteen responded to the questionnaire (no reminders were sent). Out of these, 14 had used the TB-IC plan template after the project team disseminated it to them by email. The remaining four TB-IC service providers indicated that they were planning to use the template to develop or update their facility TB-IC plans. Related to the use of TB-IC plan template, the following broader challenges in TB-IC were identified: a lack of authority of the individuals responsible for TB-IC to implement the TB-IC measures, lack of training among facility epidemiologists on TB, underdeveloped system for reporting TB in healthcare workers, difficulties with triage of the TB suspects, and poor facility infrastructure hampering implementation of TB-IC measures. Implementing TB-IC plans in Romanian health care facilities proved to be challenging, mainly due to the fact that the national infection control plan for TB was not yet adopted at the time of project implementation, and therefore there was neither a regulatory framework to support TB facility-IC planning nor any related budget allocations for the implementation of the facilities' TB-IC plans. Nonetheless, most respondents who answered the questionnaire (18 of 42 responded) indicated that they had started using the TB-IC plan template, which represents a full package of infection control measures that, when implemented effectively and in its entirety, may be expected to reduce nosocomial transmission. The study's limitations are: very low survey response rate, thus there is a likelihood of responder bias. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Redesigning a Ministry of Health's organizational structure: exploring implementation challenges through Botswana's experiences.

PubMed

Seitio-Kgokgwe, Onalenna; Gauld, Robin D C; Hill, Philip C; Barnett, Pauline

2016-04-01

The Botswana's Ministry of Health redesigned and adopted a new organizational structure in 2005, which was poorly implemented. This article explores factors that influenced the implementation of this organizational structure. This article draws from data collected through in-depth interviews with 54 purposively selected key informants comprising policy makers, senior managers and staff of the Ministry of Health (N = 40) and senior officers from various stakeholder organizations (N = 14). Participants generally felt that the review of the Ministry of Health organizational structure was important. The previous structure was considered obsolete with fragmented functions that limited the overall performance of the health system. The new organizational structure was viewed to be aligned to current national priorities with potential to positively influence performance. Some key weaknesses identified included lack of consultation and information sharing with workers during the restructuring process, which affected the understanding of their new roles, failure to mobilize key resources to support implementation of the new structure and inadequate monitoring of the implementation process. Redesigning an organizational structure is a major change. There is a need for effective and sustained leadership to plan, direct, coordinate, monitor and evaluate the implementation phase of the reform. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

NASA and the challenge of ISDN: The role of satellites in an ISDN world

NASA Technical Reports Server (NTRS)

Byerly, Radford; Barnes, Frank; Codding, George; Hofgard, Jefferson

1988-01-01

To understand what role satellites may play in Integrated Services Digital Network (ISDN), it is necessary to understand the concept of ISDN, including key organizations involved, the current status of key standards recommendations, and domestic and international progress implementation of ISDN. Each of these areas are explained. A summary of the technical performance criteria for ISDN, current standards for satellites in ISDN, key players in the ISDN environment, and what steps can be taken to encourage application of satellites in ISDN are also covered.

Deliberation Makes a Difference: Preparation Strategies for TeamSTEPPS Implementation in Small and Rural Hospitals

PubMed Central

Zhu, Xi; Baloh, Jure; Ward, Marcia M.; Stewart, Greg L.

2016-01-01

Small and rural hospitals face special challenges to implement and sustain organization-wide quality improvement (QI) initiatives due to limited resources and infrastructures. We studied the implementation of TeamSTEPPS, a national QI initiative, in 14 critical access hospitals. Drawing on QI and organization development theories, we propose five strategic preparation steps for TeamSTEPPS: assess needs, reflect on the context, set goals, develop a shared understanding, and select change agents. We explore how hospitals’ practices correspond to suggested best practices by analyzing qualitative data collected through quarterly interviews with key informants. We find that the level of deliberation was a key factor that differentiated hospitals’ practices. Hospitals that were more deliberate in preparing for the five strategic steps were more likely to experience engagement, perceive efficacy, foresee and manage barriers, and achieve progress during implementation. We discuss potential steps that hospitals may take to better prepare for TeamSTEPPS implementation. PMID:26429835

A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities.

PubMed

Hunting, Gemma; Shahid, Nida; Sahakyan, Yeva; Fan, Iris; Moneypenny, Crystal R; Stanimirovic, Aleksandra; North, Taylor; Petrosyan, Yelena; Krahn, Murray D; Rac, Valeria E

2015-12-09

Despite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the program across three regions where it was first implemented. The study employs a multi-level framework as a conceptual guide to explore the facilitators and barriers to Telehomecare implementation and adoption across five levels: technology, patients, providers, organizations, and structures. In-depth semi-structured interviews and ethnographic observations with program stakeholders, as well as a Telehomecare document review were used to elicit key themes. Study participants (n = 89) included patients and/or informal caregivers (n = 39), health care providers (n = 23), technicians (n = 2), administrators (n = 12), and decision makers (n = 13) across three different Local Health Integration Networks in Ontario. Key facilitators to Telehomecare implementation and adoption at each level of the multi-level framework included: user-friendliness of Telehomecare technology, patient motivation to participate in the program, support for Telehomecare providers, the integration of Telehomecare into broader health service provision, and comprehensive program evaluation. Key barriers included: access-related issues to using the technology, patient language (if not English or French), Telehomecare provider time limitations, gaps in health care provision for patients, and structural barriers to patient participation related to geography and social location. Though Telehomecare has the potential to positively impact patient lives and strengthen models of health care provision, a number of key challenges remain. As such, further implementation and expansion of Telehomecare must involve continuous assessments of what is working and not working with all stakeholders. Increased dialogue, evaluation, and knowledge translation within and across regions to understand the contextual factors influencing Telehomecare implementation and adoption is required. This can inform decision-making that better reflects and addresses the needs of all program stakeholders.

Facilitating Organizational Learning in the Russian Business Context

ERIC Educational Resources Information Center

Molodchik, Mariia; Jardon, Carlos

2015-01-01

Purpose: The paper aims to identify particular traits of the Russian context which condition two key enablers of organizational learning--organizational culture and transformational leadership. Design/methodology/approach: Drawing on a literature review, the study determines management challenges by implementation of organizational learning in the…

Evidence-based Controls for Epidemics Using Spatio-temporal Stochastic Model as a Bayesian Framwork

USDA-ARS?s Scientific Manuscript database

The control of highly infectious diseases of agricultural and plantation crops and livestock represents a key challenge in epidemiological and ecological modelling, with implemented control strategies often being controversial. Mathematical models, including the spatio-temporal stochastic models con...

Pediatric Care Coordination: Lessons Learned and Future Priorities.

PubMed

Cady, Rhonda G; Looman, Wendy S; Lindeke, Linda L; LaPlante, Bonnie; Lundeen, Barbara; Seeley, Amanda; Kautto, Mary E

2015-09-30

A fundamental component of the medical home model is care coordination. In Minnesota, this model informed design and implementation of the state's health care home (HCH) model, a key element of statewide healthcare reform legislation. Children with medical complexity (CMC) often require care from multiple specialists and community resources. Coordinating this multi-faceted care within the HCH is challenging. This article describes the need for specialized models of care coordination for CMC. Two models of care coordination for CMC were developed to address this challenge. The TeleFamilies Model of Pediatric Care Coordination uses an advanced practice registered nurse care (APRN) coordinator embedded within an established HCH. The PRoSPer Model of Pediatric Care Coordination uses a registered nurse/social worker care coordinator team embedded within a specialty care system. We describe key findings from implementation of these models, and conclude with lessons learned. Replication of the models is encouraged to increase the evidence base for care coordination for the growing population of children with medical complexities.

Schools as Sites for Recruiting Participants and Implementing Research.

PubMed

Bartlett, Robin; Wright, Tiffany; Olarinde, Tia; Holmes, Tara; Beamon, Emily R; Wallace, Debra

2017-01-01

Schools can be a valuable resource for recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools can assist researchers in developing effective school partnerships. This article discusses the advantages of conducting research within the school system as well as the challenges that may also arise. Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schools are provided.

Early phase clinical trials with human immunodeficiency virus-1 and malaria vectored vaccines in The Gambia: frontline challenges in study design and implementation.

PubMed

Afolabi, Muhammed O; Adetifa, Jane U; Imoukhuede, Egeruan B; Viebig, Nicola K; Kampmann, Beate; Bojang, Kalifa

2014-05-01

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and malaria are among the most important infectious diseases in developing countries. Existing control strategies are unlikely to curtail these diseases in the absence of efficacious vaccines. Testing of HIV and malaria vaccines candidates start with early phase trials that are increasingly being conducted in developing countries where the burden of the diseases is high. Unique challenges, which affect planning and implementation of vaccine trials according to internationally accepted standards have thus been identified. In this review, we highlight specific challenges encountered during two early phase trials of novel HIV-1 and malaria vectored vaccine candidates conducted in The Gambia and how some of these issues were pragmatically addressed. We hope our experience will be useful for key study personnel involved in day-to-day running of similar clinical trials. It may also guide future design and implementation of vaccine trials in resource-constrained settings.

Software design and implementation concepts for an interoperable medical communication framework.

PubMed

Besting, Andreas; Bürger, Sebastian; Kasparick, Martin; Strathen, Benjamin; Portheine, Frank

2018-02-23

The new IEEE 11073 service-oriented device connectivity (SDC) standard proposals for networked point-of-care and surgical devices constitutes the basis for improved interoperability due to its independence of vendors. To accelerate the distribution of the standard a reference implementation is indispensable. However, the implementation of such a framework has to overcome several non-trivial challenges. First, the high level of complexity of the underlying standard must be reflected in the software design. An efficient implementation has to consider the limited resources of the underlying hardware. Moreover, the frameworks purpose of realizing a distributed system demands a high degree of reliability of the framework itself and its internal mechanisms. Additionally, a framework must provide an easy-to-use and fail-safe application programming interface (API). In this work, we address these challenges by discussing suitable software engineering principles and practical coding guidelines. A descriptive model is developed that identifies key strategies. General feasibility is shown by outlining environments in which our implementation has been utilized.

Interaction dynamics: The case of the water sector skills plan in South Africa.

PubMed

Moyo, Laurane; Wehn, Uta

2017-02-01

Despite extensive and continuous efforts to strengthen the capacity of people, organizations and institutions, there is evidence of an increasing gap between the existing and required capacities within the water sector. Consensus seems to be emerging regarding the need for national strategies to improve water sector capacity development. This paper analyses the dynamics of actors' interactions and their characteristics (motivation, cognition and power) during the formulation and implementation of a specific capacity development strategy, namely the Water Sector Skills Plan (SSP) in South Africa. Based on the Contextual Interactive Theory and empirical findings, our analysis indicates slow progression and challenges with implementing the SSP, mainly due to the lack of consultation with key stakeholders during the formulation stage, a lack of data sharing among the target group (the Sector Education Training Authorities), and a lack of capacities within the key implementing organizations. These policy dynamics need to be taken into account when advocating for national capacity development strategies as a solution for challenges with water sector capacity development. The paper proposes the recommendations that are of relevance for the SSP as well as similar initiatives in other countries. Copyright © 2016. Published by Elsevier Ltd.

Diagnosis and predictive molecular analysis of non-small-cell lung cancer in the Africa-Middle East region: challenges and strategies for improvement.

PubMed

Slavik, Tomas; Asselah, Fatima; Fakhruddin, Najla; El Khodary, Ahmed; Torjman, Fairouz; Anis, Elia; Quinn, Martin; Khankan, Azzam; Kerr, Keith M

2014-11-01

The identification of tumor biomarkers provides information on the prognosis and guides the implementation of appropriate treatment in patients with many different cancer types. In non-small cell lung cancer (NSCLC), targeted treatment plans based on biomarker identification have already been used in the clinic. However, such predictive molecular testing is not currently a universally used practice. This is the case, in particular, in developing countries where lung cancer is increasingly prevalent. In September 2012 and November 2013, a committee of 16 lung cancer experts from Africa and the Middle East met to discuss key issues related to diagnosis and biomarker testing in NSCLC and the implementation of personalized medicine in the region. The committee identified current challenges for effective diagnosis and predictive analysis in Africa and the Middle East. Moreover, strategies to encourage the implementation of biomarker testing were discussed. A practical approach for the effective diagnosis and predictive molecular testing of NSCLC in these regions was derived. We present the key issues and recommendations arising from the meetings. Copyright © 2014 Elsevier Inc. All rights reserved.

Insights from a conference on implementing comparative effectiveness research through shared decision-making

PubMed Central

Politi, Mary C; Clayman, Marla L; Fagerlin, Angela; Studts, Jamie L; Montori, Victor

2013-01-01

For decades, investigators have conducted innovative research on shared decision-making (SDM), helping patients and clinicians to discuss health decisions and balance evidence with patients' preferences for possible outcomes of options. In addition, investigators have developed and used rigorous methods for conducting comparative effectiveness research (CER), comparing the benefits and risks of different interventions in real-world settings with outcomes that matter to patients and other stakeholders. However, incorporating CER findings into clinical practice presents numerous challenges. In March 2012, we organized a conference at Washington University in St Louis (MO, USA) aimed at developing a network of researchers to collaborate in developing, conducting and disseminating research about the implementation of CER through SDM. Meeting attendees discussed conceptual similarities and differences between CER and SDM, challenges in implementing CER and SDM in practice, specific challenges when engaging SDM with unique populations and examples of ways to overcome these challenges. CER and SDM are related processes that emphasize examining the best clinical evidence and how it applies to real patients in real practice settings. SDM can provide one opportunity for clinicians to discuss CER findings with patients and engage in a dialog about how to manage uncertainty about evidence in order to make decisions on an individual patient level. This meeting highlighted key challenges and suggested avenues to pursue such that CER and SDM can be implemented into routine clinical practice. PMID:23430243

Phased implementation of spaced clinic visits for stable HIV-positive patients in Rwanda to support Treat All.

PubMed

Nsanzimana, Sabin; Remera, Eric; Ribakare, Muhayimpundu; Burns, Tracy; Dludlu, Sibongile; Mills, Edward J; Condo, Jeanine; Bucher, Heiner C; Ford, Nathan

2017-07-21

In 2016, Rwanda implemented "Treat All," requiring the national HIV programme to increase antiretroviral (ART) treatment coverage to all people living with HIV. Approximately half of the 164,262 patients on ART have been on treatment for more than five years, and long-term retention of patients in care is an increasing concern. To address these challenges, the Ministry of Health has introduced a differentiated service delivery approach to reduce the frequency of clinical visits and medication dispensing for eligible patients. This article draws on key policy documents and the views of technical experts involved in policy development to describe the process of implementation of differentiated service delivery in Rwanda. Implementation of differentiated service delivery followed a phased approach to ensure that all steps are clearly defined and agreed by all partners. Key steps included: definition of scope, including defining which patients were eligible for transition to the new model; definition of the key model components; preparation for patient enrolment; considerations for special patient groups; engagement of implementing partners; securing political and financial support; forecasting drug supply; revision, dissemination and implementation of ART guidelines; and monitoring and evaluation. Based on the outcomes of the evaluation of the new service delivery model, the Ministry of Health will review and strategically reduce costs to the national HIV program and to the patient by exploring and implementing adjustments to the service delivery model.

Institutions and the implementation of tobacco control in Brazil.

PubMed

Lencucha, Raphael; Drope, Jeffrey; Bialous, Stella Aguinaga; Richter, Ana Paula; Silva, Vera Luiza da Costa E

2017-10-19

This research examines the institutional features of Brazil's National Commission for the Implementation of the Framework Convention on Tobacco Control (CONICQ) and how these institutional features have facilitated and hindered its ability to foster intersectoral tobacco control. In particular, we evaluate the key institutional features of CONICQ starting from when it was one of the key drivers of change and improvements in early tobacco control policies, which helped to make Brazil a world leader in this area. We also examine how the committee has evolved, as tobacco control has improved and particularly elucidate some of the major challenges that it faces to bring together often disparate government sectors to generate public health policies.

Behaviour change for better health: nutrition, hygiene and sustainability.

PubMed

Newson, Rachel S; Lion, Rene; Crawford, Robert J; Curtis, Valerie; Elmadfa, Ibrahim; Feunekes, Gerda I J; Hicks, Cheryl; van Liere, Marti; Lowe, C Fergus; Meijer, Gert W; Pradeep, B V; Reddy, K Srinath; Sidibe, Myriam; Uauy, Ricardo

2013-01-01

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled 'Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability'. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today's environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes - particularly in developing and emerging countries - imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public-private partnerships.

Behaviour change for better health: nutrition, hygiene and sustainability

PubMed Central

2013-01-01

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled ‘Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability’. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today’s environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes – particularly in developing and emerging countries – imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public–private partnerships. PMID:23530770

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Implementing an interprofessional first-year teamwork project: some key reflections.

PubMed

McNaughton, Susan Maree

2013-09-01

Implementing an interprofessional teamwork project for first-year students presents pedagogical and practical challenges. While transferable skills and attributes are important, engagement of students with limited professional experience in teamwork depends on relevance to current learning needs. This report outlines principles learned from planning and implementing a teamwork project for an interprofessional health administration and service development course. Practising interprofessional teamwork as leaders and teachers, aligning with previous, current and future teamwork content and processes and responding to student feedback and achievement have been the key factors in shaping the project over three semesters. Face-to-face and online interprofessional teamwork learning has necessitated developing resources that support self-direction, using familiar technology and providing enabling physical environments. Implications for first-year interprofessional teamwork are that structured well-resourced processes, responsiveness and alignment of learning all improve student outcomes.

Concepts for Telephone-Based Health Education

ERIC Educational Resources Information Center

Brouse, Corey H.; Basch, Charles E.

2004-01-01

A key challenge facing cancer educators is the extent to which effective programmes can be widely disseminated and implemented. Differences between target populations with respect to social, psychological, and educational characteristics, as well as the social and economic context make it difficult to replicate "cookbook" approaches. Tailoring of…

A social marketing approach to changing mental health practices directed at youth and adolescents.

PubMed

Andreason, Alan R

2004-01-01

The mental health problems of children are of increasing social concern. Many best practices have been developed but often not implemented. Social marketing has been suggested as an innovative, useful approach to this challenge-along with others in the health care field. However, much confusion exists over what the approach entails, where it has been applied and how it can be adapted to significant social challenges such as changing mental health practices directed at youth and adolescents. This article defines key terms, offers historical perspective and provides a specific approach and set of models to implement an effective social marketing strategy in a range of contexts.

Implementing a strategy to promote lifelong learning in the primary care workforce: an evaluation of leadership roles, change management approaches, interim challenges and achievements.

PubMed

McLaren, Susan; Woods, Leslie; Boudioni, Markella; Lemma, Ferew; Tavabie, Abdol

2008-01-01

To identify and explore leadership roles and responsibilities for implementing the workforce development strategy; to identify approaches used to implement and disseminate the strategy; and to identify and explore challenges and achievements in the first 18 months following implementation. A formative evaluation with qualitative methods was used. Documentary analysis, interviews (n = 29) and two focus groups (n = 12) were conducted with a purposive sample of individuals responsible for strategy implementation. Data were transcribed and analysed thematically using framework analysis. Regional health area in Kent, Surrey and Sussex: 24 primary care trusts (PCTs) and 900 general practices. Primary care workforce tutors, lifelong learning advisors, GP tutors, patch associate GP deans and chairs of PCT education committees all had vital leadership roles, some existing and others newly developed. Approaches used to implement the strategy encompassed working within and across organisational boundaries, communication and dissemination of information. Challenges encountered by implementers were resistance to change - evident in some negative attitudes to uptake of training and development opportunities - and role diversity and influence. Achievements included successes in embedding appraisal and protected learning time, and changes in educational practices and services. The use of key leadership roles and change-management approaches had brought about early indications of positive transition in lifelong learning cultures.

[Evidence based practice of nurses working in university hospitals in the French speaking part of Switzerland: a descriptive and correlational study

PubMed

Gentizon, Jenny; Borrero, Patricia; Vincent-Suter, Sonja; Ballabeni, Pierluigi; Morin, Diane; Eicher, Manuela

2016-12-01

Introduction : evidence-based practice (EBP) is too scarcely applied in nursing and is a key contemporary challenge for the discipline. Method and objective : This descriptive and correlational study invited 221 nurses working in three different clinical settings of university hospitals in Switzerland. The objective of this study was to describe their level of knowledge, beliefs and implementation of EBP. Results : of the 221 nurses in this study, only 67 were familiar EBP (30%). These demonstrate favorable beliefs and attitudes towards EBP, but indicate a lack of skills and knowledge to implement it. Compared to both internal medicine and geriatric nurses clinical nurse specialists (ISC) were significantly more familiar with EBP and its implementation. Results also indicate that positive nurses’ beliefs and attitudes toward EBP are predictive of better implementation in clinical practice. Discussion and Conclusion : as demonstrated in other studies, our results show that knowledge about EBP is not that widespread and its implementation remains a challenge even in university hospitals. Future work could include testing EBP implementation strategies to overcome the barriers identified.

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations.

PubMed

Tuot, Delphine S; Leeds, Kiren; Murphy, Elizabeth J; Sarkar, Urmimala; Lyles, Courtney R; Mekonnen, Tekeshe; Chen, Alice H M

2015-12-19

Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.

Stakeholders' views on the ethical challenges of pragmatic trials investigating pharmaceutical drugs.

PubMed

Kalkman, Shona; van Thiel, Ghislaine J M W; Grobbee, Diederick E; Meinecke, Anna-Katharina; Zuidgeest, Mira G P; van Delden, Johannes J M

2016-08-22

We explored the views of key stakeholders to identify the ethical challenges of pragmatic trials investigating pharmaceutical drugs. A secondary aim was to capture stakeholders' attitudes towards the implementation of pragmatic trials in the drug development process. We conducted semistructured, in-depth interviews among individuals from different key stakeholder groups (academia and independent research institutions, the pharmaceutical industry, regulators, Health Technology Assessment (HTA) agencies and patients' organizations) through telephone or face-to-face sessions. Interviews were structured around the question "what challenges were experienced or perceived during the design, conduct and/or review of pragmatic trials." Respondents were additionally asked about their views on implementation of pragmatic trials in the drug development process. Thematic analysis was used to identify the ethically relevant features across data sets. We interviewed 34 stakeholders in 25 individual sessions and four group sessions. The four perceived challenges of ethical relevance were: (1) less controlled conditions creating safety concerns, (2) comparison with usual care potentially compromising clinical equipoise, (3) tailored or waivers of informed consent affecting patient autonomy, and (4) minimal interference with "real-world" practice reducing the knowledge value of trial results. We identified stakeholder concerns regarding risk assessment, use of suboptimal usual care as a comparator, tailoring of informed consent procedures and ensuring the social value of pragmatic trials. These concerns increased when respondents were asked about pragmatic trials conducted before market authorization.

Advancing antimicrobial stewardship: Summary of the 2015 CIDSC Report.

PubMed

Khan, F; Arthur, J; Maidment, L; Blue, D

2016-11-03

Antimicrobial resistance (AMR) is recognized as an important global public health concern that has a cross-cutting impact on human health, animal health, food and agriculture and the environment. The Communicable and Infectious Disease Steering Committee (CIDSC) of the Pan-Canadian Public Health Network (PHN) created a Task Group on Antimicrobial Stewardship to look at this issue from a Canadian perspective. To summarize the key findings of the Task Group Report that identified core components of antimicrobial stewardship programs, best practices, key challenges, gaps and recommendations to advance stewardship across jurisdictions. Search strategies were developed to identify scientific literature, grey literature and relevant websites on antimicrobial stewardship. The information was reviewed and based on this evidence, expert opinion and consensus-building, the Task Group identified core components, best practices, key challenges and gaps and developed recommendations to advance stewardship in Canada. The four components of a promising antimicrobial stewardship initiative were: leadership, interventions, monitoring/evaluation and future research. Best practices include a multi-sectoral/multipronged approach involving a wide range of stakeholders at the national, provincial/territorial, local and health care organizational levels. Key challenges and gaps identified were: the success and sustainability of stewardship undertakings require appropriate and sustained resourcing and expertise; there is limited evidence about how to effectively implement treatment guidance; and there is a challenge in ensuring accessibility, standardization and consistency of use among professionals. ​: Recommendations to the CIDSC about how to advance stewardship across jurisdictions included the following: institute a national infrastructure; develop best practices to implement stewardship programs; develop education and promote awareness; establish consistent evidence-based guidance, resources, tools and training; mandate the incorporation of stewardship education; develop audit and feedback tools; establish benchmarks and performance targets for stewardship; and conduct timely evaluation of stewardship programs. Findings of this report will inform a more systematic approach to addressing antimicrobial stewardship Canada-wide.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

PubMed

Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-06-01

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Implementation of emergency department transfer communication measures in Minnesota critical access hospitals.

PubMed

Klingner, Jill; Moscovice, Ira; Casey, Michelle; McEllistrem Evenson, Alex

2015-01-01

Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale. © 2014 National Rural Health Association.

Smokefree implementation in Colombia: Monitoring, outside funding, and business support

PubMed Central

Uang, Randy; Crosbie, Eric; Glantz, Stanton A

2017-01-01

Objective To analyze successful national smokefree policy implementation in Colombia, a middle income country. Materials and methods Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. Results Colombia’s Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners’ association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. Conclusions Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries. PMID:28562713

Opportunities and challenges in implementing community based skilled birth attendance strategy in Kenya.

PubMed

Mannah, Margaret Titty; Warren, Charlotte; Kuria, Shiphrah; Adegoke, Adetoro A

2014-08-15

Availability of skilled care at birth remains a major problem in most developing countries. In an effort to increase access to skilled birth attendance, the Kenyan government implemented the community midwifery programme in 2005. The aim of this programme was to increase women's access to skilled care during pregnancy, childbirth and post-partum within their communities. Qualitative research involving in-depth interviews with 20 community midwives and six key informants. The key informants were funder, managers, coordinators and supervisors of the programme. Interviews were conducted between June to July, 2011 in two districts in Western and Central provinces of Kenya. Findings showed major challenges and opportunities in implementing the community midwifery programme. Challenges of the programme were: socio-economic issues, unavailability of logistics, problems of transportation for referrals and insecurity. Participants also identified the advantages of having midwives in the community which were provision of individualised care; living in the same community with clients which made community midwives easily accessible; and flexible payment options. Although the community midwifery model is a culturally acceptable method to increase skilled birth attendance in Kenya, the use of skilled birth attendance however remains disproportionately lower among poor mothers. Despite several governmental efforts to increase access and coverage of delivery services to the poor, it is clear that the poor may still not access skilled care even with skilled birth attendants residing in the community due to several socio-economic barriers.

Human Performance Technology and Knowledge Management: A Case Study

ERIC Educational Resources Information Center

Massey, Anne P.; Montoya-Weiss, Mitzi M.; O'Driscoll, Tony M.

2005-01-01

As organizations respond to competitive environments and strive to enhance performance, knowledge management (KM) has increasingly become a strategic activity. A KM strategy entails consciously helping people share and put knowledge into action. A key challenge is how to develop and implement KM solutions that provide performance support to…

Rethinking the High School Diploma

ERIC Educational Resources Information Center

Finn, Chester E., Jr.; Kahlenberg, Richard D.; Kress, Sandy

2015-01-01

As states move to implement the Common Core State Standards, key challenges remain. One is how to make sure a high school diploma acknowledges what students have achieved. Should states adopt a two tiered diploma, in which students who pass internationally aligned Common Core exams at a career- and college-ready level receive an…

Introducing IT Strategy in an Introductory Course

ERIC Educational Resources Information Center

Woods, David M.

2016-01-01

Professionals working in technology fields face continuing challenges to be involved in the decision-making process about how technology is used by organizations rather than just implementing these decisions. Developing skills for thinking and acting strategically are key skills for our students. This has been recognized by the addition of an IS…

A Multiyear Investigation of Combating Bullying in Middle School: Stakeholder Perspectives

ERIC Educational Resources Information Center

Shriberg, David; Burns, Mallory; Desai, Poonam; Grunewald, Stephanie; Pitt, Rachel

2015-01-01

Working collaboratively to address bullying among middle school students is an ongoing challenge. This study used participatory action research to collaborate with key stakeholders within a middle school to identify needs and implement more effective practices. Extensive qualitative and quantitative data are presented, along with process…

Keys to Successful Community Health Worker Supervision

ERIC Educational Resources Information Center

Duthie, Patricia; Hahn, Janet S.; Philippi, Evelyn; Sanchez, Celeste

2012-01-01

For many years community health workers (CHW) have been important to the implementation of many of our health system's community health interventions. Through this experience, we have recognized some unique challenges in community health worker supervision and have highlighted what we have learned in order to help other organizations effectively…

Teacher Training in Afghanistan: Intersections of Need and Reality

ERIC Educational Resources Information Center

Husting, Sheila; Intili, Jo Ann; Kissam, Edward

2008-01-01

As post-Taliban Afghanistan moves toward the establishment of a viable educational system, key stakeholders and donors are faced with the formidable challenge of how to most rapidly implement teacher training within an environment of diverse, changing, and largely unassessed training needs. The current article explores the dilemmas inherent in…

Design and implementation of a cross-sectional nutritional phenotyping study of healthy US adults

USDA-ARS?s Scientific Manuscript database

Metabolic imbalance is a key determinant of risk of chronic diseases. Metabolic health cannot be assessed solely by body mass calculations or by static, fasted state biochemical readouts. Although previous studies have described temporal responses to dietary challenges, these studies fail to assess ...

The Constellation-X Mission: Science Prospects and Technology Challenges

NASA Technical Reports Server (NTRS)

Petre, Robert

2007-01-01

This talk will describe the Constellation-X mission. It will present the key scientific goals, relating to strong gravity, dark energy, ultra-dense matter and cosmic structure. The mission configuration will be described. Emphasis will be placed on the design and anticipated implementation of the X-ray mirror system.

A framework for addressing implementation gap in global drowning prevention interventions: experiences from Bangladesh.

PubMed

Hyder, Adnan A; Alonge, Olakunle; He, Siran; Wadhwaniya, Shirin; Rahman, Fazlur; El Arifeen, Shams

2014-12-01

Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning-global funding, political will, scale, sustainability, and capacity building; (ii) engaging-coordination, involvement of appropriate individuals; (iii) executing-focused action, multisectoral actions, quality of execution; and (iv) evaluating-rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings.

Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders.

PubMed

Coronado, Gloria D; Schneider, Jennifer L; Petrik, Amanda; Rivelli, Jennifer; Taplin, Stephen; Green, Beverly B

2017-09-01

Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.

Making habitat connectivity a reality.

PubMed

Keeley, Annika T H; Basson, Galli; Cameron, D Richard; Heller, Nicole E; Huber, Patrick R; Schloss, Carrie A; Thorne, James H; Merenlender, Adina M

2018-06-19

For over 40 years, habitat corridors have been a solution for sustaining wildlife in fragmented landscapes, and now are often suggested as a climate adaptation strategy. However, while a plethora of connectivity plans exist, protecting and restoring habitat connectivity through on-the-ground action has been slow. We identified implementation challenges and opportunities through a literature review of project implementation, a science-practice workshop, and interviews with conservation professionals. Our research indicates that connectivity challenges and solutions tend to be context-specific, dependent on land ownership patterns, socioeconomic factors, and the policy framework. We found evidence that developing and promoting a common vision shared by a diverse set of stakeholders including nontraditional conservation actors, such as water districts and recreation departments, and through communication among and between partners and the public is key to successful implementation. Other factors that lead to successful implementation include undertaking empirical studies to prioritize and validate corridors and the identification of related co-benefits of corridor projects. Engaging partners involved in land management and planning, such as non-governmental conservation organizations, public agencies, and private landowners is critical to effective strategy implementation. A clear regulatory framework including unambiguous connectivity conservation mandates would increase public resource allocation, and incentive programs are needed to promote private sector engagement. We argue that connectivity conservation must more rapidly move from planning to implementation and provide an evidence-based solution made up of key elements for successful on-the-ground connectivity implementation. The components of this new framework constitute the social processes necessary to advance habitat connectivity for biodiversity conservation and resilient landscapes under climate change. Three case studies serve to illustrate the application of the framework. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Partnerships for Policy Development: A Case Study From Uganda’s Costed Implementation Plan for Family Planning

PubMed Central

Lipsky, Alyson B; Gribble, James N; Cahaelen, Linda; Sharma, Suneeta

2016-01-01

ABSTRACT In global health, partnerships between practitioners and policy makers facilitate stakeholders in jointly addressing those issues that require multiple perspectives for developing, implementing, and evaluating plans, strategies, and programs. For family planning, costed implementation plans (CIPs) are developed through a strategic government-led consultative process that results in a detailed plan for program activities and an estimate of the funding required to achieve an established set of goals. Since 2009, many countries have developed CIPs. Conventionally, the CIP approach has not been defined with partnerships as a focal point; nevertheless, cooperation between key stakeholders is vital to CIP development and execution. Uganda launched a CIP in November 2014, thus providing an opportunity to examine the process through a partnership lens. This article describes Uganda’s CIP development process in detail, grounded in a framework for assessing partnerships, and provides the findings from 22 key informant interviews. Findings reveal strengths in Uganda’s CIP development process, such as willingness to adapt and strong senior management support. However, the evaluation also highlighted challenges, including district health officers (DHOs), who are a key group of implementers, feeling excluded from the development process. There was also a lack of planning around long-term partnership practices that could help address anticipated execution challenges. The authors recommend that future CIP development efforts use a long-term partnership strategy that fosters accountability by encompassing both the short-term goal of developing the CIP and the longer-term goal of achieving the CIP objectives. Although this study focused on Uganda’s CIP for family planning, its lessons have implications for any policy or strategy development efforts that require multiple stakeholders to ensure successful execution. PMID:27353621

Commentary: Pediatric eHealth Interventions: Common Challenges During Development, Implementation, and Dissemination

PubMed Central

Steele, Ric G.; Connelly, Mark A.; Palermo, Tonya M.; Ritterband, Lee M.

2014-01-01

Objective To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. Methods The article draws on the existing eHealth literature and the authors’ collective experience in pediatric eHealth research. Results and conclusions The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. PMID:24816766

Political economy challenges in nutrition.

PubMed

Balarajan, Yarlini; Reich, Michael R

2016-11-05

Historically, implementing nutrition policy has confronted persistent obstacles, with many of these obstacles arising from political economy sources. While there has been increased global policy attention to improving nutrition in recent years, the difficulty of translating this policy momentum into results remains. We present key political economy themes emanating from the political economy of nutrition literature. Together, these interrelated themes create a complex web of obstacles to moving nutrition policy forward. From these themes, we frame six political economy challenges facing the implementation of nutrition policy today. Building awareness of the broader political and economic issues that shape nutrition actions and adopting a more systematic approach to political economy analysis may help to mitigate these challenges. Improving nutrition will require managing the political economy challenges that persist in the nutrition field at global, national and subnational levels. We argue that a "mindshift" is required to build greater awareness of the broader political economy factors shaping the global nutrition landscape; and to embed systematic political economy analysis into the work of stakeholders navigating this field. This mindshift may help to improve the political feasibility of efforts to reform nutrition policy and implementation-and ensure that historical legacies do not continue to shape the future.

A Generalized Framework for Modeling Next Generation 911 Implementations.

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

Kelic, Andjelka; Aamir, Munaf Syed; Kelic, Andjelka

This document summarizes the current state of Sandia 911 modeling capabilities and then addresses key aspects of Next Generation 911 (NG911) architectures for expansion of existing models. Analysis of three NG911 implementations was used to inform heuristics , associated key data requirements , and assumptions needed to capture NG911 architectures in the existing models . Modeling of NG911 necessitates careful consideration of its complexity and the diversity of implementations. Draft heuristics for constructing NG911 models are pres ented based on the analysis along with a summary of current challenges and ways to improve future NG911 modeling efforts . We foundmore » that NG911 relies on E nhanced 911 (E911) assets such as 911 selective routers to route calls originating from traditional tel ephony service which are a majority of 911 calls . We also found that the diversity and transitional nature of NG911 implementations necessitates significant and frequent data collection to ensure that adequate model s are available for crisis action support .« less

Review of 11 national policies for rare diseases in the context of key patient needs.

PubMed

Dharssi, Safiyya; Wong-Rieger, Durhane; Harold, Matthew; Terry, Sharon

2017-03-31

Rare diseases collectively exert a global public health burden in the severity of their manifestations and the total number of people they afflict. For many patients, considerable barriers exist in terms of access to appropriate care, delayed diagnosis and limited or non-existing treatment options. Motivated by these challenges, the rare disease patient community has played a critical role, elevating the patient voice and mobilizing legislation to support the development of programs that address the needs of patients with rare diseases.The US Orphan Drug Act of 1983 served as a key milestone in this journey, providing a roadmap for other countries to introduce and implement similar orphan drug legislation; more recently, the European Union (EU) has gone further to encourage the widespread adoption and implementation of rare disease plans or strategies designed to more adequately address the comprehensive needs of patients with rare diseases. Despite these legislative efforts and the growing contributions of patient advocacy groups in moving forward implementation and adoption of rare disease programs, gaps still exist across the policy landscape for several countries. To gain deeper insights into the challenges and opportunities to address key needs of rare disease patients, it is critical to define the current status of rare disease legislation and policy across a geographically and economically diverse selection of countries. We analyzed the rare disease policy landscape across 11 countries: Germany, France, the United Kingdom, Canada, Bulgaria, Turkey, Argentina, Mexico, Brazil, China, and Taiwan. The status and implementation of policy was evaluated for each country in the context of key patient needs across 5 dimensions: improving coordination of care, diagnostic resources, access to treatments, patient awareness and support, and promoting innovative research. Our findings highlight the continuing role of the patient community in driving the establishment and adoption of legislation and programs to improve rare disease care. Further, we found that while national rare disease plans provide important guidance for improving care, implementation of plans is uneven across countries. More research is needed to demonstrate the effect of specific elements of rare disease plans on patient outcomes.

Scaling up HIV viral load - lessons from the large-scale implementation of HIV early infant diagnosis and CD4 testing.

PubMed

Peter, Trevor; Zeh, Clement; Katz, Zachary; Elbireer, Ali; Alemayehu, Bereket; Vojnov, Lara; Costa, Alex; Doi, Naoko; Jani, Ilesh

2017-11-01

The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business. The lessons and innovations from large-scale EID and CD4 programs described here can be adapted to inform more effective scale-up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost-effective test access. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

The challenges of implementing advanced access for residents in family medicine in Quebec. Do promising strategies exist?

PubMed

Abou Malham, Sabina; Touati, Nassera; Maillet, Lara; Breton, Mylaine

2018-12-01

The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. To identify these challenges within these clinics, as well as potential strategies to address them. The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residents' patient; 2) managing and balancing residents' appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residents' patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models.

The challenges of implementing advanced access for residents in family medicine in Quebec. Do promising strategies exist?

PubMed Central

Abou Malham, Sabina; Touati, Nassera; Maillet, Lara; Breton, Mylaine

2018-01-01

ABSTRACT Background: The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. Objective: To identify these challenges within these clinics, as well as potential strategies to address them. Design: The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residents’ patient; 2) managing and balancing residents’ appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residents’ patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. Conclusions: To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models. PMID:29464984

Drivers and challenges for implementing ISO 14001 environmental management systems in an emerging Gulf Arab country.

PubMed

Waxin, Marie-France; Knuteson, Sandra L; Bartholomew, Aaron

2017-11-13

Worldwide, ISO 14001 certification for organizations has become the norm, but the Arab world accounts for an insignificant portion of all the certified organizations. There is a dearth of research on environmental management systems (EMS) in Arab and emerging countries and in public organizations. The objectives of this research are to: (1) examine the key drivers and challenges related to implementation of ISO 14001 certified EMS in the United Arab Emirates, an emerging Arab country and (2) compare and contrast these drivers and challenges between private and public organizations. We adopt an explorative, qualitative methodology, using semi-structured interviews with environmental managers in 11 organizations (6 private and 5 public) from different industrial sectors. Drivers of EMS certification were mostly similar between private and public organizations, with some differences. Compliance with regulations and standards, and increasing environmental performance were the main drivers for ISO 14001 certification in both private and public organizations. Commitment to sustainability was more important for public organizations. Cost reduction, competitors, leadership commitment and customers' demands were shared drivers, but more stressed by private organizations. Local community and employees' pressures were reported by private organizations only. The challenges to ISO 14001 implementation were similar for private and public organizations. They were: a lack of qualified human resources, practical challenges associated with implementation, a lack of regulations, a lack of support from management, and high costs. Our findings have implications for managers, academics, consultants, and policy makers in the UAE and other emerging markets.

Laboratory automation —some perspectives on the challenges in the implementation of the technology in pharmaceutical development

PubMed Central

North, Nigel; Smith, Simon

1998-01-01

The intensifying pressure on reducing the development time for new pharmaceutical products is resulting in an increasing need for laboratory automation. A key element for the successful implementation of robotics for drug product analysis is the establishment of a reliable process for interaction of the automation team with its various customers, for example development product team and manufacturing group. The reduction of cycle time for product development appears to be resulting in more stability studies to support NDA/MAA filings for several reasons. Key clinical information may not be available before initiation of the stability studies and simultaneous world-wide development may result in an increase in the number of product strength and pack options. PMID:18924828

Enabling and challenging factors in institutional reform: The case of SCALE-UP

NASA Astrophysics Data System (ADS)

Foote, Kathleen; Knaub, Alexis; Henderson, Charles; Dancy, Melissa; Beichner, Robert J.

2016-06-01

While many innovative teaching strategies exist, integration into undergraduate science teaching has been frustratingly slow. This study aims to understand the low uptake of research-based instructional innovations by studying 21 successful implementations of the Student Centered Active Learning with Upside-down Pedagogies (SCALE-UP) instructional reform. SCALE-UP significantly restructures the classroom environment and pedagogy to promote highly active and interactive instruction. Although originally designed for university introductory physics courses, SCALE-UP has spread to many other disciplines at hundreds of departments around the world. This study reports findings from in-depth, open-ended interviews with 21 key contact people involved with successful secondary implementations of SCALE-UP throughout the United States. We defined successful implementations as those who restructured their pedagogy and classroom and sustained and/or spread the change. Interviews were coded to identify the most common enabling and challenging factors during reform implementation and compared to the theoretical framework of Kotter's 8-step Change Model. The most common enabling influences that emerged are documenting and leveraging evidence of local success, administrative support, interaction with outside SCALE-UP user(s), and funding. Many challenges are linked to the lack of these enabling factors including difficulty finding funding, space, and administrative and/or faculty support for reform. Our focus on successful secondary implementations meant that most interviewees were able to overcome challenges. Presentation of results is illuminated with case studies, quotes, and examples that can help secondary implementers with SCALE-UP reform efforts specifically. We also discuss the implications for policy makers, researchers, and the higher education community concerned with initiating structural change.

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon.

PubMed

Gelmon, Sherril; Bouranis, Nicole; Sandberg, Billie; Petchel, Shauna

2018-01-01

Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and "champions," incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a "learning organization": systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care. © Copyright 2018 by the American Board of Family Medicine.

Are We There Yet? Human Factors Knowledge and Health Information Technology - the Challenges of Implementation and Impact.

PubMed

Turner, P; Kushniruk, A; Nohr, C

2017-08-01

Objective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT. Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technology-induced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement. Georg Thieme Verlag KG Stuttgart.

Multivariate Cryptography Based on Clipped Hopfield Neural Network.

PubMed

Wang, Jia; Cheng, Lee-Ming; Su, Tong

2018-02-01

Designing secure and efficient multivariate public key cryptosystems [multivariate cryptography (MVC)] to strengthen the security of RSA and ECC in conventional and quantum computational environment continues to be a challenging research in recent years. In this paper, we will describe multivariate public key cryptosystems based on extended Clipped Hopfield Neural Network (CHNN) and implement it using the MVC (CHNN-MVC) framework operated in space. The Diffie-Hellman key exchange algorithm is extended into the matrix field, which illustrates the feasibility of its new applications in both classic and postquantum cryptography. The efficiency and security of our proposed new public key cryptosystem CHNN-MVC are simulated and found to be NP-hard. The proposed algorithm will strengthen multivariate public key cryptosystems and allows hardware realization practicality.

Clinical application of next-generation sequencing for Mendelian diseases.

PubMed

Jamuar, Saumya Shekhar; Tan, Ene-Choo

2015-06-16

Over the past decade, next-generation sequencing (NGS) has led to an exponential increase in our understanding of the genetic basis of Mendelian diseases. NGS allows for the analysis of multiple regions of the genome in one single reaction and has been shown to be a cost-effective and efficient tool in investigating patients with Mendelian diseases. More recently, NGS has been successfully deployed in the clinics, with a reported diagnostic yield of ~25 %. However, recommendations on clinical implementation of NGS are still evolving with numerous key challenges that impede the widespread use of genetics in everyday medicine. These challenges include when to order, on whom to order, what type of test to order, and how to interpret and communicate the results, including incidental findings, to the patient and family. In this review, we discuss these challenges and suggest guidelines on implementing NGS in the routine clinical workflow.

Teacher perspectives on implementing and sustaining a handwashing promotion intervention in Western Kenyan primary schools.

PubMed

Graves, Janessa M; Finsness, Erica D; Quick, Robert; Nyando Integrated Child Health And Education Project Niche Study Team; Harris, Julie R; Daniell, William E

School-based handwashing programs are challenging to establish and sustain, especially in low-resource settings. This qualitative study described teacher perspectives associated with implementing and sustaining a handwashing program in primary schools participating in the Nyando Integrated Child Health and Education (NICHE) project. Structured key informant interviews were conducted with teachers. Prevalent concepts and themes were grouped into themes and topic areas using an iterative, open coding approach. Forty-one teacher respondents reported favorable expectations and benefits of handwashing programs. The importance of available resources (e.g., reliable water) was cited as a primary concern. Other challenges included time and personal or institutional financial commitment necessary to ensure program sustainability. Handwashing programs in low-income, rural schools, where infrastructure is lacking and "student ambassadors" extend the intervention to the surrounding community, hold great promise to improve community health. Teachers must have adequate support and resources to implement and sustain the programs.

Key Informants' Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran.

PubMed

Ghodsi, Delaram; Omidvar, Nasrin; Rashidian, Arash; Raghfar, Hossein; Eini-Zinab, Hassan; Ebrahimi, Marziyeh

2016-01-01

Childhood malnutrition is a major public health issue. Multidisciplinary approach for Improvement of Nutritional Status of Children in Iran was implemented in order to reduce malnutrition among children. This study aimed to evaluate the implementation aspect of the program and to explore key informants' perceptions and experience regarding the factors affected its implementation. Data were collected through the review of secondary data and semistructured interviews at national, province, and local levels. Four layers of key informants were selected purposefully for interviewing, including policymakers, senior nutrition officers, head of Hygiene, Remedy and Insurance Affairs in Imam Khomeini Relief Foundation, and community health workers. Qualitative content analysis was carried out based on Supporting the Use of Research Evidence framework and Tailored Implementation for Chronic Diseases' checklist to interpret the viewpoints of the study participants. Results showed that the program had successes in improving mother's knowledge on health, nutrition, and child care through health system and increased families' access to food, but there were some aspects that affected program's implementation. Some of these factors are the lack of clarity in the program's protocol and indicators, human shortage and inadequate financial resources, poor facilities, inattention to staff motivation, insufficient commitment among different sections, poor communication and supervision among different executive sections, and program protocols designing regardless of practical condition. Based on the results, top-down approach in policymaking and inadequate financial and human resources were responsible for most of the challenges encountered in the implementation.

Success in the city: the road to implementation of Tobacco 21 and Sensible Tobacco Enforcement in New York City

PubMed Central

Moreland-Russell, Sarah; Combs, Todd; Schroth, Kevin; Luke, Douglas

2016-01-01

New York City, a leader in municipal tobacco control in the USA, furthered its goal of reducing the community's burden of tobacco use in 2014 by implementing Sensible Tobacco Enforcement and Tobacco 21. These policies are intended to restrict youth access and eliminate sources of cheap tobacco. Strong partnerships, substantial local data and support from the public and elected officials were key in overcoming many challenges and ensuring these policies were signed into law. PMID:27697942

Financial incentives: only one piece of the workplace wellness puzzle comment on "corporate wellness programs: implementation challenges in the modern american workplace".

PubMed

Busum, Kristin Van; Mattke, Soeren

2013-11-01

In this commentary, we argue that financial incentives are only one of many key components that employers should consider when designing and implementing a workplace wellness program. Strategies such as social encouragement and providing token rewards may also be effective in improving awareness and engagement. Should employers choose to utilize financial incentives, they should tailor them to the goals for the program as well as the targeted behaviors and health outcomes.

Process evaluation results from the HEALTHY nutrition intervention to modify the total school food environment

PubMed Central

Volpe, S. L.; Hall, W. J.; Steckler, A.; Schneider, M.; Thompson, D.; Mobley, C.; Pham, T.; El ghormli, L.

2013-01-01

The process evaluation of HEALTHY, a large multi-center trial to decrease type 2 diabetes mellitus in middle school children, monitored the implementation of the intervention to ascertain the extent that components were delivered and received as intended. The purpose of this article is to report the process evaluation findings concerning the extent to which the HEALTHY nutrition intervention was implemented during the HEALTHY trial. Overall, the observed fidelity of implementing nutrition strategies improved from baseline to the end of the study. By the last semester, all but two nutrition process evaluation goals were met. The most challenging goal to implement was serving high fiber foods, including grain-based foods and legumes. The easiest goals to implement were lowering the fat content of foods offered and offering healthier beverages. The most challenging barriers experienced by research dietitians and food service staff were costs, availability of foods and student acceptance. Forming strong relationships between the research dietitians and food service staff was identified as a key strategy to meet HEALTHY nutrition goals. PMID:24107856

Research design issues for evaluating complex multicomponent interventions in neighborhoods and communities.

PubMed

Komro, Kelli A; Flay, Brian R; Biglan, Anthony; Wagenaar, Alexander C

2016-03-01

Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3-T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.

A critical analysis of the implementation of a legal regulated market for new psychoactive substances ("legal highs") in New Zealand.

PubMed

Rychert, Marta; Wilkins, Chris

2018-05-01

In July 2013 New Zealand passed the Psychoactive Substances Act (PSA) to establish the world's first regulated legal market for new psychoactive substances (NPS) ("legal highs"). To critically analyse the implementation of the PSA. Synthesis of findings from interviews with 30 key informants (i.e. politicians, civil servants, legal high industry actors, toxicologists, NGO representatives and drug policy academics), analysis of relevant laws and policy documents, and a review of academic and grey literature on the PSA. Key challenges experienced during the implementation of the PSA included the harmfulness of interim approved products, the slowness in withdrawing products which caused adverse effects, enforcing retail restrictions, price competition by retailers, judicial challenges by the "legal high" industry, and growing opposition to the regime from local communities and key stakeholders (including local councils). The PSA lacks a tax on products and restrictions on retail opening hours which likely contributed to the problems above. The implementation of the PSA also appeared to suffer from a rushed legislative process and resource constraints on the regulatory agency which led to delays in the development of the full regulatory framework, including the product testing requirements, and issues with enforcing retail regulation, such as the minimum age of purchase. The decline in public support for the PSA regime reflected problems with communicating the aims of the policy to the general public. The troubled implementation of the PSA underlines a number of important lessons for consideration when developing a regulated legal drug market, including advanced development of regulatory systems, ensuring the sale of low risk products, adequately resourcing regulatory agencies and related enforcement activity, detailed regulation of retail outlets, establishing price controls, and ongoing engagement with stakeholders and the general public. Copyright © 2018 Elsevier B.V. All rights reserved.

Key influences in the design and implementation of mental health information systems in Ghana and South Africa.

PubMed

Ahuja, S; Mirzoev, T; Lund, C; Ofori-Atta, A; Skeen, S; Kufuor, A

2016-01-01

Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa. We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach. Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana. Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions. Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influences.

Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions

PubMed Central

Correa-de-Araujo, Rosaly

2016-01-01

Scientific literature demonstrates that advances in evidence-based nursing have improved systems of care and women’s health outcomes. Experts agree that nurses worldwide can play a key role in building such evidence and working with interdisciplinary health care teams and systems to accelerate its implementation. PMID:26473771

The International X-ray Observatory: Science Prospects and Technology Challenges

NASA Technical Reports Server (NTRS)

Petre, Robert

2008-01-01

This talk will describe the International X-ray Observatory (IXO) mission. It will present the key scientific goals, relating to strong gravity, cosmic feedback, and the life cycle of matter. The mission configuration will be described. Emphasis will be placed on the design and anticipated implementation of the X-ray mirror system.

Teaching for Present "and Future" Competency: A Productive Focus for Professional Learning

ERIC Educational Resources Information Center

Hipkins, Rosemary; McDowall, Sue

2013-01-01

The key competencies are a potentially transformative feature of the New Zealand Curriculum. However, the way in which they have been understood and implemented in schools points to tensions and challenges that may prevent them from acting as agents of curriculum change. One recent researcher/practitioner partnership developed materials that show…

Scholarship: The Key to Creating Change through Outreach

ERIC Educational Resources Information Center

Bruns, Karen; Conklin, Nikki; Wright, Mindy; Hoover, David; Brace, Ben; Wise, Greg; Pendleton, Fariba; Dann, Michael; Martin, Michael; Childers, Jeri

2002-01-01

Outreach can and should exemplify the characteristics typical of any scholarly work if it is to create change in our communities and universities. Glassick, Huber, and Maeroff's insight on the standards for scholarly work are reflected in the processes commonly used to implement outreach. Boyer challenges us to think of scholarship as a communal…

Key Methodological Aspects of Translators' Training in Ukraine and in the USA

ERIC Educational Resources Information Center

Skyba, Kateryna

2015-01-01

The diversity of international relations in the globalized world has influenced the role of a translator that is becoming more and more important. Translators' training institutions today are to work out and to implement the best teaching methodology taking into consideration the new challenges of modern multinational and multicultural society.…

Increasing Explanatory Behaviour, Problem-Solving, and Reasoning within Classes Using Cooperative Group Work

ERIC Educational Resources Information Center

Gillies, Robyn M.; Haynes, Michele

2011-01-01

The present study builds on research that indicates that teachers play a key role in promoting those interactional behaviours that challenge children's thinking and scaffold their learning. It does this by seeking to determine whether teachers who implement cooperative learning and receive training in explicit strategic questioning strategies…

A Conceptual Model for School-Based Management Operation and Quality Assurance in Nigerian Secondary Schools

ERIC Educational Resources Information Center

Ayeni, Adeolu Joshua; Ibukun, Williams Olusola

2013-01-01

This paper examined the School-Based Management Committee's (SBMC) involvement and effectiveness in school governance, curriculum implementation and students' learning outcomes in Nigerian secondary schools; the major challenges facing effective operation of SBMCs were identified as low capacity of key members of the SBMCs; poor attendance of…

A Balancing Act: School Budgeting and Resource Allocation on a New Dual Language Campus

ERIC Educational Resources Information Center

Knight, David S.; Izquierdo, Elena; DeMatthews, David E.

2016-01-01

Dual language instructional models have great potential to create inclusive learning environments for traditional under-served students and boost student outcomes. However, principals face many barriers to implementation. One of the key challenges is aligning resources to ensure that the school has (a) an appropriate number of certificated…

Systemic Change for RTI: Key Shifts for Practice

ERIC Educational Resources Information Center

Kozleski, Elizabeth B.; Huber, Jennifer J.

2010-01-01

RTI has the potential to meet the challenges of increasing diversity in student populations and the need for increasingly complex systems of instructional design. Three fundamental shifts in understanding systems and systems change must ground RTI policy and implementation work. First, RTI must be seen as an activity system nested within a larger…

Changes and Challenges: Key Issues for Scottish Rural Schools and Communities

ERIC Educational Resources Information Center

Dowling, Jennie

2009-01-01

Education in rural Scottish schools has changed rapidly over the past 15 years. These changes include the implementation of national curriculum and assessment guidelines, increased parental influence and a shift from local authority based management to more locally based schemes. During the 1990s, research in the field focused largely on learning…

Food commodity pipeline management in transitional settings: challenges and lessons learned from the first USAID food development program in South Sudan

PubMed Central

Tappis, Hannah; Doocy, Shannon; Amoako, Stephen

2013-01-01

ABSTRACT Despite decades of support for international food assistance programs by the U.S. Agency for International Development (USAID) Office of Food for Peace, relatively little is known about the commodity pipeline and management issues these programs face in post-conflict and politically volatile settings. Based on an audit of the program's commodity tracking system and interviews with 13 key program staff, this case study documents the experiences of organizations implementing the first USAID-funded non-emergency (development) food assistance program approved for Sudan and South Sudan. Key challenges and lessons learned in this experience about food commodity procurement, transport, and management may help improve the design and implementation of future development food assistance programs in a variety of complex, food-insecure settings around the world. Specifically, expanding shipping routes in complex political situations may facilitate reliable and timely commodity delivery. In addition, greater flexibility to procure commodities locally, rather than shipping U.S.-procured commodities, may avoid unnecessary shipping delays and reduce costs. PMID:25276532

Workflow Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper.

PubMed

Towbin, Alexander J; Roth, Christopher J; Bronkalla, Mark; Cram, Dawn

2016-10-01

With the advent of digital cameras, there has been an explosion in the number of medical specialties using images to diagnose or document disease and guide interventions. In many specialties, these images are not added to the patient's electronic medical record and are not distributed so that other providers caring for the patient can view them. As hospitals begin to develop enterprise imaging strategies, they have found that there are multiple challenges preventing the implementation of systems to manage image capture, image upload, and image management. This HIMSS-SIIM white paper will describe the key workflow challenges related to enterprise imaging and offer suggestions for potential solutions to these challenges.

Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America.

PubMed

Salvo, Deborah; Reis, Rodrigo S; Sarmiento, Olga L; Pratt, Michael

2014-12-01

There is evidence linking the built environment (BE) with physical activity (PA), but few studies have been conducted in Latin America (LA). State-of-the-art methods and protocols have been designed in and applied in high-income countries (HIC). In this paper, we identify key challenges and potential solutions to conducting high-quality PA and BE research in LA. The experience of implementing the IPEN data collection protocol (IPEN: International Physical Activity Environment Network) in Curitiba, Brazil; Bogotá, Colombia; and Cuernavaca, Mexico (2010-2011); is described to identify challenges for conducting PA and BE research in LA. Five challenges were identified: lack of academic capacity (implemented solutions (IS): building a strong international collaborative network); limited data availability, access and quality (IS: partnering with influential local institutions, and crafting creative solutions to use the best-available data); socio-political, socio-cultural and socio-economic context (IS: in-person recruitment and data collection, alternative incentives); safety (IS: strict rules for data collection procedures, and specific measures to increase trust); and appropriateness of instruments and measures (IS: survey adaptation, use of standardized additional survey components, and employing a context-based approach to understanding the relationship between PA and the BE). Advantages of conducting PA and BE research in LA were also identified. Conducting high-quality PA and BE research in LA is challenging but feasible. Networks of institutions and researchers from both HIC and LMIC play a key role. The lessons learned from the IPEN LA study may be applicable to other LMIC. Copyright © 2014 Elsevier Inc. All rights reserved.

Virtualization of the Y.E.S. Congress 2009 Roundtable Symposia (Invited)

NASA Astrophysics Data System (ADS)

Gonzales, L. M.; Gaines, S. M.

2009-12-01

The Y.E.S. Congress 2009 was the first international conference organized by the Y.E.S. Network, an association of early-career geoscientists who represent professional societies, geoscience companies, geoscience departments, and interested policy makers from across the world, in collaboration with the International Year of Planet Earth (IYPE). The conference, hosted by the China University of Geosciences in Beijing, focused on scientific and career challenges faced by early-career geoscientists, with a particular emphasis on how the Y.E.S. Network can work collaboratively and internationally towards solving these challenges and furthering the IYPE motto of “Earth Sciences for Society”. A key features of the Y.E.S. Congress was the implementation of “virtualized” roundtable symposia which engaged senior and early-career geoscientists via presentations, panel discussions, and working group sessions in which strategies related to scientific challenges (i.e. climate change in the polar regions, natural hazards, natural resource sustainability) and academic and career pathway challenges (i.e. academic-industry linkages, gender parity in the geosciences, geoscience education sustainability, and international licensure issues) were developed. These strategies were then tasked to the Y.E.S. Network for further development and implementation. The virtualization of the roundtable symposia facilitated active discussion between those participants and speakers who were physically located at the conference facilities in Beijing with a wider international audience of virtual participants and speakers. This talk will address the key features of the roundtable virtualization, the successes and challenges faced during the pre-conference set-up as well as during the roundtable sessions, and potential future applications.

Overcoming the challenges of conducting physical activity and built environment research in Latin America: IPEN Latin America

PubMed Central

Salvo, Deborah; Reis, Rodrigo S.; Sarmiento, Olga L.; Pratt, Michael

2014-01-01

Objective There is evidence linking the built environment (BE) with physical activity (PA), but few studies have been conducted in Latin America (LA). State-of-the-art methods and protocols have been designed in and applied in high-income countries (HIC). In this paper we identify key challenges and potential solutions to conducting high quality PA and BE research in LA. Methods The experience of implementing the IPEN data collection protocol (IPEN: International Physical Activity Environment Network) in Curitiba, Brazil; Bogotá, Colombia; and Cuernavaca, Mexico (2010-2011); is described to identify challenges for conducting PA and BE research in LA. Results Five challenges were identified: Lack of academic capacity (implemented solutions (IS): building a strong international collaborative network); limited data availability, access and quality (IS: partnering with influential local institutions, and crafting creative solutions to use the best-available data); socio-political, socio-cultural and socio-economic context (IS: in-person recruitment and data collection, alternative incentives); safety (IS: strict rules for data collection procedures, and specific measures to increase trust); appropriateness of instruments and measures (IS: survey adaptation, use of standardized additional survey components, and employing a context-based approach to understanding the relationship between PA and the BE). Advantages of conducting PA and BE research in LA were also identified. Conclusions Conducting high quality PA and BE research in LA is challenging but feasible. Networks of institutions and researchers from both HIC and LMIC play a key role. The lessons learnt from the IPEN LA study may be applicable to other LMIC. PMID:25456800

Community led active schools programme (CLASP) exploring the implementation of health interventions in primary schools: headteachers' perspectives.

PubMed

Christian, Danielle; Todd, Charlotte; Davies, Helen; Rance, Jaynie; Stratton, Gareth; Rapport, Frances; Brophy, Sinead

2015-03-13

Schools are repeatedly utilised as a key setting for health interventions. However, the translation of effective research findings to the school setting can be problematic. In order to improve effective translation of future interventions, it is imperative key challenges and facilitators of implementing health interventions be understood from a school's perspective. Nineteen semi-structured interviews were conducted in primary schools (headteachers n = 16, deputy headteacher n = 1, healthy school co-ordinator n = 2). Interviews were transcribed verbatim and analysed using thematic analysis. The main challenges for schools in implementing health interventions were; government-led academic priorities, initiative overload, low autonomy for schools, lack of staff support, lack of facilities and resources, litigation risk and parental engagement. Recommendations to increase the application of interventions into the school setting included; better planning and organisation, greater collaboration with schools and external partners and elements addressing sustainability. Child-centred and cross-curricular approaches, inclusive whole school approaches and assurances to be supportive of the school ethos were also favoured for consideration. This work explores schools' perspectives regarding the implementation of health interventions and utilises these thoughts to create guidelines for developing future school-based interventions. Recommendations include the need to account for variability between school environments, staff and pupils. Interventions with an element of adaptability were preferred over the delivery of blanket fixed interventions. Involving schools in the developmental stage would add useful insights to ensure the interventions can be tailored to best suit each individual schools' needs and improve implementation.

Perceived benefits and barriers of implementing nursing residency programs in Jordan.

PubMed

AbuAlRub, R F; Abu Alhaija'a, M G

2018-03-02

To explore the challenges that face Jordanian nurses in the first year of employment; and understand the benefits and barriers of implementing a Nursing Residency Program from the perspectives of nurses and key informants. Many researchers reported that novice nurses do not have an adequate level of competence needed in the real clinical practice to meet the increasing demands of healthcare systems. A descriptive qualitative approach using individual interviews and focus group discussions was utilized. The sample was a purposive one that consisted of 30 Jordanian nurses and six key informants. Data were recorded and then transcribed. Content analysis was used to analyze the data. The results revealed several challenges that face nurses in their first year of experience such as reality shock, lack of self-confidence, and burnout and intent to leave. Some of the perceived barriers of implementing the Program were issues concerned with the responsible regulatory body, payment, and monitoring and evaluation. The findings asserted that the implementation of the Nursing Residency Program for new practicing nurses would enhance their competencies and self- confidence; and decrease the rate of reality shock and turnover within the first year of employment. Policy makers, nurse educators, and nurse administrators and clinical nurses need to collaborate to develop a formal system with binding policies and regulations concerning the implementation of Nursing Residency Program. There is also a need to address and modify current orientation programmes offered by hospitals for novice nurses to enhance their transition into clinical practice. © 2018 International Council of Nurses.

Diagnosing climate change impacts and identifying adaptation strategies by involving key stakeholder organisations and farmers in Sikkim, India: Challenges and opportunities.

PubMed

Azhoni, Adani; Goyal, Manish Kumar

2018-06-01

Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact water security. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers to that of the perspectives of development agencies, researchers and farmers in the Himalayan state of Sikkim in India. Our case study examined the perspectives of various stakeholders for climate change impacts, current adaptation strategies, knowledge gaps and adaptation barriers, particularly in the context of implementing the Sikkim State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the Sikkim State Government, researchers, consultants, local academia, development agencies and farmers. Using Stakeholders Network Analysis tools, this research unravels the complexities of perceiving climate change impacts, identifying strategies, and implementing adaptation. While farmers are less aware about the global phenomenon of climate change impacts for water security, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them opportunities. Although important steps are being initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and hence, strengthening the networks of close coordination between the various implementing agencies will pay dividends. Knowledge gaps and the need for capacity building identified in this research, based on the understandings of key stakeholders are highly relevant to both the research community and for informing policy. Copyright © 2018 Elsevier B.V. All rights reserved.

Implementation of safety management systems in Hong Kong construction industry - A safety practitioner's perspective.

PubMed

Yiu, Nicole S N; Sze, N N; Chan, Daniel W M

2018-02-01

In the 1980s, the safety management system (SMS) was introduced in the construction industry to mitigate against workplaces hazards, reduce the risk of injuries, and minimize property damage. Also, the Factories and Industrial Undertakings (Safety Management) Regulation was introduced on 24 November 1999 in Hong Kong to empower the mandatory implementation of a SMS in certain industries including building construction. Therefore, it is essential to evaluate the effectiveness of the SMS in improving construction safety and identify the factors that influence its implementation in Hong Kong. A review of the current state-of-the-practice helped to establish the critical success factors (CSFs), benefits, and difficulties of implementing the SMS in the construction industry, while structured interviews were used to establish the key factors of the SMS implementation. Results of the state-of-the-practice review and structured interviews indicated that visible senior commitment, in terms of manpower and cost allocation, and competency of safety manager as key drivers for the SMS implementation. More so, reduced accident rates and accident costs, improved organization framework, and increased safety audit ratings were identified as core benefits of implementing the SMS. Meanwhile, factors such as insufficient resources, tight working schedule, and high labor turnover rate were the key challenges to the effective SMS implementation in Hong Kong. The findings of the study were consistent and indicative of the future development of safety management practice and the sustainable safety improvement of Hong Kong construction industry in the long run. Copyright © 2018 National Safety Council and Elsevier Ltd. All rights reserved.

Technical challenges in designing post-marketing eCRFs to address clinical safety and pharmacovigilance needs.

PubMed

Lu, Zhengwu

2010-01-01

To identify key challenges and propose technical considerations in designing electronic case report form (eCRF) for post-marketing studies, the author undertakes a comprehensive literature review of peer reviewed and grey literature to assess the key aspects, processes, standards, recommendations, and best practices in designing eCRFs based on industry experience in designing and supporting electronic data capture (EDC) studies. Literature search using strings on MEDLINE and PUBMED returned few papers directly related to CRF design. Health informatics and general practice journals were searched and results reviewed. Many conference, government commission, health professional and special interests group websites provide relevant information from practical experience - summarization of this information is presented. Further, we presented a list of concrete technical considerations in dealing with EDC technology/system limitations based on literature assessment and industry implementation experience. It is recognized that cross-functional teams be involved in eCRF design process and decision making. To summarize the keys in designing eCRFs to address post-market study safety and pharmacovigilance needs, the first is to identify required data elements from the study protocol supporting data analyses and reporting requirements. Secondly, accepted best practices, CDASH & CDISC guidelines, and company internal or therapeutic unit standard should be considered and applied. Coding (MedDRA & WHODD) mapping should be managed and implemented as well when possible. Finally, we need to be on top of the EDC technologies, challenge the technologies, drive EDC improvement via working with vendors, and utilize the technologies to drive clinical effectiveness. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Implementing Peer Learning in Clinical Education: A Framework to Address Challenges In the "Real World".

PubMed

Tai, Joanna Hong Meng; Canny, Benedict J; Haines, Terry P; Molloy, Elizabeth K

2017-01-01

Phenomenon: Peer learning has many benefits and can assist students in gaining the educational skills required in future years when they become teachers themselves. Peer learning may be particularly useful in clinical learning environments, where students report feeling marginalized, overwhelmed, and unsupported. Educational interventions often fail in the workplace environment, as they are often conceived in the "ideal" rather than the complex, messy real world. This work sought to explore barriers and facilitators to implementing peer learning activities in a clinical curriculum. Previous peer learning research results and a matrix of empirically derived peer learning activities were presented to local clinical education experts to generate discussion around the realities of implementing such activities. Potential barriers and limitations of and strategies for implementing peer learning in clinical education were the focus of the individual interviews. Thematic analysis of the data identified three key considerations for real-world implementation of peer learning: culture, epistemic authority, and the primacy of patient-centered care. Strategies for peer learning implementation were also developed from themes within the data, focusing on developing a culture of safety in which peer learning could be undertaken, engaging both educators and students, and establishing expectations for the use of peer learning. Insights: This study identified considerations and strategies for the implementation of peer learning activities, which took into account both educator and student roles. Reported challenges were reflective of those identified within the literature. The resultant framework may aid others in anticipating implementation challenges. Further work is required to test the framework's application in other contexts and its effect on learner outcomes.

Towards vertical integration in general practice education: literature review and discussion paper.

PubMed

O'Regan, A; Culhane, A; Dunne, C; Griffin, M; Meagher, D; McGrath, D; O'Dwyer, P; Cullen, W

2013-09-01

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

Newborn Survival Case Study in Rwanda - Bottleneck Analysis and Projections in Key Maternal and Child Mortality Rates Using Lives Saved Tool (LiST).

PubMed

Khurmi, Manpreet Singh; Sayinzoga, Felix; Berhe, Atakilt; Bucyana, Tatien; Mwali, Assumpta Kayinamura; Manzi, Emmanuel; Muthu, Maharajan

2017-01-01

The Newborn Survival Case study in Rwanda provides an analysis of the newborn health and survival situation in the country. It reviews evidence-based interventions and coverage levels already implemented in the country; identifies key issues and bottlenecks in service delivery and uptake of services by community/beneficiaries, and provides key recommendations aimed at faster reduction in newborn mortality rate. This study utilized mixed method research including qualitative and quantitative analyses of various maternal and newborn health programs implemented in the country. This included interviewing key stakeholders at each level, field visits and also interviewing beneficiaries for assessment of uptake of services. Monitoring systems such as Health Management Information Systems (HMIS), maternal and newborn death audits were reviewed and data analyzed to aid these analyses. Policies, protocols, various guidelines and tools for monitoring are already in place however, implementation of these remains a challenge e.g. infection control practices to reduce deaths due to sepsis. Although existing staff are quite knowledgeable and are highly motivated, however, shortage of health personnel especially doctors in an issue. New facilities are being operationalized e.g. at Gisenyi, however, the existing facilities needs expansion. It is essential to implement high impact evidence based interventions but coverage levels need to be significantly high in order to achieve higher reduction in newborn mortality rate. Equity approach should be considered in planning so that the services are better implemented and the poor and needy can get the benefits of public health programs.

The Alabama Coalition for a Healthier Black belt: a proof of concept project.

PubMed

Savage, Robert M; Dillon, Jacqueline M; Hammel, Jacinda C; Lewis, Tonia C; Johnson, Natasha C; Barlow, Lafon M; Brooms, Molly M; Moore, Patricia M; Parker, Henry E; Rodney, Kanini Z

2013-02-01

The Alabama Coalition for a Healthier Black was a demonstration of concept project. This paper is a descriptive and qualitative overview of this 2.5 year project. Limited key project results are reported here. Located in the rural Black Belt region of Alabama this coalition had several key aims: to develop a collaboration between primary care and mental health care through co-location of services; use of video-conferencing capability to provide mental health services more efficiently; enhanced training in rural healthcare; and development of stigma reduction campaigns along with other coalition partner specific initiatives. Co-location and telepsychiatry implementation produced the major challenges and resulting adaptations to original aims. Despite many challenges these new service patterns were put into place and appear to be sustainable.

Challenges in the Accurate Surveillance of Booster Seat and Bicycle Helmet Usage by Children: Lessons from the Field

PubMed Central

Pankratz, Curt; Warda, Lynne; Piotrowski, Caroline

2016-01-01

Motor vehicle collisions and bicycle collisions and falls are a leading cause of death by preventable injury for children. In order to design, implement and evaluate campaigns and programs aimed at improving child safety, accurate surveillance is needed. This paper examined the challenges that confront efforts to collect surveillance data relevant to child traffic safety, including observation, interview, and focus group methods. Strategies to address key challenges in order to improve the efficiency and accuracy of surveillance methods were recommended. The potential for new technology to enhance existing surveillance methods was also explored. PMID:27399749

Pharmacists' Perceptions of the Barriers and Facilitators to the Implementation of Clinical Pharmacy Key Performance Indicators

PubMed Central

Minard, Laura V; Deal, Heidi; Harrison, Megan E; Toombs, Kent; Neville, Heather; Meade, Andrea

2016-01-01

Background In hospitals around the world, there has been no consensus regarding which clinical activities a pharmacist should focus on until recently. In 2011, a Canadian clinical pharmacy key performance indicator (cpKPI) collaborative was formed. The goal of the collaborative was to advance pharmacy practice in order to improve patient outcomes and enhance the quality of care provided to patients by hospital pharmacists. Following a literature review, which indicated that pharmacists can improve patient outcomes by carrying out specific activities, and an evidence-informed consensus process, a final set of eight cpKPIs were established. Canadian hospitals leading the cpKPI initiative are currently in the early stages of implementing these indicators. Objective To explore pharmacists' perceptions of the barriers and facilitators to the implementation of cpKPIs. Methods Clinical pharmacists employed by the Nova Scotia Health Authority were invited to participate in focus groups. Focus group discussions were audio-recorded and transcribed, and data was analyzed using thematic analysis. Findings Three focus groups, including 26 pharmacists, were conducted in February 2015. Three major themes were identified. Resisting the change was comprised of documentation challenges, increased workload, practice environment constraints, and competing priorities. Embracing cpKPIs was composed of seeing the benefit, demonstrating value, and existing supports. Navigating the unknown was made up of quality versus quantity battle, and insights into the future. Conclusions Although pharmacists were challenged by documentation and other changes associated with the implementation of cpKPIs, they demonstrated significant support for cpKPIs and were able to see benefits of the implementation. Pharmacists came up with suggestions for overcoming resistance associated with the implementation of cpKPIs and provided insights into the future of pharmacy practice. The identification of barriers and facilitators to cpKPI implementation will be used to inform the implementation process on a local and national level. PMID:27043716

Pharmacists' Perceptions of the Barriers and Facilitators to the Implementation of Clinical Pharmacy Key Performance Indicators.

PubMed

Minard, Laura V; Deal, Heidi; Harrison, Megan E; Toombs, Kent; Neville, Heather; Meade, Andrea

2016-01-01

In hospitals around the world, there has been no consensus regarding which clinical activities a pharmacist should focus on until recently. In 2011, a Canadian clinical pharmacy key performance indicator (cpKPI) collaborative was formed. The goal of the collaborative was to advance pharmacy practice in order to improve patient outcomes and enhance the quality of care provided to patients by hospital pharmacists. Following a literature review, which indicated that pharmacists can improve patient outcomes by carrying out specific activities, and an evidence-informed consensus process, a final set of eight cpKPIs were established. Canadian hospitals leading the cpKPI initiative are currently in the early stages of implementing these indicators. To explore pharmacists' perceptions of the barriers and facilitators to the implementation of cpKPIs. Clinical pharmacists employed by the Nova Scotia Health Authority were invited to participate in focus groups. Focus group discussions were audio-recorded and transcribed, and data was analyzed using thematic analysis. Three focus groups, including 26 pharmacists, were conducted in February 2015. Three major themes were identified. Resisting the change was comprised of documentation challenges, increased workload, practice environment constraints, and competing priorities. Embracing cpKPIs was composed of seeing the benefit, demonstrating value, and existing supports. Navigating the unknown was made up of quality versus quantity battle, and insights into the future. Although pharmacists were challenged by documentation and other changes associated with the implementation of cpKPIs, they demonstrated significant support for cpKPIs and were able to see benefits of the implementation. Pharmacists came up with suggestions for overcoming resistance associated with the implementation of cpKPIs and provided insights into the future of pharmacy practice. The identification of barriers and facilitators to cpKPI implementation will be used to inform the implementation process on a local and national level.

Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya

PubMed Central

Lencucha, Raphael; Magati, Peter; Drope, Jeffrey

2016-01-01

Introduction This research examines the institutional dynamics of tobacco control following the establishment of Kenya’s 2007 landmark tobacco control legislation. Our analysis focuses specifically on coordination challenges within the health sector. Methods We conducted semi-structured interviews with key informants (n = 17) involved in tobacco regulation and control in Kenya. We recruited participants from different offices and sectors of government and non-governmental organizations. Results We find that the main challenges toward successful implementation of tobacco control are a lack of coordination and clarity of mandate of the principal institutions involved in tobacco control efforts. In a related development, the passage of a new constitution in 2010 created structural changes that have affected the successful implementation of the country’s tobacco control legislation. Discussion We discuss how proponents of tobacco control navigated these two overarching institutional challenges. These findings point to the institutional factors that influence policy implementation extending beyond the traditional focus on the dynamic between government and the tobacco industry. These findings specifically point to the intragovernmental challenges that bear on policy implementation. The findings suggest that for effective implementation of tobacco control legislation and regulation, there is need for increased cooperation among institutions charged with tobacco control, particularly within or involving the Ministry of Health. Decisive leadership was also widely presented as a component of successful institutional reform. Conclusion This study points to the importance of coordinating policy development and implementation across levels of government and the need for leadership and clear mandates to guide cooperation within the health sector. The Kenyan experience offers useful lessons in the pitfalls of institutional incoherence, but more importantly, the value of investing in and then promoting well-functioning institutions. PMID:27418654

Designing New Academic Pathways: Reimaging the Community College Experience with Students' Needs and Best Interests at Heart

ERIC Educational Resources Information Center

McClenney, Kay; Dare, Donna

2013-01-01

This is the second article in a three-part series on reimagining the community college student experience, describing a new model for academic pathways, key design principles, examples from colleges leading the way, and implementation challenges. Community colleges are beginning to embrace the task of reimagining students' educational experiences.…

Fuels treatments in the 21st century - do they matter?

Treesearch

Erik C. Christiansen

2015-01-01

Fuels treatments have long mattered, and are expected to into the future. Mangers are trying desperately to quantitatively answer the question "How much of the risk of wildfire to key values is being reduced through fuels management programs?" Serious challenges to continued implementation of fuels treatments persist, such as lack of sufficient resources to...

Research Commentary: Educational Technology--An Equity Challenge to the Common Core

ERIC Educational Resources Information Center

Kitchen, Richard; Berk, Sarabeth

2016-01-01

The implementation of the Common Core State Standards for Mathematics (National Governors Association Center for Best Practices & Council of Chief State School Officers, 2010) has the potential to move forward key features of standards-based reforms in mathematics that have been promoted in the United States for more than 2 decades (e.g.,…

The challenge of benchmarking health systems: is ICT innovation capacity more systemic than organizational dependent?

PubMed

Lapão, Luís Velez

2015-01-01

The article by Catan et al. presents a benchmarking exercise comparing Israel and Portugal on the implementation of Information and Communication Technologies in the healthcare sector. Special attention was given to e-Health and m-Health. The authors collected information via a set of interviews with key stakeholders. They compared two different cultures and societies, which have reached slightly different implementation outcomes. Although the comparison is very enlightening, it is also challenging. Benchmarking exercises present a set of challenges, such as the choice of methodologies and the assessment of the impact on organizational strategy. Precise benchmarking methodology is a valid tool for eliciting information about alternatives for improving health systems. However, many beneficial interventions, which benchmark as effective, fail to translate into meaningful healthcare outcomes across contexts. There is a relationship between results and the innovational and competitive environments. Differences in healthcare governance and financing models are well known; but little is known about their impact on Information and Communication Technology implementation. The article by Catan et al. provides interesting clues about this issue. Public systems (such as those of Portugal, UK, Sweden, Spain, etc.) present specific advantages and disadvantages concerning Information and Communication Technology development and implementation. Meanwhile, private systems based fundamentally on insurance packages, (such as Israel, Germany, Netherlands or USA) present a different set of advantages and disadvantages - especially a more open context for innovation. Challenging issues from both the Portuguese and Israeli cases will be addressed. Clearly, more research is needed on both benchmarking methodologies and on ICT implementation strategies.

Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries.

PubMed

Rwabukwisi, Felix Cyamatare; Bawah, Ayaga A; Gimbel, Sarah; Phillips, James F; Mutale, Wilbroad; Drobac, Peter

2017-12-21

Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia. Four major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private) are necessary to address complex health system issues at all levels. Second, a learning culture that promotes evidence creation and ability to efficiently adapt were key in order to meet changing contextual needs. Third, inclusion of strong implementation science tools and strategies allowed informed and measured learning processes and efficient dissemination of best practices. Fourth, five to seven years was the minimum time frame necessary to effectively implement complex health system strengthening interventions and generate the evidence base needed to advocate for sustainable change for the PHIT partnership projects. The AHI experience has raised remaining, if not overlooked, challenges and potential solutions to address complex health systems strengthening intervention designs and implementation issues, while aiming to measurably accomplish sustainable positive change in dynamic, learning, and varied contexts.

Regulatory and quality considerations for continuous manufacturing. May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Allison, Gretchen; Cain, Yanxi Tan; Cooney, Charles; Garcia, Tom; Bizjak, Tara Gooen; Holte, Oyvind; Jagota, Nirdosh; Komas, Bekki; Korakianiti, Evdokia; Kourti, Dora; Madurawe, Rapti; Morefield, Elaine; Montgomery, Frank; Nasr, Moheb; Randolph, William; Robert, Jean-Louis; Rudd, Dave; Zezza, Diane

2015-03-01

This paper assesses the current regulatory environment, relevant regulations and guidelines, and their impact on continuous manufacturing. It summarizes current regulatory experience and learning from both review and inspection perspectives. It outlines key regulatory aspects, including continuous manufacturing process description and control strategy in regulatory files, process validation, and key Good Manufacturing Practice (GMP) requirements. In addition, the paper identifies regulatory gaps and challenges and proposes a way forward to facilitate implementation. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Integrated quantum key distribution sender unit for daily-life implementations

NASA Astrophysics Data System (ADS)

Mélen, Gwenaelle; Vogl, Tobias; Rau, Markus; Corrielli, Giacomo; Crespi, Andrea; Osellame, Roberto; Weinfurter, Harald

2016-03-01

Unlike currently implemented encryption schemes, Quantum Key Distribution provides a secure way of generating and distributing a key among two parties. Although a multitude of research platforms has been developed, the integration of QKD units within classical communication systems remains a tremendous challenge. The recently achieved maturity of integrated photonic technologies could be exploited to create miniature QKD add-ons that could extend the primary function of various existing systems such as mobile devices or optical stations. In this work we report on an integrated optics module enabling secure short-distance communication for, e.g., quantum access schemes. Using BB84-like protocols, Alice's mobile low-cost device can exchange secure key and information everywhere within a trusted node network. The new optics platform (35×20×8mm) compatible with current smartphone's technology generates NIR faint polarised laser pulses with 100MHz repetition rate. Fully automated beam tracking and live basis-alignment on Bob's side ensure user-friendly operation with a quantum link efficiency as high as 50% stable over a few seconds.

Unified Compact ECC-AES Co-Processor with Group-Key Support for IoT Devices in Wireless Sensor Networks

PubMed Central

Castillo, Encarnación; López-Ramos, Juan A.; Morales, Diego P.

2018-01-01

Security is a critical challenge for the effective expansion of all new emerging applications in the Internet of Things paradigm. Therefore, it is necessary to define and implement different mechanisms for guaranteeing security and privacy of data interchanged within the multiple wireless sensor networks being part of the Internet of Things. However, in this context, low power and low area are required, limiting the resources available for security and thus hindering the implementation of adequate security protocols. Group keys can save resources and communications bandwidth, but should be combined with public key cryptography to be really secure. In this paper, a compact and unified co-processor for enabling Elliptic Curve Cryptography along to Advanced Encryption Standard with low area requirements and Group-Key support is presented. The designed co-processor allows securing wireless sensor networks with independence of the communications protocols used. With an area occupancy of only 2101 LUTs over Spartan 6 devices from Xilinx, it requires 15% less area while achieving near 490% better performance when compared to cryptoprocessors with similar features in the literature. PMID:29337921

Unified Compact ECC-AES Co-Processor with Group-Key Support for IoT Devices in Wireless Sensor Networks.

PubMed

Parrilla, Luis; Castillo, Encarnación; López-Ramos, Juan A; Álvarez-Bermejo, José A; García, Antonio; Morales, Diego P

2018-01-16

Security is a critical challenge for the effective expansion of all new emerging applications in the Internet of Things paradigm. Therefore, it is necessary to define and implement different mechanisms for guaranteeing security and privacy of data interchanged within the multiple wireless sensor networks being part of the Internet of Things. However, in this context, low power and low area are required, limiting the resources available for security and thus hindering the implementation of adequate security protocols. Group keys can save resources and communications bandwidth, but should be combined with public key cryptography to be really secure. In this paper, a compact and unified co-processor for enabling Elliptic Curve Cryptography along to Advanced Encryption Standard with low area requirements and Group-Key support is presented. The designed co-processor allows securing wireless sensor networks with independence of the communications protocols used. With an area occupancy of only 2101 LUTs over Spartan 6 devices from Xilinx, it requires 15% less area while achieving near 490% better performance when compared to cryptoprocessors with similar features in the literature.

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

PubMed

Wu, Yelena P; Steele, Ric G; Connelly, Mark A; Palermo, Tonya M; Ritterband, Lee M

2014-07-01

To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The implementation of mindfulness in healthcare systems: a theoretical analysis.

PubMed

Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

2015-01-01

Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

Climate change challenges for central banks and financial regulators

NASA Astrophysics Data System (ADS)

Campiglio, Emanuele; Dafermos, Yannis; Monnin, Pierre; Ryan-Collins, Josh; Schotten, Guido; Tanaka, Misa

2018-06-01

The academic and policy debate regarding the role of central banks and financial regulators in addressing climate-related financial risks has rapidly expanded in recent years. This Perspective presents the key controversies and discusses potential research and policy avenues for the future. Developing a comprehensive analytical framework to assess the potential impact of climate change and the low-carbon transition on financial stability seems to be the first crucial challenge. These enhanced risk measures could then be incorporated in setting financial regulations and implementing the policies of central banks.

Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

PubMed

Darlington, Emily Joan; Violon, Nolwenn; Jourdan, Didier

2018-01-22

Implementing complex and multi-level public health programmes is challenging in school settings. Discrepancies between expected and actual programme outcomes are often reported. Such discrepancies are due to complex interactions between contextual factors. Contextual factors relate to the setting, the community, in which implementation occurs, the stakeholders involved, and the characteristics of the programme itself. This work uses realist evaluation to understand how contextual factors influence the implementation process, to result in variable programme outcomes. This study focuses on identifying contextual factors, pinpointing combinations of contextual factors, and understanding interactions and effects of such factors and combinations on programme outcomes on different levels of the implementation process. Schools which had participated in a school-based health promotion programme between 2012 and 2015 were included. Two sets of qualitative data were collected: semi-structured interviews with school staff and programme coordinators; and written documents about the actions implemented in a selection of four schools. Quantitative data included 1553 questionnaires targeting pupils aged 8 to 11 in 14 schools to describe the different school contexts. The comparison between what was expected from the programme (programme theory) and the outcomes identified in the field data, showed that some of the mechanisms expected to support the implementation of the programme, did not operate as anticipated (e.g. inclusion of training, initiation by decision-maker). Key factors which influenced the implementation process included, amongst other factors, the mode of introduction of the programme, home/school relationship, leadership of the management team, and the level of delegated power. Five types of interactions between contextual factors were put forward: enabling, hindering, neutral, counterbalancing and moderating effects. Recurrent combinations of factors were identified. Implementation was more challenging in vulnerable schools where school climate was poor. A single programme cannot be suited or introduced in the same manner in every context. However, key recurrent combinations of contextual factors could contribute to the design of implementation patterns, which could provide guidelines and recommendation for grass-root programme implementation.

A Framework for Addressing Implementation Gap in Global Drowning Prevention Interventions: Experiences from Bangladesh

PubMed Central

Alonge, Olakunle; He, Siran; Wadhwaniya, Shirin; Rahman, Fazlur; Rahman, Aminur; Arifeen, Shams El

2014-01-01

ABSTRACT Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning—global funding, political will, scale, sustainability, and capacity building; (ii) engaging—coordination, involvement of appropriate individuals; (iii) executing—focused action, multisectoral actions, quality of execution; and (iv) evaluating—rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings. PMID:25895188

State experiences implementing youth sports concussion laws: challenges, successes, and lessons for evaluating impact.

PubMed

Lowrey, Kerri McGowan; Morain, Stephanie R

2014-01-01

While provisions of youth sports concussion laws are very similar, little is known as to how they are being implemented, factors that promote or impede implementation, or the level of compliance in each jurisdiction. We aimed to describe state experiences with implementation in order to inform ongoing efforts to reduce the harm of sports-related traumatic brain injury and to guide future evaluations of the laws' impacts and the development of future public health laws. We conducted key-informant interviews in 35 states with recently enacted concussion legislation. States varied considerably in their readiness and capacity for implementation. Factors facilitating implementation included existing partnerships, procedures, and resources; centralized implementation authority; prior related efforts; and involvement in the policymaking process by those now charged with implementation. Inhibitors included ambiguous statutory language, unclear delegation of authority, and compliance difficulties. Ongoing challenges persist, including primary prevention; determining which providers are qualified to make return-to-play assessments and contents of those assessments; compliance difficulties in rural and under-served areas; and unclear responsibility for enforcement. Despite the similarity of youth sports concussion laws, early evidence suggests there is considerable variation in their implementation. These findings are critical for ongoing empirical investigations to accurately evaluate the laws' provisions and to identify successful legal approaches to protecting young athletes. © 2014 American Society of Law, Medicine & Ethics, Inc.

Implementing Accountable Care Organizations: Lessons From a Qualitative Analysis of Four Private Sector Organizations.

PubMed

Walker, Daniel M; Hefner, Jennifer L; Sova, Lindsey N; Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

Accountable care organizations (ACOs) are emerging across the healthcare marketplace and now include Medicare, Medicaid, and private sector payers covering more than 24 million lives. However, little is known about the process of organizational change required to achieve cost savings and quality improvements from the ACO model. This study applies the complex innovation implementation framework to understand the challenges and facilitators associated with the ACO implementation process. We conducted four case studies of private sector ACOs, selected to achieve variation in terms of geography and organizational maturity. Across sites, we used semistructured interviews with 68 key informants to elicit information regarding ACO implementation. Our analysis found challenges and facilitators across all domains in the conceptual framework. Notably, our findings deviated from the framework in two ways. First, findings from the financial resource availability domain revealed both financial and nonfinancial (i.e., labor) resources that contributed to implementation effectiveness. Second, a new domain, patient engagement, emerged as an important factor in implementation effectiveness. We present these deviations in an adapted framework. As the ACO model proliferates, these findings can support implementation efforts, and they highlight the importance of focusing on patients throughout the process. Importantly, this study extends the complex innovation implementation framework to incorporate consumers into the implementation framework, making it more patient centered and aiding future efforts.

Implementing Innovation: The Creation of an iUnit and the Role of Nursing.

PubMed

Tiase, Victoria L; Ventura, Rosemary; Sorbello, Daniel; Robinson, Kenya

2016-01-01

NewYork-Presbyterian Hospital took on the challenge of thinking about innovation differently with the implementation of an innovation unit or iUnit to create the patient care unit of the future. Goals were to understand more about the innovation process and to test new service models, technology platforms, devices, and deployment models. Key findings from the focus groups included the need for additional training and technical support. In general, the initiative was felt to improve overall communication and represents a starting point for further innovation programs.

Carolina Care at University of North Carolina Health Care: Implementing a Theory-Driven Care Delivery Model Across a Healthcare System.

PubMed

Tonges, Mary; Ray, Joel D; Herman, Suzanne; McCann, Meghan

2018-04-01

Patient satisfaction is a key component of healthcare organizations' performance. Providing a consistent, positive patient experience across a system can be challenging. This article describes an organization's approach to achieving this goal by implementing a successful model developed at the flagship academic healthcare center across an 8-hospital system. The Carolina Care at University of North Carolina Health Care initiative has resulted in substantive qualitative and quantitative benefits including higher patient experience scores for both overall rating and nurse communication.

Health care networks implementation and regional governance challenges in the Legal Amazon Region: an analysis of the QualiSUS-Rede Project.

PubMed

Casanova, Angela Oliveira; Cruz, Marly Marques; Giovanella, Ligia; Alves, Glaydes Dos Reis; Cardoso, Gisela Cordeiro Pereira

2017-04-01

This paper aims to analyze the potential, limits and challenges of regional governance in the implementation process of health care networks in three Brazilian regions: Alto Solimões (Amazonas), Belém (Pará) and an interstate region comprising Tocantins, Pará and Maranhão states (Topama). The study is based on the evaluation study on the implementation of the Quality Health Care Network Development and Improvement Project (QualiSUS-Rede). This is a qualitative multiple case study with the analysis of official documents and use of semi-structured interviews with key stakeholders conducted from July to December 2014. Governance review encompassed three components: stakeholders involved, especially local steering groups and their regional coordination capacity; strategies used for strengthening regional governance, anchored on the intervention's modeling; and implementation of local health care networks. Results point that the regional managing commissions were the main governance strategy and that the QualiSUS-Rede Project strengthened regional governance and integration differently in every case, depending on stakeholders' administration and consensus capacity on regional and political priorities.

Operational Earthquake Forecasting and Earthquake Early Warning: The Challenges of Introducing Scientific Innovations for Public Safety

NASA Astrophysics Data System (ADS)

Goltz, J. D.

2016-12-01

Although variants of both earthquake early warning and short-term operational earthquake forecasting systems have been implemented or are now being implemented in some regions and nations, they have been slow to gain acceptance within the disciplines that produced them as well as among those for whom they were intended to assist. To accelerate the development and implementation of these technologies will require the cooperation and collaboration of multiple disciplines, some inside and others outside of academia. Seismologists, social scientists, emergency managers, elected officials and key opinion leaders from the media and public must be the participants in this process. Representatives of these groups come from both inside and outside of academia and represent very different organizational cultures, backgrounds and expectations for these systems, sometimes leading to serious disagreements and impediments to further development and implementation. This presentation will focus on examples of the emergence of earthquake early warning and operational earthquake forecasting systems in California, Japan and other regions and document the challenges confronted in the ongoing effort to improve seismic safety.

Advances and challenges in sustainable tourism toward a green economy.

PubMed

Pan, Shu-Yuan; Gao, Mengyao; Kim, Hyunook; Shah, Kinjal J; Pei, Si-Lu; Chiang, Pen-Chi

2018-09-01

This paper provides an overview of the interrelationships between tourism and sustainability from a cross-disciplinary perspective. The current challenges and barriers in the tourism sustainability, such as high energy use, extensive water consumption and habitat destruction, are first reviewed. Then the key cross-disciplinary elements in sustainable tourism, including green energy, green transportation, green buildings, green infrastructure, green agriculture and smart technologies, are discussed. To overcome the challenges and barriers, a few implementation strategies on achieving sustainable tourism from the aspects of policy/regulation, institution, finance, technology and culture are proposed, along with the framework and details of a key performance indicator system. Finally, prospects of the potential for tourism to contribute to the transformative changes, e.g., a green economy system, are illustrated. This paper shine a light on issues of importance within sustainable tourism and encourage researchers from different disciplines in investigating the inter-relationships among community/culture, environment/ecology, and energy/water/food more broadly. Copyright © 2018 Elsevier B.V. All rights reserved.

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

Detector-device-independent quantum key distribution: Security analysis and fast implementation

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

Boaron, Alberto; Korzh, Boris; Houlmann, Raphael

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant “time-reversal” QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. But, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, we proposed an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) in order to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. We analyze the security of DDI-QKD and elucidate its security assumptions. We find thatmore » DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625 MHz), capable of secret key exchange up to more than 90 km.« less

Detector-device-independent quantum key distribution: Security analysis and fast implementation

DOE PAGES

Boaron, Alberto; Korzh, Boris; Houlmann, Raphael; ...

2016-08-09

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant “time-reversal” QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. But, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, we proposed an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) in order to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. We analyze the security of DDI-QKD and elucidate its security assumptions. We find thatmore » DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625 MHz), capable of secret key exchange up to more than 90 km.« less

Challenges in and lessons learned during the implementation of the 1-3-7 malaria surveillance and response strategy in China: a qualitative study.

PubMed

Lu, Guangyu; Liu, Yaobao; Beiersmann, Claudia; Feng, Yu; Cao, Jun; Müller, Olaf

2016-10-05

China has made great progress in malaria control over the last century and now aims to eliminate malaria by 2020. In 2012, the country launched its 1-3-7 surveillance and response strategy for malaria elimination. The strategy involves to case reporting within 1 day, case investigation within 3 days, and focus investigation and public health actions within 7 days. The aim of this study was to evaluate the challenges in and lessons learned during the implementation of the 1-3-7 strategy in China so far. This qualitative study was conducted in two provinces in China: Gansu province (northwestern China) and Jiangsu province (southeastern China) in 2014. Key informant interviews (n = 6) and in-depth interviews (n = 36) about the implementation aspects of the 1-3-7 strategy were conducted with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels. Broad themes related to the challenges in and lessons learned during the implementation of the 1-3-7 strategy were identified according to: case reporting within 1 day, case investigation within 3 days, focus investigation within 7 days, and the overall strategy. The major challenges outlined were related to respecting the timeline of surveillance procedures, the absence of or difficulties in following guidelines on conducting focus investigations, diagnostics, and the increasing number of returning migrant workers from malaria-endemic countries. Important lessons learned revolve around the importance of continuous capacity building, supervision and motivation, quality control, information technology support, applied research, governmental commitment, and intersectoral collaboration. Surveillance is a key intervention in malaria elimination programs. The Chinese 1-3-7 strategy has already proven to be successful but still needs to be improved. In particular, dealing appropriately with imported malaria cases through the screening of migrant workers from malaria-endemic countries is essential for achieving and sustaining malaria elimination in China. China has perfect preconditions for successful malaria elimination provided political commitment and financial investment are guaranteed. The 1-3-7 strategy may also be considered as a model for other countries.

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Pharmaceutical Market Access: current state of affairs and key challenges - results of the Market Access Launch Excellence Inventory (MALEI).

PubMed

Koch, Marcus A

2015-01-01

To take inventory of the current state of affairs of Market Access Launch Excellence in the life sciences industry. To identify key gaps and challenges for Market Access (MA) and discuss how they can be addressed. To generate a baseline for benchmarking MA launch excellence. An online survey was conducted with pharmaceutical executives primarily working in MA, marketing, or general management. The survey aimed to evaluate MA excellence prerequisites across the product life cycle (rated by importance and level of implementation) and to describe MA activity models in the respective companies. Composite scores were calculated from respondents' ratings and answers. Implementation levels of MA excellence prerequisites generally lagged behind their perceived importance. Item importance and the respective level of implementation correlated well, which can be interpreted as proof of the validity of the questionnaire. The following areas were shown to be particularly underimplemented: 1) early integration of MA and health economic considerations in research and development decision making, 2) developing true partnerships with payers, including the development of services 'beyond the pill', and 3) consideration of human resource and talent management. The concept of importance-adjusted implementation levels as a hybrid parameter was introduced and shown to be a viable tool for benchmarking purposes. More than 70% of respondents indicated that their companies will invest broadly in MA in terms of capital and headcount within the next 3 years. MA (launch) excellence needs to be further developed in order to close implementation gaps across the entire product life cycle. As MA is a comparatively young pharmaceutical discipline in a complex and dynamic environment, this effort will require strategic focus and dedication. The Market Access Launch Excellence Inventory benchmarking tool may help guide decision makers to prioritize their endeavors.

Implementing a Healthy Food Distribution Program: A Supply Chain Strategy to Increase Fruit and Vegetable Access in Underserved Areas.

PubMed

DeFosset, Amelia R; Kwan, Allison; Rizik-Baer, Daniel; Gutierrez, Luis; Gase, Lauren N; Kuo, Tony

2018-05-24

Increasing access to fresh produce in small retail venues could improve the diet of people in underserved communities. However, small retailers face barriers to stocking fresh produce. In 2014, an innovative distribution program, Community Markets Purchasing Real and Affordable Foods (COMPRA), was launched in Los Angeles with the aim of making it more convenient and profitable for small retailers to stock fresh produce. Our case study describes the key processes and lessons learned in the first 2 years of implementing COMPRA. Considerable investments in staff capacity and infrastructure were needed to launch COMPRA. Early successes included significant week-to-week increases in the volume of produce distributed. Leveraging partnerships, maintaining a flexible operational and funding structure, and broadly addressing store owners' needs contributed to initial gains. We describe key challenges and next steps to scaling the program. Lessons learned from implementing COMPRA could inform other jurisdictions considering supply-side approaches to increase access to healthy food.

Social Return on Investment (SROI): An Innovative Approach to Sustainable Development Goals for Sexual and Reproductive Health Programming in sub-Saharan Africa.

PubMed

Kumar, Shubha R; Banke-Thomas, Aduragbemi

2016-09-01

Despite efforts, sub-Saharan Africa did not achieve many key Sexual and Reproductive Health (SRH) targets under the Millennium Development Goals. In the post 2015 era, the Sustainable Development Goals (SDGs) will frame decisions on donor priorities and resource allocations. Successfully addressing SRH challenges in sub-Saharan Africa have been blunted due to fragmentation of SRH interventions in planning and implementation, lack of coherence between policies and program implementation, resulting in poor program performance and lack of accountability. We suggest the Social Return on Investment (SROI) framework offers a strategic approach for sub-Saharan Africa in support of the implementation, monitoring and evaluation of SRH programs given its capacity to capture social and economic impacts, stakeholder participation, and sensitivity towards key human rights concerns relevant to SRH. SROI disrupts a -business as usual‖ approach for one that is systematic, participatory, and supportive of economic and human rights needs for success in the SDG era.

Adaptive management of natural resources-framework and issues

USGS Publications Warehouse

Williams, B.K.

2011-01-01

Adaptive management, an approach for simultaneously managing and learning about natural resources, has been around for several decades. Interest in adaptive decision making has grown steadily over that time, and by now many in natural resources conservation claim that adaptive management is the approach they use in meeting their resource management responsibilities. Yet there remains considerable ambiguity about what adaptive management actually is, and how it is to be implemented by practitioners. The objective of this paper is to present a framework and conditions for adaptive decision making, and discuss some important challenges in its application. Adaptive management is described as a two-phase process of deliberative and iterative phases, which are implemented sequentially over the timeframe of an application. Key elements, processes, and issues in adaptive decision making are highlighted in terms of this framework. Special emphasis is given to the question of geographic scale, the difficulties presented by non-stationarity, and organizational challenges in implementing adaptive management. ?? 2010.

The clinical academic workforce in Australia and New Zealand: report on the second binational summit to implement a sustainable training pathway.

PubMed

Windsor, John; Garrod, Tamsin; Talley, Nicholas J; Tebbutt, Carmel; Churchill, James; Farmer, Elizabeth; Baur, Louise; Smith, Julian A

2017-04-01

There has been a decline in the proportion of clinical academics compared with full-time clinicians, since 2004. A Working Party was established to help develop and implement a model for the training of clinical academics. After a highly successful first summit in 2014 that summarised the challenges faced by clinical academics in Australia and New Zealand, a second summit was convened late in 2015 to report on progress and to identify key areas for further action. The second summit provided survey results that identified the varied training pathways currently offered to clinical academics and the institutions willing to be involved in developing improved pathways. A literature review also described the contributions that clinical academics make to the health sector and the challenges faced by this workforce sector. Current training pathways created for clinical academics by Australasian institutions were presented as examples of what can be done. The perspectives of government and research organisations presented at the summit helped define how key stakeholders can contribute. Following the summit, there was a strong commitment to continue to work towards developing a sustainable and defined training pathway for clinical academics. The need for a coordinated and integrated approach was highlighted. Some key objectives were agreed upon for the next phase, including identifying and engaging key advocates within government and leading institutions; publishing and profiling the contributions of successful clinical academics to healthcare outcomes; defining the stages of a clinical academic training pathway; and establishing a mentoring programme for training clinical academics. © 2017 Royal Australasian College of Physicians.

Progress in satellite quantum key distribution

NASA Astrophysics Data System (ADS)

Bedington, Robert; Arrazola, Juan Miguel; Ling, Alexander

2017-08-01

Quantum key distribution (QKD) is a family of protocols for growing a private encryption key between two parties. Despite much progress, all ground-based QKD approaches have a distance limit due to atmospheric losses or in-fibre attenuation. These limitations make purely ground-based systems impractical for a global distribution network. However, the range of communication may be extended by employing satellites equipped with high-quality optical links. This manuscript summarizes research and development which is beginning to enable QKD with satellites. It includes a discussion of protocols, infrastructure, and the technical challenges involved with implementing such systems, as well as a top level summary of on-going satellite QKD initiatives around the world.

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument.

PubMed

Finch, Tracy L; Mair, Frances S; O'Donnell, Catherine; Murray, Elizabeth; May, Carl R

2012-05-17

Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field. A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals. The developed instrument was pre-tested in two professional samples (N=46; N=231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts. To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.

Understanding and Improving Recruitment to Randomised Controlled Trials: Qualitative Research Approaches.

PubMed

Elliott, Daisy; Husbands, Samantha; Hamdy, Freddie C; Holmberg, Lars; Donovan, Jenny L

2017-11-01

The importance of evidence from randomised trials is now widely recognised, although recruitment is often difficult. Qualitative research has shown promise in identifying the key barriers to recruitment, and interventions have been developed to reduce organisational difficulties and support clinicians undertaking recruitment. This article provides an introduction to qualitative research techniques and explains how this approach can be used to understand-and subsequently improve-recruitment and informed consent within a range of clinical trials. A literature search was performed using Medline, Embase, and CINAHL. All studies with qualitative research methods that focused on the recruitment activity of clinicians were included in the review. The majority of studies reported that organisational difficulties and lack of time for clinical staff were key barriers to recruitment. However, a synthesis of qualitative studies highlighted the intellectual and emotional challenges that arise when combining research with clinical roles, particularly in relation to equipoise and patient eligibility. To support recruiters to become more comfortable with the design and principles of randomised controlled trials, interventions have been developed, including the QuinteT Recruitment Intervention, which comprises in-depth investigation of recruitment obstacles in real time, followed by implementation of tailored strategies to address these challenges as the trial proceeds. Qualitative research can provide important insights into the complexities of recruitment to trials and inform the development of interventions, and provide support and training initiatives as required. Investigators should consider implementing such methods in trials expected to be challenging or recruiting below target. Qualitative research is a term used to describe a range of methods that can be implemented to understand participants' perspectives and behaviours. Data are gathered from interviews, focus groups, or observations. In this review, we demonstrate how this approach can be used to understand-and improve-recruitment to clinical trials. Taken together, our review suggests that healthcare professionals can find recruiting to trials challenging and require support with this process. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Education Quality and the Kenyan 8-4-4 Curriculum: Secondary School Learners' Experiences

ERIC Educational Resources Information Center

Milligan, Lizzi O.

2017-01-01

This article explores the implementation of Kenyan secondary education in rural Western Kenya, focusing on learners' experiences. One of the key challenges to educational quality is shown to be the size and breadth of the secondary education curriculum. Learners are in school 12 hours a day with those approaching their final exams working three to…

The Promise and Challenge of Mentoring High-Risk Youth: Findings from the National Faith-Based Initiative

ERIC Educational Resources Information Center

Bauldry, Shawn; Hartmann, Tracey A.

2004-01-01

This report, the third derived from research out of the National Faith-Based Initiative (NFBI), examines how faith-based organizations designed and implemented mentoring programs for high-risk youth. Focusing on four NFBI sites (in the Bronx and Brooklyn, NY; Baton Rouge, LA; and Philadelphia, PA), the report takes up three key questions: How were…

An Evaluation of an Intervention Sequence Outline in Positive Behaviour Support for People with Autism and Severe Escape-Motivated Challenging Behaviour

ERIC Educational Resources Information Center

McClean, Brian; Grey, Ian

2012-01-01

Background: Positive behaviour support emphasises the impact of contextual variables to enhance participation, choice, and quality of life. This study evaluates a sequence for implementing changes to key contextual variables for 4 individuals. Interventions were maintained and data collection continued over a 3-year period. Method: Functional…

Enjoyment Fosters Engagement: The Key to Involving Middle School Students in Physical Education and Physical Activity

ERIC Educational Resources Information Center

Pharez, Emily S.

2016-01-01

This article describes the challenges faced by a middle school teacher who inherited a recreation-based physical education program in which students had been accustomed to choosing what they wanted to do. Stressing the importance of implementing a standards-based program in which students of all skill levels and activity preferences were able to…

Gearing up to Teach the Common Core State Standards for Mathematics in Rural Northeast Region Schools. REL 2015-031

ERIC Educational Resources Information Center

Walters, Kirk; Torres, Aubrey Scheopner; Smith, Toni; Ford, Jennifer

2014-01-01

This study describes key challenges and necessary supports related to implementation of the Common Core State Standards for Mathematics (CCSSM) identified by rural math educators in the Northeast. The research team interviewed state and district math coordinators and surveyed teachers in Maine, New Hampshire, New York and Vermont, to assess their…

Taking digital imaging to the next level: challenges and opportunities.

PubMed

Hobbs, W Cecyl

2004-01-01

New medical imaging technology, such as multi-detector computed tomography (CT) scanners and positron emission tomography (PET) scanners, are creating new possibilities for non-invasive diagnosis that are leading providers to invest heavily in these new technologies. The volume of data produced by such technology is so large that it cannot be "read" using traditional film-based methods, and once in digital form, it creates a massive data integration and archiving challenge. Despite the benefits of digital imaging and archiving, there are several key challenges that healthcare organizations should consider in planning, selecting, and implementing the information technology (IT) infrastructure to support digital imaging. Decisions about storage and image distribution are essentially questions of "where" and "how fast." When planning the digital archiving infrastructure, organizations should think about where they want to store and distribute their images. This is similar to decisions that organizations have to make in regard to physical film storage and distribution, except the portability of images is even greater in a digital environment. The principle of "network effects" seems like a simple concept, yet the effect is not always considered when implementing a technology plan. To fully realize the benefits of digital imaging, the radiology department must integrate the archiving solutions throughout the department and, ultimately, with applications across other departments and enterprises. Medical institutions can derive a number of benefits from implementing digital imaging and archiving solutions like PACS. Hospitals and imaging centers can use the transition from film-based imaging as a foundational opportunity to reduce costs, increase competitive advantage, attract talent, and improve service to patients. The key factors in achieving these goals include attention to the means of data storage, distribution and protection.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges.

PubMed

Bajorek, Beata; Lemay, Kate S; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol L

2016-01-01

Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

PubMed Central

2016-01-01

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context. PMID:27382427

Implementing recovery: an analysis of the key technologies in Scotland

PubMed Central

2011-01-01

Background Over the past ten years the promotion of recovery has become a stated aim of mental health policies within a number of English speaking countries, including Scotland. Implementation of a recovery approach involves a significant reorientation of mental health services and practices, which often poses significant challenges for reformers. This article examines how four key technologies of recovery have assisted in the move towards the creation of a recovery-oriented mental health system in Scotland. Methods Drawing on documentary analysis and a series of interviews we examine the construction and implementation of four key recovery 'technologies' as they have been put to use in Scotland: recovery narratives, the Scottish Recovery Indicator (SRI), Wellness Recovery Action Planning (WRAP) and peer support. Results Our findings illuminate how each of these technologies works to instantiate, exemplify and disseminate a 'recovery orientation' at different sites within the mental health system in order to bring about a 'recovery oriented' mental health system. They also enable us to identify some of the factors that facilitate or hinder the effectiveness of those technologies in bringing about a change in how mental health services are delivered in Scotland. These finding provide a basis for some general reflections on the utility of 'recovery technologies' to implement a shift towards recovery in mental health services in Scotland and elsewhere. Conclusions Our analysis of this process within the Scottish context will be valuable for policy makers and service coordinators wishing to implement recovery values within their own national mental health systems. PMID:21569633

Introduction to the special issue: toward implementing physiological measures in clinical child and adolescent assessments.

PubMed

De Los Reyes, Andres; Aldao, Amelia

2015-01-01

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). The RDoC is an initiative to improve classification of mental health concerns by promoting research on the brain mechanisms underlying these concerns, with the ultimate goal of developing interventions that target these brain mechanisms. A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures. The RDoC presents unique challenges to mental health professionals who work with children and adolescents. Indeed, mental health professionals rarely integrate biological measures into clinical assessments. Thus, RDoC's ability to improve patient care rests, in part, on the development of strategies for implementing biological measures within mental health assessments. Further, mental health professionals already carry out comprehensive assessments that frequently yield inconsistent findings. These inconsistencies have historically posed challenges to interpreting research findings as well as assessment outcomes in practice settings. In this introductory article, we review key issues that informed the development of a special issue of articles demonstrating methods for implementing low-cost measures of physiological functioning in clinical child and adolescent assessments. We also outline a conceptual framework, informed by theoretical work on using and interpreting multiple informants' clinical reports (De Los Reyes, Thomas, Goodman, & Kundey, 2013 ), to guide hypothesis testing when using physiological measures within clinical child and adolescent assessments. This special issue and the conceptual model described in this article may open up new lines of research testing paradigms for implementing clinically feasible physiological measures in clinical child and adolescent assessments.

Senior managers' viewpoints toward challenges of implementing clinical governance: a national study in iran.

PubMed

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-11-01

Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government's intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers' viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers' attitude toward CG and ultimately affected the success of quality improvement activities.

Regulatory perspective on remaining challenges for utilization of pharmacogenomics-guided drug developments.

PubMed

Otsubo, Yasuto; Ishiguro, Akihiro; Uyama, Yoshiaki

2013-01-01

Pharmacogenomics-guided drug development has been implemented in practice in the last decade, resulting in increased labeling of drugs with pharmacogenomic information. However, there are still many challenges remaining in utilizing this process. Here, we describe such remaining challenges from the regulatory perspective, specifically focusing on sample collection, biomarker qualification, ethnic factors, codevelopment of companion diagnostics and means to provide drugs for off-target patients. To improve the situation, it is important to strengthen international harmonization and collaboration among academia, industries and regulatory agencies, followed by the establishment of an international guideline on this topic. Communication with a regulatory agency from an early stage of drug development is also a key to success.

Local Implementation of Alcohol Screening and Brief Intervention at Five Veterans Health Administration Primary Care Clinics: Perspectives of Clinical and Administrative Staff.

PubMed

Williams, Emily C; Achtmeyer, Carol E; Young, Jessica P; Rittmueller, Stacey E; Ludman, Evette J; Lapham, Gwen T; Lee, Amy K; Chavez, Laura J; Berger, Douglas; Bradley, Katharine A

2016-01-01

Population-based alcohol screening, followed by brief intervention for patients who screen positive for unhealthy alcohol use, is widely recommended for primary care settings and considered a top prevention priority, but is challenging to implement. However, new policy initiatives in the U.S., including the Affordable Care Act, may help launch widespread implementation. While the nationwide Veterans Health Administration (VA) has achieved high rates of documented alcohol screening and brief intervention, research has identified quality problems with both. We conducted a qualitative key informant study to describe local implementation of alcohol screening and brief intervention from the perspectives of frontline adopters in VA primary care in order to understand the process of implementation and factors underlying quality problems. A purposive snowball sampling method was used to identify and recruit key informants from 5 VA primary care clinics in the northwestern U.S. Key informants completed 20-30 minute semi-structured interviews, which were recorded, transcribed, and qualitatively analyzed using template analysis. Key informants (N=32) included: clinical staff (n=14), providers (n=14), and administrative informants (n=4) with varying participation in implementation of and responsibility for alcohol screening and brief intervention at the medical center. Ten inter-related themes (5 a priori and 5 emergent) were identified and grouped into 3 applicable domains of Greenhalgh's conceptual framework for dissemination of innovations, including values of adopters (theme 1), processes of implementation (themes 2 and 3), and post-implementation consequences in care processes (themes 4-10). While key informants believed alcohol use was relevant to health and important to address, the process of implementation (in which no training was provided and electronic clinical reminders "just showed up") did not address critical training and infrastructure needs. Key informants lacked understanding of the goals of screening and brief intervention, believed referral to specialty addictions treatment (as opposed to offering brief intervention) was the only option for following up on a positive screen, reported concern regarding limited availability of treatment resources, and lacked optimism regarding patients' interest in seeking help. Findings suggest that the local process of implementing alcohol screening and brief intervention may have inadequately addressed important adopter needs and thus may have ultimately undermined, instead of capitalized on, staff and providers' belief in the importance of addressing alcohol use as part of primary care. Additional implementation strategies, such as training or academic detailing, may address some unmet needs and help improve the quality of both screening and brief intervention. However, these strategies may be resource-intensive and insufficient for comprehensively addressing implementation barriers. Published by Elsevier Inc.

Developing technology-enhanced active learning for medical education: challenges, solutions, and future directions.

PubMed

McCoy, Lise; Pettit, Robin K; Lewis, Joy H; Bennett, Thomas; Carrasco, Noel; Brysacz, Stanley; Makin, Inder Raj S; Hutman, Ryan; Schwartz, Frederic N

2015-04-01

Growing up in an era of video games and Web-based applications has primed current medical students to expect rapid, interactive feedback. To address this need, the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa) has developed and integrated a variety of approaches using technology-enhanced active learning for medical education (TEAL-MEd) into its curriculum. Over the course of 3 years (2010-2013), the authors facilitated more than 80 implementations of games and virtual patient simulations into the education of 550 osteopathic medical students. The authors report on 4 key aspects of the TEAL-MEd initiative, including purpose, portfolio of tools, progress to date regarding challenges and solutions, and future directions. Lessons learned may be of benefit to medical educators at academic and clinical training sites who wish to implement TEAL-MEd activities.

Comparison of Various Similarity Measures for Average Image Hash in Mobile Phone Application

NASA Astrophysics Data System (ADS)

Farisa Chaerul Haviana, Sam; Taufik, Muhammad

2017-04-01

One of the main issue in Content Based Image Retrieval (CIBR) is similarity measures for resulting image hashes. The main key challenge is to find the most benefits distance or similarity measures for calculating the similarity in term of speed and computing costs, specially under limited computing capabilities device like mobile phone. This study we utilize twelve most common and popular distance or similarity measures technique implemented in mobile phone application, to be compared and studied. The results show that all similarity measures implemented in this study was perform equally under mobile phone application. This gives more possibilities for method combinations to be implemented for image retrieval.

Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study.

PubMed

Wright, Adam; Sittig, Dean F; Ash, Joan S; Erickson, Jessica L; Hickman, Trang T; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A; Middleton, Blackford

2015-11-01

To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Stakeholder engagement: a key component of integrating genomic information into electronic health records

PubMed Central

Hartzler, Andrea; McCarty, Catherine A.; Rasmussen, Luke V.; Williams, Marc S.; Brilliant, Murray; Bowton, Erica A.; Clayton, Ellen Wright; Faucett, William A.; Ferryman, Kadija; Field, Julie R.; Fullerton, Stephanie M.; Horowitz, Carol R.; Koenig, Barbara A.; McCormick, Jennifer B.; Ralston, James D.; Sanderson, Saskia C.; Smith, Maureen E.; Trinidad, Susan Brown

2014-01-01

Integrating genomic information into clinical care and the electronic health record can facilitate personalized medicine through genetically guided clinical decision support. Stakeholder involvement is critical to the success of these implementation efforts. Prior work on implementation of clinical information systems provides broad guidance to inform effective engagement strategies. We add to this evidence-based recommendations that are specific to issues at the intersection of genomics and the electronic health record. We describe stakeholder engagement strategies employed by the Electronic Medical Records and Genomics Network, a national consortium of US research institutions funded by the National Human Genome Research Institute to develop, disseminate, and apply approaches that combine genomic and electronic health record data. Through select examples drawn from sites of the Electronic Medical Records and Genomics Network, we illustrate a continuum of engagement strategies to inform genomic integration into commercial and homegrown electronic health records across a range of health-care settings. We frame engagement as activities to consult, involve, and partner with key stakeholder groups throughout specific phases of health information technology implementation. Our aim is to provide insights into engagement strategies to guide genomic integration based on our unique network experiences and lessons learned within the broader context of implementation research in biomedical informatics. On the basis of our collective experience, we describe key stakeholder practices, challenges, and considerations for successful genomic integration to support personalized medicine. PMID:24030437

Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria.

PubMed

Peterson, Lauren; Comfort, Alison; Hatt, Laurel; van Bastelaer, Thierry

2018-04-15

As a growing number of low- and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria. Study methods included a survey of microfinance clients, key informant interviews, and a review of administrative records. Demographic, health care seeking, and willingness-to-pay data suggested that microfinance clients, particularly women, could benefit from a comprehensive MHI plan that improved access to health care and reduced out-of-pocket spending on health services. However, administrative data revealed declining enrollment, and key informant interviews further suggested low use of the health insurance plan. Key implementation challenges, including changes to mandatory enrollment requirements, insufficient client education and marketing, misaligned incentives, and weak back-office systems, undermined enrollment and use of the plan. Mandatory MHI plans, intended to mitigate adverse selection and facilitate private insurers' entry into new markets, present challenges for covering informal sector workers, including when distributed through agents such as a microfinance bank. Properly aligning the incentives of the insurer and the agent are critical to effectively distribute and service insurance. Further, an urban environment presents unique challenges for distributing MHI, addressing client perceptions of health insurance, and meeting their health care needs. Copyright © 2018 John Wiley & Sons, Ltd.

Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda.

PubMed

Paina, Ligia; Wilkinson, Annie; Tetui, Moses; Ekirapa-Kiracho, Elizabeth; Barman, Debjani; Ahmed, Tanvir; Mahmood, Shehrin Shaila; Bloom, Gerry; Knezovich, Jeff; George, Asha; Bennett, Sara

2017-12-28

The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening. This paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams' experiences along four potential uses of ToCs, namely planning, communication, learning and accountability. The three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams' experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams' initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes. The ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement.

Multisector Nutrition Program Governance and Implementation in Ethiopia: Opportunities and Challenges.

PubMed

Kennedy, Eileen; Tessema, Masresha; Hailu, Tesfaye; Zerfu, Dilnesaw; Belay, Adamu; Ayana, Girmay; Kuche, Desalegn; Moges, Tibebu; Assefa, Tsehai; Samuel, Aregash; Kassaye, Tarik; Fekadu, Habtamu; Van Wassenhove, Joan

2015-12-01

Governments globally are stressing both direct nutrition interventions combined with nutrition sensitive policies and programs to combat malnutrition. Governance at all levels has been identified as a critical element in ensuring success of national nutrition plans. For example, the most recent National Nutrition Program (NNP) in Ethiopia discusses the essentiality of governance and coordination at all levels. The research uses a qualitative study based on semi-structured interviews with key informant. The research discussed in this article focuses on governance structures from national to regional to district level in Ethiopia with an emphasis on translation of a strategy and implementation of the NNP. This article concentrates primarily on results from the national and regional levels. Data at both the national and regional levels indicate that there is general agreement on the nature of the nutrition problems in Ethiopia. At all levels of government, under nutrition, food insecurity, and micronutrient deficiencies were listed as the main nutrition problems. The challenges in governance and implementation identified at both the national and regional levels, however, varied. The implementation of the 2013 NNP was in its early stages at the time of this research. While there was palpable energy around the launch of the NNP, respondents indicated issues related to leadership, coordination, collaboration, advocacy, and budget would be challenges in sustaining momentum. © The Author(s) 2015.

Regulatory and Quality Considerations for Continuous Manufacturing May 20-21, 2014 Continuous Manufacturing Symposium.

PubMed

Allison, Gretchen; Cain, Yanxi Tan; Cooney, Charles; Garcia, Tom; Bizjak, Tara Gooen; Holte, Oyvind; Jagota, Nirdosh; Komas, Bekki; Korakianiti, Evdokia; Kourti, Dora; Madurawe, Rapti; Morefield, Elaine; Montgomery, Frank; Nasr, Moheb; Randolph, William; Robert, Jean-Louis; Rudd, Dave; Zezza, Diane

2015-03-01

This paper assesses the current regulatory environment, relevant regulations and guidelines, and their impact on continuous manufacturing. It summarizes current regulatory experience and learning from both review and inspection perspectives. It outlines key regulatory aspects, including continuous manufacturing process description and control strategy in regulatory files, process validation, and key Good Manufacturing Practice (GMP) requirements. In addition, the paper identifies regulatory gaps and challenges and proposes a way forward to facilitate implementation. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

Case Study: The Role of eLearning in Midwifery Pre-Service Education in Ghana.

PubMed

Appiagyei, Martha; Trump, Alison; Danso, Evans; Yeboah, Alex; Searle, Sarah; Carr, Catherine

The issues and challenges of implementing eLearning in pre-service health education were explored through a pilot study conducted in six nurse-midwifery education programs in Ghana. Case-based, interactive computer mediated eLearning modules, targeted to basic emergency and obstetrical signal functions, were delivered both online and offline using a free-for-use eLearning platform, skoool HE(®). Key success factors included broad stakeholder support, an established curriculum and student and tutor interest. Challenges included infrastructure limitations, large class sizes and added workloads for tutors and information technology staff. National scale up is planned.

A review of clinical practice guidelines for lung cancer

PubMed Central

Ball, David; Silvestri, Gerard A.

2013-01-01

Clinical practice guidelines are important evidence-based resources to guide complex clinical decision making. However, it is challenging for health professionals to keep abreast available guidelines and to know how and where to access relevant guidelines. This review examines currently available guidelines for lung cancer published in the English language. Important key features are listed for each identified guideline. The methodology, approaches to dissemination and implementation, and associated resources are summarised. General challenges in the area of guideline development are highlighted. The potential to collaborate more widely across lung cancer guideline developers by sharing literature searches and assessments is discussed. PMID:24163752

Shortridge academy: positive youth development in action within a therapeutic community.

PubMed

Baber, Kristine M; Rainer, Adam

2011-01-01

This chapter presents a case example of the implementation of Positive Youth Development (PYD) at a therapeutic boarding school including the theoretical, conceptual, and empirical information about PYD, adolescent brain development, authoritative communities, and youth-adult partnerships that guided this work. Specific examples demonstrate how key concepts and underlying principles of PYD were put into practice. The chapter provides information about parents' perceptions of the school's effectiveness and explains a theory of change approach used to develop the program evaluation. The chapter concludes with a discussion of challenges and opportunities experienced in the development and implementation of the program.

Automated selection of synthetic biology parts for genetic regulatory networks.

PubMed

Yaman, Fusun; Bhatia, Swapnil; Adler, Aaron; Densmore, Douglas; Beal, Jacob

2012-08-17

Raising the level of abstraction for synthetic biology design requires solving several challenging problems, including mapping abstract designs to DNA sequences. In this paper we present the first formalism and algorithms to address this problem. The key steps of this transformation are feature matching, signal matching, and part matching. Feature matching ensures that the mapping satisfies the regulatory relationships in the abstract design. Signal matching ensures that the expression levels of functional units are compatible. Finally, part matching finds a DNA part sequence that can implement the design. Our software tool MatchMaker implements these three steps.

Florida's propagation report

NASA Technical Reports Server (NTRS)

Helmken, Henry; Henning, Rudolf

1994-01-01

One of the key goals of the Florida Center is to obtain a maximum of useful information on propagation behavior unique to its subtropical weather and subtropical climate. Such weather data is of particular interest when it is (or has the potential to become) useful for developing and implementing techniques to compensate for adverse weather effects. Also discussed are data observations, current challenges, CDF's, sun movement, and diversity experiments.

Gearing up to Teach the Common Core State Standards for Mathematics in the Rural Northeast Region. Stated Briefly. REL 2015-066

ERIC Educational Resources Information Center

Kirk, Walters; Smith, Toni M.; Ford, Jennifer; Scheopner Torres, Aubrey

2014-01-01

This study describes key challenges and necessary supports related to implementation of the Common Core State Standards for Mathematics (CCSSM) identified by rural math educators in the Northeast. The research team interviewed state and district math coordinators and surveyed teachers in Maine, New Hampshire, New York and Vermont, to assess their…

From Administrative to Customer-Oriented Banking. Re-designing Strategy, Organization, Qualifications and Training in European Banks. Synthesis Report. CEDEFOP Panorama. First Edition.

ERIC Educational Resources Information Center

Bertrand, Olivier; And Others

This paper makes a comparative analysis of main trends that have emerged or are about to emerge in the banking sector, stressing factors that influence employment, qualifications, and staff training in banking as well as policies implemented by banking institutions to meet such challenges. Chapter 1 analyzes the change drivers--key factors that…

Transforming Oncology Care: Developing a Strategy and Measuring Success.

PubMed

Reid Ponte, Patricia; Berry, Donna; Buswell, Lori; Gross, Anne; Hayes, Carolyn; Kostka, Judy; Poyner-Reed, Mary; West, Colleen

2016-05-01

To examine accountability and performance measurement in health care and present a case study that illustrates the link between goal setting and measurement and how a strategic plan can provide a framework for metric selection. National reports, literature review and institutional experience. Nurse leaders and clinicians in oncology settings are challenged to anticipate future trends in oncology care and create a culture, infrastructure, and practice environment that supports innovation, advancement of oncology nursing practice and excellence in patient- and family-centered care. Performance metrics assessing key processes and outcomes of care are essential to meet this challenge. With an increasing number of national organizations offering their version of key quality standards and metrics, it is critical for nurses to have a formal process in place to determine and implement the measures most useful in guiding change for a particular clinical setting. Copyright © 2016 Elsevier Inc. All rights reserved.

Advanced visualization platform for surgical operating room coordination: distributed video board system.

PubMed

Hu, Peter F; Xiao, Yan; Ho, Danny; Mackenzie, Colin F; Hu, Hao; Voigt, Roger; Martz, Douglas

2006-06-01

One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

Standardizing assessment practices of undergraduate medical competencies across medical schools: challenges, opportunities and lessons learned from a consortium of medical schools in Uganda.

PubMed

Mubuuke, Aloysius Gonzaga; Mwesigwa, Catherine; Maling, Samuel; Rukundo, Godfrey; Kagawa, Mike; Kitara, David Lagoro; Kiguli, Sarah

2014-01-01

Health professions education is gradually moving away from the more traditional approaches to new innovative ways of training aimed at producing professionals with the necessary competencies to address the community health needs. In response to these emerging trends, Medical Education for Equitable Services to All Ugandans (MESAU), a consortium of Ugandan medical schools developed key competencies desirable of graduates and successfully implemented Competency Based Education (CBE) for undergraduate medical students. To examine the current situation and establish whether assessment methods of the competencies are standardized across MESAU schools as well as establish the challenges, opportunities and lessons learned from the MESAU consortium. It was a cross-sectional descriptive study involving faculty of the medical schools in Uganda. Data was collected using focus group discussions and document reviews. Findings were presented in form of themes. Although the MESAU schools have implemented the developed competencies within their curricular, the assessment methods are still not standardized with each institution having its own assessment procedures. Lack of knowledge and skills regarding assessment of the competencies was evident amongst the faculty. The fear for change amongst lecturers was also noted as a major challenge. However, the institutional collaboration created while developing competencies was identified as key strength. Findings demonstrated that despite having common competencies, there is no standardized assessment blue print applicable to all MESAU schools. Continued collaboration and faculty development in assessment is strongly recommended.

Standardizing assessment practices of undergraduate medical competencies across medical schools: challenges, opportunities and lessons learned from a consortium of medical schools in Uganda

PubMed Central

Mubuuke, Aloysius Gonzaga; Mwesigwa, Catherine; Maling, Samuel; Rukundo, Godfrey; Kagawa, Mike; Kitara, David Lagoro; Kiguli, Sarah

2014-01-01

Introduction Health professions education is gradually moving away from the more traditional approaches to new innovative ways of training aimed at producing professionals with the necessary competencies to address the community health needs. In response to these emerging trends, Medical Education for Equitable Services to All Ugandans (MESAU), a consortium of Ugandan medical schools developed key competencies desirable of graduates and successfully implemented Competency Based Education (CBE) for undergraduate medical students. Objectives To examine the current situation and establish whether assessment methods of the competencies are standardized across MESAU schools as well as establish the challenges, opportunities and lessons learned from the MESAU consortium. Methods It was a cross-sectional descriptive study involving faculty of the medical schools in Uganda. Data was collected using focus group discussions and document reviews. Findings were presented in form of themes. Results Although the MESAU schools have implemented the developed competencies within their curricular, the assessment methods are still not standardized with each institution having its own assessment procedures. Lack of knowledge and skills regarding assessment of the competencies was evident amongst the faculty. The fear for change amongst lecturers was also noted as a major challenge. However, the institutional collaboration created while developing competencies was identified as key strength. Conclusion Findings demonstrated that despite having common competencies, there is no standardized assessment blue print applicable to all MESAU schools. Continued collaboration and faculty development in assessment is strongly recommended. PMID:25995778

Lessons learned from implementing the HIV infant tracking system (HITSystem): A web-based intervention to improve early infant diagnosis in Kenya.

PubMed

Finocchario-Kessler, S; Odera, I; Okoth, V; Bawcom, C; Gautney, B; Khamadi, S; Clark, K; Goggin, K

2015-12-01

Guided by the RE-AIM model, we describe preliminary data and lessons learned from multiple serial implementations of an eHealth intervention to improve early infant diagnosis (EID) of HIV in Kenya. We describe the reach, effectiveness, adoption, implementation and maintenance of the HITSystem, an eHealth intervention that links key stakeholders to improve retention and outcomes in EID. Our target community includes mother-infant pairs utilizing EID services and government health care providers and lab personnel. We also explore our own role as program and research personnel supporting the dissemination and scale up of the HITSystem in Kenya. Key findings illustrate the importance of continual adaptation of the HITSystem interface to accommodate varied stakeholders' workflows in different settings. Surprisingly, technology capacity and internet connectivity posed minimal short-term challenges. Early and sustained ownership of the HITSystem among stakeholders proved critical to reach, effectiveness and successful adoption, implementation and maintenance. Preliminary data support the ability of the HITSystem to improve EID outcomes in Kenya. Strong and sustained collaborations with stakeholders improve the quality and reach of eHealth public health interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Tight finite-key analysis for quantum cryptography

PubMed Central

Tomamichel, Marco; Lim, Charles Ci Wen; Gisin, Nicolas; Renner, Renato

2012-01-01

Despite enormous theoretical and experimental progress in quantum cryptography, the security of most current implementations of quantum key distribution is still not rigorously established. One significant problem is that the security of the final key strongly depends on the number, M, of signals exchanged between the legitimate parties. Yet, existing security proofs are often only valid asymptotically, for unrealistically large values of M. Another challenge is that most security proofs are very sensitive to small differences between the physical devices used by the protocol and the theoretical model used to describe them. Here we show that these gaps between theory and experiment can be simultaneously overcome by using a recently developed proof technique based on the uncertainty relation for smooth entropies. PMID:22252558

Tight finite-key analysis for quantum cryptography.

PubMed

Tomamichel, Marco; Lim, Charles Ci Wen; Gisin, Nicolas; Renner, Renato

2012-01-17

Despite enormous theoretical and experimental progress in quantum cryptography, the security of most current implementations of quantum key distribution is still not rigorously established. One significant problem is that the security of the final key strongly depends on the number, M, of signals exchanged between the legitimate parties. Yet, existing security proofs are often only valid asymptotically, for unrealistically large values of M. Another challenge is that most security proofs are very sensitive to small differences between the physical devices used by the protocol and the theoretical model used to describe them. Here we show that these gaps between theory and experiment can be simultaneously overcome by using a recently developed proof technique based on the uncertainty relation for smooth entropies.

Detector-device-independent quantum key distribution

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

Lim, Charles Ci Wen; Korzh, Boris; Martin, Anthony

2014-12-01

Recently, a quantum key distribution (QKD) scheme based on entanglement swapping, called measurement-device-independent QKD (mdiQKD), was proposed to bypass all measurement side-channel attacks. While mdiQKD is conceptually elegant and offers a supreme level of security, the experimental complexity is challenging for practical systems. For instance, it requires interference between two widely separated independent single-photon sources, and the secret key rates are dependent on detecting two photons—one from each source. Here, we demonstrate a proof-of-principle experiment of a QKD scheme that removes the need for a two-photon system and instead uses the idea of a two-qubit single-photon to significantly simplify themore » implementation and improve the efficiency of mdiQKD in several aspects.« less

High-speed polarization-encoded quantum key distribution based on silicon photonic integrated devices

NASA Astrophysics Data System (ADS)

Bunandar, Darius; Urayama, Junji; Boynton, Nicholas; Martinez, Nicholas; Derose, Christopher; Lentine, Anthony; Davids, Paul; Camacho, Ryan; Wong, Franco; Englund, Dirk

We present a compact polarization-encoded quantum key distribution (QKD) transmitter near a 1550-nm wavelength implemented on a CMOS-compatible silicon-on-insulator photonics platform. The transmitter generates arbitrary polarization qubits at gigahertz bandwidth with an extinction ratio better than 30 dB using high-speed carrier-depletion phase modulators. We demonstrate the performance of this device by generating secret keys at a rate of 1 Mbps in a complete QKD field test. Our work shows the potential of using advanced photonic integrated circuits to enable high-speed quantum-secure communications. This work was supported by the SECANT QKD Grand Challenge, the Samsung Global Research Outreach Program, and the Air Force Office of Scientific Research.

Development and implementation of a peer mentoring program for early career gerontological faculty.

PubMed

Bryant, Ashley Leak; Aizer Brody, Abraham; Perez, Adriana; Shillam, Casey; Edelman, Linda S; Bond, Stewart M; Foster, Victoria; Siegel, Elena O

2015-05-01

The Hartford Gerontological Nursing Leaders (HGNL) formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), in conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), developed and executed a peer mentoring program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of HGNL members. The purpose of this article is to describe key strategies used to develop and execute the peer mentoring program and to present formative program evaluation. The program was launched in January 2011 with seven peer mentor and mentee matches. In June 2012, the peer mentoring committee solicited feedback on the development of the peer mentoring program and changes were made for the subsequent cohorts. An additional 12 matches were made in the following 2 years (2012 and 2013), for a total of 31 matches to date. We have learned several key lessons from our three cohorts regarding how to structure, implement, and carefully evaluate a peer mentoring program. Informal evaluation of our peer mentoring program noted several challenges for both peer mentors and mentees. Having knowledge of and addressing those challenges may increase the overall quality and effectiveness of peer mentoring programs and, in turn, benefit academic nursing by strengthening the faculty workforce. Findings from development and implementation of a peer mentoring program for gerontological faculty could lead to new and adaptable programs in a variety of clinical and education settings. © 2015 Sigma Theta Tau International.

Factors influencing the adoption and implementation of teledentistry in the UK, with a focus on orthodontics.

PubMed

Patel, Reena N; Antonarakis, Gregory S

2013-10-01

Utilizing Rogers' diffusion of innovation theory, this study aims to develop a better understanding of the challenges faced in teledental projects, and outline the factors that impact upon the adoption and implementation of teledental projects, with a focus on orthodontics, thus attempting to provide an explanation for the low uptake in the UK, as well as to suggest factors to encourage success. A literature search was carried out to obtain information concerning teledentistry (and telemedicine) from both primary and secondary research sources. Using the relevant information obtained, Rogers' diffusion of innovation theory was used as a framework, which was subsequently applied to the key stakeholder groups of a healthcare organization. The model describes five characteristics of an innovation: relative advantage, compatibility, complexity, trialability and observability. These attributes are discussed in the context of key stakeholder groups within a healthcare organization: clinicians, patients, hospital managers, and healthcare decision-makers and funders. Each stakeholder group is motivated by different values and experiences, which in turn influence their decision to adopt a new technology. Implementing teledental applications necessitates full comprehension and consideration of the healthcare environment and also a commitment to completely integrate teledentistry within that environment. This is a process that demands strategic alignment with clinical and organizational goals, clinical engagement and strong political support. The challenges within each stakeholder group must be specifically targeted. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Optimizing Approximate Weighted Matching on Nvidia Kepler K40

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

Naim, Md; Manne, Fredrik; Halappanavar, Mahantesh

Matching is a fundamental graph problem with numerous applications in science and engineering. While algorithms for computing optimal matchings are difficult to parallelize, approximation algorithms on the other hand generally compute high quality solutions and are amenable to parallelization. In this paper, we present efficient implementations of the current best algorithm for half-approximate weighted matching, the Suitor algorithm, on Nvidia Kepler K-40 platform. We develop four variants of the algorithm that exploit hardware features to address key challenges for a GPU implementation. We also experiment with different combinations of work assigned to a warp. Using an exhaustive set ofmore » $269$ inputs, we demonstrate that the new implementation outperforms the previous best GPU algorithm by $10$ to $$100\\times$$ for over $100$ instances, and from $100$ to $$1000\\times$$ for $15$ instances. We also demonstrate up to $$20\\times$$ speedup relative to $2$ threads, and up to $$5\\times$$ relative to $16$ threads on Intel Xeon platform with $16$ cores for the same algorithm. The new algorithms and implementations provided in this paper will have a direct impact on several applications that repeatedly use matching as a key compute kernel. Further, algorithm designs and insights provided in this paper will benefit other researchers implementing graph algorithms on modern GPU architectures.« less

Examining implementation and preliminary performance indicators of veterans treatment courts: The Kentucky experience.

PubMed

Shannon, Lisa M; Birdwhistell, Shira; Hulbig, Shelia K; Jones, Afton Jackson; Newell, Jennifer; Payne, Connie

2017-08-01

Veterans' Treatment Courts (VTCs) are posited as a solution to offer rehabilitation for veterans involved in the criminal justice system. Despite the pervasive implementation of VTCs, there is little research focused specifically on VTC implementation and outcomes, which are based on other problem-solving court models such as drug court. The current study presents qualitative process evaluation data from key stakeholders (n=21) and veteran participants (n=4) to show accomplishments, challenges, and lessons learned during first-year implementation at two VTC sites. Quantitative performance data is also presented on veteran participants (n=19) served during the first year to show: types of services, monitoring, judicial interaction, sanctions/therapeutic responses, and rewards, as well as preliminary data on recidivism. Qualitative data, from both key stakeholders and veteran participants, suggests that offering rehabilitation via various program components, services/referrals, and accountability are critical to the success of the VTC. Data also provides valuable lessons learned for VTC implementation including communication, collaboration, information/protocols, and resources. Performance data shows that a variety of services are utilized and that frequent judicial interaction, drug testing, and sanctions are cornerstones of the VTC. Implications and future directions for research are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

The demonstration of a theory-based approach to the design of localized patient safety interventions

PubMed Central

2013-01-01

Background There is evidence of unsafe care in healthcare systems globally. Interventions to implement recommended practice often have modest and variable effects. Ideally, selecting and adapting interventions according to local contexts should enhance effects. However, the means by which this can happen is seldom systematic, based on theory, or made transparent. This work aimed to demonstrate the applicability, feasibility, and acceptability of a theoretical domains framework implementation (TDFI) approach for co-designing patient safety interventions. Methods We worked with three hospitals to support the implementation of evidence-based guidance to reduce the risk of feeding into misplaced nasogastric feeding tubes. Our stepped process, informed by the TDF and key principles from implementation literature, entailed: involving stakeholders; identifying target behaviors; identifying local factors (barriers and levers) affecting behavior change using a TDF-based questionnaire; working with stakeholders to generate specific local strategies to address key barriers; and supporting stakeholders to implement strategies. Exit interviews and audit data collection were undertaken to assess the feasibility and acceptability of this approach. Results Following audit and discussion, implementation teams for each Trust identified the process of checking the positioning of nasogastric tubes prior to feeding as the key behavior to target. Questionnaire results indicated differences in key barriers between organizations. Focus groups generated innovative, generalizable, and adaptable strategies for overcoming barriers, such as awareness events, screensavers, equipment modifications, and interactive learning resources. Exit interviews identified themes relating to the benefits, challenges, and sustainability of this approach. Time trend audit data were collected for 301 patients over an 18-month period for one Trust, suggesting clinically significant improved use of pH and documentation of practice following the intervention. Conclusions The TDF is a feasible and acceptable framework to guide the implementation of patient safety interventions. The stepped TDFI approach engages healthcare professionals and facilitates contextualization in identifying the target behavior, eliciting local barriers, and selecting strategies to address those barriers. This approach may be of use to implementation teams and policy makers, although our promising findings confirm the need for a more rigorous evaluation; a balanced block evaluation is currently underway. PMID:24131864

Conservation challenges and research needs for Pacific lamprey in the Columbia River Basin

USGS Publications Warehouse

Clemens, Benjamin J.; Beamish, Richard J.; Coates, Kelly C.; Docker, Margaret F.; Dunham, Jason B.; Gray, Ann E.; Hess, Jon E.; Jolley, Jeffrey C.; Lampman, Ralph T.; McIlraith, Brian J.; Moser, Mary L.; Murauskas, Joshua G.; Noakes, David L. G.; Schaller, Howard A.; Schreck, Carl B.; Starcevich, Steven J.; Streif, Bianca; van de Wetering, Stan J.; Wade, Joy; Weitkamp, Laurie A.; Wyss, Lance A.

2017-01-01

The Pacific Lamprey Entosphenus tridentatus, an anadromous fish native to the northern Pacific Ocean and bordering freshwater habitats, has recently experienced steep declines in abundance and range contractions along the West Coast of North America. During the early 1990s, Native American tribes recognized the declining numbers of lamprey and championed their importance. In 2012, 26 entities signed a conservation agreement to coordinate and implement restoration and research for Pacific Lamprey. Regional plans have identified numerous threats, monitoring needs, and strategies to conserve and restore Pacific Lamprey during their freshwater life stages. Prime among these are needs to improve lamprey passage, restore freshwater habitats, educate stakeholders, and implement lamprey-specific research and management protocols. Key unknowns include range-wide trends in status, population dynamics, population delineation, limiting factors, and marine influences. We synthesize these key unknowns, with a focus on the freshwater life stages of lamprey in the Columbia River basin.

Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults.

PubMed

Waycott, Jenny; Morgans, Amee; Pedell, Sonja; Ozanne, Elizabeth; Vetere, Frank; Kulik, Lars; Davis, Hilary

2015-11-01

The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process. Drawing on the ethical principles of beneficence, research merit and integrity, justice, and respect, we identify key issues to consider in the future design and implementation of social isolation interventions that use new technologies. Key issues include (a) providing sufficient support to facilitate ongoing social interactions, (b) managing older adults' expectations, (c) providing encouragement without coercion, and (d) responding to individual needs. We conclude that it is important to report on ethical challenges incurred when evaluating social isolation interventions to inform future research in this important area. © The Author(s) 2015.

Innovation and Transformation in California’s Safety-net Healthcare Settings: An Inside Perspective

PubMed Central

Lyles, Courtney R.; Aulakh, Veenu; Jameson, Wendy; Schillinger, Dean; Yee, Hal; Sarkar, Urmimala

2016-01-01

Background Health reform requires safety-net settings to transform care delivery, but how they will innovate in order to achieve this transformation is unknown. Methods We conducted two series of key informant interviews (N= 28) in 2012 with leadership from both California’s public hospital systems and community health centers. Interviews focused on how innovation was conceptualized and solicited examples of successful innovations. Results In contrast to disruptive innovation, interviewees often defined innovation as improving implementation, making incremental changes, and promoting integration. Many leaders gave examples of existing innovative practices such as patient-centered approaches to meeting their diverse patient needs. Participants expressed challenges to adapting quickly, but a desire to partner together. Conclusions Safety-net systems have already begun implementing innovative practices supporting their key priority areas. However, more support is needed, specifically to accelerate the change needed to succeed under health reform. PMID:24170938

Facilitators and Barriers to Implementing Clinical Governance: A Qualitative Study among Senior Managers in Iran.

PubMed

Ravaghi, Hamid; Rafiei, Sima; Heidarpour, Peigham; Mohseni, Maryam

2014-09-01

Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data. Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers' commitment, effective communication and well designed incentives. Pe rceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators.

Navigating institutional complexity in the health sector: lessons from tobacco control in Kenya.

PubMed

Lencucha, Raphael; Magati, Peter; Drope, Jeffrey

2016-12-01

 This research examines the institutional dynamics of tobacco control following the establishment of Kenya's 2007 landmark tobacco control legislation. Our analysis focuses specifically on coordination challenges within the health sector.  We conducted semi-structured interviews with key informants (n = 17) involved in tobacco regulation and control in Kenya. We recruited participants from different offices and sectors of government and non-governmental organizations.  We find that the main challenges toward successful implementation of tobacco control are a lack of coordination and clarity of mandate of the principal institutions involved in tobacco control efforts. In a related development, the passage of a new constitution in 2010 created structural changes that have affected the successful implementation of the country's tobacco control legislation.  We discuss how proponents of tobacco control navigated these two overarching institutional challenges. These findings point to the institutional factors that influence policy implementation extending beyond the traditional focus on the dynamic between government and the tobacco industry. These findings specifically point to the intragovernmental challenges that bear on policy implementation. The findings suggest that for effective implementation of tobacco control legislation and regulation, there is need for increased cooperation among institutions charged with tobacco control, particularly within or involving the Ministry of Health. Decisive leadership was also widely presented as a component of successful institutional reform.  This study points to the importance of coordinating policy development and implementation across levels of government and the need for leadership and clear mandates to guide cooperation within the health sector. The Kenyan experience offers useful lessons in the pitfalls of institutional incoherence, but more importantly, the value of investing in and then promoting well-functioning institutions. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice.

PubMed

Aarons, Gregory A; Fettes, Danielle L; Hurlburt, Michael S; Palinkas, Lawrence A; Gunderson, Lara; Willging, Cathleen E; Chaffin, Mark J

2014-01-01

Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team approach. Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare. Semistructured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment framework. Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration; competing priorities across levels of leadership; power struggles; and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. System-wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes.

Collaboration, Negotiation, and Coalescence for Interagency-Collaborative Teams to Scale-up Evidence-Based Practice

PubMed Central

Aarons, Gregory A.; Fettes, Danielle; Hurlburt, Michael; Palinkas, Lawrence; Gunderson, Lara; Willging, Cathleen; Chaffin, Mark

2014-01-01

Objective Implementation and scale-up of evidence-based practices (EBPs) is often portrayed as involving multiple stakeholders collaborating harmoniously in the service of a shared vision. In practice, however, collaboration is a more complex process that may involve shared and competing interests and agendas, and negotiation. The present study examined the scale-up of an EBP across an entire service system using the Interagency Collaborative Team (ICT) approach. Methods Participants were key stakeholders in a large-scale county-wide implementation of an EBP to reduce child neglect, SafeCare®. Semi-structured interviews and/or focus groups were conducted with 54 individuals representing diverse constituents in the service system, followed by an iterative approach to coding and analysis of transcripts. The study was conceptualized using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Results Although community stakeholders eventually coalesced around implementation of SafeCare, several challenges affected the implementation process. These challenges included differing organizational cultures, strategies, and approaches to collaboration, competing priorities across levels of leadership, power struggles, and role ambiguity. Each of the factors identified influenced how stakeholders approached the EBP implementation process. Conclusions System wide scale-up of EBPs involves multiple stakeholders operating in a nexus of differing agendas, priorities, leadership styles, and negotiation strategies. The term collaboration may oversimplify the multifaceted nature of the scale-up process. Implementation efforts should openly acknowledge and consider this nexus when individual stakeholders and organizations enter into EBP implementation through collaborative processes. PMID:24611580

Radio frequency analog electronics based on carbon nanotube transistors

PubMed Central

Kocabas, Coskun; Kim, Hoon-sik; Banks, Tony; Rogers, John A.; Pesetski, Aaron A.; Baumgardner, James E.; Krishnaswamy, S. V.; Zhang, Hong

2008-01-01

The potential to exploit single-walled carbon nanotubes (SWNTs) in advanced electronics represents a continuing, major source of interest in these materials. However, scalable integration of SWNTs into circuits is challenging because of difficulties in controlling the geometries, spatial positions, and electronic properties of individual tubes. We have implemented solutions to some of these challenges to yield radio frequency (RF) SWNT analog electronic devices, such as narrow band amplifiers operating in the VHF frequency band with power gains as high as 14 dB. As a demonstration, we fabricated nanotube transistor radios, in which SWNT devices provide all of the key functions, including resonant antennas, fixed RF amplifiers, RF mixers, and audio amplifiers. These results represent important first steps to practical implementation of SWNTs in high-speed analog circuits. Comparison studies indicate certain performance advantages over silicon and capabilities that complement those in existing compound semiconductor technologies. PMID:18227509

[Process of construction of the national research agenda on Human Resources in Health in Peru 2011 - 2014].

PubMed

Curisinche, Maricela; Yagui, Martín; Castilla, Teresa; Cabezas, César; Escalante, Giovanni; Casas, María; Lucero, Jorge

2011-06-01

The National Health Authority of Peru, as part of the implementation of national priorities for health research in 2010 developed the process of building the national research agenda on health manpower (HM). In a scenario of technical challenges, national and international policy and under a nation-wide participatory approach with key stakeholders in the health system, training and aid HM linked to the subject, establishing a socially agreed agenda. Process consists of 3 phases: 1. National review of evidence and relevant information on RHUS, 2. Consultation with opinion leaders and subject experts, and 3. A collaborative space (national workshop) of deliberation, consensus and legitimacy of the agenda. Finally, we present the agenda consists of 30 research topics on health manpower, to be developed in the period 2011- 2014, and raises the challenges and prospects for implementation.

Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum.

PubMed

Yano, Elizabeth M; Green, Lawrence W; Glanz, Karen; Ayanian, John Z; Mittman, Brian S; Chollette, Veronica; Rubenstein, Lisa V

2012-05-01

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability.

Implementation and Spread of Interventions Into the Multilevel Context of Routine Practice and Policy: Implications for the Cancer Care Continuum

PubMed Central

Green, Lawrence W.; Glanz, Karen; Ayanian, John Z.; Mittman, Brian S.; Chollette, Veronica; Rubenstein, Lisa V.

2012-01-01

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability. PMID:22623601

A qualitative study assessing the acceptability and adoption of implementing a results based financing intervention to improve maternal and neonatal health in Malawi.

PubMed

Wilhelm, Danielle J; Brenner, Stephan; Muula, Adamson S; De Allegri, Manuela

2016-08-17

Results Based Financing (RBF) interventions have recently gained significant momentum, especially in sub-Saharan Africa. However, most of the research has focused on the evaluation of the impacts of this approach, providing little insight into how the contextual circumstances surrounding the implementation have contributed to its success or failure. This study aims to fill a void in the current literature on RBF by focusing explicitly on the process of implementing a RBF intervention rather than on its impact. Specifically, this study focuses on the acceptability and adoption of the RBF intervention's implementation among local and international key stakeholders with the aim to inform further implementation. The Results Based Financing for Maternal and Neonatal Health (RBF4MNH) Initiative is currently being implemented in Malawi. Our study employed an exploratory cross-sectional qualitative design to explore the factors affecting the acceptability and adoption of the intervention's implementation. Purposeful sampling techniques were used to identify each key stakeholder who participated in all or parts of the implementation process. In-depth interviews were conducted and analyzed using a deductive open coding approach. The final interpretation of the findings emerged through active discussion among the co-authors. Despite encountering several challenges, such as delay in procurement of equipment and difficulties in arranging local bank accounts, all stakeholders responded positively to the RBF4MNH Initiative. Stakeholders' acceptance of the RBF4MNH Initiative grew stronger over time as understanding of the intervention improved and was supported by early inclusion during the design and implementation process. In addition, stakeholders took on functions not directly incentivized by the intervention, suggesting that they turned adoption into actual ownership. All stakeholders raised concerns that the intervention may not be sustainable after its initial program phase would end, which contributed to hesitancy in fully accepting the intervention. Based on the results of this study, we recommend the inclusion of local stakeholders into the intervention's implementation process at the earliest stages. We also recommend setting up continuous feedback mechanisms to tackle challenges encountered during the implementation process. The sustainability of the intervention and its incorporation into national budgets should be addressed from the earliest stages.

Protecting water and wastewater infrastructure from cyber attacks

NASA Astrophysics Data System (ADS)

Panguluri, Srinivas; Phillips, William; Cusimano, John

2011-12-01

Multiple organizations over the years have collected and analyzed data on cyber attacks and they all agree on one conclusion: cyber attacks are real and can cause significant damages. This paper presents some recent statistics on cyber attacks and resulting damages. Water and wastewater utilities must adopt countermeasures to prevent or minimize the damage in case of such attacks. Many unique challenges are faced by the water and wastewater industry while selecting and implementing security countermeasures; the key challenges are: 1) the increasing interconnection of their business and control system networks, 2) large variation of proprietary industrial control equipment utilized, 3) multitude of cross-sector cyber-security standards, and 4) the differences in the equipment vendor's approaches to meet these security standards. The utilities can meet these challenges by voluntarily selecting and adopting security standards, conducting a gap analysis, performing vulnerability/risk analysis, and undertaking countermeasures that best meets their security and organizational requirements. Utilities should optimally utilize their limited resources to prepare and implement necessary programs that are designed to increase cyber-security over the years. Implementing cyber security does not necessarily have to be expensive, substantial improvements can be accomplished through policy, procedure, training and awareness. Utilities can also get creative and allocate more funding through annual budgets and reduce dependence upon capital improvement programs to achieve improvements in cyber-security.

Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach.

PubMed

Leyva, Bryan; Allen, Jennifer D; Ospino, Hosffman; Tom, Laura S; Negrón, Rosalyn; Buesa, Richard; Torres, Maria Idalí

2017-09-01

Evidence-based interventions (EBIs) to promote cancer control among Latinos have proliferated in recent years, though adoption and implementation of these interventions by faith-based organizations (FBOs) is limited. Capacity building may be one strategy to promote implementation. In this qualitative study, 18 community key informants were interviewed to (a) understand existing capacity for health programming among Catholic parishes, (b) characterize parishes' resource gaps and capacity-building needs implementing cancer control EBIs, and (c) elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs. Semi-structured qualitative interviews were conducted. Key informants concurred about the capacity of Catholic parishes to deliver health programs, and described attributes of parishes that make them strong partners in health promotion initiatives, including a mission to address physical and mental health, outreach to marginalized groups, altruism among members, and existing engagement in health programming. However, resource gaps and capacity building needs were also identified. Specific recommendations participants made about how existing resources might be leveraged to address challenges include to: establish parish wellness committees; provide "hands-on" learning opportunities for parishioners to gain program planning skills; offer continuous, tailored, on-site technical assistance; facilitate relationships between parishes and community resources; and provide financial support for parishes. Leveraging parishes' existing resources and addressing their implementation needs may improve adoption of cancer control EBIs.

Indoor air pollution in developing countries: research and implementation needs for improvements in global public health.

PubMed

Gall, Elliott T; Carter, Ellison M; Earnest, C Matt; Stephens, Brent

2013-04-01

Exposure to indoor air pollution (IAP) from the burning of solid fuels for cooking, heating, and lighting accounts for a significant portion of the global burden of death and disease, and disproportionately affects women and children in developing regions. Clean cookstove campaigns recently received more attention and investment, but their successes might hinge on greater integration of the public health community with a variety of other disciplines. To help guide public health research in alleviating this important global environmental health burden, we synthesized previous research on IAP in developing countries, summarized successes and challenges of previous cookstove implementation programs, and provided key research and implementation needs from structured discussions at a recent symposium.

Indoor Air Pollution in Developing Countries: Research and Implementation Needs for Improvements in Global Public Health

PubMed Central

Gall, Elliott T.; Carter, Ellison M.; Matt Earnest, C.

2013-01-01

Exposure to indoor air pollution (IAP) from the burning of solid fuels for cooking, heating, and lighting accounts for a significant portion of the global burden of death and disease, and disproportionately affects women and children in developing regions. Clean cookstove campaigns recently received more attention and investment, but their successes might hinge on greater integration of the public health community with a variety of other disciplines. To help guide public health research in alleviating this important global environmental health burden, we synthesized previous research on IAP in developing countries, summarized successes and challenges of previous cookstove implementation programs, and provided key research and implementation needs from structured discussions at a recent symposium. PMID:23409891

Detector-device-independent quantum key distribution: Security analysis and fast implementation

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

Boaron, Alberto; Korzh, Boris; Boso, Gianluca

One of the most pressing issues in quantum key distribution (QKD) is the problem of detector side-channel attacks. To overcome this problem, researchers proposed an elegant “time-reversal” QKD protocol called measurement-device-independent QKD (MDI-QKD), which is based on time-reversed entanglement swapping. However, MDI-QKD is more challenging to implement than standard point-to-point QKD. Recently, an intermediary QKD protocol called detector-device-independent QKD (DDI-QKD) has been proposed to overcome the drawbacks of MDI-QKD, with the hope that it would eventually lead to a more efficient detector side-channel-free QKD system. Here, we analyze the security of DDI-QKD and elucidate its security assumptions. We find thatmore » DDI-QKD is not equivalent to MDI-QKD, but its security can be demonstrated with reasonable assumptions. On the more practical side, we consider the feasibility of DDI-QKD and present a fast experimental demonstration (clocked at 625 MHz), capable of secret key exchange up to more than 90 km.« less

Translating Health Services Research into Practice in the Safety Net.

PubMed

Moore, Susan L; Fischer, Ilana; Havranek, Edward P

2016-02-01

To summarize research relating to health services research translation in the safety net through analysis of the literature and case study of a safety net system. Literature review and key informant interviews at an integrated safety net hospital. This paper describes the results of a comprehensive literature review of translational science literature as applied to health care paired with qualitative analysis of five key informant interviews conducted with senior-level management at Denver Health and Hospital Authority. Results from the literature suggest that implementing innovation may be more difficult in the safety net due to multiple factors, including financial and organizational constraints. Results from key informant interviews confirmed the reality of financial barriers to innovation implementation but also implied that factors, including institutional respect for data, organizational attitudes, and leadership support, could compensate for disadvantages. Translating research into practice is of critical importance to safety net providers, which are under increased pressure to improve patient care and satisfaction. Results suggest that translational research done in the safety net can better illuminate the special challenges of this setting; more such research is needed. © Health Research and Educational Trust.

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.

Baseline integrated behavioural and biological assessment among most at-risk populations in six high-prevalence states of India: design and implementation challenges.

PubMed

Saidel, Tobi; Adhikary, Rajatashuvra; Mainkar, Mandar; Dale, Jayesh; Loo, Virginia; Rahman, Motiur; Ramesh, Banadakoppa M; Paranjape, Ramesh S

2008-12-01

This paper presents key methodological approaches and challenges in implementing and analysing the first round of the integrated biobehavioural assessment of most-at-risk populations, conducted in conjunction with evaluation of Avahan, the India AIDS initiative. The survey collected data on HIV risk behaviours, sexually transmitted infections and HIV prevalence in 29 districts in six high-prevalence states of India. Groups included female sex workers and clients, men who have sex with men, injecting drug users and truck drivers. Strategies for overcoming some challenges of the large-scale surveys among vulnerable populations, including sampling hidden populations, involvement of the communities targeted by the survey, laboratory and quality control in remote, non-clinic field settings, and data analysis and data use are presented. Satisfying the need for protocols, guidelines and tools that allowed for sufficient standardization, while being tailored enough to fit diverse local situations on such a large scale, with so many implementing partners, emerged as a major management challenge. A major lesson from the first round is the vital importance of investing upfront time in tailoring the sampling methods, data collection instruments, and analysis plan to match measurement objectives. Despite the challenges, the integrated biobehavioural assessment was a huge achievement, and was largely successful in providing previously unavailable information about the HIV situation among populations that are critical to the curtailment of HIV spread in India. Lessons from the first round will be used to evolve the second round into an exercise with increased evaluative capability for Avahan.

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

PubMed Central

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-01-01

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities. PMID:24596887

Optimising implementation of reforms to better prevent and respond to child sexual abuse in institutions: Insights from public health, regulatory theory, and Australia's Royal Commission.

PubMed

Mathews, Ben

2017-12-01

The Australian Royal Commission Into Institutional Responses to Child Sexual Abuse has identified multiple systemic failures to protect children in government and non-government organizations providing educational, religious, welfare, sporting, cultural, arts and recreational activities. Its recommendations for reform will aim to ensure organizations adopt more effective and ethical measures to prevent, identify and respond to child sexual abuse. However, apart from the question of what measures institutions should adopt, an under-explored question is how to implement and regulate those measures. Major challenges confronting reform include the diversity of organizations providing services to children; organizational resistance; and the need for effective oversight. Failure to adopt theoretically sound strategies to overcome implementation barriers will jeopardize reform and compromise reduction of institutional child sexual abuse. This article first explains the nature of the Royal Commission, and focuses on key findings from case studies and data analysis. It then analyzes public health theory and regulatory theory to present a novel analysis of theoretically justified approaches to the implementation of measures to prevent, identify and respond to CSA, while isolating challenges to implementation. The article reviews literature on challenges to reform and compliance, and on prevention of institutional CSA and situational crime prevention, to identify measures which have attracted emerging consensus as recommended practice. Finally, it applies its novel integration of regulatory theory and public health theory to the context of CSA in institutional contexts, to develop a theoretical basis for a model of implementation and regulation, and to indicate the nature and functions of a regulatory body for this context. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

[Business intelligence in radiology. Challenges and opportunities].

PubMed

Escher, A; Boll, D

2015-10-01

Due to economic pressures and need for higher transparency, a ubiquitous availability of administrative information is needed. Therefore radiology managers should consider implementing business intelligence (BI) solutions. BI is defined as a systemic approach to support decision-making in business administration. It is an important part of the overall strategy of an organization. Implementation and operation is initially associated with costs and for a successful launch important prerequisites must be fulfilled. First, a suitable product must be selected, followed by the technical and organizational implementation. After consideration of the type of data to be collected and a system of key performance indicators must be established. BI replaces classic retrospective business reporting with multidimensional and multifactorial analyses, real-time monitoring, and predictive analyses. The benefits of BI include the rapid availability of important information and the depth of possible data analysis. The simple and intuitive use of modern BI applications by the users themselves (!) combined with a continuous availability of information is the key to success. Professional BI will be an important part of management in radiology in the future.

Process evaluation of a regional public health model to reduce chronic disease through policy and systems changes, Washington State, 2010-2014.

PubMed

Walkinshaw, Lina P; Mason, Caitlin; Allen, Claire L; Vu, Thuy; Nandi, Paj; Santiago, Patti Migliore; Hannon, Peggy A

2015-03-19

Although the regionalization of public health systems has been well documented in the case of emergency preparedness, there is little literature on the application of regional approaches to other aspects of public health. From 2011 through 2014 the Washington State Department of Health implemented a Community Transformation Grant to support community-level policy and systems changes to decrease chronic disease risk factors and increase access to clinical preventive services. The Department of Health implemented the grant through a regional model, grouping 32 of the state's 35 local health jurisdictions into 5 regions. Our process evaluation identifies the challenges and facilitators to Community Transformation Grant planning and implementation. We conducted 34 key informant interviews with people directly involved in the implementation of the Community Transformation Grant. We interviewed state and local partners, including representatives from each region, the Department of Health, external consultants, and regional partners. We collected data from October 2013 through July 2014. Challenges for planning, building, and implementing a regional model for chronic disease prevention included stakeholder buy-in, regional geography, and communication; facilitators included shared regional history and infrastructure, strong leadership, collaborative relationships, shared vision and goals, sufficient funding, and direct technical assistance and training. Lessons learned in Washington State provide a foundation for other states interested in using a regional approach to reduce chronic disease risk. Policy and systems changes require adequate time, funding, and staffing. States and funders should work closely with local leaders to address these challenges and facilitators.

Connecting Medical Records: An Evaluation of Benefits and Challenges for Primary Care Practices.

PubMed

Compeau, Deborah Ruth; Terry, Amanda

2017-06-30

Implementation of systems to support health information sharing has lagged other areas of healthcare IT, yet offers a strong possibility for benefit.  Clinical acceptance is a key limiting factor in health IT adoption. To assess the benefits and challenges experienced by clinicians using a custom-developed health information exchange system, and to show how perceptions of benefits and challenges influence perceptions of productivity and care-related outcomes. We used a mixed methods design with two phases. First, we conducted interviews with stakeholders who were familiar with the health information exchange system to inform the development of a measure of benefits and challenges of the use of this system. Second, using this measure we conducted a survey of current and former users of the health information exchange system using a modified Dillman method. 105 current and former users completed the survey. The results showed information quality, ease of completing tasks and clinical process improvement as key benefits that reduced workload and improved patient care.  Challenges related to system reliability, quality of reports and service quality increased workload and decreased impact on care, though the effect of the challenges was smaller than that of the benefits.  Even very limited health information exchange capabilities can improve outcomes for primary care users.  Improving perceptions of benefits may be even more important the removing challenges to use, though it is likely that a threshold of quality must be achieved for this to be true.

Integrated river basin management, ICT and DSS: Challenges and needs

NASA Astrophysics Data System (ADS)

Gourbesville, Philippe

River basin management is a complex task. Therefore, instruments that help to assess the present situation and assist in the development and evaluation of solutions may be important. Since several decades and after the implementation of the first compulsory legal environments and institutional organizations for IWRM and IRBM, the need for an efficient support in the different decision-making processes has emerged. After several experiences, the demonstration of the interest of ICT and DSS systems is obvious in the water resources management domain. However and until now, most of the efforts have been focused on the theoretical aspects with very few integrations into operational approaches. The implementation of the new European water framework directive (2000) represents today one key example from which some lessons can be learned in the way of definition and use of ICT and DSS systems for IWRM and IRBM. The paper presents the concepts available through ICT and DSS. The example of the WFD is used to underline the challenges and the difficulties for the elaboration of new tools - DSSs - which could be able to answer of the challenges of IWRM and IRBM.

Galvanising the NHS to Adopt Innovation

PubMed Central

Parris, Stuart; Cochrane, Gavin; Marjanovic, Sonja; Ling, Tom; Chataway, Joanna

2016-01-01

Abstract The Department of Health and the Wellcome Trust, in co-operation with NHS England, asked RAND Europe to conduct a limited consultation with key stakeholders about the practicality of measures and incentives proposed as part of the NHS Accelerated Access Review (AAR), which aims to assess the pathways for the development, assessment, and adoption of innovative medicines and medical technology. Through a focused engagement exercise with key healthcare stakeholders this project explored the implications of selected interim AAR propositions and feasibility of implementation for key actors, in primary and secondary care as well as commissioners and academia. Specifically, the project investigated the feasibility of implementation of three specific propositions including: a new earmarked fund to encourage AHSNs and other key innovation actors to re-design systems to embrace innovation; mobilising the influence of clinical system leaders to champion change; and encouraging secondary care organisations to take on “innovation champion” roles linked to financial incentives and a new emphasis on accountable care organisations. Data was collected on the feasibility of the three AAR propositions from a workshop with AHSN CEOs and Commercial Directors and interviews with senior NHS staff in three AHSN regions (South West, University College London Partners, and North East, North Cumbria). The study concludes with reflections on the feasibility of each recommendation and identifies factors expected to facilitate or challenge their implementation, as well as considering the wider cross cutting issues that may influence the adoption and diffusion of innovation in the NHS. PMID:28083436

The Relationship Between Key Supply Chain Management Process Implementation, Competitive Advantage and Organizational Performance

DTIC Science & Technology

2012-03-01

with inputs from 3M; CEMEX; The Coca - Cola Company; CSX Corporation; Fletcher-Challenge; Goodyear Tire and Rubber Company; Hewlett-Packard Company...customer or market ” (Lambert, Cooper, & Pagh, 1998). In general, the strategic sub- processes comprise the actions and decisions related to...silos such as marketing , research and development, finance, production and purchasing and logistics (Croxton, Garcia-Dastugue, Lambert, and Rogers

Effectiveness and Usability of the Sensory Processing Measure-Preschool Quick Tips: Data-Driven Intervention Following the Use of the SPM-Preschool in an Early Childhood, Multiple-Case Study

ERIC Educational Resources Information Center

Olson, Carol H.; Henry, Diana A.; Kliner, Ashley Peck; Kyllo, Alissa; Richter, Chelsea Munson; Charley, Jane; Whitcher, Meagan Chapman; Reinke, Katherine Roth; Tysver, Chelsay Horner; Wagner, Lacey; Walworth, Jessica

2016-01-01

This pre- and posttest multiple-case study examined the effectiveness and usability of the Sensory Processing Measure-Preschool Quick Tips (SPM-P QT) by key stakeholders (parents and teachers) for implementing data-driven intervention to address sensory processing challenges. The Sensory Processing Measure-Preschool (SPM-P) was administered as an…

Developing the next generation of dissemination and implementation researchers: insights from initial trainees.

PubMed

Stamatakis, Katherine A; Norton, Wynne E; Stirman, Shannon W; Melvin, Cathy; Brownson, Ross C

2013-03-12

Dissemination and implementation (D&I) research is a relatively young discipline, underscoring the importance of training and career development in building and sustaining the field. As such, D&I research faces several challenges in designing formal training programs and guidance for career development. A cohort of early-stage investigators (ESI) recently involved in an implementation research training program provided a resource for formative data in identifying needs and solutions around career development. Responses outlined fellows' perspectives on the perceived usefulness and importance of, as well as barriers to, developing practice linkages, acquiring additional methods training, academic advancement, and identifying institutional supports. Mentorship was a cross-cutting issue and was further discussed in terms of ways it could foster career advancement in the context of D&I research. Advancing an emerging field while simultaneously developing an academic career offers a unique challenge to ESIs in D&I research. This article summarizes findings from the formative data that outlines some directions for ESIs and provides linkages to the literature and other resources on key points.

Incentive-Based Conservation Programs in Developing Countries: A Review of Some Key Issues and Suggestions for Improvements

NASA Astrophysics Data System (ADS)

Spiteri, Arian; Nepalz, Sanjay K.

2006-01-01

Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different “community” scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of “target” beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.

Ten key principles for successful health systems integration.

PubMed

Suter, Esther; Oelke, Nelly D; Adair, Carol E; Armitage, Gail D

2009-01-01

Integrated health systems are considered part of the solution to the challenge of sustaining Canada's healthcare system. This systematic literature review was undertaken to guide decision-makers and others to plan for and implement integrated health systems. This review identified 10 universal principles of successfully integrated healthcare systems that may be used by decision-makers to assist with integration efforts. These principles define key areas for restructuring and allow organizational flexibility and adaptation to local context. The literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes.

Maximizing Team Performance: The Critical Role of the Nurse Leader.

PubMed

Manges, Kirstin; Scott-Cawiezell, Jill; Ward, Marcia M

2017-01-01

Facilitating team development is challenging, yet critical for ongoing improvement across healthcare settings. The purpose of this exemplary case study is to examine the role of nurse leaders in facilitating the development of a high-performing Change Team in implementing a patient safety initiative (TeamSTEPPs) using the Tuckman Model of Group Development as a guiding framework. The case study is the synthesis of 2.5 years of critical access hospital key informant interviews (n = 50). Critical juncture points related to team development and key nurse leader actions are analyzed, suggesting that nurse leaders are essential to maximize clinical teams' performance. © 2016 Wiley Periodicals, Inc.

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences.

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; Noseworthy, Tom; Wang, Jenney Meng Han; DeMone, Brie; Wright, Brock; Marshall, Deborah A

2018-02-01

Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences. On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons' offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care. Copyright © 2017 Elsevier B.V. All rights reserved.

MRI Measurements of Iron Load in Transfusion‐Dependent Patients: Implementation, Challenges, and Pitfalls

PubMed Central

St Pierre, Tim G.

2015-01-01

Magnetic resonance imaging (MRI) has played a key role in studies of iron overload in transfusion‐dependent patients, providing insights into the relations among liver and cardiac iron loading, iron chelator dose, and morbidity. Currently, there is rapid uptake of these methods into routine clinical practice as part of the management strategy for iron overload in regularly transfused patients. Given the manifold methods of data acquisition and analysis, there are several potential pitfalls that may result in inappropriate decision making. Herein, we review the challenges of establishing suitable MRI techniques for tissue iron measurement in regularly transfused patients. PMID:26713769

Reconstruction software of the silicon tracker of DAMPE mission

NASA Astrophysics Data System (ADS)

Tykhonov, A.; Gallo, V.; Wu, X.; Zimmer, S.

2017-10-01

DAMPE is a satellite-borne experiment aimed to probe astroparticle physics in the GeV-TeV energy range. The Silicon tracker (STK) is one of the key components of DAMPE, which allows the reconstruction of trajectories (tracks) of detected particles. The non-negligible amount of material in the tracker poses a challenge to its reconstruction and alignment. In this paper we describe methods to address this challenge. We present the track reconstruction algorithm and give insight into the alignment algorithm. We also present our CAD-to-GDML converter, an in-house tool for implementing detector geometry in the software from the CAD drawings of the detector.

Qualitative process evaluation of an Australian alcohol media literacy study: recommendations for designing culturally responsive school-based programs.

PubMed

Gordon, Chloe S; Kervin, Lisa K; Jones, Sandra C; Howard, Steven J

2017-02-02

Alcohol media literacy programs seek to mitigate the potentially harmful effects of alcohol advertising on children's drinking intentions and behaviours through equipping them with skills to challenge media messages. In order for such programs to be effective, the teaching and learning experiences must be tailored to their specific cultural context. Media in the Spotlight is an alcohol media literacy program aimed at 9 to 12 year old Australian children. This study evaluates the process and implementation of the program, outlining the factors that facilitated and inhibited implementation. From this evaluation, a pedagogical framework has been developed for health professionals implementing culturally responsive programs in school settings. Process measures included: semi-structured interviews with teachers before and after the program was implemented (n = 11 interviews), program evaluation questionnaires completed by children (n = 166), lesson observations completed by teachers (n = 35 observations), and reflective journal entries completed by the researcher (n = 44 entries). A thematic analysis approach was used to analyse all of the data sets using NVivo. Inductive coding was used, whereby the findings were derived from the research objectives and multiple readings and interpretations of the data. Five key pedagogical considerations were identified that facilitated implementation. These were: connecting to the students' life worlds to achieve cultural significance; empowering students with real-world skills to ensure relevance; ensuring programs are well structured with strong connections to the school curriculum; creating developmentally appropriate activities while providing a range of assessment opportunities; and including hands-on and interactive activities to promote student engagement. Three potential inhibitors to implementing the alcohol media literacy program in upper-elementary school classrooms were identified. These included topic sensitivities, classroom management challenges, and fitting new programs into already busy school schedules. Overall, the program content and individual lessons were well received by the teachers and students. The lessons learned from the development, implementation and evaluation of this program can provide health professionals with key pedagogical strategies for designing culturally responsive educational programs. Culturally responsive programs are critical for ensuring interventions are effective for their specific context.

The work and challenges of care managers in the implementation of collaborative care: A qualitative study.

PubMed

Overbeck, G; Kousgaard, M B; Davidsen, A S

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: In collaborative care models between psychiatry and general practice, mental health nurses are used as care managers who carry out the treatment of patients with anxiety or depression in general practice and establish a collaborating relationship with the general practitioner. Although the care manager is the key person in the collaborative care model, there is little knowledge about this role and the challenges involved in it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study shows that before the CMs could start treating patients in a routine collaborative relationship with GPs, they needed to carry out an extensive amount of implementation work. This included solving practical problems of location and logistics, engaging GPs in the intervention, and tailoring collaboration to meet the GP's particular preferences. Implementing the role requires high commitment and an enterprising approach on the part of the care managers. The very experienced mental health nurses of this study had these skills. However, the same expertise cannot be presumed in a disseminated model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When introducing new collaborative care interventions, the care manager role should be well defined and be well prepared, especially as regards the arrival of the care manager in general practice, and supported during implementation by a coordinated leadership established in collaboration between hospital psychiatry and representatives from general practice. Introduction In collaborative care models for anxiety and depression, the care manager (CM), often a mental health nurse, has a key role. However, the work and challenges related to this role remain poorly investigated. Aim To explore CMs' experiences of their work and the challenges they face when implementing their role in a collaborative care intervention in the Capital Region of Denmark. Methods Interviews with eight CMs, a group interview with five CMs and a recording of one supervision session were analysed by thematic analysis. Results The CM carried out considerable implementation work. This included finding suitable locations; initiating and sustaining communication with the GPs and maintaining their engagement in the model; adapting to the patient population in general practice; dealing with personal security issues, and developing supportive peer relations and meaningful supervision. Discussion We compare our findings to previous studies of collaborative care and advanced nursing roles in general practice. The importance of organizational leadership to support the CM's bridge-building role is emphasized. Implications for practice The planners of new collaborative care interventions should not only focus on the CM's clinical tasks but also on ensuring the sufficient organizational conditions for carrying out the role. © 2017 John Wiley & Sons Ltd.

Pharmaceutical Market Access: current state of affairs and key challenges – results of the Market Access Launch Excellence Inventory (MALEI)

PubMed Central

Koch, Marcus A.

2015-01-01

Objectives To take inventory of the current state of affairs of Market Access Launch Excellence in the life sciences industry. To identify key gaps and challenges for Market Access (MA) and discuss how they can be addressed. To generate a baseline for benchmarking MA launch excellence. Methodology An online survey was conducted with pharmaceutical executives primarily working in MA, marketing, or general management. The survey aimed to evaluate MA excellence prerequisites across the product life cycle (rated by importance and level of implementation) and to describe MA activity models in the respective companies. Composite scores were calculated from respondents’ ratings and answers. Results Implementation levels of MA excellence prerequisites generally lagged behind their perceived importance. Item importance and the respective level of implementation correlated well, which can be interpreted as proof of the validity of the questionnaire. The following areas were shown to be particularly underimplemented: 1) early integration of MA and health economic considerations in research and development decision making, 2) developing true partnerships with payers, including the development of services ‘beyond the pill’, and 3) consideration of human resource and talent management. The concept of importance-adjusted implementation levels as a hybrid parameter was introduced and shown to be a viable tool for benchmarking purposes. More than 70% of respondents indicated that their companies will invest broadly in MA in terms of capital and headcount within the next 3 years. Conclusions MA (launch) excellence needs to be further developed in order to close implementation gaps across the entire product life cycle. As MA is a comparatively young pharmaceutical discipline in a complex and dynamic environment, this effort will require strategic focus and dedication. The Market Access Launch Excellence Inventory benchmarking tool may help guide decision makers to prioritize their endeavors. PMID:29785250

Continuous high speed coherent one-way quantum key distribution.

PubMed

Stucki, Damien; Barreiro, Claudio; Fasel, Sylvain; Gautier, Jean-Daniel; Gay, Olivier; Gisin, Nicolas; Thew, Rob; Thoma, Yann; Trinkler, Patrick; Vannel, Fabien; Zbinden, Hugo

2009-08-03

Quantum key distribution (QKD) is the first commercial quantum technology operating at the level of single quanta and is a leading light for quantum-enabled photonic technologies. However, controlling these quantum optical systems in real world environments presents significant challenges. For the first time, we have brought together three key concepts for future QKD systems: a simple high-speed protocol; high performance detection; and integration both, at the component level and for standard fibre network connectivity. The QKD system is capable of continuous and autonomous operation, generating secret keys in real time. Laboratory and field tests were performed and comparisons made with robust InGaAs avalanche photodiodes and superconducting detectors. We report the first real world implementation of a fully functional QKD system over a 43 dB-loss (150 km) transmission line in the Swisscom fibre optic network where we obtained average real-time distribution rates over 3 hours of 2.5 bps.

Quantum key distribution without detector vulnerabilities using optically seeded lasers

NASA Astrophysics Data System (ADS)

Comandar, L. C.; Lucamarini, M.; Fröhlich, B.; Dynes, J. F.; Sharpe, A. W.; Tam, S. W.-B.; Yuan, Z. L.; Penty, R. V.; Shields, A. J.

2016-05-01

Security in quantum cryptography is continuously challenged by inventive attacks targeting the real components of a cryptographic set-up, and duly restored by new countermeasures to foil them. Owing to their high sensitivity and complex design, detectors are the most frequently attacked components. It was recently shown that two-photon interference from independent light sources can be used to remove any vulnerability from detectors. This new form of detection-safe quantum key distribution (QKD), termed measurement-device-independent (MDI), has been experimentally demonstrated but with modest key rates. Here, we introduce a new pulsed laser seeding technique to obtain high-visibility interference from gain-switched lasers and thereby perform MDI-QKD with unprecedented key rates in excess of 1 megabit per second in the finite-size regime. This represents a two to six orders of magnitude improvement over existing implementations and supports the new scheme as a practical resource for secure quantum communications.

Implementing Community-based Health Planning and Services in impoverished urban communities: health workers' perspective.

PubMed

Nwameme, Adanna Uloaku; Tabong, Philip Teg-Nefaah; Adongo, Philip Baba

2018-03-20

Three-quarters of sub-Saharan Africa's urban population currently live under slum conditions making them susceptible to ill health and diseases. Ghana characterizes the situation in many developing countries where the urban poor have become a group much afflicted by complex health problems associated with their living conditions, and the intra-city inequity between them and the more privileged urban dwellers with respect to health care accessibility. Adopting Ghana's rural Community-Based Health Planning and Service (CHPS) programme in urban areas is challenging due to the differences in social networks and health challenges thus making modifications necessary. The Community Health Officers (CHOs) and their supervisors are the frontline providers of health in the community and there is a need to analyze and document the health sector response to urban CHPS. The study was solely qualitative and 19 in-depth interviews were conducted with all the CHOs and key health sector individuals in supervisory/coordinating positions working in urban CHPS zones to elicit relevant issues concerning urban CHPS implementation. Thematic content data analysis was done using the NVivo 7 software. Findings from this appraisal suggest that the implementation of this urban concept of the CHPS programme has been well undertaken by the health personnel involved in the process despite the challenges that they face in executing their duties. Several issues came to light including the lack of first aid drugs, as well as the need for the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) programme and more indepth training for CHOs. In addition, the need to provide incentives for the volunteers and Community Health Committee members to sustain their motivation and the CHOs' apprehensions with regards to furthering their education and progression in their careers were key concerns raised. The establishment of the CHPS concept in the urban environment albeit challenging has been fraught with several opportunities to introduce innovations which tailor the rural milestones to meet urban needs. Modifications such as adjusting timing of home visits and renting accommodation in the communities for the CHOs have been beneficial to the programme.

Lessons learned from national food fortification projects: experiences from Morocco, Uzbekistan, and Vietnam.

PubMed

Wirth, James P; Laillou, Arnaud; Rohner, Fabian; Northrop-Clewes, Christine A; Macdonald, Barbara; Moench-Pfanner, Regina

2012-12-01

Fortification of staple foods has been repeatedly recommended as an effective approach to reduce micronutrient deficiencies. With the increased number of fortification projects globally, there is a need to share practical lessons learned relating to their implementation and responses to project-related and external challenges. To document the achievements, challenges, lessons learned, and management responses associated with national fortification projects in Morocco, Uzbekistan, and Vietnam. Independent end-of-project evaluations conducted for each project served as the primary data source and contain the history of and project activities undertaken for, each fortification project. Other sources, including national policy documents, project reports from the Global Alliance for Improved Nutrition (GAIN) and other stakeholders, industry assessments, and peer-reviewed articles, were used to document the current responses to challenges and future project plans. All projects had key achievements related to the development of fortification standards and the procurement of equipment for participating industry partners. Mandatory fortification of wheat flour was a key success in Morocco and Uzbekistan. Ensuring the quality of fortified foods was a common challenge experienced across the projects, as were shifts in consumption patterns and market structures. Adjustments were made to the projects' design to address the challenges faced. National fortification projects are dynamic and must be continually modified in response to specific performance issues and broader shifts in market structure and consumption patterns.

Parallel Computational Fluid Dynamics: Current Status and Future Requirements

NASA Technical Reports Server (NTRS)

Simon, Horst D.; VanDalsem, William R.; Dagum, Leonardo; Kutler, Paul (Technical Monitor)

1994-01-01

One or the key objectives of the Applied Research Branch in the Numerical Aerodynamic Simulation (NAS) Systems Division at NASA Allies Research Center is the accelerated introduction of highly parallel machines into a full operational environment. In this report we discuss the performance results obtained from the implementation of some computational fluid dynamics (CFD) applications on the Connection Machine CM-2 and the Intel iPSC/860. We summarize some of the experiences made so far with the parallel testbed machines at the NAS Applied Research Branch. Then we discuss the long term computational requirements for accomplishing some of the grand challenge problems in computational aerosciences. We argue that only massively parallel machines will be able to meet these grand challenge requirements, and we outline the computer science and algorithm research challenges ahead.

DCE-MRI, DW-MRI, and MRS in Cancer: Challenges and Advantages of Implementing Qualitative and Quantitative Multi-parametric Imaging in the Clinic

PubMed Central

Winfield, Jessica M.; Payne, Geoffrey S.; Weller, Alex; deSouza, Nandita M.

2016-01-01

Abstract Multi-parametric magnetic resonance imaging (mpMRI) offers a unique insight into tumor biology by combining functional MRI techniques that inform on cellularity (diffusion-weighted MRI), vascular properties (dynamic contrast-enhanced MRI), and metabolites (magnetic resonance spectroscopy) and has scope to provide valuable information for prognostication and response assessment. Challenges in the application of mpMRI in the clinic include the technical considerations in acquiring good quality functional MRI data, development of robust techniques for analysis, and clinical interpretation of the results. This article summarizes the technical challenges in acquisition and analysis of multi-parametric MRI data before reviewing the key applications of multi-parametric MRI in clinical research and practice. PMID:27748710

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

PubMed Central

2013-01-01

Background Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Objectives Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Study design Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Results Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space. The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. Conclusions The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases. PMID:24010683

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study.

PubMed

Shaw, Ryan J; Kaufman, Miriam A; Bosworth, Hayden B; Weiner, Bryan J; Zullig, Leah L; Lee, Shoou-Yih Daniel; Kravetz, Jeffrey D; Rakley, Susan M; Roumie, Christianne L; Bowen, Michael E; Del Monte, Pamela S; Oddone, Eugene Z; Jackson, George L

2013-09-08

Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.

Experimental quantum key distribution with simulated ground-to-satellite photon losses and processing limitations

NASA Astrophysics Data System (ADS)

Bourgoin, Jean-Philippe; Gigov, Nikolay; Higgins, Brendon L.; Yan, Zhizhong; Meyer-Scott, Evan; Khandani, Amir K.; Lütkenhaus, Norbert; Jennewein, Thomas

2015-11-01

Quantum key distribution (QKD) has the potential to improve communications security by offering cryptographic keys whose security relies on the fundamental properties of quantum physics. The use of a trusted quantum receiver on an orbiting satellite is the most practical near-term solution to the challenge of achieving long-distance (global-scale) QKD, currently limited to a few hundred kilometers on the ground. This scenario presents unique challenges, such as high photon losses and restricted classical data transmission and processing power due to the limitations of a typical satellite platform. Here we demonstrate the feasibility of such a system by implementing a QKD protocol, with optical transmission and full post-processing, in the high-loss regime using minimized computing hardware at the receiver. Employing weak coherent pulses with decoy states, we demonstrate the production of secure key bits at up to 56.5 dB of photon loss. We further illustrate the feasibility of a satellite uplink by generating a secure key while experimentally emulating the varying losses predicted for realistic low-Earth-orbit satellite passes at 600 km altitude. With a 76 MHz source and including finite-size analysis, we extract 3374 bits of a secure key from the best pass. We also illustrate the potential benefit of combining multiple passes together: while one suboptimal "upper-quartile" pass produces no finite-sized key with our source, the combination of three such passes allows us to extract 165 bits of a secure key. Alternatively, we find that by increasing the signal rate to 300 MHz it would be possible to extract 21 570 bits of a secure finite-sized key in just a single upper-quartile pass.

Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines.

PubMed

Ijaz, Nadine; Boon, Heather

2018-04-01

The World Health Organization (WHO) has called for the increased statutory regulation of traditional and complementary medicine practitioners and practices, currently implemented in about half of nations surveyed. According to recent WHO data, however, the absence of policy guidelines in this area represents a significant barrier to implementation of such professional regulations. This commentary reviews several key challenges that distinguish the statutory regulation of traditional medicine practitioners and practices from biomedical professional regulation, providing a foundation for the development of policy making parameters in this area. Foremost in this regard are the ongoing impacts of the European colonial encounter, which reinforce biomedicine's disproportionate political dominance across the globe despite traditional medicine's ongoing widespread use (particularly in the global South). In this light, the authors discuss the conceptual and historical underpinnings of contemporary professional regulatory structures, the tensions between institutional and informal traditional medicine training pathways, and the policy challenges presented by the prospect of standardizing internally diverse indigenous healing approaches. Epistemic and evidentiary tensions, as well as the policy complexities surrounding the intersection of cultural and clinical considerations, present additional challenges to regulators. Conceptualizing professional regulation as an intellectual property claim under the law, the authors further consider what it means to protect traditional knowledge and prevent misappropriation in this context. Overall, the authors propose that innovative professional regulatory approaches are needed in this area to address safety, quality of care, and accessibility as key public interest concerns, while prioritizing the redress of historical inequities, protection of diverse indigenous knowledges, and delivery of care to underserved populations.

Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines

PubMed Central

Boon, Heather

2018-01-01

Abstract The World Health Organization (WHO) has called for the increased statutory regulation of traditional and complementary medicine practitioners and practices, currently implemented in about half of nations surveyed. According to recent WHO data, however, the absence of policy guidelines in this area represents a significant barrier to implementation of such professional regulations. This commentary reviews several key challenges that distinguish the statutory regulation of traditional medicine practitioners and practices from biomedical professional regulation, providing a foundation for the development of policy making parameters in this area. Foremost in this regard are the ongoing impacts of the European colonial encounter, which reinforce biomedicine's disproportionate political dominance across the globe despite traditional medicine's ongoing widespread use (particularly in the global South). In this light, the authors discuss the conceptual and historical underpinnings of contemporary professional regulatory structures, the tensions between institutional and informal traditional medicine training pathways, and the policy challenges presented by the prospect of standardizing internally diverse indigenous healing approaches. Epistemic and evidentiary tensions, as well as the policy complexities surrounding the intersection of cultural and clinical considerations, present additional challenges to regulators. Conceptualizing professional regulation as an intellectual property claim under the law, the authors further consider what it means to protect traditional knowledge and prevent misappropriation in this context. Overall, the authors propose that innovative professional regulatory approaches are needed in this area to address safety, quality of care, and accessibility as key public interest concerns, while prioritizing the redress of historical inequities, protection of diverse indigenous knowledges, and delivery of care to underserved populations. PMID:29359948

Challenges of Applying a Comprehensive Model of Intervention Fidelity

PubMed Central

Bosak, Kelly; Pozehl, Bunny; Yates, Bernice

2014-01-01

Applying a comprehensive model of fidelity to interventions delivered by Information and Communication Technology (ICT) has multiple challenges. Fidelity must be considered in the design, implementation, evaluation, and reporting of the intervention. The fidelity strategies must address the unique aspects of the technology, including training providers to instruct participants to use the technology and to provide standardized feedback, rather than deliver the intervention in-person. Other challenges include the nonspecific effects resulting from participants accessing unintended content in interventions delivered by the Internet. ICT allows participant receipt and enactment of intervention skills to be assessed by electronic evidence, rather than in-person observation. Interventions using ICT, such as the Internet are unique, and there is less control of participant interaction with various electronic components. Monitoring participant use and providing standardized feedback for receipt and enactment of intervention skills is key to ensuring intervention fidelity. The final challenges involve evaluating and reporting fidelity. PMID:21474676

Community-based participatory research in Little Haiti: challenges and lessons learned.

PubMed

Kobetz, Erin; Menard, Janelle; Diem, Joshua; Barton, Betsy; Blanco, Jenny; Pierre, Larry; Auguste, Pascale D; Etienne, Marie; Brewster, Cheryl

2009-01-01

Community-based participatory research (CBPR) is an effective methodology for developing relevant interventions with socially marginalized communities. However, implementing CBPR methods is challenging for several reasons. This paper presents challenges encountered in the context of an ongoing CBPR initiative in Little Haiti in Miami, Florida, and describes the solutions used to address them. We sought to describe the challenges faced and lessons learned while conducting CBPR in Little Haiti. Community-academic partnerships were created to guide the creation of culturally relevant cancer interventions and research. Historical distrust of research, cultural constructions of health and illness, and literacy issues are key considerations when developing partnerships with Haitian and other marginalized, immigrant communities. Partnerships are fostered over time through demonstrated mutual commitment to improving health and building community capacity. Communities must play an active role throughout the research process to ensure that studies are culturally relevant, and ensuing intervention, sustainable.

Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation

PubMed Central

Pintye, Jillian; Jacob, Sheena; Chung, Michael H.; Middleton, Lyn; Iliffe, Jill; Kim, H. Nina

2017-01-01

Background As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Methods Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Results Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. Conclusion To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes. PMID:29040303

Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation.

PubMed

Feldacker, Caryl; Pintye, Jillian; Jacob, Sheena; Chung, Michael H; Middleton, Lyn; Iliffe, Jill; Kim, H Nina

2017-01-01

As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes.

Key LIC (Low Intensity Conflict) Speeches, 1984-1989

DTIC Science & Technology

1989-09-01

certainty is the fact that little of what is understood has been applied effectively in the effort to contain the slow erosion of human liberty and self...this challenge have only themselves to blame if, and when, Congress mandates further initiatives because of the failure to make effective progress. It is...we continue to just sit back and listen? No! Now is the time for action in planning, preparing, and implementing effective low intensity conflict

Dynamic Metabolic Model Building Based on the Ensemble Modeling Approach

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

Liao, James C.

2016-10-01

Ensemble modeling of kinetic systems addresses the challenges of kinetic model construction, with respect to parameter value selection, and still allows for the rich insights possible from kinetic models. This project aimed to show that constructing, implementing, and analyzing such models is a useful tool for the metabolic engineering toolkit, and that they can result in actionable insights from models. Key concepts are developed and deliverable publications and results are presented.

Automated Monitoring of Pipeline Rights-of-Way

NASA Technical Reports Server (NTRS)

Frost, Chard Ritchie

2010-01-01

NASA Ames Research Center and the Pipeline Research Council International, Inc. have partnered in the formation of a research program to identify and develop the key technologies required to enable automated detection of threats to gas and oil transmission and distribution pipelines. This presentation describes the Right-of-way Automated Monitoring (RAM) program and highlights research successes to date, continuing challenges to implementing the RAM objectives, and the program's ongoing work and plans.

Lean Six Sigma Challenges and Opportunities

DTIC Science & Technology

2008-02-13

five key stages: Define, Measure, Analyze, Improve, and Control ( DMAIC ). During the ‘Define’ stage, participants identify the process that will be...that wastes time and effort. 4 The ‘Measure’ stage of DMAIC documents the measure of time or quantity of activities that occur at this stage of...chosen to be implemented. In the final ‘Control’ stage of the DMAIC methodology, the purpose is to ensure that benefits from the improved process

A devolved model for public involvement in the field of mental health research: case study learning.

PubMed

Moule, Pam; Davies, Rosie

2016-12-01

Patient and public involvement in all aspects of research is espoused and there is a continued interest in understanding its wider impact. Existing investigations have identified both beneficial outcomes and remaining issues. This paper presents the impact of public involvement in one case study led by a mental health charity conducted as part of a larger research project. The case study used a devolved model of working, contracting with service user-led organizations to maximize the benefits of local knowledge on the implementation of personalized budgets, support recruitment and local user-led organizations. To understand the processes and impact of public involvement in a devolved model of working with user-led organizations. Multiple data collection methods were employed throughout 2012. These included interviews with the researchers (n = 10) and research partners (n = 5), observation of two case study meetings and the review of key case study documentation. Analysis was conducted in NVivo10 using a coding framework developed following a literature review. Five key themes emerged from the data; Devolved model, Nature of involvement, Enabling factors, Implementation challenges and Impact. While there were some challenges of implementing the devolved model it is clear that our findings add to the growing understanding of the positive benefits research partners can bring to complex research. A devolved model can support the involvement of user-led organizations in research if there is a clear understanding of the underpinning philosophy and support mechanisms are in place. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Development and Implementation of a Peer Mentoring Program for Early Career Gerontological Faculty

PubMed Central

Bryant, Ashley Leak; Brody, Ab; Perez, Adriana; Shillam, Casey; Edelman, Linda S.; Bond, Stewart M.; Foster, Victoria; Siegel, Elena

2016-01-01

Purpose In conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), the Hartford Gerontological Nursing Leaders (HGNL) developed and executed a program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of the HGNL. The purpose of this article is to describe key strategies used to develop and execute the mentoring program and to present the formative and summative program evaluation. Design The program was launched in January 2011 with seven peer mentor and mentee matches. In June 2012, the peer mentoring committee solicited feedback on the development of the peer mentoring program and changes were made for the subsequent cohorts. Findings An additional 12 matches were made in the following 2 years (2012 and 2013), for a total of 31 matches to date. We have learned several key lessons from our three cohorts regarding how to structure, implement, and carefully evaluate a peer mentoring program. Conclusions Informal evaluation of our peer mentoring program noted several challenges for both peer mentors and mentees. Having knowledge of and addressing those challenges may increase the overall quality and effectiveness of peer mentoring programs and, in turn, benefit academic nursing by strengthening the faculty workforce. Clinical Relevance Findings from development and implementation of a peer mentoring program for gerontological faculty could lead to new and adaptable programs in a variety of clinical and education settings. PMID:25808927

In-Space Assembly Capability Assessment for Potential Human Exploration and Science Applications

NASA Technical Reports Server (NTRS)

Jefferies, Sharon A.; Jones, Christopher A.; Arney, Dale C.; Stillwagen, Frederic H.; Chai, Patrick R.; Hutchinson, Craig D.; Stafford, Matthew A.; Moses, Robert W.; Dempsey, James A.; Rodgers, Erica M.;

Impact Challenges in Community Science-with-Practice: Lessons from PROSPER on Transformative Practitioner-Scientist Partnerships and Prevention Infrastructure Development

PubMed Central

Greenberg, Mark

2011-01-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships—networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy. PMID:21222151

Impact challenges in community science-with-practice: lessons from PROSPER on transformative practitioner-scientist partnerships and prevention infrastructure development.

PubMed

Spoth, Richard; Greenberg, Mark

2011-09-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.

Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration

PubMed Central

Somme, Dominique; Trouvé, Hélène; Perisset, Catherine; Corvol, Aline; Ankri, Joël; Saint-Jean, Olivier; de Stampa, Matthieu

2014-01-01

Introduction Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008–2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion. Discussion The approaching end of the president's term led to the method's institutionalization (2011–2012), before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that ‘lost’ study (presented herein) have, nonetheless, ‘found’ some key lessons. Key lessons/conclusion It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level. PMID:24959112

Learning the Landscape: Implementation Challenges of Primary Care Innovators around Cancer Survivorship Care

PubMed Central

O’Malley, Denalee; Hudson, Shawna V.; Nekhlyudov, Larissa; Howard, Jenna; Rubinstein, Ellen; Lee, Heather S.; Overholser, Linda S.; Shaw, Amy; Givens, Sarah; Burton, Jay S.; Grunfeld, Eva; Parry, Carly; Crabtree, Benjamin F.

2016-01-01

PURPOSE This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. METHODS Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators’ summaries of care models. We used a multi-step immersion/crystallization analytic approach, guided by a primary care organizational change model. RESULTS Innovative practice models included: 1) a consultative model in a primary care setting; 2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; 3) an oncology nurse navigator in a primary care practice; and 4) two sub-specialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included: (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers. CONCLUSIONS Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors’ needs. PMID:27277895

Adapting and implementing evidence-based cancer education interventions in rural Appalachia: real world experiences and challenges

PubMed Central

Vanderpool, RC; Gainor, SJ; Conn, ME; Spencer, C; Allen, AR; Kennedy, S

2014-01-01

Introduction There is recognition among public health scholars and community practitioners that translating cancer prevention and control research into practice is challenging. This circumstance is particularly germane to medically underserved communities, such as rural Appalachia, where few evidence-based interventions originate and cancer incidence and mortality are elevated. Methods A case study approach was selected to examine the collective experience of 13 West Virginia community organizations awarded mini-grants requiring the use of an evidence-based cancer control intervention. Methods included a systematic review of grant applications and final programmatic reports, a faxed survey, and qualitative, in-depth interviews with key stakeholders. Results Appalachian grantees reported notable challenges with selecting, adapting, and implementing evidence-based cancer education interventions. Evidence-based programming was viewed as a barrier. Grantees made a range of adaptations to meet constituent needs, thereby jeopardizing intervention fidelity. However, programs were perceived as successful due to community participation and engagement, some element of behavioral change, dissemination of the health message, and establishment of collaborative partnerships. Conclusions A descriptive examination provides insights into the challenges of translating research to practice. This Appalachian cancer education grant program also highlights areas of compromise that are important for researchers and practitioners to understand. PMID:21988459

Advantages and Challenges of A Village Doctor-Based Cognitive Behavioral Therapy for Late-Life Depression in Rural China: A Qualitative Study.

PubMed

Tang, Xinfeng; Yang, Fahui; Tang, Tan; Yang, Xuemei; Zhang, Weijun; Wang, Xiaohua; Ji, Li; Xiao, Yun; Ma, Kun; Wang, Ying; Kong, Xianglei; Wang, Jianping; Liu, Jun; Xu, Qian; Tian, Donghua; Qu, Zhiyong

2015-01-01

The delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China. We conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis. The village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders' access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention. The present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed.

Facilitators and Barriers to Implementing Clinical Governance: A Qualitative Study among Senior Managers in Iran

PubMed Central

RAVAGHI, Hamid; RAFIEI, Sima; HEIDARPOUR, Peigham; MOHSENI, Maryam

2014-01-01

Abstract Background Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. Methods A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data Results Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers’ commitment, effective communication and well designed incentives. Pe rceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Conclusions Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators. PMID:26175981

Decentralized water resources management in Mozambique: Challenges of implementation at the river basin level

NASA Astrophysics Data System (ADS)

Inguane, Ronaldo; Gallego-Ayala, Jordi; Juízo, Dinis

In the context of integrated water resources management implementation, the decentralization of water resources management (DWRM) at the river basin level is a crucial aspect for its success. However, decentralization requires the creation of new institutions on the ground, to stimulate an environment enabling stakeholder participation and integration into the water management decision-making process. In 1991, Mozambique began restructuring its water sector toward operational decentralized water resources management. Within this context of decentralization, new legal and institutional frameworks have been created, e.g., Regional Water Administrations (RWAs) and River Basin Committees. This paper identifies and analyzes the key institutional challenges and opportunities of DWRM implementation in Mozambique. The paper uses a critical social science research methodology for in-depth analysis of the roots of the constraining factors for the implementation of DWRM. The results obtained suggest that RWAs should be designed considering the specific geographic and infrastructural conditions of their jurisdictional areas and that priorities should be selected in their institutional capacity building strategies that match local realities. Furthermore, the results also indicate that RWAs have enjoyed limited support from basin stakeholders, mainly in basins with less hydraulic infrastructure, in securing water availability for their users and minimizing the effect of climate variability.

The challenges of leading change in health-care delivery from the front-line.

PubMed

Byers, Vivienne

2017-09-01

The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change. Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment. A survey of nursing practice in person-centred health-policy implementation is presented. Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change. Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement. Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support. © 2015 John Wiley & Sons Ltd.

Qualitative analysis of vendor discussions on the procurement of Computerised Physician Order Entry and Clinical Decision Support systems in hospitals

PubMed Central

Cresswell, Kathrin M; Lee, Lisa; Slee, Ann; Coleman, Jamie; Bates, David W; Sheikh, Aziz

2015-01-01

Objectives We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. Setting Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. Participants Nine participants, representing 6 key vendors operating in the UK, attended. The discussions were transcribed verbatim and thematically analysed. Results Vendors reported a range of challenges surrounding the procurement and contracting processes of CPOE/CDS systems, including hospitals’ inability to adequately assess their own needs and then select a suitable product, rushed procurement and implementation processes that resulted in difficulties in meaningfully engaging with vendors, as well as challenges relating to contracting leading to ambiguities in implementation roles. Consequently, relationships between system vendors and hospitals were often strained, the vendors attributing this to a lack of hospital management's appreciation of the complexities associated with implementation efforts. Future anticipated challenges included issues surrounding the standardisation of data to enable their aggregation across systems for effective secondary uses, and implementation of data exchange with providers outside the hospital. Conclusions Our results indicate that there are significant issues surrounding capacity to procure and optimise CPOE/CDS systems among UK hospitals. There is an urgent need to encourage more synergistic and collaborative working between providers and vendors and for a more centralised support for National Health Service hospitals, which draws on a wider body of experience, including a formalised procurement framework with value-based product specifications. PMID:26503385

"I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.

PubMed

Brundage, Michael D; Hart, Margaret; O'Donnell, Jennifer; Reddeman, Lindsay; Gutierrez, Eric; Foxcroft, Sophie; Warde, Padraig

Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs). Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus. A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs. Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans. Copyright © 2016. Published by Elsevier Inc.

Facilitating central line-associated bloodstream infection prevention: a qualitative study comparing perspectives of infection control professionals and frontline staff.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L

2014-10-01

Infection control professionals (ICPs) play a critical role in implementing and managing healthcare-associated infection reduction interventions, whereas frontline staff are responsible for delivering direct and ongoing patient care. The objective of our study was to determine if ICPs and frontline staff have different perspectives about the facilitators and challenges of central line-associated bloodstream infection (CLABSI) prevention program success. We conducted key informant interviews at 8 hospitals that participated in the Agency for Healthcare Research and Quality CLABSI prevention initiative called "On the CUSP: Stop BSI." We analyzed interview data from 50 frontline nurses and 26 ICPs to identify common themes related to program facilitators and challenges. We identified 4 facilitators of CLABSI program success: education, leadership, data, and consistency. We also identified 3 common challenges: lack of resources, competing priorities, and physician resistance. However, the perspective of ICPs and frontline nurses differed. Whereas ICPs tended to focus on general descriptions, frontline staff noted program specifics and often discussed concrete examples. Our results suggest that ICPs need to take into account the perspectives of staff nurses when implementing infection control and broader quality improvement initiatives. Further, the deliberate inclusion of frontline staff in the implementation of these programs may be critical to program success. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Critical elements in implementations of just-in-time management: empirical study of cement industry in Pakistan.

PubMed

Qureshi, Muhammad Imran; Iftikhar, Mehwish; Bhatti, Mansoor Nazir; Shams, Tauqeer; Zaman, Khalid

2013-01-01

In recent years, inventory management is continuous challenge for all organizations not only due to heavy cost associated with inventory holding, but also it has a great deal to do with the organizations production process. Cement industry is a growing sector of Pakistan's economy which is now facing problems in capacity utilization of their plants. This study attempts to identify the key strategies for successful implementation of just-in-time (JIT) management philosophy on the cement industry of Pakistan. The study uses survey responses from four hundred operations' managers of cement industry in order to know about the advantages and benefits that cement industry have experienced by Just in time (JIT) adoption. The results show that implementing the quality, product design, inventory management, supply chain and production plans embodied through the JIT philosophy which infect enhances cement industry competitiveness in Pakistan. JIT implementation increases performance by lower level of inventory, reduced operations & inventory costs was reduced eliminates wastage from the processes and reduced unnecessary production which is a big challenge for the manufacturer who are trying to maintain the continuous flow processes. JIT implementation is a vital manufacturing strategy that reaches capacity utilization and minimizes the rate of defect in continuous flow processes. The study emphasize the need for top management commitment in order to incorporate the necessary changes that need to take place in cement industry so that JIT implementation can take place in an effective manner.

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals.

PubMed

Kaji, Aiko; Thi, Sein Sein; Smith, Terrence; Charunwatthana, Prakaykaew; Nosten, Francois H

2015-10-09

Myanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border. The study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes. A total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human resources, limited staff capacities within organizations and poor socioeconomic status of patients. Health professionals face many challenges in effectively addressing TB control. Addressing the insufficient coordination and collaboration by strengthening bi-national collaborative mechanisms among health care organizations is an essential step in reducing the burden of disease. Additional support and resources from governmental and non-governmental agencies will be required to address the challenges.

Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review

PubMed Central

Cummings, Amanda; Lund, Susi; Campling, Natasha; May, Carl; Richardson, Alison; Myall, Michelle

2017-01-01

Objectives To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. Design and methods A scoping review was undertaken based on the methodological framework of Arksey and O’Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. Results Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. Conclusions A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex and contentious interventions. PMID:28988176

Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory.

PubMed

Bamford, Claire; Poole, Marie; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Iliffe, Steve; Manthorpe, Jill; Robinson, Louise

2014-11-08

Case management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States' model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation. Ethnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory. The primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring). Despite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers' inability to identify, and act on, emerging patient and carer needs (an essential, but previously unrecognised, training need). In the light of these barriers it is unclear whether primary care is the most appropriate setting for case management in England. The process evaluation highlights key aspects of implementation and training to be addressed in future studies of case management for dementia.

The development of an online decision support tool for organizational readiness for change.

PubMed

Khan, Sobia; Timmings, Caitlyn; Moore, Julia E; Marquez, Christine; Pyka, Kasha; Gheihman, Galina; Straus, Sharon E

2014-05-10

Much importance has been placed on assessing readiness for change as one of the earliest steps of implementation, but measuring it can be a complex and daunting task. Organizations and individuals struggle with how to reliably and accurately measure readiness for change. Several measures have been developed to help organizations assess readiness, but these are often underused due to the difficulty of selecting the right measure. In response to this challenge, we will develop and test a prototype of a decision support tool that is designed to guide individuals interested in implementation in the selection of an appropriate readiness assessment measure for their setting. A multi-phase approach will be used to develop the decision support tool. First, we will identify key measures for assessing organizational readiness for change from a recently completed systematic review. Included measures will be those developed for healthcare settings (e.g., acute care, public health, mental health) and that have been deemed valid and reliable. Second, study investigators and field experts will engage in a mapping exercise to categorize individual items of included measures according to key readiness constructs from an existing framework. Third, a stakeholder panel will be recruited and consulted to determine the feasibility and relevance of the selected measures using a modified Delphi process. Fourth, findings from the mapping exercise and stakeholder consultation will inform the development of a decision support tool that will guide users in appropriately selecting change readiness measures. Fifth, the tool will undergo usability testing. Our proposed decision support tool will address current challenges in the field of organizational change readiness by aiding individuals in selecting a valid and reliable assessment measure that is relevant to user needs and practice settings. We anticipate that implementers and researchers who use our tool will be more likely to conduct readiness for change assessments in their settings when planning for implementation. This, in turn, may contribute to more successful implementation outcomes. We will test this tool in a future study to determine its efficacy and impact on implementation processes.

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

PubMed

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

Reference-Frame-Independent and Measurement-Device-Independent Quantum Key Distribution Using One Single Source

NASA Astrophysics Data System (ADS)

Li, Qian; Zhu, Changhua; Ma, Shuquan; Wei, Kejin; Pei, Changxing

2018-04-01

Measurement-device-independent quantum key distribution (MDI-QKD) is immune to all detector side-channel attacks. However, practical implementations of MDI-QKD, which require two-photon interferences from separated independent single-photon sources and a nontrivial reference alignment procedure, are still challenging with current technologies. Here, we propose a scheme that significantly reduces the experimental complexity of two-photon interferences and eliminates reference frame alignment by the combination of plug-and-play and reference frame independent MDI-QKD. Simulation results show that the secure communication distance can be up to 219 km in the finite-data case and the scheme has good potential for practical MDI-QKD systems.

The development of health care data warehouses to support data mining.

PubMed

Lyman, Jason A; Scully, Kenneth; Harrison, James H

2008-03-01

Clinical data warehouses offer tremendous benefits as a foundation for data mining. By serving as a source for comprehensive clinical and demographic information on large patient populations, they streamline knowledge discovery efforts by providing standard and efficient mechanisms to replace time-consuming and expensive original data collection, organization, and processing. Building effective data warehouses requires knowledge of and attention to key issues in database design, data acquisition and processing, and data access and security. In this article, the authors provide an operational and technical definition of data warehouses, present examples of data mining projects enabled by existing data warehouses, and describe key issues and challenges related to warehouse development and implementation.

Compact SPAD-Based Pixel Architectures for Time-Resolved Image Sensors

PubMed Central

Perenzoni, Matteo; Pancheri, Lucio; Stoppa, David

2016-01-01

This paper reviews the state of the art of single-photon avalanche diode (SPAD) image sensors for time-resolved imaging. The focus of the paper is on pixel architectures featuring small pixel size (<25 μm) and high fill factor (>20%) as a key enabling technology for the successful implementation of high spatial resolution SPAD-based image sensors. A summary of the main CMOS SPAD implementations, their characteristics and integration challenges, is provided from the perspective of targeting large pixel arrays, where one of the key drivers is the spatial uniformity. The main analog techniques aimed at time-gated photon counting and photon timestamping suitable for compact and low-power pixels are critically discussed. The main features of these solutions are the adoption of analog counting techniques and time-to-analog conversion, in NMOS-only pixels. Reliable quantum-limited single-photon counting, self-referenced analog-to-digital conversion, time gating down to 0.75 ns and timestamping with 368 ps jitter are achieved. PMID:27223284

The Primary Care Behavioral Health (PCBH) Model: An Overview and Operational Definition.

PubMed

Reiter, Jeffrey T; Dobmeyer, Anne C; Hunter, Christopher L

2018-06-01

The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.

In acceptance we trust? Conceptualising acceptance as a viable approach to NGO security management.

PubMed

Fast, Larissa A; Freeman, C Faith; O'Neill, Michael; Rowley, Elizabeth

2013-04-01

This paper documents current understanding of acceptance as a security management approach and explores issues and challenges non-governmental organisations (NGOs) confront when implementing an acceptance approach to security management. It argues that the failure of organisations to systematise and clearly articulate acceptance as a distinct security management approach and a lack of organisational policies and procedures concerning acceptance hinder its efficacy as a security management approach. The paper identifies key and cross-cutting components of acceptance that are critical to its effective implementation in order to advance a comprehensive and systematic concept of acceptance. The key components of acceptance illustrate how organisational and staff functions affect positively or negatively an organisation's acceptance, and include: an organisation's principles and mission, communications, negotiation, programming, relationships and networks, stakeholder and context analysis, staffing, and image. The paper contends that acceptance is linked not only to good programming, but also to overall organisational management and structures. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Optimizing Implementation of Obesity Prevention Programs: A Qualitative Investigation Within a Large-Scale Randomized Controlled Trial.

PubMed

Kozica, Samantha L; Teede, Helena J; Harrison, Cheryce L; Klein, Ruth; Lombard, Catherine B

2016-01-01

The prevalence of obesity in rural and remote areas is elevated in comparison to urban populations, highlighting the need for interventions targeting obesity prevention in these settings. Implementing evidence-based obesity prevention programs is challenging. This study aimed to investigate factors influencing the implementation of obesity prevention programs, including adoption, program delivery, community uptake, and continuation, specifically within rural settings. Nested within a large-scale randomized controlled trial, a qualitative exploratory approach was adopted, with purposive sampling techniques utilized, to recruit stakeholders from 41 small rural towns in Australia. In-depth semistructured interviews were conducted with clinical health professionals, health service managers, and local government employees. Open coding was completed independently by 2 investigators and thematic analysis undertaken. In-depth interviews revealed that obesity prevention programs were valued by the rural workforce. Program implementation is influenced by interrelated factors across: (1) contextual factors and (2) organizational capacity. Key recommendations to manage the challenges of implementing evidence-based programs focused on reducing program delivery costs, aided by the provision of a suite of implementation and evaluation resources. Informing the scale-up of future prevention programs, stakeholders highlighted the need to build local rural capacity through developing supportive university partnerships, generating local program ownership and promoting active feedback to all program partners. We demonstrate that the rural workforce places a high value on obesity prevention programs. Our results inform the future scale-up of obesity prevention programs, providing an improved understanding of strategies to optimize implementation of evidence-based prevention programs. © 2015 National Rural Health Association.

Wireless communication and spectrum sharing for public safety in the United States.

PubMed

Kapucu, Naim; Haupt, Brittany; Yuksel, Murat

2016-01-01

With the vast number of fragmented, independent public safety wireless communication systems, the United States is encountering major challenges with enhancing interoperability and effectively managing costs while sharing limited availability of critical spectrum. The traditional hierarchical approach of emergency management does not always allow for needed flexibility and is not a mandate. A national system would reduce equipment needs, increase effectiveness, and enrich quality and coordination of response; however, it is dependent on integrating the commercial market. This article discusses components of an ideal national wireless public safety system consists along with key policies in regulating wireless communication and spectrum sharing for public safety and challenges for implementation.

Towards a cyberinfrastructure for the biological sciences: progress, visions and challenges.

PubMed

Stein, Lincoln D

2008-09-01

Biology is an information-driven science. Large-scale data sets from genomics, physiology, population genetics and imaging are driving research at a dizzying rate. Simultaneously, interdisciplinary collaborations among experimental biologists, theorists, statisticians and computer scientists have become the key to making effective use of these data sets. However, too many biologists have trouble accessing and using these electronic data sets and tools effectively. A 'cyberinfrastructure' is a combination of databases, network protocols and computational services that brings people, information and computational tools together to perform science in this information-driven world. This article reviews the components of a biological cyberinfrastructure, discusses current and pending implementations, and notes the many challenges that lie ahead.

AFRL Commander's Challenge 2015: stopping the active shooter

NASA Astrophysics Data System (ADS)

McIntire, John P.; Boston, Jonathan; Smith, Brandon; Swartz, Pete; Whitney-Rawls, Amy; Martinez Calderon, Julian; Magin, Jonathan

2017-05-01

In this work, we describe a rapid-innovation challenge to combat and deal with the problem of internal, insider physical threats (e.g., active shooters) and associated first-responder situation awareness on military installations. Our team's research and development effort described within focused on several key tech development areas: (1) indoor acoustical gunshot detection, (2) indoor spatial tracking of first responders, (3) bystander safety and protection, (4) two-way mass alerting capability, and (5) spatial information displays for command and control. The technological solutions were specifically designed to be innovative, low-cost, and (relatively) easy-to-implement, and to provide support across the spectrum of possible users including potential victims/bystanders, first responders, dispatch, and incident command.

A review of active control approaches in stabilizing combustion systems in aerospace industry

NASA Astrophysics Data System (ADS)

Zhao, Dan; Lu, Zhengli; Zhao, He; Li, X. Y.; Wang, Bing; Liu, Peijin

2018-02-01

Self-sustained combustion instabilities are one of the most plaguing challenges and problems in lean-conditioned propulsion and land-based engine systems, such as rocket motors, gas turbines, industrial furnace and boilers, and turbo-jet thrust augmenters. Either passive or active control in open- or closed-loop configurations can be implemented to mitigate such instabilities. One of the classical disadvantages of passive control is that it is only implementable to a designed combustor over a limited frequency range and can not respond to the changes in operating conditions. Compared with passive control approaches, active control, especially in closed-loop configuration is more adaptive and has inherent capacity to be implemented in practice. The key components in closed-loop active control are 1) sensor, 2) controller (optimization algorithm) and 3) dynamic actuator. The present work is to outline the current status, technical challenges and development progress of the active control approaches (in open- or closed-loop configurations). A brief description of feedback control, adaptive control, model-based control and sliding mode control are provided first by introducing a simplified Rijke-type combustion system. The modelled combustion system provides an invaluable platform to evaluate the performance of these feedback controllers and a transient growth controller. The performance of these controllers are compared and discussed. An outline of theoretical, numerical and experimental investigations are then provided to overview the research and development progress made during the last 4 decades. Finally, potential, challenges and issues involved with the design, application and implementation of active combustion control strategies on a practical engine system are highlighted.

[Innovations in vaccinology: challenge and opportunities for Africa].

PubMed

Diop, Doudou; Sanicas, Melvin

2017-01-01

Immunization is undoubtedly one of the most effective and most cost-effective health interventions. Vaccines continue to revolutionize our ability to prevent diseases and improve health. With all the technological advances, we are able to extend the benefits of vaccines to more people and to provide better protection from life-threatening infectious diseases. Nevertheless, thanks to the unceasing implementation of novel microbial strains on a worldwide basis, research in vaccinology must innovate continuously. African countries have made great progress in increasing routine immunization coverage rates and in introducing newly developed vaccines. New types of vaccines associated with vectorization, administration and specific licensing tools as well as with adjuvants designed to finely modulate immune responses are expected to be achieved in the near future. African countries need to work to develop a regional approach to respond effectively to the many challenges. Providing better information, implementing healthcare personnel vaccinology training programs and well targeted research projects are the keys to future achievements in the field.

Advanced physical assessment skills: implementation of a module.

PubMed

Aldridge-Bent, Sharon

2011-02-01

This article aims to explore and examine advanced physical assessment skills and the role of the district nurse. It will particularly highlight district nurses' perceptions of how they may implement skills learnt on a new module introduced into the Community Health Care Nursing degree at a university in London. Physical assessment skills have traditionally been viewed as part of a doctor's role; however, with the advancement of nursing roles, it is argued that it has become a key nursing skill. As Government policy continues to expect health professionals to keep patients in the community who have complex health and social care needs, the role of the district nurse presents as 'best placed' to take on this challenge (Department of Health (DH), 2005a; 2005b). Evaluation of the district nurses' perceptions of their practice is shared here, highlighting some of the challenges that they face. The article will address the complexity of developing a curriculum in response to the DH initiatives and the importance of listening to students on courses.

Ethical and Diversity Challenges in Ecologically Sensitive Systems-Oriented Interventions

PubMed Central

Jason, Leonard A.

2016-01-01

This article discusses ethical and diversity challenges involved in implementing ecologically sensitive, systems-oriented research. These issues are considered with reference to a series of community-based interventions dealing with stigma and chronic illness, recovery from substance-use disorders, and prevention of tobacco use. Each of these ecological interventions incorporates a systems approach, which allows an understanding of how individuals affect and are influenced by their social environments. In addition, issues of diversity with respect to underrepresented and marginalized groups are considered, including overcoming obstacles to gaining access to resources and promoting increased opportunities and empowerment. Throughout, the central importance of developing relationships with key gatekeepers and stakeholders, as well as timely and effective communications with various coalition members, is highlighted. By bringing into the research and policy process diverse citizen/participant suggestions and input regarding the need for, or design and implementation of ecologically and systems-based interventions, researchers can build collaborative relationships that fuel trust and partnerships, leading to more ethically responsible research. PMID:26618968

Data sharing policy design for consortia: challenges for sustainability.

PubMed

Kaye, Jane; Hawkins, Naomi

2014-01-01

The field of human genomics has led advances in the sharing of data with a view to facilitating translation of research into innovations for human health. This change in scientific practice has been implemented through new policy developed by many principal investigators, project managers and funders, which has ultimately led to new forms of practice and innovative governance models for data sharing. Here, we examine the development of the governance of data sharing in genomics, and explore some of the key challenges associated with the design and implementation of these policies. We examine how the incremental nature of policy design, the perennial problem of consent, the gridlock caused by multiple and overlapping access systems, the administrative burden and the problems with incentives and acknowledgment all have an impact on the potential for data sharing to be maximized. We conclude by proposing ways in which the scientific community can address these problems, to improve the sustainability of data sharing into the future.

Implementing personalisation for people with mental health problems: a comparative case study of four local authorities in England.

PubMed

Larsen, John; Ainsworth, Emily; Harrop, Clare; Patterson, Sue; Hamilton, Sarah; Szymczynska, Paulina; Tew, Jerry; Manthorpe, Jill; Pinfold, Vanessa

2013-04-01

Enhancing choice and control for people using services is a mental health and social-care service priority in England. Personalisation is a new policy and practice for delivery of social-care services where eligible adults are allocated a personal budget to spend to meet their agreed support needs. To describe approaches to introducing personal budgets to people with severe and enduring mental health needs, and to identify facilitators or barriers encountered. Within four English local authority (LA) areas, purposively selected to provide maximum variation, semi-structured interviews were undertaken with 58 participants from LAs, NHS trusts and third-sector organisations. An Interpretive Framework analysis considered within- and across-site insights. Issues arising from the implementation of personalisation for people with mental health needs are presented under two general themes: "responsibility and power" and "vision and leadership". Key challenges identified were complexities of working across NHS and LAs, the importance of effective leadership and engagement with service user representatives. Implementing personal budgets in mental health requires effective engagement of health and social-care systems. Change processes need strong leadership, clear vision and personal commitment, with ownership by all key stakeholders, including front-line practitioners.

Implementing healthcare excellence: the vital role of the CEO in evidence-based design.

PubMed

Zimring, Craig; Augenbroe, Godfried L; Malone, Eileen B; Sadler, Blair L

2008-01-01

This paper explores the role of the chief executive officer (CEO) in evidence-based design (EBD), discussing the internal and external challenges that a CEO faces, such as demands for increased quality, safety, patient-and-family-centeredness, increased revenue, and reduced cost. Based on a series of interviews and case studies and the experience of the authors as researchers, consultants, and CEOs, this paper provides a model for EBD and recommends actions that a CEO can undertake to create an effective project over the life cycle of a building. TOPICAL HEADINGS: Evidence-Based Design: A Performance-Based Approach to Achieving Key Goals; Key Approaches to Executing Evidence-Based Design; Overcoming Barriers to Innovation: The CEO's Vital Role in Implementing Evidence-Based Design The CEO bears special responsibility for successful facility project implementation. Only the CEO possesses the responsibility and authority to articulate the strategy, vision, goals, and resource constraints that frame every project. With the support of their boards, CEOs set the stage for the transformation of an organization's culture and fuel clinical and business process reengineering by encouraging and, if necessary, forcing collaboration between the strong disciplinary and departmental divisions found in healthcare systems.

Business Intelligence in Hospital Management.

PubMed

Escher, Achim; Hainc, Nicolin; Boll, Daniel

2016-01-01

Business intelligence (BI) is a worthwhile investment, and will play a significant role in hospital management in the near future. Implementation of BI is challenging and requires resources, skills, and a strategy, but enables management to have easy access to relevant analysis of data and visualization of important key performance indicators (KPI). Modern BI applications will help to overcome shortages of common "hand-made" analysis, save time and money, and will enable even managers to do "self-service" analysis and reporting.

Public-Private Leadership Forum; 21st Century Power Partnership

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

None

The PPLF convenes stakeholders from across the power sector, spanning electricity supply, delivery, and end-use, and plays a key role in guiding the strategic direction of the Power Partnership. In addition, PPLF members support the implementation of activities set out in the Power Partnership Program of Work. Taken together, the activities of the PPLF span the dynamic landscape of power challenges and opportunities, with a focus on business models, ?nancial tools, and regulatory frameworks.

Coalition, partnership, and constituency building by a state public health agency: a retrospective.

PubMed

Kimbrell, J D

2000-03-01

This article is a retrospective that traces the development of an evolutionary process for a state health agency in addressing the challenge of implementing core public health functions and the provision of essential services. Coalition, partnership, and constituency building were critical elements in the process. Various initiatives are described and their importance as building blocks to a larger process of organizational change is explained. Key lessons from the process are outlined.

Corporate dashboard for payphone service

NASA Astrophysics Data System (ADS)

Siraj, Fadzilah; Shadan, Hezlin

2015-12-01

Making assured that managements are kept abreast of what is happening in the company is not an easy task. The quantity of data generated by the business process is astonishing large and non-centralized. The challenge facing business organizations is how to extract, load, transform data, and then deliver useful information to key decision makers. The major challenge for the payphone industries is in making a good decision, particularly to increase quality of service, customer satisfaction while achieving high revenue. With current practice, the process is very time consuming and therefore, a systematic and informative corporate dashboard needs to be provided especially for managerial level in supporting their decision making process. This paper proposed a dashboard application design that provides a single-screen display of relevant information such as the phone performance and coin collection reports, as well as generated revenue to enable faster and more effective decision making. The development of the dashboard is divided into requirement, design and implementation phases. The implementation using real data has demonstrated the potential use of the dashboard. The evaluation results indicate that the dashboard can be used as a tool that can support payphone operation works and decision process by providing the analytical analysis of the KPI report and the performance status. In addition, the results can be used as a guideline for the dashboard developer to understand the process and focuses on the key elements and the principle in designing the effective dashboard.

Planning a graduate programme in public health nutrition for experienced nutrition professionals.

PubMed

Fox, Ann; Beyers, Joanne

2011-08-01

Public health renewal in Canada has highlighted the need for development and expansion of the public health nutrition workforce, particularly in northern and rural communities. The purpose of the present paper is to describe the planning of a more accessible graduate programme for experienced nutrition professionals. The planning effort was challenged by a short timeframe between programme approval and implementation and required intense collaboration with stakeholders and students. The programme planning model developed by The Health Communication Unit (THCU) at the Centre for Health Promotion was used to guide the process. This six-step model was familiar to key stakeholders and involved pre-planning, conducting a situational assessment, establishing goals and objectives, developing strategies and outcome indicators, and monitoring feedback. Resource constraints, short timelines and debates around distance education options presented challenges that were overcome by conducting a thorough needs assessment, creating an advisory committee, engaging key stakeholders in the planning process, and building on existing resources. Extensive involvement of the first cohort of students in ongoing planning and evaluation was particularly helpful in informing the evolution of the programme. The THCU planning model provided a useful framework for stakeholder collaboration and for planning and implementing the new graduate programme in public health nutrition. Preliminary data suggest that graduates are benefiting from their educational experiences through career enhancement opportunities. The evaluation strategies built into the programme design will be useful in informing ongoing programme development.

Challenges and possible solutions to colorectal cancer screening for the underserved.

PubMed

Gupta, Samir; Sussman, Daniel A; Doubeni, Chyke A; Anderson, Daniel S; Day, Lukejohn; Deshpande, Amar R; Elmunzer, B Joseph; Laiyemo, Adeyinka O; Mendez, Jeanette; Somsouk, Ma; Allison, James; Bhuket, Taft; Geng, Zhuo; Green, Beverly B; Itzkowitz, Steven H; Martinez, Maria Elena

2014-04-01

Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, "the best test is the one that gets done"; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention, epidemiology, gastroenterology, and primary care from across the country who formed the Coalition to Boost Screening among the Underserved in the United States. The group was organized and held its first annual working group meeting in conjunction with the World Endoscopy Organization's annual Colorectal Cancer Screening Committee meeting during Digestive Disease Week 2012 in San Diego, California.

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

PubMed Central

2014-01-01

Background Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. Methods The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Results Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. Conclusion The study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level. PMID:25086597

Governing the implementation of emergency obstetric care: experiences of rural district health managers, Tanzania.

PubMed

Mkoka, Dickson Ally; Kiwara, Angwara; Goicolea, Isabel; Hurtig, Anna-Karin

2014-08-03

Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. The study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level.

Challenges of Implementing ESD in the Education Sector; Experiences in Norway

NASA Astrophysics Data System (ADS)

Sandås, Astrid; Benedict, Faye

This article presents and reflects on Norwegian experiences over a period of about 15 years with implementing the Norwegian national strategy for education for sustainable development (ESD) in the education system. We extract lessons about integration of ESD into education systems. After an introduction to central ideas of sustainable development and ESD, the article discusses the need for appropriate strategies and instruments. Key factors are collaboration to allow pupils and schools to actively contribute to a positive development locally and globally, interdisciplinary approaches to complex sustainability issues, and appropriate use of the ICT and other media. ESD programmes and activities should support school development and build the capacity of schools and teachers for integration of ESD.

Evidence-Informed, Individual Treatment of a Child with Sexual Behavior Problems: A Case Study.

PubMed

Allen, Brian; Berliner, Lucy

2015-11-01

Children with sexual behavior problems pose a significant challenge for community-based mental health clinicians. Very few clinical trials are available to guide intervention and those interventions that are available are based in a group format. The current case study demonstrates the application of evidence-informed treatment techniques during the individual treatment of a 10-year-old boy displaying interpersonal sexual behavior problems. Specifically, the clinician adapts and implements a group-based model developed and tested by Bonner et al. (1999) for use with an individual child and his caregivers. Key points of the case study are discussed within the context of implementing evidence-informed treatments for children with sexual behavior problems.

The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations

PubMed Central

Ngo, Victoria K.; Weiss, Bahr; Lam, Trung; Dang, Thanh; Nguyen, Tam; Nguyen, Mai Hien

2014-01-01

In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings. PMID:25568593

Training in dissemination and implementation research: a field-wide perspective.

PubMed

Proctor, Enola K; Chambers, David A

2017-09-01

We report outcomes of an NIH-convened meeting on training for dissemination and implementation (D&I) research, focused on accelerating translation of research to healthcare practice. Participants included leaders of current trainings, center directors, and those trained in existing programs. Given the large proportion of D&I research focused on cancer control, mental health, and substance abuse, participants overwhelmingly reflected the experiences and challenges of gaining capacity in behavioral health-related D&I research. The 2-day meeting required participants to draw upon their experiences to help build a field-wide perspective for D&I research training, identify resources needed to support this perspective, and brainstorm gaps in training that needed to be filled. Questions were sent to participants in advance, and responses were synthesized and presented to discuss during the meeting. A preliminary "field-wide" perspective emerged, spanning multiple disciplines, training models, and career levels. Current programs face high demand, need for continued evolution to reflect field advances, and sustainability challenges. Current gaps include implementation practice and predoctoral training. Federal funding is key to D&I research training, be it through grants or agency-led training programs, in order to span and address specialized disease and disorder foci and career tracks.

The use of genetically-engineered animals in science: perspectives of Canadian Animal Care Committee members.

PubMed

Ormandy, Elisabeth H; Dale, Julie; Griffin, Gilly

2013-05-01

The genetic engineering of animals for their use in science challenges the implementation of refinement and reduction in several areas, including the invasiveness of the procedures involved, unanticipated welfare concerns, and the numbers of animals required. Additionally, the creation of genetically-engineered animals raises problems with the Canadian system of reporting animal numbers per Category of Invasiveness, as well as raising issues of whether ethical limits can, or should, be placed on genetic engineering. A workshop was held with the aim of bringing together Canadian animal care committee members to discuss these issues, to reflect on progress that has been made in addressing them, and to propose ways of overcoming any challenges. Although previous literature has made recommendations with regard to refinement and reduction when creating new genetically-engineered animals, the perception of the workshop participants was that some key opportunities are being missed. The participants identified the main roadblocks to the implementation of refinement and reduction alternatives as confidentiality, cost and competition. If the scientific community is to make progress concerning the implementation of refinement and reduction, particularly in the creation and use of genetically-engineered animals, addressing these roadblocks needs to be a priority. 2013 FRAME.

Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action

PubMed Central

Downs, Shauna M; Mayes, Christopher; Trevena, Helen; Waqanivalu, Temo; Cawley, John

2018-01-01

Abstract The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, we describe the evidence base for diet-related interventions based on fiscal policies and consider the key questions that need to be asked by both health and economic policy-makers. From the health sector’s perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. We highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions. PMID:29531419

Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action.

PubMed

Thow, Anne Marie; Downs, Shauna M; Mayes, Christopher; Trevena, Helen; Waqanivalu, Temo; Cawley, John

2018-03-01

The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, we describe the evidence base for diet-related interventions based on fiscal policies and consider the key questions that need to be asked by both health and economic policy-makers. From the health sector's perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. We highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.

A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration.

PubMed

Rosen, C S; Matthieu, M M; Wiltsey Stirman, S; Cook, J M; Landes, S; Bernardy, N C; Chard, K M; Crowley, J; Eftekhari, A; Finley, E P; Hamblen, J L; Harik, J M; Kehle-Forbes, S M; Meis, L A; Osei-Bonsu, P E; Rodriguez, A L; Ruggiero, K J; Ruzek, J I; Smith, B N; Trent, L; Watts, B V

2016-11-01

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.

Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study.

PubMed

Thomas, Kristin; Bendtsen, Preben; Krevers, Barbro

2015-01-01

Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting. A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources. Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles. The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.

A policy analysis of the implementation of a Reproductive Health Vouchers Program in Kenya.

PubMed

Abuya, Timothy; Njuki, Rebecca; Warren, Charlotte E; Okal, Jerry; Obare, Francis; Kanya, Lucy; Askew, Ian; Bellows, Ben

2012-07-23

Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government's role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

PubMed Central

2012-01-01

Background Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Methods Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. Results The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. Conclusions OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government’s role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies. PMID:22823923

Multi-Stakeholder Taskforces in Bangladesh — A Distinctive Approach to Build Sustainable Tobacco Control Implementation

PubMed Central

Jackson-Morris, Angela M.; Chowdhury, Ishrat; Warner, Valerie; Bleymann, Kayleigh

2015-01-01

The MPOWER policy package enables countries to implement effective, evidence-based strategies to address the threat posed to their population by tobacco. All countries have challenges to overcome when implementing tobacco control policy. Some are generic such as tobacco industry efforts to undermine and circumvent legislation; others are specific to national or local context. Various factors influence how successfully challenges are addressed, including the legal-political framework for enforcement, public and administrative attitudes towards the law, and whether policy implementation measures are undertaken. This paper examines District Tobacco Control Taskforces, a flexible policy mechanism developed in Bangladesh to support the implementation of the Smoking and Tobacco Products Usage (Control) Act 2005 and its 2013 Amendment. At the time of this study published research and/or data was not available and understanding about these structures, their role, contribution, limitations and potential, was limited. We consider Taskforce characteristics and suggest that the “package” comprises a distinctive tobacco control implementation model. Qualitative data is presented from interviews with key informants in ten districts with activated taskforces (n = 70) to provide insight from the perspectives of taskforce members and non-members. In all ten districts taskforces were seen as a crucial tool for tobacco control implementation. Where taskforces were perceived to be functioning well, current positive impacts were perceived, including reduced smoking in public places and tobacco advertising, and increased public awareness and political profile. In districts with less well established taskforces, interviewees believed in their taskforce’s ‘potential’ to deliver similar benefits once their functioning was improved. Recommendations to improve functioning and enhance impact were made. The distinctive taskforce concept and lessons from their development may provide other countries with a flexible local implementation model for tobacco control. PMID:25575369

Multi-stakeholder taskforces in Bangladesh--a distinctive approach to build sustainable tobacco control implementation.

PubMed

Jackson-Morris, Angela M; Chowdhury, Ishrat; Warner, Valerie; Bleymann, Kayleigh

2015-01-07

The MPOWER policy package enables countries to implement effective, evidence-based strategies to address the threat posed to their population by tobacco. All countries have challenges to overcome when implementing tobacco control policy. Some are generic such as tobacco industry efforts to undermine and circumvent legislation; others are specific to national or local context. Various factors influence how successfully challenges are addressed, including the legal-political framework for enforcement, public and administrative attitudes towards the law, and whether policy implementation measures are undertaken. This paper examines District Tobacco Control Taskforces, a flexible policy mechanism developed in Bangladesh to support the implementation of the Smoking and Tobacco Products Usage (Control) Act 2005 and its 2013 Amendment. At the time of this study published research and/or data was not available and understanding about these structures, their role, contribution, limitations and potential, was limited. We consider Taskforce characteristics and suggest that the "package" comprises a distinctive tobacco control implementation model. Qualitative data is presented from interviews with key informants in ten districts with activated taskforces (n = 70) to provide insight from the perspectives of taskforce members and non-members. In all ten districts taskforces were seen as a crucial tool for tobacco control implementation. Where taskforces were perceived to be functioning well, current positive impacts were perceived, including reduced smoking in public places and tobacco advertising, and increased public awareness and political profile. In districts with less well established taskforces, interviewees believed in their taskforce's 'potential' to deliver similar benefits once their functioning was improved. Recommendations to improve functioning and enhance impact were made. The distinctive taskforce concept and lessons from their development may provide other countries with a flexible local implementation model for tobacco control.

Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success.

PubMed

Rangachari, Pavani

2018-01-01

In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.

Otolaryngology residency education: a scoping review on the shift towards competency-based medical education.

PubMed

Wagner, N; Fahim, C; Dunn, K; Reid, D; Sonnadara, R R

2017-06-01

Residency training programmes worldwide are experiencing a shift from the traditional time-based curriculum to competency-based medical education (CBME), due to changes in the healthcare system that have impacted clinical learning opportunities. Otolaryngology-Head and Neck Surgery (OTL-HNS) programmes are one of the first North American surgical specialties to adopt the new CBME curriculum. The purpose of this scoping review is to examine the literature pertaining to CBME in OTL-HNS programmes worldwide, to identify the tools that have been developed and identify potential barriers to the implementation of CBME. Four online databases, OVID MEDLINE (R) from 1946 to 5 August 2015, EMBASE 1974 to 5 August 2015, Cochrane and CINAHL databases up to 5 August 2015, were searched using key words related to OTL-HNS and CBME. Two researchers independently reviewed the literature in a systematic manner and met to discuss and address any discrepancies at each step of the review process. Of the 207 publications identified in the initial search, 31 were included in this scoping review. Two key themes emerged from the literature: first, OTL-HNS programmes reported a need for new assessment tools that assess competency and also provide the learner with formative feedback. Second, although varieties of tools assessing both technical and non-technical skills have been developed, implementation of such tools has been met with some challenges. These challenges include a lack of faculty support, inadequate administrative support and a lack of knowledge on how to start the transition to CBME. This scoping review suggests that task-specific checklists, entrustment scales, evaluation portfolios from multiple assessments and faculty training sessions are key aspects to incorporate as OTL-HNS training programmes shift towards a CBME curriculum. © 2016 John Wiley & Sons Ltd.

Improving the adaptability of WHO evidence-informed guidelines for nutrition actions: results of a mixed methods evaluation.

PubMed

Dedios, Maria Cecilia; Esperato, Alexo; De-Regil, Luz Maria; Peña-Rosas, Juan Pablo; Norris, Susan L

2017-03-21

Over the past decade, the World Health Organization (WHO) has implemented a standardized, evidence-informed guideline development process to assure technically sound and policy-relevant guidelines. This study is an independent evaluation of the adaptability of the guidelines produced by the Evidence and Programme Guidance unit, at the Department of Nutrition for Health and Development (NHD). The study systematizes the lessons learned by the NHD group at WHO. We used a mixed methods approach to determine the adaptability of the nutrition guidelines. Adaptability was defined as having two components; methodological quality and implementability of guidelines. Additionally, we gathered recommendations to improve future guideline development in nutrition actions for health and development. Data sources for this evaluation were official documentation and feedback (both qualitative and quantitative) from key stakeholders involved in the development of nutrition guidelines. The qualitative data was collected through a desk review and two waves of semi-structured interviews (n = 12) and was analyzed through axial coding. Guideline adaptability was assessed quantitatively using two standardized instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n = 6), while implementability was assessed with the electronic version of the GuideLine Implementability Appraisal (n = 7). The nutrition evidence-informed guideline development process has several strengths, among them are the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. These features contribute to increase the methodological quality of the guidelines. The key areas for improvement are the limited implementability of the recommendations, the lack of explicit and precise implementation advice in the guidelines and challenges related to collaborative work within interdisciplinary groups. Overall, our study found that the nutrition evidence-informed guidelines are of good methodological quality but that the implementability requires improvement. The recommendations to improve guideline adaptability address the guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility. As WHO relies heavily on a standardized procedure to develop guidelines, the lessons learned may be applicable to guideline development across the organization and to other groups developing guidelines.

The economics, financing and implementation of HIV treatment as prevention: what will it take to get there?

PubMed

Wilson, David; Taaffe, Jessica; Fraser-Hurt, Nicole; Gorgens, Marelize

2014-01-01

The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a "grand convergence" of health initiatives to reduce both infectious diseases, and child and maternal mortality--diseases that still plague low income countries--would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1000 live births, reducing deaths due to HIV/AIDS to 8 per 100,000 population, and reducing annual TB deaths to 4 per 100,000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission, and morbidity and mortality associated with HIV/AIDS--and therefore contributing to Global Health 2035 goals. However, TasP requires large financial investments and poses significant implementation challenges. In this review, we discuss the potential effectiveness, financing and implementation of TasP. Overall, we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat, though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis, antiretroviral (ARV) initiation, ARV adherence and retention, and increased drug resistance with long-term enrolment on ART. Overcoming these implementation challenges will require targeted implementation, not focusing exclusively on TasP, most-at-risk population (MARP)-friendly services for key populations, integrating services, task shifting, more efficient programme management, balancing supply and demand, integration into universal health coverage efforts, demand creation, improved ART retention and adherence strategies, the use of incentives to improve HIV treatment outcomes and reduce unit costs, continued operational research and tapping into technological innovations.

Translating an early childhood obesity prevention program for local community implementation: a case study of the Melbourne InFANT Program.

PubMed

Laws, R; Hesketh, K D; Ball, K; Cooper, C; Vrljic, K; Campbell, K J

2016-08-08

While there is a growing interest in the field of research translation, there are few published examples of public health interventions that have been effectively scaled up and implemented in the community. This paper provides a case study of the community-wide implementation of the Melbourne Infant, Feeding, Activity and Nutrition Trial (InFANT), an obesity prevention program for parents with infants aged 3-18 months. The study explored key factors influencing the translation of the Program into routine practice and the respective role of policy makers, researchers and implementers. Case studies were conducted of five of the eight prevention areas in Victoria, Australia who implemented the Program. Cases were selected on the basis of having implemented the Program for 6 months or more. Data were collected from January to June 2015 and included 18 individual interviews, one focus group and observation of two meetings. A total of 28 individuals, including research staff (n = 4), policy makers (n = 2) and implementers (n = 22), contributed to the data collected. Thematic analysis was conducted using cross case comparisons and key themes were verified through member checking. Key facilitators of implementation included availability of a pre-packaged evidence based program addressing a community need, along with support and training provided by research staff to local implementers. Partnerships between researchers and policy makers facilitated initial program adoption, while local partnerships supported community implementation. Community partnerships were facilitated by local coordinators through alignment of program goals with existing policies and services. Workforce capacity for program delivery and administration was a challenge, largely overcome by embedding the Program into existing roles. Adapting the Program to fit local circumstance was critical for feasible and sustainable delivery, however balancing this with program fidelity was a critical issue. The lack of ongoing funding to support translation activities was a barrier for researchers continued involvement in community implementation. Policy makers, researchers and practitioners have important and complementary roles to play in supporting the translation of effective research interventions into practice. New avenues need to be explored to strengthen partnerships between researchers and end users to support the integration of effective public health research interventions into practice.

Beyond the rhetoric: what do we mean by a 'model of care'?

PubMed

Davidson, Patricia; Halcomb, Elizabeth; Hickman, L; Phillips, J; Graham, B

2006-01-01

Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and non-pharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidence-based practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including 'model*', 'framework*', 'models, theoretical' and 'nursing models, theoretical'. The collated material was then analysed and synthesised into this review. This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. national or state system) in order to achieve sustainable, effective and efficient changes a well-planned, systematic process is essential.

Acceptability of HIV Pre-Exposure Prophylaxis (PrEP) and Implementation Challenges Among Men Who Have Sex with Men in India: A Qualitative Investigation.

PubMed

Chakrapani, Venkatesan; Newman, Peter A; Shunmugam, Murali; Mengle, Shruta; Varghese, Jarvis; Nelson, Ruban; Bharat, Shalini

2015-10-01

This qualitative study explored the acceptability of HIV pre-exposure prophylaxis (PrEP) among MSM in India, and identified facilitators and barriers to future PrEP uptake. In 2014, we conducted 10 focus groups (n=61) among a purposive sample of diverse MSM recruited through community-based organizations in Chennai and Mumbai, and 10 key informant interviews with community leaders and health care providers. Participants' mean age was 26.1 years (SD 4.8); 62% completed secondary education, and 42% engaged in sex work. No focus group participants had heard of PrEP, but once explained, most reported they would likely use it. PrEP was alternately perceived as a 'back-up plan', a condom substitute, or a burden with concurrent condom use. Facilitators were potential for covert use, sex without condoms, and anxiety-less sex. Potential barriers emerged around stigma associated with PrEP use, fear of disclosures to one's family, wife, or male steady partner, and being labeled as HIV-positive or promiscuous by peers. Preferences emerged for intermittent rather than daily PrEP use, injectable PrEP, and free or subsidized access through community organizations or government hospitals. Key informants expressed additional concerns about risk compensation, non-adherence, and impact on ART availability for treatment. Demonstration projects are needed in India to support PrEP implementation tailored for at-risk MSM. Educational interventions for MSM should address concerns about PrEP effectiveness, side effects, and mitigate risk compensation. Community engagement may facilitate broad acceptability and challenge stigma around PrEP use. Importantly, provision of free or subsidized PrEP is necessary to making implementation feasible among low socioeconomic status MSM in India.

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

PubMed

Schneider, Helen; Nxumalo, Nonhlanhla

2017-09-15

National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.

Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program.

PubMed

Li, Madeline; Macedo, Alyssa; Crawford, Sean; Bagha, Sabira; Leung, Yvonne W; Zimmermann, Camilla; Fitzgerald, Barbara; Wyatt, Martha; Stuart-McEwan, Terri; Rodin, Gary

2016-05-01

Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center. DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement. There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization. Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff. Copyright © 2016 by American Society of Clinical Oncology.

Tracking implementation strategies: a description of a practical approach and early findings.

PubMed

Bunger, Alicia C; Powell, Byron J; Robertson, Hillary A; MacDowell, Hannah; Birken, Sarah A; Shea, Christopher

2017-02-23

Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children's access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.'s (Med Care Res Rev 69:123-57, 2012) taxonomy of implementation strategies. Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.

Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives.

PubMed

Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L

2014-01-01

Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Computational Materials: Modeling and Simulation of Nanostructured Materials and Systems

NASA Technical Reports Server (NTRS)

Gates, Thomas S.; Hinkley, Jeffrey A.

2003-01-01

The paper provides details on the structure and implementation of the Computational Materials program at the NASA Langley Research Center. Examples are given that illustrate the suggested approaches to predicting the behavior and influencing the design of nanostructured materials such as high-performance polymers, composites, and nanotube-reinforced polymers. Primary simulation and measurement methods applicable to multi-scale modeling are outlined. Key challenges including verification and validation of models are highlighted and discussed within the context of NASA's broad mission objectives.

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa

PubMed Central

2017-01-01

Background Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. Aim This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. Setting The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. Methods The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Results Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. Conclusion South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised. PMID:28828878

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

PubMed

Mburu, Grace; George, Gavin

2017-07-31

Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

Addressing unmeasured confounding in comparative observational research.

PubMed

Zhang, Xiang; Faries, Douglas E; Li, Hu; Stamey, James D; Imbens, Guido W

2018-04-01

Observational pharmacoepidemiological studies can provide valuable information on the effectiveness or safety of interventions in the real world, but one major challenge is the existence of unmeasured confounder(s). While many analytical methods have been developed for dealing with this challenge, they appear under-utilized, perhaps due to the complexity and varied requirements for implementation. Thus, there is an unmet need to improve understanding the appropriate course of action to address unmeasured confounding under a variety of research scenarios. We implemented a stepwise search strategy to find articles discussing the assessment of unmeasured confounding in electronic literature databases. Identified publications were reviewed and characterized by the applicable research settings and information requirements required for implementing each method. We further used this information to develop a best practice recommendation to help guide the selection of appropriate analytical methods for assessing the potential impact of unmeasured confounding. Over 100 papers were reviewed, and 15 methods were identified. We used a flowchart to illustrate the best practice recommendation which was driven by 2 critical components: (1) availability of information on the unmeasured confounders; and (2) goals of the unmeasured confounding assessment. Key factors for implementation of each method were summarized in a checklist to provide further assistance to researchers for implementing these methods. When assessing comparative effectiveness or safety in observational research, the impact of unmeasured confounding should not be ignored. Instead, we suggest quantitatively evaluating the impact of unmeasured confounding and provided a best practice recommendation for selecting appropriate analytical methods. Copyright © 2018 John Wiley & Sons, Ltd.

[Mobile Health Units: An Analysis of Concepts and Implementation Requirements in Rural Regions.

PubMed

Hämel, K; Kutzner, J; Vorderwülbecke, J

2017-12-01

Access to health services in rural regions represents a challenge. The development of care models that respond to health service shortages and pay particular attention to the increasing health care needs of the elderly is an important concern. A model that has been implemented in other countries is that of mobile health units. But until now, there is no overview of their possible objectives, functions and implementation requirements. This paper is based on a literature analysis and an internet research on mobile health units in rural regions. Mobile health units aim to avoid regional undersupply and address particularly vulnerable population groups. In the literature, mobile health units are described with a focus on specific illnesses, as well as those that provide comprehensive, partly multi-professional primary care that is close to patients' homes. The implementation of mobile health units is demanding; the key challenges are (a) alignment to the needs of the regional population, (b) user-oriented access and promotion of awareness and acceptance of mobile health units by the local population, and (c) network building within existing care structures to ensure continuity of care for patients. To fulfill these requirements, a community-oriented program development and implementation is important. Mobile health units could represent an interesting model for the provision of health care in rural regions in Germany. International experiences are an important starting point and should be taken into account for the further development of models in Germany. © Georg Thieme Verlag KG Stuttgart · New York.

Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.

PubMed

O'Malley, Denalee; Hudson, Shawna V; Nekhlyudov, Larissa; Howard, Jenna; Rubinstein, Ellen; Lee, Heather S; Overholser, Linda S; Shaw, Amy; Givens, Sarah; Burton, Jay S; Grunfeld, Eva; Parry, Carly; Crabtree, Benjamin F

2017-02-01

This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. Snowball sampling was used to identify innovators. Twelve participants (five cancer survivorship primary care innovators and seven content experts) attended a working conference focused on cancer survivorship population strategies and primary care transformation. Data included meeting discussion transcripts/field notes, transcribed in-depth innovator interviews, and innovators' summaries of care models. We used a multistep immersion/crystallization analytic approach, guided by a primary care organizational change model. Innovative practice models included: (1) a consultative model in a primary care setting; (2) a primary care physician (PCP)-led, blended consultative/panel-based model in an oncology setting; (3) an oncology nurse navigator in a primary care practice; and (4) two subspecialty models where PCPs in a general medical practice dedicated part of their patient panel to cancer survivors. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers. Cancer survivorship delivery models are potentially feasible in primary care; however, significant barriers to widespread implementation exist. Implementation efforts would benefit from increasing the awareness and potential value-add of primary care-focused strategies to address survivors' needs. Current models of primary care-based cancer survivorship care may not be sustainable. Innovative strategies to provide quality care to this growing population of survivors need to be developed and integrated into primary care settings.

Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success

PubMed Central

Rangachari, Pavani

2018-01-01

In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as “innovation implementation failure” in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on “innovation implementation” in hospitals and health systems over the last decade, since the spotlight was cast on “innovation implementation failure” in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the “what”), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the “how”). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues. PMID:29546884

Randomized Controlled Trials in Music Therapy: Guidelines for Design and Implementation.

PubMed

Bradt, Joke

2012-01-01

Evidence from randomized controlled trials (RCTs) plays a powerful role in today's healthcare industry. At the same time, it is important that multiple types of evidence contribute to music therapy's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence-based practice. Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate, RCTs can contribute important knowledge to our field. Therefore, it is important that music therapists are prepared to design trials that meet current methodological standards and, equally important, are able to respond appropriately to those design aspects that may not be feasible in music therapy research. To provide practical guidelines to music therapy researchers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence. This article reviews key design aspects of RCTs and discusses how to best implement these standards in music therapy trials. A systematic presentation of basic randomization methods, allocation concealment strategies, issues related to blinding in music therapy trials and strategies for implementation, the use of treatment manuals, types of control groups, outcome selection, and sample size computation is provided. Despite the challenges of meeting all key design demands typical of an RCT, it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits.

Overcoming Barriers to Experience Benefits: A Qualitative Analysis of Electronic Health Records and Health Information Exchange Implementation in Local Health Departments

PubMed Central

Williams, Karmen S.; Shah, Gulzar H.; Leider, JP; Gupta, Akarti

2017-01-01

Introduction: Electronic Health Records (EHRs) and Health Information Exchanges (HIEs) are changing surveillance and analytic operations within local health departments (LHDs) across the United States. The objective of this study was to analyze the status, benefits, barriers, and ways of overcoming challenges in the implementation of EHRs and HIEs in LHDs. Methods: This study employed a mixed methods approach, first using the 2013 National Profile of LHDs survey to ascertain the status of EHR and HIE implementation across the US, as well as to aid in selection of respondents for the second, interview-based part of project. Next, forty-nine key-informant interviews of local health department staff were conducted. Data were coded thematically and independently by two researchers. Coding was compared and re-coded using the consensus definitions. Results: Twenty-three percent of LHDs nationwide are using EHRs and 14 percent are using HIEs. The most frequently mentioned benefits for implementation were identified as care coordination, retrieval or managing information, and the ability to track outcomes of care. A few mentioned barriers included financial resources, resistance to change, and IT related issues during implementation. Discussion: Despite financial, technical capacity, and operational constraints, leaders interviewed as part of this project were optimistic about the future of EHRs in local health departments. Recent policy changes and accreditation have implications of improving processes to affect populations served. Conclusions: Overcoming the challenges in implementing EHRs can result in increased efficiencies in surveillance and higher quality patient care and tracking. However, significant opportunity cost does exist. PMID:29881738

Factors Supporting Implementation among CDSMP Organizations

PubMed Central

Paone, Deborah

2015-01-01

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP – citing the alignment between the program and their organizations’ mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption – particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program. PMID:25964928

Factors Supporting Implementation among CDSMP Organizations.

PubMed

Paone, Deborah

2014-01-01

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP - citing the alignment between the program and their organizations' mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption - particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program.

Lessons Learned From a Community-Based Participatory Research Mental Health Promotion Program for American Indian Youth.

PubMed

Langdon, Sarah E; Golden, Shannon L; Arnold, Elizabeth Mayfield; Maynor, Rhonda F; Bryant, Alfred; Freeman, V Kay; Bell, Ronny A

2016-05-01

Background American Indian (AI) youth have the highest rates of suicide among racial/ethnic minority groups in the United States. Community-based strategies are essential to address this issue, and community-based participatory research (CBPR) offers a model to engage AI communities in mental health promotion programming. Objectives This article describes successes and challenges of a CBPR, mixed-method project, The Lumbee Rite of Passage (LROP), an academic-community partnership to develop and implement a suicide prevention program for Lumbee AI youth in North Carolina. Method LROP was conducted in two phases to (1) understand knowledge and perceptions of existing mental health resources and (2) develop, implement, and evaluate a cultural enrichment program as a means of suicide prevention. Discussion/Results LROP implemented an effective community-academic partnership by (1) identifying and understanding community contexts, (2) maintaining equitable partnerships, and (3) implementing a culturally tailored research design targeting multilevel changes to support mental health. Strategies formed from the partnership alleviated challenges in each of these key CBPR concept areas. Conclusions LROP highlights how a CBPR approach contributes to positive outcomes and identifies opportunities for future collaboration in a tribal community. Using culturally appropriate CBPR strategies is critical to achieving sustainable, effective programs to improve mental health of AI youth. © 2016 Society for Public Health Education.

Implementing the new clinical nurse leader role while gleaning insights from the past.

PubMed

Moore, Linda Weaver; Leahy, Cathy

2012-01-01

This qualitative study explored the experiences of clinical nurse leaders (CNLs) as they implemented this new role. Twenty-four CNLs participated. Data were collected via an e-mail-distributed questionnaire. Data from open-ended questions were used to conduct a qualitative content analysis. Data were categorized according to question, key thoughts and phrases were established, and themes were determined. Findings revealed that nonsystematic role introduction was common. Two challenges to role implementation included role confusion and being overworked. The most positive aspect of the role was remaining close to the point of care. Participants noted that the overall response of the health care team to the role was positive despite participants' belief that the greatest roadblock to role success was the lack of support by nurse administrators. The support of nurse administrators and clear role expectations were viewed as essential for role sustain-ability. Understanding the experiences of CNLs as they launch this new role can provide insights for educators, administrators, CNLs, and other health care providers regarding the success and sustainability of the role. In addition, understanding the similarities between the clinical nurse specialist (CNS) role initiation in the past and the CNL role initiation today can foster the development of strategies for confronting the challenges of new role implementation. Copyright © 2012 Elsevier Inc. All rights reserved.

The evolution of medical imaging from qualitative to quantitative: opportunities, challenges, and approaches (Conference Presentation)

NASA Astrophysics Data System (ADS)

Jackson, Edward F.

2016-04-01

Over the past decade, there has been an increasing focus on quantitative imaging biomarkers (QIBs), which are defined as "objectively measured characteristics derived from in vivo images as indicators of normal biological processes, pathogenic processes, or response to a therapeutic intervention"1. To evolve qualitative imaging assessments to the use of QIBs requires the development and standardization of data acquisition, data analysis, and data display techniques, as well as appropriate reporting structures. As such, successful implementation of QIB applications relies heavily on expertise from the fields of medical physics, radiology, statistics, and informatics as well as collaboration from vendors of imaging acquisition, analysis, and reporting systems. When successfully implemented, QIBs will provide image-derived metrics with known bias and variance that can be validated with anatomically and physiologically relevant measures, including treatment response (and the heterogeneity of that response) and outcome. Such non-invasive quantitative measures can then be used effectively in clinical and translational research and will contribute significantly to the goals of precision medicine. This presentation will focus on 1) outlining the opportunities for QIB applications, with examples to demonstrate applications in both research and patient care, 2) discussing key challenges in the implementation of QIB applications, and 3) providing overviews of efforts to address such challenges from federal, scientific, and professional organizations, including, but not limited to, the RSNA, NCI, FDA, and NIST. 1Sullivan, Obuchowski, Kessler, et al. Radiology, epub August 2015.

Schools for health, education and development: a call for action.

PubMed

Tang, Kwok-Cho; Nutbeam, Don; Aldinger, Carmen; St Leger, Lawrence; Bundy, Donald; Hoffmann, Anna Maria; Yankah, Ekua; McCall, Doug; Buijs, Goof; Arnaout, Said; Morales, Sofialeticia; Robinson, Faye; Torranin, Charuaypon; Drake, Lesley; Abolfotouh, Mostafa; Whitman, Cheryl Vince; Meresman, Sergio; Odete, Cossa; Joukhadar, Abdul-Halim; Avison, Claire; Wright, Cream; Huerta, Franscico; Munodawafa, Davison; Nyamwaya, David; Heckert, Karen

2009-03-01

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement.

On analyzing colour constancy approach for improving SURF detector performance

NASA Astrophysics Data System (ADS)

Zulkiey, Mohd Asyraf; Zaki, Wan Mimi Diyana Wan; Hussain, Aini; Mustafa, Mohd. Marzuki

2012-04-01

Robust key point detector plays a crucial role in obtaining a good tracking feature. The main challenge in outdoor tracking is the illumination change due to various reasons such as weather fluctuation and occlusion. This paper approaches the illumination change problem by transforming the input image through colour constancy algorithm before applying the SURF detector. Masked grey world approach is chosen because of its ability to perform well under local as well as global illumination change. Every image is transformed to imitate the canonical illuminant and Gaussian distribution is used to model the global change. The simulation results show that the average number of detected key points have increased by 69.92%. Moreover, the average of improved performance cases far out weight the degradation case where the former is improved by 215.23%. The approach is suitable for tracking implementation where sudden illumination occurs frequently and robust key point detection is needed.

Cars, CONSORT 2010, and clinical practice.

PubMed

Williams, Hywel C

2010-03-24

Just like you would not buy a car without key information such as service history, you would not "buy" a clinical trial report without key information such as concealment of allocation. Implementation of the updated CONSORT 2010 statement enables the reader to see exactly what was done in a trial, to whom and when. A fully "CONSORTed" trial report does not necessarily mean the trial is a good one, but at least the reader can make a judgement. Clear reporting is a pre-requisite for judgement of study quality. The CONSORT statement evolves as empirical research moves on. CONSORT 2010 is even clearer than before and includes some new items with a particular emphasis on selective reporting of outcomes. The challenge is for everyone to use it.

Quantum key distribution with untrusted detectors

NASA Astrophysics Data System (ADS)

González, P.; Rebón, L.; Ferreira da Silva, T.; Figueroa, M.; Saavedra, C.; Curty, M.; Lima, G.; Xavier, G. B.; Nogueira, W. A. T.

2015-08-01

Side-channel attacks currently constitute the main challenge for quantum key distribution (QKD) to bridge theory with practice. So far two main approaches have been introduced to address this problem, (full) device-independent QKD and measurement-device-independent QKD. Here we present a third solution that might exceed the performance and practicality of the previous two in circumventing detector side-channel attacks, which arguably is the most hazardous part of QKD implementations. Our proposal has, however, one main requirement: the legitimate users of the system need to ensure that their labs do not leak any unwanted information to the outside. The security in the low-loss regime is guaranteed, while in the high-loss regime we already prove its robustness against some eavesdropping strategies.

Passive and active adaptive management: Approaches and an example

USGS Publications Warehouse

Williams, B.K.

2011-01-01

Adaptive management is a framework for resource conservation that promotes iterative learning-based decision making. Yet there remains considerable confusion about what adaptive management entails, and how to actually make resource decisions adaptively. A key but somewhat ambiguous distinction in adaptive management is between active and passive forms of adaptive decision making. The objective of this paper is to illustrate some approaches to active and passive adaptive management with a simple example involving the drawdown of water impoundments on a wildlife refuge. The approaches are illustrated for the drawdown example, and contrasted in terms of objectives, costs, and potential learning rates. Some key challenges to the actual practice of AM are discussed, and tradeoffs between implementation costs and long-term benefits are highlighted. ?? 2010 Elsevier Ltd.

Conversion of wastes into bioelectricity and chemicals by using microbial electrochemical technologies.

PubMed

Logan, Bruce E; Rabaey, Korneel

2012-08-10

Waste biomass is a cheap and relatively abundant source of electrons for microbes capable of producing electrical current outside the cell. Rapidly developing microbial electrochemical technologies, such as microbial fuel cells, are part of a diverse platform of future sustainable energy and chemical production technologies. We review the key advances that will enable the use of exoelectrogenic microorganisms to generate biofuels, hydrogen gas, methane, and other valuable inorganic and organic chemicals. Moreover, we examine the key challenges for implementing these systems and compare them to similar renewable energy technologies. Although commercial development is already underway in several different applications, ranging from wastewater treatment to industrial chemical production, further research is needed regarding efficiency, scalability, system lifetimes, and reliability.

Summary of the 2014 Sandia V&V Challenge Workshop

DOE PAGES

Schroeder, Benjamin B.; Hu, Kenneth T.; Mullins, Joshua Grady; ...

2016-02-19

A discussion of the five responses to the 2014 Sandia Verification and Validation (V&V) Challenge Problem, presented within this special issue, is provided hereafter. Overviews of the challenge problem workshop, workshop participants, and the problem statement are also included. Brief summations of teams' responses to the challenge problem are provided. Issues that arose throughout the responses that are deemed applicable to the general verification, validation, and uncertainty quantification (VVUQ) community are the main focal point of this paper. The discussion is oriented and organized into big picture comparison of data and model usage, VVUQ activities, and differentiating conceptual themes behindmore » the teams' VVUQ strategies. Significant differences are noted in the teams' approaches toward all VVUQ activities, and those deemed most relevant are discussed. Beyond the specific details of VVUQ implementations, thematic concepts are found to create differences among the approaches; some of the major themes are discussed. Lastly, an encapsulation of the key contributions, the lessons learned, and advice for the future are presented.« less

Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

PubMed Central

Lund, Susi; Richardson, Alison; May, Carl

2015-01-01

Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

Challenges, alternatives, and paths to sustainability: better public health promotion using social networking pages as key tools.

PubMed

Zaidan, A A; Zaidan, B B; Kadhem, Z; Larbani, M; Lakulu, M B; Hashim, M

2015-02-01

This paper discusses the possibility of promoting public health and implementing educational health services using Facebook. We discuss the challenges and strengths of using such a platform as a tool for public health care systems from two different perspectives, namely, the view of IT developers and that of physicians. We present a new way of evaluating user interactivity in health care systems from tools provided by Facebook that measure statistical traffic in the Internet. Findings show that Facebook is a very promising tool in promoting e-health services in Web 2.0. Results from statistical traffic show that a Facebook page is more efficient than other pages in promoting public health.

Worksite health promotion programs in college settings

PubMed Central

Hill-Mey, Patricia E.; Kumpfer, Karol L.; Merrill, Ray M.; Reel, Justine; Hyatt-Neville, Beverly; Richardson, Glenn E.

2015-01-01

The purpose of this paper is to describe the multifaceted nature and benefits of worksite health promotion programs (WHPPs), with emphasis on the college setting. An assessment of the peer-reviewed literature was conducted of articles published since 2000. Several search engines were accessed and selected key words were used. Most studies examining WHPPs have focused on return on investment and productivity. Research that targets the softer side-benefits of health promotion programs in the workplace is less available. Although the college setting offers some advantages for implementing health promotion programs. They may also have unique challenges due to their large and diverse employee population. There is little research to show the effectiveness and unique challenges of college-based health promotion programs. PMID:25861657

Improving data collection processes for routine evaluation of treatment cost-effectiveness.

PubMed

Monto, Sari; Penttilä, Riku; Kärri, Timo; Puolakka, Kari; Valpas, Antti; Talonpoika, Anna-Maria

2016-04-01

The healthcare system in Finland has begun routine collection of health-related quality of life (HRQoL) information for patients in hospitals to support more systematic cost-effectiveness analysis (CEA). This article describes the systematic collection of HRQoL survey data, and addresses challenges in the implementation of patient surveys and acquisition of cost data in the case hospital. Challenges include problems with incomplete data and undefined management processes. In order to support CEA of hospital treatments, improvements are sought from the process management literature and in the observation of healthcare professionals. The article has been written from an information system and process management perspective, concluding that process ownership, automation of data collection and better staff training are keys to generating more reliable data.

The relationship between school-level characteristics and implementation fidelity of a coordinated school health childhood obesity prevention intervention.

PubMed

Lederer, Alyssa M; King, Mindy H; Sovinski, Danielle; Seo, Dong-Chul; Kim, Nayoung

2015-01-01

Curtailing childhood obesity is a public health imperative. Although multicomponent school-based programs reduce obesity among children, less is known about the implementation fidelity of these interventions. This study examines process evaluation findings for the Healthy, Energetic Ready, Outstanding, Enthusiastic, Schools (HEROES) Initiative, a tri-state school-based childhood obesity prevention intervention based on the coordinated school health (CSH) model. Site visits were conducted that included key stakeholder interviews, observation, and document review. Scores were given for 8 domains, and a total implementation score was calculated. Two-way analyses of variance were conducted to examine the relationship of 4 school-level characteristics: elementary vs. middle/high schools, public vs. private schools, district vs. building level implementation, and socioeconomic status on each implementation area. Overall, schools had high fidelity scores, although some domains were implemented more successfully than others. Three school-level characteristics were associated with 1 or more domains, with elementary schools and schools implementing at the building level consistently having higher implementation scores than their counterparts. Process evaluation findings provide insight into successes and challenges schools implementing the CSH approach may encounter. Although preliminary, these findings on school-level characteristics establish a new area of research related to school-based childhood obesity prevention programs' implementation fidelity. © 2014, American School Health Association.

Recruiting, Retaining and Engaging Men in Social Interventions: Lessons for Implementation Focusing on a Prison-based Parenting Intervention for Young Incarcerated Fathers

PubMed Central

Buston, Katie

2018-01-01

ABSTRACT Recruiting, retaining and engaging men in social interventions can be challenging. The focus of this paper is the successful implementation of a parenting programme for incarcerated fathers, delivered in a Young Offender Institution (YOI) in Scotland. Reasons for high levels of recruitment, retention and engagement are explored, with barriers identified. A qualitative design was employed using ethnographic approaches including participant observation of the programme, informal interactions, and formal interviews with programme participants, the facilitators and others involved in managing the programme. Framework analysis was conducted on the integrated data set. The prison as the setting for programme delivery was both an opportunity and a challenge. It enabled easy access to participants and required low levels of effort on their part to attend. The creation of a nurturing and safe environment within the prison classroom facilitated engagement: relationships between the facilitators and participants, and between the participants themselves were key to understanding high levels of retention and engagement. The most fundamental challenge to high engagement levels arose from clashes in embedded institutional ways of working, between the host institution and the organisation experienced in delivering such intervention work. This threatened to compromise trust between the participants and the facilitators. Whilst adding specifically to the very sparse literature on reaching incarcerated young fathers and engaging them in parenting work, the findings have transferability to other under-researched areas: the implementation of social interventions generally in the prison setting, and engaging marginalised fathers in parenting/family work in community settings. The paper highlights ways of overcoming some of the challenges faced. PMID:29503596

The laboratory workforce shortage: a managerial perspective.

PubMed

Cortelyou-Ward, Kendall; Ramirez, Bernardo; Rotarius, Timothy

2011-01-01

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

PubMed Central

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Optimizing learning in healthcare: how Island Health is evolving to learn at the speed of change.

PubMed

Gottfredson, Conrad; Stroud, Carol; Jackson, Mary; Stevenson, R Lynn; Archer, Jana

2014-01-01

Healthcare organizations are challenged with constrained resources and increasing service demands by an aging population with complex care needs. Exponential growth in competency requirements also challenges staff's ability to provide quality patient care. How can a healthcare organization support its staff to learn "at or above the speed of change" while continuing to provide the quality patient care? Island Health is addressing this challenge by transforming its traditional education model into an innovative, evidence-based learning and performance support approach. Implementation of the methodology is yielding several lessons learned, both for the internal Learning and Performance Support team, and for what it takes to bring a new way of doing business into an organization. A key result is that this approach is enabling the organization to be more responsive in helping staff gain and maintain competencies.

THE CHALLENGING ROLE OF A READING COACH, A CAUTIONARY TALE.

PubMed

Al Otaiba, Stephanie; Hosp, John L; Smartt, Susan; Dole, Janice A

2008-04-01

The purpose of this case study is to describe the challenges one coach faced during the initial implementation of a coaching initiative involving 33 teachers in an urban, high-poverty elementary school. Reading coaches are increasingly expected to play a key role in the professional development efforts to improve reading instruction in order to improve reading achievement for struggling readers. Data sources included initial reading scores for kindergarten and first-graders, pretest and posttest scores of teachers' knowledge, a teacher survey, focus group interviews, project documents, and field notes. Data were analyzed using a mixed methods approach. Findings revealed several challenges that have important implications for research and practice: that teachers encountered new information about teaching early reading that conflicted with their current knowledge, this new information conflicted with their core reading program, teachers had differing perceptions of the role of the reading coach that affected their feelings about the project, and reform efforts are time-intensive.

Technical challenges in the construction of the steady-state stellarator Wendelstein 7-X

NASA Astrophysics Data System (ADS)

Bosch, H.-S.; Wolf, R. C.; Andreeva, T.; Baldzuhn, J.; Birus, D.; Bluhm, T.; Bräuer, T.; Braune, H.; Bykov, V.; Cardella, A.; Durodié, F.; Endler, M.; Erckmann, V.; Gantenbein, G.; Hartmann, D.; Hathiramani, D.; Heimann, P.; Heinemann, B.; Hennig, C.; Hirsch, M.; Holtum, D.; Jagielski, J.; Jelonnek, J.; Kasparek, W.; Klinger, T.; König, R.; Kornejew, P.; Kroiss, H.; Krom, J. G.; Kühner, G.; Laqua, H.; Laqua, H. P.; Lechte, C.; Lewerentz, M.; Maier, J.; McNeely, P.; Messiaen, A.; Michel, G.; Ongena, J.; Peacock, A.; Pedersen, T. S.; Riedl, R.; Riemann, H.; Rong, P.; Rust, N.; Schacht, J.; Schauer, F.; Schroeder, R.; Schweer, B.; Spring, A.; Stäbler, A.; Thumm, M.; Turkin, Y.; Wegener, L.; Werner, A.; Zhang, D.; Zilker, M.; Akijama, T.; Alzbutas, R.; Ascasibar, E.; Balden, M.; Banduch, M.; Baylard, Ch.; Behr, W.; Beidler, C.; Benndorf, A.; Bergmann, T.; Biedermann, C.; Bieg, B.; Biel, W.; Borchardt, M.; Borowitz, G.; Borsuk, V.; Bozhenkov, S.; Brakel, R.; Brand, H.; Brown, T.; Brucker, B.; Burhenn, R.; Buscher, K.-P.; Caldwell-Nichols, C.; Cappa, A.; Cardella, A.; Carls, A.; Carvalho, P.; Ciupiński, Ł.; Cole, M.; Collienne, J.; Czarnecka, A.; Czymek, G.; Dammertz, G.; Dhard, C. P.; Davydenko, V. I.; Dinklage, A.; Drevlak, M.; Drotziger, S.; Dudek, A.; Dumortier, P.; Dundulis, G.; Eeten, P. v.; Egorov, K.; Estrada, T.; Faugel, H.; Fellinger, J.; Feng, Y.; Fernandes, H.; Fietz, W. H.; Figacz, W.; Fischer, F.; Fontdecaba, J.; Freund, A.; Funaba, T.; Fünfgelder, H.; Galkowski, A.; Gates, D.; Giannone, L.; García Regaña, J. M.; Geiger, J.; Geißler, S.; Greuner, H.; Grahl, M.; Groß, S.; Grosman, A.; Grote, H.; Grulke, O.; Haas, M.; Haiduk, L.; Hartfuß, H.-J.; Harris, J. H.; Haus, D.; Hein, B.; Heitzenroeder, P.; Helander, P.; Heller, R.; Hidalgo, C.; Hildebrandt, D.; Höhnle, H.; Holtz, A.; Holzhauer, E.; Holzthüm, R.; Huber, A.; Hunger, H.; Hurd, F.; Ihrke, M.; Illy, S.; Ivanov, A.; Jablonski, S.; Jaksic, N.; Jakubowski, M.; Jaspers, R.; Jensen, H.; Jenzsch, H.; Kacmarczyk, J.; Kaliatk, T.; Kallmeyer, J.; Kamionka, U.; Karaleviciu, R.; Kern, S.; Keunecke, M.; Kleiber, R.; Knauer, J.; Koch, R.; Kocsis, G.; Könies, A.; Köppen, M.; Koslowski, R.; Koshurinov, J.; Krämer-Flecken, A.; Krampitz, R.; Kravtsov, Y.; Krychowiak, M.; Krzesinski, G.; Ksiazek, I.; Kubkowska, M.; Kus, A.; Langish, S.; Laube, R.; Laux, M.; Lazerson, S.; Lennartz, M.; Li, C.; Lietzow, R.; Lohs, A.; Lorenz, A.; Louche, F.; Lubyako, L.; Lumsdaine, A.; Lyssoivan, A.; Maaßberg, H.; Marek, P.; Martens, C.; Marushchenko, N.; Mayer, M.; Mendelevitch, B.; Mertens, Ph.; Mikkelsen, D.; Mishchenko, A.; Missal, B.; Mizuuchi, T.; Modrow, H.; Mönnich, T.; Morizaki, T.; Murakami, S.; Musielok, F.; Nagel, M.; Naujoks, D.; Neilson, H.; Neubauer, O.; Neuner, U.; Nocentini, R.; Noterdaeme, J.-M.; Nührenberg, C.; Obermayer, S.; Offermanns, G.; Oosterbeek, H.; Otte, M.; Panin, A.; Pap, M.; Paquay, S.; Pasch, E.; Peng, X.; Petrov, S.; Pilopp, D.; Pirsch, H.; Plaum, B.; Pompon, F.; Povilaitis, M.; Preinhaelter, J.; Prinz, O.; Purps, F.; Rajna, T.; Récsei, S.; Reiman, A.; Reiter, D.; Remmel, J.; Renard, S.; Rhode, V.; Riemann, J.; Rimkevicius, S.; Riße, K.; Rodatos, A.; Rodin, I.; Romé, M.; Roscher, H.-J.; Rummel, K.; Rummel, Th.; Runov, A.; Ryc, L.; Sachtleben, J.; Samartsev, A.; Sanchez, M.; Sano, F.; Scarabosio, A.; Schmid, M.; Schmitz, H.; Schmitz, O.; Schneider, M.; Schneider, W.; Scheibl, L.; Scholz, M.; Schröder, G.; Schröder, M.; Schruff, J.; Schumacher, H.; Shikhovtsev, I. V.; Shoji, M.; Siegl, G.; Skodzik, J.; Smirnow, M.; Speth, E.; Spong, D. A.; Stadler, R.; Sulek, Z.; Szabó, V.; Szabolics, T.; Szetefi, T.; Szökefalvi-Nagy, Z.; Tereshchenko, A.; Thomsen, H.; Thumm, M.; Timmermann, D.; Tittes, H.; Toi, K.; Tournianski, M.; Toussaint, U. v.; Tretter, J.; Tulipán, S.; Turba, P.; Uhlemann, R.; Urban, J.; Urbonavicius, E.; Urlings, P.; Valet, S.; Van Eester, D.; Van Schoor, M.; Vervier, M.; Viebke, H.; Vilbrandt, R.; Vrancken, M.; Wauters, T.; Weissgerber, M.; Weiß, E.; Weller, A.; Wendorf, J.; Wenzel, U.; Windisch, T.; Winkler, E.; Winkler, M.; Wolowski, J.; Wolters, J.; Wrochna, G.; Xanthopoulos, P.; Yamada, H.; Yokoyama, M.; Zacharias, D.; Zajac, J.; Zangl, G.; Zarnstorff, M.; Zeplien, H.; Zoletnik, S.; Zuin, M.

2013-12-01

The next step in the Wendelstein stellarator line is the large superconducting device Wendelstein 7-X, currently under construction in Greifswald, Germany. Steady-state operation is an intrinsic feature of stellarators, and one key element of the Wendelstein 7-X mission is to demonstrate steady-state operation under plasma conditions relevant for a fusion power plant. Steady-state operation of a fusion device, on the one hand, requires the implementation of special technologies, giving rise to technical challenges during the design, fabrication and assembly of such a device. On the other hand, also the physics development of steady-state operation at high plasma performance poses a challenge and careful preparation. The electron cyclotron resonance heating system, diagnostics, experiment control and data acquisition are prepared for plasma operation lasting 30 min. This requires many new technological approaches for plasma heating and diagnostics as well as new concepts for experiment control and data acquisition.

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services.

PubMed

Georgiou, Andrew; Westbrook, Johanna; Braithwaite, Jeffrey

2010-07-13

Information and communication technologies (ICT) are contributing to major changes taking place in pathology and within health services more generally. In this article, we draw on our research experience for over 7 years investigating the implementation and diffusion of computerized provider order entry (CPOE) systems to articulate some of the key informatics challenges confronting pathology laboratories. The implementation of these systems, with their improved information management and decision support structures, provides the potential for enhancing the role that pathology services play in patient care pathways. Beyond eliminating legibility problems, CPOE systems can also contribute to the efficiency and safety of healthcare, reducing the duplication of test orders and diminishing the risk of misidentification of patient samples and orders. However, despite the enthusiasm for CPOE systems, their diffusion across healthcare settings remains variable and is often beset by implementation problems. Information systems like CPOE may have the ability to integrate work, departments and organizations, but unfortunately, health professionals, departments and organizations do not always want to be integrated in ways that information systems allow. A persistent theme that emerges from the research evidence is that one size does not fit all, and system success or otherwise is reliant on the conditions and circumstances in which they are located. These conditions and circumstances are part of what is negotiated in the complex, messy and challenging area of ICT implementation. The solution is not likely to be simple and easy, but current evidence suggests that a combination of concerted efforts, better research designs, more sophisticated theories and hypotheses as well as more skilled, multidisciplinary research teams, tackling this area of study will bring substantial benefits, improving the effectiveness of pathology services, and, as a direct corollary, the quality of patient care.

Rural Household Preferences for Active Participation in “Payment for Ecosystem Service” Programs: A Case in the Miyun Reservoir Catchment, China

PubMed Central

Jiang, Xuemei; Zhang, Kebin; Yang, Xiaohui

2017-01-01

Many payment for ecosystem services (PES) programs, such as the Slope Land Conversion Program (SLCP), are passive and require full participation by impacted households. In contrast, this study considers the alternative of “active and incomplete” participation in PES programs, in which participants are not obliged to contract their own land, and have the right to select into the program or not. This type of program has been popular over the last decade in China; however, there have been few studies on the characteristics of willingness to participate and implementation. As such, this paper uses the Choice Experiment (CE) method to explore ways for inducing effective program participation, by analyzing the effects of different regime attributes. The case study used to analyze participation utility was the Jing-Ji Afforestation Program for Ecological and Water Protection (JAPEWP), a typical active-participation forestry PES program, and a key source of water near Beijing in the Miyun Reservoir Catchment (MRC). Analyzing rural household survey data indicated that the program faces a variety of challenges, including long-term maintenance, implementation performance, cost-effectiveness, and monitoring approaches. There are also challenges with one-size-fits-all payment strategies, due to ineffective program participation or imperfect implementation regimes. In response, this study proposes several policies, including providing secure and complete land tenure to the participants, creating more local off-farm employment opportunities, designing performance-based monitoring systems that are integrated with financial incentives, applying differentiated payment strategies, providing capacity building to support forestation activities, and establishing a comprehensive implementation regime that would address these challenges. These policy conclusions provide valuable lessons for other active-participation PES programs as well. PMID:28046106

Rural Household Preferences for Active Participation in "Payment for Ecosystem Service" Programs: A Case in the Miyun Reservoir Catchment, China.

PubMed

Li, Hao; Bennett, Michael T; Jiang, Xuemei; Zhang, Kebin; Yang, Xiaohui

2017-01-01

Many payment for ecosystem services (PES) programs, such as the Slope Land Conversion Program (SLCP), are passive and require full participation by impacted households. In contrast, this study considers the alternative of "active and incomplete" participation in PES programs, in which participants are not obliged to contract their own land, and have the right to select into the program or not. This type of program has been popular over the last decade in China; however, there have been few studies on the characteristics of willingness to participate and implementation. As such, this paper uses the Choice Experiment (CE) method to explore ways for inducing effective program participation, by analyzing the effects of different regime attributes. The case study used to analyze participation utility was the Jing-Ji Afforestation Program for Ecological and Water Protection (JAPEWP), a typical active-participation forestry PES program, and a key source of water near Beijing in the Miyun Reservoir Catchment (MRC). Analyzing rural household survey data indicated that the program faces a variety of challenges, including long-term maintenance, implementation performance, cost-effectiveness, and monitoring approaches. There are also challenges with one-size-fits-all payment strategies, due to ineffective program participation or imperfect implementation regimes. In response, this study proposes several policies, including providing secure and complete land tenure to the participants, creating more local off-farm employment opportunities, designing performance-based monitoring systems that are integrated with financial incentives, applying differentiated payment strategies, providing capacity building to support forestation activities, and establishing a comprehensive implementation regime that would address these challenges. These policy conclusions provide valuable lessons for other active-participation PES programs as well.

Implementing the ABCDE Bundle into Everyday Care: Opportunities, Challenges and Lessons Learned for Implementing the ICU Pain, Agitation and Delirium (PAD) Guidelines

PubMed Central

Balas, Michele C.; Burke, William J.; Gannon, David; Cohen, Marlene Z.; Colburn, Lois; Bevil, Catherine; Franz, Doug; Olsen, Keith M.; Ely, E. Wesley; Vasilevskis, Eduard E.

2014-01-01

Objective The Awakening and Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle is an evidence-based, interprofessional, multicomponent strategy for minimizing sedative exposure, reducing duration of mechanical ventilation and managing intensive care unit (ICU) acquired delirium and weakness. The purpose of this study was to identify facilitators and barriers to ABCDE bundle adoption and to evaluate the extent to which bundle implementation was effective, sustainable, and conducive to dissemination. Design Prospective, before-after, mixed-methods study. Setting Five adult ICUs, 1 step-down unit, and a special care unit located in a 624 bed, academic medical center Subjects Interprofessional ICU team members at participating institution. Interventions and Measurements In collaboration with the participating institution, we developed, implemented, and refined an ABCDE bundle policy. Over the course of an 18 month period, all ICU team members were offered the opportunity to participate in numerous, multimodal educational efforts. Three focus group sessions, 3 online surveys, and 1 educational evaluation were administered in an attempt to identify facilitators and barriers to bundle adoption. Main Results Factors believed to facilitate bundle implementation included: 1) the performance of daily, interdisciplinary, rounds, 2) engagement of key implementation leaders, 3) sustained and diverse educational efforts, and 4) the bundle's quality and strength. Barriers identified included: 1) intervention related issues (e.g. timing of trials, fear of adverse events), 2) communication and care coordination challenges, 3) knowledge deficits, 4) workload concerns, and 5) documentation burden. Despite these challenges, participants believed implementation ultimately benefited patients, improved interdisciplinary communication, and empowered nurses and other ICU team members. Conclusions In this study of the implementation of the ABCDE bundle in a tertiary care setting, clear factors were identified that both advanced and impeded adoption of this complex intervention that requires interprofessional education, coordination, and cooperation. Focusing on these factors preemptively should enable a more effective and lasting implementation of the bundle and better care for critically ill patients. Lessons learned from this study will also help healthcare providers optimize implementation of the recent ICU Pain, Agitation and Delirium (PAD) Guidelines, which has many similarities but also some important differences as compared to the ABCDE bundle PMID:23989089

Blood conservation: the CEO perspective.

PubMed

Morgan, Timothy O

2004-08-01

Hospital CEOs are concerned about more than just cost of services to their patients. The advancement of patient car along with maintaining or improving patient safety are also key elements to the CEO, to limit patient risks, hospital liability, and negative public relations. The CEO is accountable to the hospital staff, the patients, and the general public. Establishing programs such as blood management or bloodless medicine can be implemented by using a team approach. A physician champion with a clear business plan that addresses all issues and challenges is critical for successful implementation. As blood and blood product costs rise and supply decreases, alternatives such as cell saving techniques and the use of pharmacologic interventions can have a significant impact on net hospital expenditures.

Role of Landlords in Creating Healthy Homes: Section 8 Landlord Perspectives on Healthy Housing Practices.

PubMed

Polletta, Valerie L; Reid, Margaret; Barros, Eugene; Duarte, Catherine; Donaher, Kevin; Wensley, Howard; Wolff, Lisa

2017-11-01

This article presents qualitative research findings of Section 8 landlord perceptions regarding healthy housing practices to inform landlord-focused initiatives. Approach or Design: Five focus groups were conducted with landlords. Boston, Massachusetts. Section 8 landlords participated in focus groups (n = 39). Focus group transcripts were coded for key themes using a grounded theory approach. Landlords' primary challenges to creating a healthy housing environment included tenant behavior, financial burden, and policy enforcement; tenant safety and cost savings were seen as primary benefits. Landlords play a critical role in implementing healthy housing practices. Several opportunities exist to reduce barriers and capitalize on perceived benefits of implementing these practices, including increasing access to educational and financial resources.

Explanation of Change (EoC) Study: Considerations and Implementation Challenges

NASA Technical Reports Server (NTRS)

Bitten, Robert E.; Emmons, Debra L.; Hart, Matthew J.; Bordi, Francesco; Scolese, Christopher; Hinners, Noel

2013-01-01

This paper discusses the implementation of considerations resulting from a study investigating the cost change experienced by historical NASA science missions. The study investigated historical milestone and monthly status report documentation followed by interviews with key project personnel. The reasons for cost change were binned as being external to NASA, external to the project and internal to the project relative to the project's planning and execution. Based on the results of the binning process and the synthesis of project meetings and interviews, ten considerations were made with the objective to decrease the potential for cost change in future missions. Although no one magic bullet consideration was discovered, the considerations taken as a whole should help reduce cost and schedule change in future NASA missions.

An outcome-based assessment process for accrediting computing programmes

NASA Astrophysics Data System (ADS)

Harmanani, Haidar M.

2017-11-01

The calls for accountability in higher education have made outcome-based assessment a key accreditation component. Accreditation remains a well-regarded seal of approval on college quality, and requires the programme to set clear, appropriate, and measurable goals and courses to attain them. Furthermore, programmes must demonstrate that responsibilities associated with the goals are being carried out. Assessment leaders face various challenges including process design and implementation, faculty buy-in, and resources availability. This paper presents an outcome-based assessment approach that facilitates faculty participation while simplifying the assessment and reporting processes through effective and meaningful visualisation. The proposed approach has been implemented and used for the successful ABET accreditation of a computer science programme, and can be easily adapted to any higher education programme.

Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy.

PubMed

Empey, Philip E; Stevenson, James M; Tuteja, Sony; Weitzel, Kristin W; Angiolillo, Dominick J; Beitelshees, Amber L; Coons, James C; Duarte, Julio D; Franchi, Francesco; Jeng, Linda J B; Johnson, Julie A; Kreutz, Rolf P; Limdi, Nita A; Maloney, Kristin A; Owusu Obeng, Aniwaa; Peterson, Josh F; Petry, Natasha; Pratt, Victoria M; Rollini, Fabiana; Scott, Stuart A; Skaar, Todd C; Vesely, Mark R; Stouffer, George A; Wilke, Russell A; Cavallari, Larisa H; Lee, Craig R

2017-12-26

CYP2C19 genotype-guided antiplatelet therapy following percutaneous coronary intervention is increasingly implemented in clinical practice. However, challenges such as selecting a testing platform, communicating test results, building clinical decision support processes, providing patient and provider education, and integrating methods to support the translation of emerging evidence to clinical practice are barriers to broad adoption. In this report, we compare and contrast implementation strategies of 12 early adopters, describing solutions to common problems and initial performance metrics for each program. Key differences between programs included the test result turnaround time and timing of therapy changes, which are both related to the CYP2C19 testing model and platform used. Sites reported the need for new informatics infrastructure, expert clinicians such as pharmacists to interpret results, physician champions, and ongoing education. Consensus lessons learned are presented to provide a path forward for those seeking to implement similar clinical pharmacogenomics programs within their institutions. © 2018, The American Society for Clinical Pharmacology and Therapeutics.

Implementing enhanced recovery in gynaecology oncology.

PubMed

Rooth, Carolyn; Sidhu, Amar

Enhanced recovery involves the adoption of a selected number of evidence-based interventions used together and implemented in a 'fast track' care pathway during preoperative management, surgery itself and throughout the immediate postoperative period. Aimed at promoting effective patient recovery after surgery, this has been shown to improve the patient experience and facilitate early patient discharge following major surgery in some clinical areas (Department of Health, 2010). Applied to the clinical management and nursing care of women affected by gynaecological malignancies in one London tertiary referral centre hospital, enhanced recovery has been seen to improve patient experience and shorten the length of overall hospital stay. Implementation requires careful planning, appointment of key practitioners and commitment of the multidisciplinary team to realise successful outcomes. The authors' experience suggests that challenges are associated with changing practice and that while careful planning is essential, successes are to be gained, which significantly benefit patients, staff and the NHS Trust. In sharing this experience of implementing enhanced recovery, the authors hope to encourage others to consider application of this innovative strategy.

ProvenCare-Psoriasis: A disease management model to optimize care.

PubMed

Gionfriddo, Michael R; Pulk, Rebecca A; Sahni, Dev R; Vijayanagar, Sonal G; Chronowski, Joseph J; Jones, Laney K; Evans, Michael A; Feldman, Steven R; Pride, Howard

2018-03-15

There are a variety of evidence-based treatments available for psoriasis. The transition of this evidence into practice is challenging. In this article, we describe the design of our disease management approach for Psoriasis (ProvenCare®) and present preliminary evidence of the effect of its implementation. In designing our approach, we identified three barriers to optimal care: 1) lack of a standardized and discrete disease activity measure within the electronic health record, 2) lack of a system-wide, standardized approach to care, and 3) non-uniform financial access to appropriate non-pharmacologic treatments. We implemented several solutions, which collectively form our approach. We standardized the documentation of clinical data such as body surface area (BSA), created a disease management algorithm for psoriasis, and aligned incentives to facilitate the implementation of the algorithm. This approach provides more coordinated, cost effective care for psoriasis, while being acceptable to key stakeholders. Future work will examine the effect of the implementation of our approach on important clinical and patient outcomes.

Understanding the context of balanced scorecard implementation: a hospital-based case study in Pakistan.

PubMed

Rabbani, Fauziah; Lalji, Sabrina Nh; Abbas, Farhat; Jafri, Sm Wasim; Razzak, Junaid A; Nabi, Naheed; Jahan, Firdous; Ajmal, Agha; Petzold, Max; Brommels, Mats; Tomson, Goran

2011-03-31

As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation. Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks. Variable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits.

Patient-Centered Precision Health In A Learning Health Care System: Geisinger's Genomic Medicine Experience.

PubMed

Williams, Marc S; Buchanan, Adam H; Davis, F Daniel; Faucett, W Andrew; Hallquist, Miranda L G; Leader, Joseph B; Martin, Christa L; McCormick, Cara Z; Meyer, Michelle N; Murray, Michael F; Rahm, Alanna K; Schwartz, Marci L B; Sturm, Amy C; Wagner, Jennifer K; Williams, Janet L; Willard, Huntington F; Ledbetter, David H

2018-05-01

Health care delivery is increasingly influenced by the emerging concepts of precision health and the learning health care system. Although not synonymous with precision health, genomics is a key enabler of individualized care. Delivering patient-centered, genomics-informed care based on individual-level data in the current national landscape of health care delivery is a daunting challenge. Problems to overcome include data generation, analysis, storage, and transfer; knowledge management and representation for patients and providers at the point of care; process management; and outcomes definition, collection, and analysis. Development, testing, and implementation of a genomics-informed program requires multidisciplinary collaboration and building the concepts of precision health into a multilevel implementation framework. Using the principles of a learning health care system provides a promising solution. This article describes the implementation of population-based genomic medicine in an integrated learning health care system-a working example of a precision health program.

Implementing the global health security agenda: lessons from global health and security programs.

PubMed

Paranjape, Suman M; Franz, David R

2015-01-01

The Global Health Security Agenda (GHSA) describes a vision for a world that is safe and secure from infectious disease threats; it underscores the importance of developing the international capacity to prevent, detect, and respond to pandemic agents. In February 2014, the United States committed to support the GHSA by expanding and intensifying ongoing efforts across the US government. Implementing these goals will require interagency coordination and harmonization of diverse health security elements. Lessons learned from the Global Health Initiative (GHI), the President's Emergency Program for AIDS Relief (PEPFAR), and the Cooperative Threat Reduction (CTR) program underscore that centralized political, technical, and fiscal authority will be key to developing robust, sustainable, and integrated global health security efforts across the US government. In this article, we review the strengths and challenges of GHI, PEPFAR, and CTR and develop recommendations for implementing a unified US global health security program.

Neuromorphic computing enabled by physics of electron spins: Prospects and perspectives

NASA Astrophysics Data System (ADS)

Sengupta, Abhronil; Roy, Kaushik

2018-03-01

“Spintronics” refers to the understanding of the physics of electron spin-related phenomena. While most of the significant advancements in this field has been driven primarily by memory, recent research has demonstrated that various facets of the underlying physics of spin transport and manipulation can directly mimic the functionalities of the computational primitives in neuromorphic computation, i.e., the neurons and synapses. Given the potential of these spintronic devices to implement bio-mimetic computations at very low terminal voltages, several spin-device structures have been proposed as the core building blocks of neuromorphic circuits and systems to implement brain-inspired computing. Such an approach is expected to play a key role in circumventing the problems of ever-increasing power dissipation and hardware requirements for implementing neuro-inspired algorithms in conventional digital CMOS technology. Perspectives on spin-enabled neuromorphic computing, its status, and challenges and future prospects are outlined in this review article.

Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana.

PubMed

Emerson, C; Lipke, V; Kapata, N; Mwananyambe, N; Mwinga, A; Garekwe, M; Lanje, S; Moshe, Y; Pals, S L; Nakashima, A K; Miller, B

2016-07-01

Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.

Research funders' roles and perceived responsibilities in relation to the implementation of clinical research results: a multiple case study of Swedish research funders.

PubMed

Brantnell, Anders; Baraldi, Enrico; van Achterberg, Theo; Winblad, Ulrika

2015-07-17

Implementation of clinical research results is challenging, yet the responsibility for implementation is seldom addressed. The process from research to the use of clinical research results in health care can be facilitated by research funders. In this paper, we report the roles of ten Swedish research funders in relation to implementation and their views on responsibilities in implementation. Ten cases were studied and compared using semi-structured interviews. In addition, websites and key documents were reviewed. Eight facilitative roles for research funders in relation to the implementation of clinical research results were identified. Three of them were common for several funders: "Advocacy work," "Monitoring implementation outcomes," and "Dissemination of knowledge." Moreover, the research funders identified six different actors responsible for implementation, five of which belonged to the healthcare setting. Collective and organizational responsibilities were the most common forms of responsibilities among the identified actors responsible for implementation. The roles commonly identified by the Swedish funders, "Advocacy work," "Monitoring implementation outcomes," and "Dissemination of knowledge," seem feasible facilitative roles in relation to the implementation of clinical research results. However, many actors identified as responsible for implementation together with the fact that collective and organizational responsibilities were the most common forms of responsibilities entail a risk of implementation becoming no one's responsibility.

SO x /NO x Removal from Flue Gas Streams by Solid Adsorbents: A Review of Current Challenges and Future Directions

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

Rezaei, Fateme; Rownaghi, Ali A.; Monjezi, Saman

One of the main challenges in the power and chemical industries is to remove generated toxic or environmentally harmful gases before atmospheric emission. To comply with stringent environmental and pollutant emissions control regulations, coal-fired power plants must be equipped with new technologies that are efficient and less energy-intensive than status quo technologies for flue gas cleanup. While conventional sulfur oxide (SOx) and nitrogen oxide (NOx) removal technologies benefit from their large-scale implementation and maturity, they are quite energy-intensive. In view of this, the development of lower-cost, less energy-intensive technologies could offer an advantage. Significant energy and cost savings can potentiallymore » be realized by using advanced adsorbent materials. One of the major barriers to the development of such technologies remains the development of materials that are efficient and productive in removing flue gas contaminants. In this review, adsorption-based removal of SOx/NOx impurities from flue gas is discussed, with a focus on important attributes of the solid adsorbent materials as well as implementation of the materials in conventional and emerging acid gas removal technologies. The requirements for effective adsorbents are noted with respect to their performance, key limitations, and suggested future research directions. The final section includes some key areas for future research and provides a possible roadmap for the development of technologies for the removal of flue gas impurities that are more efficient and cost-effective than status quo approaches.« less

Improving access to emergent spinal care through knowledge translation: an ethnographic study.

PubMed

Webster, Fiona; Fehlings, Michael G; Rice, Kathleen; Malempati, Harsha; Fawaz, Khaled; Nicholls, Fred; Baldeo, Navindra; Reeves, Scott; Singh, Anoushka; Ahn, Henry; Ginsberg, Howard; Yee, Albert J

2014-04-14

For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery. An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario's call centre. Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation. Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts.

A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery.

PubMed

Tuepker, Anaïs; Elnitsky, Christine; Newell, Summer; Zaugg, Tara; Henry, James A

2018-01-01

Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress, but implementation of the intervention outside of a research setting has not been studied, even though dissemination is underway within the Veterans Health Administration (VHA) system in the United States. This study was designed to address a gap in knowledge of PTM clinical implementation to date, with a focus on factors facilitating or hindering implementation in VHA audiology and mental health clinic contexts, and whether implementing sites had developed intervention adaptations. Qualitative interviews were conducted with 21 audiology and mental health clinicians and service chiefs across a regional service network. Interviews were transcribed and coded using a hybrid inductive-deductive analytic approach guided by existing implementation research frameworks and then iteratively developed for emergent themes. PTM prioritization was rare overall, with providers across disciplines challenged by lack of capacity for implementation, but with differences by discipline in challenges to prioritization. Where PTM was prioritized and delivered, this was facilitated by perception of unique value, provider's own experience of tinnitus, observation/experience with PTM delivery, intervention fit with provider's skills, and an environment with supportive leadership and adaptive reserve. PTM was frequently adapted to local contexts to address delivery challenges and diversify patient options. Adaptations included shifting from group to individual formats, reducing or combining sessions, and employing novel therapeutic approaches. Existing adaptations highlight the need to better understand mechanisms underlying PTM's effectiveness, and research on the impact of adaptations on patient outcomes is an important next step. Prioritization of PTM is a key barrier to the scale up and spread of this evidence-based intervention. Developing clinician champions may facilitate dissemination, especially if accompanied by signals of systemic prioritization. Novel approaches exposing clinicians and administrators to PTM may identify and develop clinical champions. Acknowledging the potential for PTM adaptations may make delivery more feasible in the context of existing system constraints and priorities.

Model Meets Data: Challenges and Opportunities to Implement Land Management in Earth System Models

NASA Astrophysics Data System (ADS)

Pongratz, J.; Dolman, A. J.; Don, A.; Erb, K. H.; Fuchs, R.; Herold, M.; Jones, C.; Luyssaert, S.; Kuemmerle, T.; Meyfroidt, P.

2016-12-01

Land-based demand for food and fibre is projected to increase in the future. In light of global sustainability challenges only part of this increase will be met by expansion of land use into relatively untouched regions. Additional demand will have to be fulfilled by intensification and other adjustments in management of land that already is under agricultural and forestry use. Such land management today occurs on about half of the ice-free land surface, as compared to only about one quarter that has undergone a change in land cover. As the number of studies revealing substantial biogeophysical and biogeochemical effects of land management is increasing, moving beyond land cover change towards including land management has become a key focus for Earth system modeling. However, a basis for prioritizing land management activities for implementation in models is lacking. We lay this basis for prioritization in a collaborative project across the disciplines of Earth system modeling, land system science, and Earth observation. We first assess the status and plans of implementing land management in Earth system and dynamic global vegetation models. A clear trend towards higher complexity of land use representation is visible. We then assess five criteria for prioritizing the implementation of land management activities: (1) spatial extent, (2) evidence for substantial effects on the Earth system, (3) process understanding, (4) possibility to link the management activity to existing concepts and structures of models, (5) availability of data required as model input. While the first three criteria have been assessed by an earlier study for ten common management activities, we review strategies for implementation in models and the availability of required datasets. We can thus evaluate the management activities for their performance in terms of importance for the Earth system, possibility of technical implementation in models, and data availability. This synthesis reveals some "low-hanging" fruits for model implementation, but also challenges for the assessment of land management effects by modeling. The identified gaps can guide prioritization within the data community from the Earth system and Earth system modeling perspective.

Model meets data: Challenges and opportunities to implement land management in Earth System Models

NASA Astrophysics Data System (ADS)

Pongratz, Julia; Dolman, Han; Don, Axel; Erb, Karl-Heinz; Fuchs, Richard; Herold, Martin; Jones, Chris; Luyssaert, Sebastiaan; Kuemmerle, Tobias; Meyfroidt, Patrick; Naudts, Kim

2017-04-01

Land-based demand for food and fibre is projected to increase in the future. In light of global sustainability challenges only part of this increase will be met by expansion of land use into relatively untouched regions. Additional demand will have to be fulfilled by intensification and other adjustments in management of land that already is under agricultural and forestry use. Such land management today occurs on about half of the ice-free land surface, as compared to only about one quarter that has undergone a change in land cover. As the number of studies revealing substantial biogeophysical and biogeochemical effects of land management is increasing, moving beyond land cover change towards including land management has become a key focus for Earth system modeling. However, a basis for prioritizing land management activities for implementation in models is lacking. We lay this basis for prioritization in a collaborative project across the disciplines of Earth system modeling, land system science, and Earth observation. We first assess the status and plans of implementing land management in Earth system and dynamic global vegetation models. A clear trend towards higher complexity of land use representation is visible. We then assess five criteria for prioritizing the implementation of land management activities: (1) spatial extent, (2) evidence for substantial effects on the Earth system, (3) process understanding, (4) possibility to link the management activity to existing concepts and structures of models, (5) availability of data required as model input. While the first three criteria have been assessed by an earlier study for ten common management activities, we review strategies for implementation in models and the availability of required datasets. We can thus evaluate the management activities for their performance in terms of importance for the Earth system, possibility of technical implementation in models, and data availability. This synthesis reveals some "low-hanging" fruits for model implementation, but also challenges for the assessment of land management effects by modeling. The identified gaps can guide prioritization within the data community from the Earth system and Earth system modeling perspective.

CONSORT to community: translation of an RCT to a large-scale community intervention and learnings from evaluation of the upscaled program.

PubMed

Moores, Carly Jane; Miller, Jacqueline; Perry, Rebecca Anne; Chan, Lily Lai Hang; Daniels, Lynne Allison; Vidgen, Helen Anna; Magarey, Anthea Margaret

2017-11-29

Translation encompasses the continuum from clinical efficacy to widespread adoption within the healthcare service and ultimately routine clinical practice. The Parenting, Eating and Activity for Child Health (PEACH™) program has previously demonstrated clinical effectiveness in the management of child obesity, and has been recently implemented as a large-scale community intervention in Queensland, Australia. This paper aims to describe the translation of the evaluation framework from a randomised controlled trial (RCT) to large-scale community intervention (PEACH™ QLD). Tensions between RCT paradigm and implementation research will be discussed along with lived evaluation challenges, responses to overcome these, and key learnings for future evaluation conducted at scale. The translation of evaluation from PEACH™ RCT to the large-scale community intervention PEACH™ QLD is described. While the CONSORT Statement was used to report findings from two previous RCTs, the REAIM framework was more suitable for the evaluation of upscaled delivery of the PEACH™ program. Evaluation of PEACH™ QLD was undertaken during the project delivery period from 2013 to 2016. Experiential learnings from conducting the evaluation of PEACH™ QLD to the described evaluation framework are presented for the purposes of informing the future evaluation of upscaled programs. Evaluation changes in response to real-time changes in the delivery of the PEACH™ QLD Project were necessary at stages during the project term. Key evaluation challenges encountered included the collection of complete evaluation data from a diverse and geographically dispersed workforce and the systematic collection of process evaluation data in real time to support program changes during the project. Evaluation of large-scale community interventions in the real world is challenging and divergent from RCTs which are rigourously evaluated within a more tightly-controlled clinical research setting. Constructs explored in an RCT are inadequate in describing the enablers and barriers of upscaled community program implementation. Methods for data collection, analysis and reporting also require consideration. We present a number of experiential reflections and suggestions for the successful evaluation of future upscaled community programs which are scarcely reported in the literature. PEACH™ QLD was retrospectively registered with the Australian New Zealand Clinical Trials Registry on 28 February 2017 (ACTRN12617000315314).

The process of changing national malaria treatment policy: lessons from country-level studies.

PubMed

Williams, Holly Ann; Durrheim, David; Shretta, Rima

2004-11-01

Widespread resistance of Plasmodium falciparum parasites to commonly used antimalarials, such as chloroquine, has resulted in many endemic countries considering changing their malaria treatment policy. Identifying and understanding the key influences that affect decision-making, and factors that facilitate or undermine policy implementation, is critical for improving the policy process and guiding resource allocation during this process. A historical review of archival documents from Malaŵi and data obtained from in-depth policy studies in four countries (Tanzania, South Africa, Kenya and Peru) that have changed malaria treatment policy provides important lessons about decision-making, the policy cycle and complex policy environment, while specifically identifying strategies successfully employed to facilitate policy-making and implementation. Findings from these country-level studies indicate that the process of malaria drug policy review should be institutionalized in endemic countries and based on systematically collected data. Key stakeholders need to be identified early and engaged in the process, while improved communication is needed on all levels. Although malaria drug policy change is often perceived to be a daunting task, using these and other proven strategies should assist endemic countries to tackle this challenge in a systematic fashion that ensures the development and implementation of the rational malaria drug policy.

The BACnet Campus Challenge - Part 1

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

Masica, Ken; Tom, Steve

Here, the BACnet protocol was designed to achieve interoperability among building automation vendors and evolve over time to include new functionality as well as support new communication technologies such as the Ethernet and IP protocols as they became prevalent and economical in the market place. For large multi-building, multi-vendor campus environments, standardizing on the BACnet protocol as an implementation strategy can be a key component in meeting the challenge of an interoperable, flexible, and scalable building automation system. The interoperability of BACnet is especially important when large campuses with legacy equipment have DDC upgrades to facilities performed over different timemore » frames and use different contractors that install equipment from different vendors under the guidance of different campus HVAC project managers. In these circumstances, BACnet can serve as a common foundation for interoperability when potential variability exists in approaches to the design-build process by numerous parties over time. Likewise, BACnet support for a range of networking protocols and technologies can be a key strategy for achieving flexible and scalable automation systems as campuses and enterprises expand networking infrastructures using standard interoperable protocols like IP and Ethernet.« less

Developing a Strategic Program for Chilean Health Information Technology: Environmental Scan and Key Informant Interviews.

PubMed

Taylor, Erin Audrey; Fischer, Shira H; Gracner, Tadeja; Tejeda, Ivo; Kim, Alice; Chavez-Herrerias, Emilio; de la Guardia, Fernando Hoces

2016-06-20

As part of an effort to assist Chile in developing a strategic program to foster the development of the health information technology (health IT) sector over the next five to ten years, this study assesses the current state of health IT adoption and implementation in Chile, as well as the challenges and opportunities facing the sector over the coming years. The authors conducted an environmental scan and ten key informant interviews and found that there are a number of successful health IT projects and strategies for further development currently underway in Chile, but that the successful projects are generally localized within specific health care providers and lack integration. These and other challenges suggest significant potential for the Ministry of Economy and other stakeholders to take specific actions designed to encourage further development of the health IT sector in Chile over the coming years. The next phase of this effort will use the results from this study to develop a roadmap for the Ministry of Economy to encourage health IT development in Chile over the short, medium, and long terms.

The BACnet Campus Challenge - Part 1

DOE PAGES

Masica, Ken; Tom, Steve

2015-12-01

Here, the BACnet protocol was designed to achieve interoperability among building automation vendors and evolve over time to include new functionality as well as support new communication technologies such as the Ethernet and IP protocols as they became prevalent and economical in the market place. For large multi-building, multi-vendor campus environments, standardizing on the BACnet protocol as an implementation strategy can be a key component in meeting the challenge of an interoperable, flexible, and scalable building automation system. The interoperability of BACnet is especially important when large campuses with legacy equipment have DDC upgrades to facilities performed over different timemore » frames and use different contractors that install equipment from different vendors under the guidance of different campus HVAC project managers. In these circumstances, BACnet can serve as a common foundation for interoperability when potential variability exists in approaches to the design-build process by numerous parties over time. Likewise, BACnet support for a range of networking protocols and technologies can be a key strategy for achieving flexible and scalable automation systems as campuses and enterprises expand networking infrastructures using standard interoperable protocols like IP and Ethernet.« less

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting.

PubMed

Koorts, Harriet; Gillison, Fiona

2015-11-06

Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice. A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes. Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity. This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.

Challenges in knowledge translation: the early years of Cancer Care Ontario's Program in Evidence-Based Care.

PubMed

Browman, G P

2012-02-01

Cancer Care Ontario's Program in Evidence-Based Care (pebc) was formalized in 1997 to produce clinical practice guidelines for cancer management for the Province of Ontario. At the time, the gap between guideline development and implementation was beginning to be acknowledged. The Program implemented strategies to promote use of guidelines. The program had to overcome numerous social challenges to survive. Prospective strategies useful to practitioners-including participation, transparent communication, a methodological vision, and methodology skills development offerings-were used to create a culture of research-informed oncology practice within a broad community of practitioners.Reactive strategies ensured the survival of the program in the early years, when some within the influential academic community and among decision-makers were skeptical about the feasibility of a rigorous methodologic approach meeting the fast turnaround times necessary for policy. The paper details the pebc strategies within the context of what was known about knowledge translation (kt) at the time, and it tries to identify key success factors. Many of the barriers faced in the implementation of kt-and the strategies for overcoming them-are unavailable in the public domain because the relevant reporting does not fit the traditional paradigm for publication. Telling the "stories behind the story" should be encouraged to enhance the practice of kt beyond the science.

Implementation and benefits of advanced process control for lithography CD and overlay

NASA Astrophysics Data System (ADS)

Zavyalova, Lena; Fu, Chong-Cheng; Seligman, Gary S.; Tapp, Perry A.; Pol, Victor

2003-05-01

Due to the rapidly reduced imaging process windows and increasingly stingent device overlay requirements, sub-130 nm lithography processes are more severely impacted than ever by systamic fault. Limits on critical dimensions (CD) and overlay capability further challenge the operational effectiveness of a mix-and-match environment using multiple lithography tools, as such mode additionally consumes the available error budgets. Therefore, a focus on advanced process control (APC) methodologies is key to gaining control in the lithographic modules for critical device levels, which in turn translates to accelerated yield learning, achieving time-to-market lead, and ultimately a higher return on investment. This paper describes the implementation and unique challenges of a closed-loop CD and overlay control solution in high voume manufacturing of leading edge devices. A particular emphasis has been placed on developing a flexible APC application capable of managing a wide range of control aspects such as process and tool drifts, single and multiple lot excursions, referential overlay control, 'special lot' handling, advanced model hierarchy, and automatic model seeding. Specific integration cases, including the multiple-reticle complementary phase shift lithography process, are discussed. A continuous improvement in the overlay and CD Cpk performance as well as the rework rate has been observed through the implementation of this system, and the results are studied.

Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience.

PubMed

Bennett, Sara; Ozawa, Sachiko; Rodriguez, Daniela; Paul, Amy; Singh, Kriti; Singh, Suneeta

2015-10-01

In low and middle-income countries, programs funded and implemented by international donors frequently transition to local funding and management, yet such processes are rarely evaluated. We reflect upon experience evaluating the transition of a large scale HIV/AIDS prevention program in India, known as Avahan, in order to draw lessons about transition evaluation approaches and implementation challenges. In terms of conceptualizing the transition theory, the evaluation team identified tensions between the idea of institutionalizing key features of the Avahan program, and ensuring program flexibility to promote sustainability. The transition was planned in three rounds allowing for adaptations to transition intervention and program design during the transition period. The assessment team found it important to track these changes in order to understand which strategies and contextual features supported transition. A mixed methods evaluation was employed, combining semi-structured surveys of transitioning entities (conducted pre and post transition), with longitudinal case studies. Qualitative data helped explain quantitative findings. Measures of transition readiness appeared robust, but we were uncertain of the robustness of institutionalization measures. Finally, challenges to the implementation of such an evaluation are discussed. Given the scarceness of transition evaluations, the lessons from this evaluation may have widespread relevance. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Scalable and cost-effective NGS genotyping in the cloud.

PubMed

Souilmi, Yassine; Lancaster, Alex K; Jung, Jae-Yoon; Rizzo, Ettore; Hawkins, Jared B; Powles, Ryan; Amzazi, Saaïd; Ghazal, Hassan; Tonellato, Peter J; Wall, Dennis P

2015-10-15

While next-generation sequencing (NGS) costs have plummeted in recent years, cost and complexity of computation remain substantial barriers to the use of NGS in routine clinical care. The clinical potential of NGS will not be realized until robust and routine whole genome sequencing data can be accurately rendered to medically actionable reports within a time window of hours and at scales of economy in the 10's of dollars. We take a step towards addressing this challenge, by using COSMOS, a cloud-enabled workflow management system, to develop GenomeKey, an NGS whole genome analysis workflow. COSMOS implements complex workflows making optimal use of high-performance compute clusters. Here we show that the Amazon Web Service (AWS) implementation of GenomeKey via COSMOS provides a fast, scalable, and cost-effective analysis of both public benchmarking and large-scale heterogeneous clinical NGS datasets. Our systematic benchmarking reveals important new insights and considerations to produce clinical turn-around of whole genome analysis optimization and workflow management including strategic batching of individual genomes and efficient cluster resource configuration.

Healthcare predictive analytics: An overview with a focus on Saudi Arabia.

PubMed

Alharthi, Hana

2018-03-08

Despite a newfound wealth of data and information, the healthcare sector is lacking in actionable knowledge. This is largely because healthcare data, though plentiful, tends to be inherently complex and fragmented. Health data analytics, with an emphasis on predictive analytics, is emerging as a transformative tool that can enable more proactive and preventative treatment options. This review considers the ways in which predictive analytics has been applied in the for-profit business sector to generate well-timed and accurate predictions of key outcomes, with a focus on key features that may be applicable to healthcare-specific applications. Published medical research presenting assessments of predictive analytics technology in medical applications are reviewed, with particular emphasis on how hospitals have integrated predictive analytics into their day-to-day healthcare services to improve quality of care. This review also highlights the numerous challenges of implementing predictive analytics in healthcare settings and concludes with a discussion of current efforts to implement healthcare data analytics in the developing country, Saudi Arabia. Copyright © 2018 The Author. Published by Elsevier Ltd.. All rights reserved.

Advantages and Challenges of A Village Doctor-Based Cognitive Behavioral Therapy for Late-Life Depression in Rural China: A Qualitative Study

PubMed Central

Tang, Tan; Yang, Xuemei; Zhang, Weijun; Wang, Xiaohua; Ji, Li; Xiao, Yun; Ma, Kun; Wang, Ying; Kong, Xianglei; Wang, Jianping; Liu, Jun; Xu, Qian; Tian, Donghua; Qu, Zhiyong

2015-01-01

Background The delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China. Methods We conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis. Results The village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders’ access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention. Conclusions The present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed. PMID:26371473

Restructuring Principal Preparation in Illinois: Perspectives on Implementation Successes, Challenges, and Future Outlook. IERC 2015-3

ERIC Educational Resources Information Center

Klostermann, Brenda K.; Pareja, Amber Stitziel; Hart, Holly; White, Bradford R.; Huynh, Michelle Hanh

2015-01-01

The goals of the current mixed methods study--the Illinois Principal Preparation Implementation Review Project (I-PREP)--are to describe how the new policy is being implemented, learning which aspects of the implementation have been challenging and why they present challenges, and how programs are addressing challenges and realizing improvements…

Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review.

PubMed

Cummings, Amanda; Lund, Susi; Campling, Natasha; May, Carl R; Richardson, Alison; Myall, Michelle

2017-10-06

To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. A scoping review was undertaken based on the methodological framework of Arksey and O'Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex and contentious interventions. © 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.

The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program.

PubMed

Scovil, Carol Y; Flett, Heather M; McMillan, Lan T; Delparte, Jude J; Leber, Diane J; Brown, Jacquie; Burns, Anthony S

2014-09-01

To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Quality improvement. SCI Rehabilitation Center. Inpatients admitted January 2012 to July 2013. Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges. Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation). Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

PubMed Central

2012-01-01

Background A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries. PMID:22545646

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems.

PubMed

Takian, Amirhossein; Petrakaki, Dimitra; Cornford, Tony; Sheikh, Aziz; Barber, Nicholas

2012-04-30

A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS). We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles.

PubMed

Horne, Avril C; Szemis, Joanna M; Webb, J Angus; Kaur, Simranjit; Stewardson, Michael J; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

A collaborative approach to improving and expanding an experiential education program.

PubMed

Cox, Cheryl E; Lindblad, Adrienne J

2012-04-10

The lessons learned from a collaboration between a faculty of pharmacy and a practice site that involved implementation of an innovative experiential placement model are described, as well as the broader impact of the project on other practice sites, the faculty of pharmacy's experiential education program, and experiential placement capacity. The partnerships and collaborative strategies formed were key to the implementation and evaluation of a pharmacy student clinical teaching unit pilot program and integration of concepts used in the unit into the advanced pharmacy practice experience (APPE) program to enhance capacity and quality. The university-practice partnerships have made it possible to promote the delegation of responsibility and accountability for patient care to students, challenge the anticipated workload burden for preceptors, question the optimal length of an APPE placement, and highlight the value of higher student-to-preceptor ratios that facilitate peer-assisted learning (PAL) and optimize the practice learning experiences for preceptors and students. Collaboration in experiential education between universities and practice sites can provide opportunities to address challenges faced by practitioners and academics alike.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles

NASA Astrophysics Data System (ADS)

Horne, Avril C.; Szemis, Joanna M.; Webb, J. Angus; Kaur, Simranjit; Stewardson, Michael J.; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Working with Research Integrity-Guidance for Research Performing Organisations: The Bonn PRINTEGER Statement.

PubMed

Forsberg, Ellen-Marie; Anthun, Frank O; Bailey, Sharon; Birchley, Giles; Bout, Henriette; Casonato, Carlo; Fuster, Gloria González; Heinrichs, Bert; Horbach, Serge; Jacobsen, Ingrid Skjæggestad; Janssen, Jacques; Kaiser, Matthias; Lerouge, Inge; van der Meulen, Barend; de Rijcke, Sarah; Saretzki, Thomas; Sutrop, Margit; Tazewell, Marta; Varantola, Krista; Vie, Knut Jørgen; Zwart, Hub; Zöller, Mira

2018-05-31

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity-Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on the following key issues: § 1. Providing information about research integrity § 2. Providing education, training and mentoring § 3. Strengthening a research integrity culture § 4. Facilitating open dialogue § 5. Wise incentive management § 6. Implementing quality assurance procedures § 7. Improving the work environment and work satisfaction § 8. Increasing transparency of misconduct cases § 9. Opening up research § 10. Implementing safe and effective whistle-blowing channels § 11. Protecting the alleged perpetrators § 12. Establishing a research integrity committee and appointing an ombudsperson § 13. Making explicit the applicable standards for research integrity.

On the Consideration of Adoption and Implementation of The Next Generation Science Standards in a Local-Control Context: Supporting the Epistemology of Science through Education Policy

NASA Astrophysics Data System (ADS)

Lazzaro, Christopher C.

On the Consideration of Adoption and Implementation of The Next Generation Science Standards in a Local-Control Context: Supporting the Epistemology of Science through Education Policy. Christopher C Lazzaro. The primary purpose of this research is to understand how and why members at each of the three levels of the education system within a local-control state made the decisions they did in supporting or hindering the adoption and implementation of the Next Generation Science Standards. This research concentrates on three levels of the education system in a local-control state; 1) the state level, 2) the district level, and 3) the school/teacher level, while investigating the following questions: 1. To what extent, and in what ways, do members in each of the three levels of the state education system advocate for adoption and implementation of the Next Generation Science Standards? 2. Are the members in each of the three levels motivated or compelled to consider adoption and implementation of the Next Generation Science Standards, why or why not? 3. To what extent, and in what ways, do the members in each of the three levels take into account science epistemology in their overall consideration of adoption/implementation of the NGSS? The data drew from a series of interviews from a prior study, "Challenges of Implementing the Next Generation Science Standards in Local-Control States in the U.S." (Sevian, Foster, & Scheff, 2012). After these data were coded and analyzed around the three research questions, this phenomenographic research study identified four key findings: Key Finding 1 - As the District Coordinators are uniquely situated within the state education system to be able to see both the on-the-ground practical implications and the high-level policy pressures of adopting and implementing the NGSS, they reflect the deepest level of awareness of how to best advocate for adoption and implementation of the NGSS. Key Finding 2 - Motivation to adopt and implement the NGSS is highly nuanced. The most significant factor influencing motivation to adopt or implement the NGSS at each level is related to assessment. The reasons assessment affects motivation is different at each level. Key Finding 3 - Each interviewee at each level demonstrated awareness that the NGSS are significantly different from prior standards in some way. While teachers and SSCs sometimes cited the science practices as the critical difference, they were not able to meaningfully elaborate on what "science practices" are. Conversely, the District Coordinators demonstrated a deeper level of awareness and were able to comment more specifically on the practices and how they would affect science education in their state. Key Finding 4 - Regardless of level, the better a participant reflected an awareness of epistemology, the more likely they were to advocate for adoption and implementation of the NGSS. Similarly, the better a participant reflected an awareness of epistemology, the more likely they were motivated to consider adoption and implementation of the NGSS. The implications of the findings in this current study can; inform the supplemental materials and dissemination of information by standards writers, help policy makers engage stakeholders appropriately at each level by illustrating how national reform efforts play out in local-control states, and aid school based employees by identifying how and where they can participate in state level policy discussion and where their input could be valuable.

The role of nurses/social workers in using a multidimensional guideline for diagnosis of anxiety and challenging behaviour in people with intellectual disabilities.

PubMed

Pruijssers, Addy; van Meijel, Berno; Maaskant, Marian; Keeman, Noortje; Teerenstra, Steven; van Achterberg, Theo

2015-07-01

This study seeks (1) to investigate the impact of the implementation of the 'Diagnostic Guideline for Anxiety and challenging behaviours in clients with intellectual disability' on nurses/social workers' knowledge and self-efficacy; and (2) to evaluate the role of nurses/social workers in the diagnostic process when applying the guideline. Nurses/social workers have extensive contact with clients with intellectual disabilities. Despite this key position, the contribution of nurses/social workers to the diagnosis of mental health problems and challenging behaviours is rather limited. The authors developed the multidimensional 'Diagnostic Guideline for Anxiety and challenging behaviours'. In this article, the implementation of this guideline is evaluated concerning knowledge and self-efficacy of nurses/social workers, as well the role of nurses/social workers in the diagnostic process. This study employed a comparative multiple case study design. Qualitative and quantitative research methods. Working with the 'Diagnostic Guideline for Anxiety and challenging behaviours' led to a statistically significant increase in knowledge and self-efficacy among the nurses/social workers in the experimental condition, compared with nurses/social workers in the control condition. Nurses/social workers and psychologists appreciated the more active contribution of the nurses/social workers in the diagnostic process. Working with the guideline increased the knowledge and self-efficacy of nurses/social workers, and led to more active participation of nurses/social workers in the diagnostic process. After following a training programme, nurses/social workers can effectively contribute to the diagnostic process in clients with anxiety and related challenging behaviours. © 2015 John Wiley & Sons Ltd.

Challenges encountered in providing integrated HIV, antenatal and postnatal care services: a case study of Katakwi and Mubende districts in Uganda.

PubMed

Ahumuza, Sharon Eva; Rujumba, Joseph; Nkoyooyo, Abdallah; Byaruhanga, Raymond; Wanyenze, Rhoda K

2016-04-18

Integration of sexual and reproductive health (SRH), HIV/AIDS and maternal health (MH) services is a critical strategy to confront the HIV/AIDS epidemic, high maternal mortality and the unmet need for contraception. In 2011 the AIDS Information Centre (AIC) in partnership with the Ministry of Health implemented SRH, HIV/AIDS and MH integration services in the districts of Katakwi and Mubende in Uganda. This paper documents challenges encountered in providing these integrated services in the two districts. This was a cross-sectional qualitative study conducted in Mubende and Katakwi districts in Uganda. Data were collected using 10 focus group discussions with 89 women attending ANC and postnatal care and 21 key informant interviews with district managers and health workers who were involved in the integrated service delivery. Content thematic approach was used for data analysis. The study findings indicate that various challenges were encountered in integrating HIV, ANC and PNC services. Major challenges included inadequate staff, gaps in knowledge of service providers especially with regard to provision of long-term family planning, limited space, shortage of critical supplies such as HIV test kits, drugs and gloves. These findings indicate that the delivery of integrated HIV, SRH and MH services is hampered greatly by health system challenges and depict the need for additional staffing in health facilities, capacity building of health workers and health managers as well as ensuring sufficient supplies to health facilities for smooth implementation of integrated SRH, HIV and MH services.

Organizational readiness in specialty mental health care.

PubMed

Hamilton, Alison B; Cohen, Amy N; Young, Alexander S

2010-01-01

Implementing quality improvement efforts in clinics is challenging. Assessment of organizational "readiness" for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia. To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies. EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline. At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed. The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10-50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters. Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes.

The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints

PubMed Central

Martins, João Soares; Zwi, Anthony B; Hobday, Karen; Bonaparte, Fernando; Kelly, Paul M

2012-01-01

Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on identifying key constraints. Methods A mixed method approach drew on both qualitative and quantitative data. The study included data from District Health Services in seven districts, community health centres in 14 sub-districts, four hospitals, five private clinics, one private pharmacy and the country's autonomous medical store. In-depth interviews with 36 key informants, five group interviews and 15 focus group discussions were conducted. A survey was also undertaken at community health centres and hospitals to assess the availability of a physical copy of the Malaria Treatment Protocol, as well as the availability and utilization of artemether-lumefantrine and sulphadoxine-pyrimethamine. Results Many factors impeded the implementation of the new malaria protocol. These included: inadequate introduction and training around the revised treatment protocol; unclear phasing out of sulphadoxine-pyrimethamine and phasing in of the revised treatment, artemether-lumefantrine, and the rapid diagnostic test (RDT); lack of supervision; lack of adherence to the revised guidelines by foreign health workers; lack of access to the new drug by the private sector; obstacles in the procurement process; and the use of trade names rather than generic drug description. Insufficient understanding of the rapid diagnostic test and the untimely supply of drugs further hampered implementation. Conclusion To effectively implement a revised malaria treatment protocol, barriers should be identified during the policy formulation process and those emerging during implementation should be recognized promptly and addressed. PMID:22460007

Problems, challenges and promises: perspectives on precision medicine.

PubMed

Duffy, David J

2016-05-01

The 'precision medicine (systems medicine)' concept promises to achieve a shift to future healthcare systems with a more proactive and predictive approach to medicine, where the emphasis is on disease prevention rather than the treatment of symptoms. The individualization of treatment for each patient will be at the centre of this approach, with all of a patient's medical data being computationally integrated and accessible. Precision medicine is being rapidly embraced by biomedical researchers, pioneering clinicians and scientific funding programmes in both the European Union (EU) and USA. Precision medicine is a key component of both Horizon 2020 (the EU Framework Programme for Research and Innovation) and the White House's Precision Medicine Initiative. Precision medicine promises to revolutionize patient care and treatment decisions. However, the participants in precision medicine are faced with a considerable central challenge. Greater volumes of data from a wider variety of sources are being generated and analysed than ever before; yet, this heterogeneous information must be integrated and incorporated into personalized predictive models, the output of which must be intelligible to non-computationally trained clinicians. Drawing primarily from the field of 'oncology', this article will introduce key concepts and challenges of precision medicine and some of the approaches currently being implemented to overcome these challenges. Finally, this article also covers the criticisms of precision medicine overpromising on its potential to transform patient care. © The Author 2015. Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals.

PubMed

Rushakoff, Robert J; Sullivan, Mary M; Seley, Jane Jeffrie; Sadhu, Archana; O'Malley, Cheryl W; Manchester, Carol; Peterson, Eric; Rogers, Kendall M

2014-09-01

establishing an inpatient glycemic control program is challenging, requires years of work, significant education and coordination of medical, nursing, dietary, and pharmacy staff, and support from administration and Performance Improvement departments. We undertook a 2 year quality improvement project assisting 10 medical centers (academic and community) across the US to implement inpatient glycemic control programs. the project was comprised of 3 interventions. (1) One day site visit with a faculty team (MD and CDE) to meet with key personnel, identify deficiencies and barriers to change, set site specific goals and develop strategies and timelines for performance improvement. (2) Three webinar follow-up sessions. (3) Web site for educational resources. Updates, challenges, and accomplishments for each site were reviewed at the time of each webinar and progress measured at the completion of the project with an evaluation questionnaire. as a result of our intervention, institutions revised and simplified formularies and insulin order sets (with CHO counting options); implemented glucometrics and CDE monitoring of inpatient glucoses (assisting providers with orders); added new protocols for DKA and perinatal treatment; and implemented nursing, physician and patient education initiatives. Changes were institution specific, fitting the local needs and cultures. As to the extent to which Institution׳s goals were satisfied: 2 reported "completely", 4 "mostly," 3 "partially," and 1 "marginally". Institutions continue to move toward fulfilling their goals. an individualized, structured, performance improvement approach with expert faculty mentors can help facilitate change in an institution dedicated to implementing an inpatient glycemic control program. Copyright © 2014 Elsevier Inc. All rights reserved.

Restructuring Principal Preparation in Illinois: Perspectives on Implementation Successes, Challenges, and Future Outlook. Executive Summary. IERC 2015-3

ERIC Educational Resources Information Center

Klostermann, Brenda K.; Pareja, Amber Stitziel; Hart, Holly; White, Bradford R.; Huynh, Michelle Hanh

2015-01-01

The goals of the current mixed methods study--the Illinois Principal Preparation Implementation Review Project (I-PREP)--are to describe how the new policy is being implemented, learning which aspects of the implementation have been challenging and why they present challenges, and how programs are addressing challenges and realizing improvements…

Practical challenges in quantum key distribution

DOE PAGES

Diamanti, Eleni; Lo, Hoi -Kwong; Qi, Bing; ...

2016-11-08

Here, quantum key distribution (QKD) promises unconditional security in data communication and is currently being deployed in commercial applications. Nonetheless, before QKD can be widely adopted, it faces a number of important challenges such as secret key rate, distance, size, cost and practical security. Here, we survey those key challenges and the approaches that are currently being taken to address them.

Practical challenges in quantum key distribution

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

Diamanti, Eleni; Lo, Hoi -Kwong; Qi, Bing

Here, quantum key distribution (QKD) promises unconditional security in data communication and is currently being deployed in commercial applications. Nonetheless, before QKD can be widely adopted, it faces a number of important challenges such as secret key rate, distance, size, cost and practical security. Here, we survey those key challenges and the approaches that are currently being taken to address them.

Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework.

PubMed

Francis, Jill J; O'Connor, Denise; Curran, Janet

2012-04-24

Behaviour change is key to increasing the uptake of evidence into healthcare practice. Designing behaviour-change interventions first requires problem analysis, ideally informed by theory. Yet the large number of partly overlapping theories of behaviour makes it difficult to select the most appropriate theory. The need for an overarching theoretical framework of behaviour change was addressed in research in which 128 explanatory constructs from 33 theories of behaviour were identified and grouped. The resulting Theoretical Domains Framework (TDF) appears to be a helpful basis for investigating implementation problems. Research groups in several countries have conducted TDF-based studies. It seems timely to bring together the experience of these teams in a thematic series to demonstrate further applications and to report key developments. This overview article describes the TDF, provides a brief critique of the framework, and introduces this thematic series.In a brief review to assess the extent of TDF-based research, we identified 133 papers that cite the framework. Of these, 17 used the TDF as the basis for empirical studies to explore health professionals' behaviour. The identified papers provide evidence of the impact of the TDF on implementation research. Two major strengths of the framework are its theoretical coverage and its capacity to elicit beliefs that could signify key mediators of behaviour change. The TDF provides a useful conceptual basis for assessing implementation problems, designing interventions to enhance healthcare practice, and understanding behaviour-change processes. We discuss limitations and research challenges and introduce papers in this series.

Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework

PubMed Central

2012-01-01

Behaviour change is key to increasing the uptake of evidence into healthcare practice. Designing behaviour-change interventions first requires problem analysis, ideally informed by theory. Yet the large number of partly overlapping theories of behaviour makes it difficult to select the most appropriate theory. The need for an overarching theoretical framework of behaviour change was addressed in research in which 128 explanatory constructs from 33 theories of behaviour were identified and grouped. The resulting Theoretical Domains Framework (TDF) appears to be a helpful basis for investigating implementation problems. Research groups in several countries have conducted TDF-based studies. It seems timely to bring together the experience of these teams in a thematic series to demonstrate further applications and to report key developments. This overview article describes the TDF, provides a brief critique of the framework, and introduces this thematic series. In a brief review to assess the extent of TDF-based research, we identified 133 papers that cite the framework. Of these, 17 used the TDF as the basis for empirical studies to explore health professionals’ behaviour. The identified papers provide evidence of the impact of the TDF on implementation research. Two major strengths of the framework are its theoretical coverage and its capacity to elicit beliefs that could signify key mediators of behaviour change. The TDF provides a useful conceptual basis for assessing implementation problems, designing interventions to enhance healthcare practice, and understanding behaviour-change processes. We discuss limitations and research challenges and introduce papers in this series. PMID:22531601

Implementing large-scale food fortification in Ghana: lessons learned.

PubMed

Nyumuah, Richard Odum; Hoang, Thuy-Co Caroline; Amoaful, Esi Foriwa; Agble, Rosanna; Meyer, Marc; Wirth, James P; Locatelli-Rossi, Lorenzo; Panagides, Dora

2012-12-01

Food fortification began in Ghana in 1996 when legislation was passed to enforce the iodization of salt. This paper describes the development of the Ghanaian fortification program and identifies lessons learned in implementing fortification initiatives (universal salt iodization, fortification of vegetable oil and wheat flour) from 1996 to date. This paper identifies achievements, challenges, and lessons learned in implementing large scale food fortification in Ghana. Primary data was collected through interviews with key members of the National Food Fortification Alliance (NFFA), implementation staff of the Food Fortification Project, and staff of GAIN. Secondary data was collected through desk review of documentation from the project offices of the National Food Fortification Project and the National Secretariat for the Implementation of the National Salt Iodization in Ghana. Reduction of the prevalence of goiter has been observed, and coverage of households with adequately iodized salt increased between 1996 and 2006. Two models were designed to increase production of adequately iodized salt: one to procure and distribute potassium iodate (KIO3) locally, and the second, the salt bank cooperative (SBC) model, specifically designed for small-scale artisanal salt farmers. This resulted in the establishment of a centralized potassium iodate procurement and distribution system, tailored to local needs and ensuring competitive and stable prices. The SBC model allowed for nearly 157 MT of adequately iodized salt to be produced in 2011 in a region where adequately iodized salt was initially not available. For vegetable oil fortification, implementing quantitative analysis methods for accurate control of added fortificant proved challenging but was overcome with the use of a rapid test device, confirming that 95% of vegetable oil is adequately fortified in Ghana. However, appropriate compliance with national standards on wheat flour continues to pose challenges due to adverse sensory effects, which have led producers to reduce the dosage of premix in wheat flour. Challenges to access to premix experienced by small producers can be overcome with a central procurement model in which the distributor leverages the overall volume by tendering for a consolidated order. The SBC model has the potential to be expanded and to considerably increase the coverage of the population consuming iodized salt in Ghana. Successful implementation of the cost-effective iCheck CHROMA rapid test device should be replicated in other countries where quality control of fortified vegetable oil is a challenge, and extended to additional food vehicles, such as wheat flour and salt. Only a reduced impact on iron deficiency in Ghana can be expected, given the low level of fortificant added to the wheat flour. An integrated approach, with complementary programs including additional iron-fortified food vehicles, should be explored to maximize health impact.

Encoding, training and retrieval in ferroelectric tunnel junctions

NASA Astrophysics Data System (ADS)

Xu, Hanni; Xia, Yidong; Xu, Bo; Yin, Jiang; Yuan, Guoliang; Liu, Zhiguo

2016-05-01

Ferroelectric tunnel junctions (FTJs) are quantum nanostructures that have great potential in the hardware basis for future neuromorphic applications. Among recently proposed possibilities, the artificial cognition has high hopes, where encoding, training, memory solidification and retrieval constitute a whole chain that is inseparable. However, it is yet envisioned but experimentally unconfirmed. The poor retention or short-term store of tunneling electroresistance, in particular the intermediate states, is still a key challenge in FTJs. Here we report the encoding, training and retrieval in BaTiO3 FTJs, emulating the key features of information processing in terms of cognitive neuroscience. This is implemented and exemplified through processing characters. Using training inputs that are validated by the evolution of both barrier profile and domain configuration, accurate recalling of encoded characters in the retrieval stage is demonstrated.

Progress towards autonomous, intelligent systems

NASA Technical Reports Server (NTRS)

Lum, Henry; Heer, Ewald

1987-01-01

An aggressive program has been initiated to develop, integrate, and implement autonomous systems technologies starting with today's expert systems and evolving to autonomous, intelligent systems by the end of the 1990s. This program includes core technology developments and demonstration projects for technology evaluation and validation. This paper discusses key operational frameworks in the content of systems autonomy applications and then identifies major technological challenges, primarily in artificial intelligence areas. Program content and progress made towards critical technologies and demonstrations that have been initiated to achieve the required future capabilities in the year 2000 era are discussed.

Strategies for the nurse executive to keep the rural hospitals open.

PubMed

Shride, S E

1997-01-01

Rural hospitals are confronted with multiple challenges to survive in the competitive health care environment of today's world. Declining population, corporate mergers and downsizing, transportation, cost of technology, and health manpower shortages are only a few of the issues rural hospitals must be prepared to address in order to survive. Federal- and state-administered programs are available that can contribute to the survival of the rural hospital. The nurse executive has a key role in contributing to the planning, development, and implementation of survival strategies.

Findings from the Medicaid Competition Demonstrations: A guide for States

PubMed Central

Heinen, LuAnn; Fox, Peter D.; Anderson, Maren D.

1990-01-01

The Medicaid Competition Demonstrations were initiated in 1983-84 in six States (California, Florida, Minnesota, Missouri, New Jersey, and New York). State experiences in implementing the demonstrations are presented in this article. Although problems of enrolling Medicaid recipients in prepaid plans or with primary care case managers under these demonstrations proved challenging to States, lessons were learned in three key areas: program design and administration, health plan and provider relations, and beneficiary acceptance. Therefore, States considering similar programs in the future could benefit from these findings. PMID:10113403

Improving Uptake of Key Perinatal Interventions Using Statewide Quality Collaboratives.

PubMed

Pai, Vidya V; Lee, Henry C; Profit, Jochen

2018-06-01

Regional and statewide quality improvement collaboratives have been instrumental in implementing evidence-based practices and facilitating quality improvement initiatives within neonatology. Statewide collaboratives emerged from larger collaborative organizations, like the Vermont Oxford Network, and play an increasing role in collecting and interpreting data, setting priorities for improvement, disseminating evidence-based clinical practice guidelines, and creating regional networks for synergistic learning. In this review, we highlight examples of successful statewide collaborative initiatives, as well as challenges that exist in initiating and sustaining collaborative efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

New developments in the management of speech and language disorders.

PubMed

Harding, Celia; Gourlay, Sara

2008-05-01

Speech and language disorders, which include swallowing difficulties, are usually managed by speech and language therapists. Such a diverse, complex and challenging clinical group of symptoms requires practitioners with detailed knowledge and understanding of research within those areas, as well as the ability to implement appropriate therapy strategies within many environments. These environments range from neonatal units, acute paediatric wards and health centres through to nurseries, schools and children's homes. This paper summarises the key issues that are fundamental to our understanding of this client group.

Ground systems and operations concepts for the Space Infrared Telescope Facility (SIRTF)

NASA Technical Reports Server (NTRS)

Miller, Richard B.

1991-01-01

Key requirements and ground systems implementation strategy for SIRTF which presents a significant challenge in the operational phase of the mission are discussed. The facility is aimed at reliably integrating a guaranteed time program, requests from about 200 guest observer teams per year, and observatory maintenance. SIRFT is characterized by the five-year life time due to cryogen boil-off which means that the ground system must be fully operational at launch and must operate with an efficiency and timeliness rarely achieved in previous space missions.

Linear Actuator System for the NASA Docking System

NASA Technical Reports Server (NTRS)

Dick, Brandon; Oesch, Chris

2017-01-01

The Linear Actuator System (LAS) is a major sub-system within the NASA Docking System (NDS). The NDS Block 1 will be used on the Boeing Crew Space Transportation (CST-100) system to achieve docking with the International Space Station. Critical functions in the Soft Capture aspect of docking are performed by the LAS, which implements the Soft Impact Mating and Attenuation Concept (SIMAC). This paper describes the general function of the LAS, the system's key requirements and technical challenges, and the development and qualification approach for the system.

Adoption and implementation of mandated diabetes registries by community health centers.

PubMed

Helfrich, Christian D; Savitz, Lucy A; Swiger, Kathleen D; Weiner, Bryan J

2007-07-01

Innovations adopted by healthcare organizations are often externally mandated. However, few studies examine how mandated innovations progress from adoption to sustained effective use. This study uses Rogers's model of organizational innovation to explore community health centers' (CHCs') mandated adoption and implementation of disease registries in the federal Health Disparities Collaborative (HDC). Case studies were conducted on six CHCs in North Carolina participating in the HDC on type 2 diabetes mellitus. Data were collected from semistructured interviews with key staff, and from site-level and individual-level surveys. Although disease registry adoption and implementation were mandated, CHCs exercised prerogative in the timing of registry adoption and the functions emphasized. Executive and medical director involvement, often directly on the HDC teams, was the single most salient influence on adoption and implementation. Staff members' personal experience with diabetes also provided context and gave registries added significance. Participants lauded HDC's technique of small-scale, rapid-cycle change, but valued even more shared problem solving and peer learning among HDC teams. However, lack of cross-training, inadequate resources, and staff turnover posed serious threats to sustainability of the registries. The present study illustrates the usefulness of Rogers's model for studying mandated innovation and highlights several key factors, including direct, personal involvement of organizational leadership, and shared problem solving and peer learning facilitated by the HDC. However, these six CHCs elected to participate early in the HDC, and may not be typical of North Carolina's remaining CHCs. Furthermore, most face important long-term challenges that threaten routinization.

From clinical integration to accountable care.

PubMed

Shields, Mark

2011-01-01

Four key challenges to reforming health care organizations can be addressed by a clinical integration model patterned after Advocate Physician Partners (APP). These challenges are: predominance of small group practices, dominant fee-for-service reimbursement methods, weaknesses of the traditional hospital medical staff structure and a need to partner with commercial insurance companies. APP has demonstrated teamwork between 3800 physicians and hospitals to improve quality, patient safety and cost-effectiveness. Building on this model, an innovative contract with Blue Cross Blue Shield of Illinois serves as a prototype for a commercial Accountable Care Organization. For this contract to succeed, APP must outperform the market competition. To accomplish this, APP has implemented strategies to reduce readmissions, avoid unnecessary admissions and emergency room visits, expand primary care access, and enhance quality and patient safety.

Progress in the development of paper-based diagnostics for low-resource point-of-care settings

PubMed Central

Byrnes, Samantha; Thiessen, Gregory; Fu, Elain

2014-01-01

This Review focuses on recent work in the field of paper microfluidics that specifically addresses the goal of translating the multistep processes that are characteristic of gold-standard laboratory tests to low-resource point-of-care settings. A major challenge is to implement multistep processes with the robust fluid control required to achieve the necessary sensitivity and specificity of a given application in a user-friendly package that minimizes equipment. We review key work in the areas of fluidic controls for automation in paper-based devices, readout methods that minimize dedicated equipment, and power and heating methods that are compatible with low-resource point-of-care settings. We also highlight a focused set of recent applications and discuss future challenges. PMID:24256361

[Progress in the spectral library based protein identification strategy].

PubMed

Yu, Derui; Ma, Jie; Xie, Zengyan; Bai, Mingze; Zhu, Yunping; Shu, Kunxian

2018-04-25

Exponential growth of the mass spectrometry (MS) data is exhibited when the mass spectrometry-based proteomics has been developing rapidly. It is a great challenge to develop some quick, accurate and repeatable methods to identify peptides and proteins. Nowadays, the spectral library searching has become a mature strategy for tandem mass spectra based proteins identification in proteomics, which searches the experiment spectra against a collection of confidently identified MS/MS spectra that have been observed previously, and fully utilizes the abundance in the spectrum, peaks from non-canonical fragment ions, and other features. This review provides an overview of the implement of spectral library search strategy, and two key steps, spectral library construction and spectral library searching comprehensively, and discusses the progress and challenge of the library search strategy.

Graph-Based Cooperative Localization Using Symmetric Measurement Equations.

PubMed

Gulati, Dhiraj; Zhang, Feihu; Clarke, Daniel; Knoll, Alois

2017-06-17

Precise localization is a key requirement for the success of highly assisted or autonomous vehicles. The diminishing cost of hardware has resulted in a proliferation of the number of sensors in the environment. Cooperative localization (CL) presents itself as a feasible and effective solution for localizing the ego-vehicle and its neighboring vehicles. However, one of the major challenges to fully realize the effective use of infrastructure sensors for jointly estimating the state of a vehicle in cooperative vehicle-infrastructure localization is an effective data association. In this paper, we propose a method which implements symmetric measurement equations within factor graphs in order to overcome the data association challenge with a reduced bandwidth overhead. Simulated results demonstrate the benefits of the proposed approach in comparison with our previously proposed approach of topology factors.

Graph-Based Cooperative Localization Using Symmetric Measurement Equations

PubMed Central

Gulati, Dhiraj; Zhang, Feihu; Clarke, Daniel; Knoll, Alois

2017-01-01

Precise localization is a key requirement for the success of highly assisted or autonomous vehicles. The diminishing cost of hardware has resulted in a proliferation of the number of sensors in the environment. Cooperative localization (CL) presents itself as a feasible and effective solution for localizing the ego-vehicle and its neighboring vehicles. However, one of the major challenges to fully realize the effective use of infrastructure sensors for jointly estimating the state of a vehicle in cooperative vehicle-infrastructure localization is an effective data association. In this paper, we propose a method which implements symmetric measurement equations within factor graphs in order to overcome the data association challenge with a reduced bandwidth overhead. Simulated results demonstrate the benefits of the proposed approach in comparison with our previously proposed approach of topology factors. PMID:28629141

Taking a unified approach to teaching and implementing quality improvements across multiple residency programs: the Atlantic Health experience.

PubMed

Daniel, Donna M; Casey, Donald E; Levine, Jeffrey L; Kaye, Susan T; Dardik, Raquel B; Varkey, Prathibha; Pierce-Boggs, Kimberly

2009-12-01

The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation. Each session included didactic presentations from a multidisciplinary team of clinical experts as well as the application of principles that identified challenges, barriers, and solutions to QI initiatives. The learning sessions emphasized the fundamental principles of medication reconciliation, its critical importance as a vital part of patient handoff in all health care settings, and the challenges of achieving successful medication reconciliation improvement in light of work hours restrictions and patient loads. Each residency program developed a detailed implementation and measurement plan for individual "action learning" projects, using the Plan-Do-Study-Act method of improvement. Each program then implemented its QI project, and expert faculty (e.g., physicians, nurses, pharmacists, QI staff) provided mentoring between learning sessions. Several projects resulted in permanent changes in medication reconciliation processes, which were then adopted by other programs. The structure, process, and outcomes of this effort are described in detail.

One Health in South Asia and its challenges in implementation from stakeholder perspective.

PubMed

Dahal, Rojan; Upadhyay, Atul; Ewald, Benjamin

2017-12-01

One Health is a concept which fosters collaborative relationships between human health, animal health and environmental health partners. Diseases are emerging and re-emerging in South Asia due to poor sanitation, close proximity of people to livestock, deforestation, porous borders, climate change, changes in human behaviour and unhygienic food preparation and consumption practices. This review was completed in two stages. First, we conducted a review of peer-reviewed literature and grey literature available in Google search engine related to One Health in four countries (Bangladesh, Bhutan, India and Nepal). Second, we used a structured questionnaire completed by the key stakeholders working on One Health for the collection of information related to the challenges in implementing One Health. Most of the One Health activities in South Asia are determined by donor preferences. Bangladesh and India did considerable work in advancing One Health with limited support from the government agencies. Weak surveillance mechanisms, uncertain cost-effectiveness of One Health compared with the existing approach, human resources and laboratory capacity are some of the factors hindering implementation of the One Health concept. Implementation of One Health is growing in the South Asia region with limited or no government acceptance. To institutionalise it, there is a need for leadership, government support and funding. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Gutter oil: an overview of Chinese food safety issues and policies.

PubMed

Li, Jia; Cui, Naixue; Liu, Jianghong

2017-09-01

Food safety has become a focus of attention worldwide. In China, one of the top concerns in food safety is gutter oil, known as 'swill-cooked oil'. This Commentary summarizes the key incidents disclosed to the public by the media, and the policies regarding gutter oil at national, regional, and provincial or city levels. Several challenges the country still faces in tackling this issue are identified, including a lack of evaluation of the implementation and effect of the policies, a lack of effective technology to detect and recycle gutter oil, and the overlooking of the hazardous effect of gutter oil on health. This commentary suggests that strengthening policy implementation and evaluation, improving measurement and recycling technologies, and launching public health campaigns would help eliminate gutter oil from dining tables.

Three decades of MSM donor deferral policies. What have we learned?

PubMed

Wilson, Kumanan; Atkinson, Katherine; Keelan, Jennifer

2014-01-01

In the early 1980s, donor deferrals targeting men who have sex with men (MSM) and other high-risk groups were implemented in response to the outbreak of HIV/AIDS. It has now been three decades since the implementation of these deferrals. We review the international experience with developing these policies, which involves combining scientific evidence with ethical and moral concerns and the challenge of moving from precautionary to risk management policies as scientific knowledge and technology evolves. We provide key lessons that can guide blood policymakers as they confront potential new threats to the safety of the blood system and also provide lessons to the wider public health community on how best to incorporate precaution into the policymaking process. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Teacher Perceptions of the Integration of Laptop Computers in Their High School Biology Classrooms

NASA Astrophysics Data System (ADS)

Gundy, Morag S.

2011-12-01

Studies indicate that teachers, and in particular science teachers in the senior high school grades, do not integrate laptop computers into their instruction to the extent anticipated by researchers. This technology has not spread easily to other teachers even with improved access to hardware and software, increased support, and a paradigm shift from teacher-centred to student-centred education. Although a number of studies have focused on the issues and problems related to the integration of laptops in classroom instruction, these studies, largely quantitative in nature, have tended to bypass the role teachers play in integrating laptop computers into their instruction. This thesis documents and describes the role of Ontario high school science teachers in the integration of laptop computers in the classroom. Ten teachers who have successfully integrated laptop computers into their biology courses participated in this descriptive study. Their perceptions of implementing laptops into their biology courses, key factors about the implementation process, and how the implementation was accomplished are examined. The study also identifies the conditions which they feel would allow this innovation to be implemented by other teachers. Key findings of the study indicate that teachers must initiate, implement and sustain an emergent and still evolving innovation; teacher perceptions change and continue to change with increased experience using laptops in the science classroom; changes in teaching approaches are significant as a result of the introduction of laptop technology; and, the teachers considered the acquisition and use of new teaching materials to be an important aspect of integrating laptop computers into instruction. Ongoing challenges for appropriate professional development, sharing of knowledge, skills and teaching materials are identified. The study provides a body of practical knowledge for biology teachers who are considering the integration of laptops into their instruction. The results are of interest to science teachers, those whose decisions affect the meaningful integration of technology in science education, those researching the teaching of science in secondary schools and those who prepare science graduates to teach at this level. Key Words: innovation, laptop, computer, biology, science, secondary, implementation, perceptions, instruction, professional development, qualitative, descriptive.

Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.

PubMed

Urquhart, Robin; Porter, Geoffrey A; Sargeant, Joan; Jackson, Lois; Grunfeld, Eva

2014-09-16

The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care. Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study. The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases. The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.

Yield enhancement of 3D flash devices through broadband brightfield inspection of the channel hole process module

NASA Astrophysics Data System (ADS)

Lee, Jung-Youl; Seo, Il-Seok; Ma, Seong-Min; Kim, Hyeon-Soo; Kim, Jin-Woong; Kim, DoOh; Cross, Andrew

2013-03-01

The migration to a 3D implementation for NAND flash devices is seen as the leading contender to replace traditional planar NAND architectures. However the strategy of replacing shrinking design rules with greater aspect ratios is not without its own set of challenges. The yield-limiting defect challenges for the planar NAND front end were primarily bridges, protrusions and residues at the bottom of the gates, while the primary challenges for front end 3D NAND is buried particles, voids and bridges in the top, middle and bottom of high aspect ratio structures. Of particular interest are the yield challenges in the channel hole process module and developing an understanding of the contribution of litho and etch defectivity for this challenging new integration scheme. The key defectivity and process challenges in this module are missing, misshapen channel holes or under-etched channel holes as well as reducing noise sources related to other none yield limiting defect types and noise related to the process integration scheme. These challenges are expected to amplify as the memory density increases. In this study we show that a broadband brightfield approach to defect monitoring can be uniquely effective for the channel hole module. This approach is correlated to end-of-line (EOL) Wafer Bin Map for verification of capability.