Evidence-Based Practices in Special Education: Current Assumptions and Future Considerations

ERIC Educational Resources Information Center

Russo-Campisi, Jacqueline

2017-01-01

Background: The research on evidence-based practices (EBP) in special education has shifted over the last decade from identifying efficacious interventions to exploring issues that impede implementation in the classroom. Common barriers to implementation include absence of training and resources, limited collaboration between researchers and…

Identification of Good Practices in the Implementation of Innovative Learning Methodologies

ERIC Educational Resources Information Center

Lincaru, Cristina; Ciuca, Vasilica; Grecu, Liliana; Atanasiu, Draga; Dragoiu, Codruta

2011-01-01

We intend to present the partial issues resulted from the development of the European Project DeInTRA "cooperation for innovative training methodologies deployment in the European Labour Market"--Stage 4: Identification of good practices in the implementation of innovative learning methodologies. This project is included into the…

Social Justice: A Long-Term Challenge for Counseling Psychology

ERIC Educational Resources Information Center

Ivey, Allen E.; Collins, Noah M.

2003-01-01

Counseling psychology has a long history of interest and commitment to social justice and multicultural issues. This article discusses some of that history and, in addition, speaks to specifics of implementing a liberation psychology frame of reference into clinical practice along with the issues of implementation and challenges faced by those of…

Information Retrieval System Design Issues in a Microcomputer-Based Relational DBMS Environment.

ERIC Educational Resources Information Center

Wolfram, Dietmar

1992-01-01

Outlines the file structure requirements for a microcomputer-based information retrieval system using FoxPro, a relational database management system (DBMS). Issues relating to the design and implementation of such systems are discussed, and two possible designs are examined in terms of space economy and practicality of implementation. (15…

Interagency Collaborative Team Model for Capacity Building to Scale-Up Evidence-Based Practice

PubMed Central

Hurlburt, Michael; Aarons, Gregory A; Fettes, Danielle; Willging, Cathleen; Gunderson, Lara; Chaffin, Mark J

2015-01-01

Background System-wide scale up of evidence-based practice (EBP) is a complex process. Yet, few strategic approaches exist to support EBP implementation and sustainment across a service system. Building on the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework, we developed and are testing the Interagency Collaborative Team (ICT) process model to implement an evidence-based child neglect intervention (i.e., SafeCare®) within a large children’s service system. The ICT model emphasizes the role of local agency collaborations in creating structural supports for successful implementation. Methods We describe the ICT model and present preliminary qualitative results from use of the implementation model in one large scale EBP implementation. Qualitative interviews were conducted to assess challenges in building system, organization, and home visitor collaboration and capacity to implement the EBP. Data collection and analysis centered on EBP implementation issues, as well as the experiences of home visitors under the ICT model. Results Six notable issues relating to implementation process emerged from participant interviews, including: (a) initial commitment and collaboration among stakeholders, (b) leadership, (c) communication, (d) practice fit with local context, (e) ongoing negotiation and problem solving, and (f) early successes. These issues highlight strengths and areas for development in the ICT model. Conclusions Use of the ICT model led to sustained and widespread use of SafeCare in one large county. Although some aspects of the implementation model may benefit from enhancement, qualitative findings suggest that the ICT process generates strong structural supports for implementation and creates conditions in which tensions between EBP structure and local contextual variations can be resolved in ways that support the expansion and maintenance of an EBP while preserving potential for public health benefit. PMID:27512239

Interagency Collaborative Team Model for Capacity Building to Scale-Up Evidence-Based Practice.

PubMed

Hurlburt, Michael; Aarons, Gregory A; Fettes, Danielle; Willging, Cathleen; Gunderson, Lara; Chaffin, Mark J

2014-04-01

System-wide scale up of evidence-based practice (EBP) is a complex process. Yet, few strategic approaches exist to support EBP implementation and sustainment across a service system. Building on the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework, we developed and are testing the Interagency Collaborative Team (ICT) process model to implement an evidence-based child neglect intervention (i.e., SafeCare®) within a large children's service system. The ICT model emphasizes the role of local agency collaborations in creating structural supports for successful implementation. We describe the ICT model and present preliminary qualitative results from use of the implementation model in one large scale EBP implementation. Qualitative interviews were conducted to assess challenges in building system, organization, and home visitor collaboration and capacity to implement the EBP. Data collection and analysis centered on EBP implementation issues, as well as the experiences of home visitors under the ICT model. Six notable issues relating to implementation process emerged from participant interviews, including: (a) initial commitment and collaboration among stakeholders, (b) leadership, (c) communication, (d) practice fit with local context, (e) ongoing negotiation and problem solving, and (f) early successes. These issues highlight strengths and areas for development in the ICT model. Use of the ICT model led to sustained and widespread use of SafeCare in one large county. Although some aspects of the implementation model may benefit from enhancement, qualitative findings suggest that the ICT process generates strong structural supports for implementation and creates conditions in which tensions between EBP structure and local contextual variations can be resolved in ways that support the expansion and maintenance of an EBP while preserving potential for public health benefit.

Supports and Concerns for Teacher Professional Growth During the Implementation of a Science Curriculum Innovation

NASA Astrophysics Data System (ADS)

Peers, Cheryl (Shelley) E.; Diezmann, Carmel M.; Watters, James J.

2003-02-01

Internationally, considerable reform in science education is occurring which promotes constructivist philosophies and advocates constructivist-inspired pedagogical strategies that are new to many teachers. This paper reports on the supporting factors necessary for teacher professional growth and the issues of concern that were evident during one primary teacher''s successful implementation of a unit of work based on a draft of a new state-wide science syllabus which proposes such approaches. One researcher (CEP) provided guidance during the writing and implementation of the unit through professional development workshops complemented by ongoing collegial support. The analysis of the teacher''s practice reveals that professional growth required a willingness of the teacher to engage with change and modify his professional practice. The support factors for teacher growth consisted of an appropriate program of professional development, teacher understanding of the elements of the curriculum innovation, and successful experiences in implementing new approaches. In contrast, the issues of concern were: the adequacy of support for planning including the time required to understand the innovation and make changes to teaching practice; science equipment; teacher knowledge; classroom management strategies; and ways to cope with change. Understanding of these support factors and issues of concern is vital for the successful implementation of science curriculum innovations.

Practical Issues in Developing a Culturally Tailored Physical Activity Promotion Program for Chinese and Korean American Midlife Women: A Pilot Study.

PubMed

Chee, Wonshik; Kim, Sangmi; Chu, Tsung-Lan; Tsai, Hsiu-Min; Ji, Xiaopeng; Zhang, Jingwen; Chee, Eunice; Im, Eun-Ok

2016-11-21

With advances in computer technologies, Web-based interventions are widely accepted and welcomed by health care providers and researchers. Although the benefits of Web-based interventions on physical activity promotion have been documented, the programs have rarely targeted Asian Americans, including Asian American midlife women. Subsequently, culturally competent Web-based physical activity programs for Asian Americans may be necessary. The purpose of our study was to explore practical issues in developing and implementing a culturally competent Web-based physical activity promotion program for 2 groups of Asian American women-Chinese American and Korean American midlife women-and to provide implications for future research. While conducting the study, the research team members wrote individual memos on issues and their inferences on plausible reasons for the issues. The team had group discussions each week and kept the minutes of the discussions. Then, the memos and minutes were analyzed using a content analysis method. We identified practical issues in 4 major idea categories: (1) bilingual translators' language orientations, (2) cultural sensitivity requirement, (3) low response rate, interest, and retention, and (4) issues in implementation logistics. Based on the issues, we make several suggestions for the use of bilingual translators, motivational strategies, and implementation logistics. ©Wonshik Chee, Sangmi Kim, Tsung-Lan Chu, Hsiu-Min Tsai, Xiaopeng Ji, Jingwen Zhang, Eunice Chee, Eun-Ok Im. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.11.2016.

Changing personnel behavior to promote quality care practices in an intensive care unit

PubMed Central

Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh

2005-01-01

The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574

Building a COTS archive for satellite data

NASA Technical Reports Server (NTRS)

Singer, Ken; Terril, Dave; Kelly, Jack; Nichols, Cathy

1994-01-01

The goal of the NOAA/NESDIS Active Archive was to provide a method of access to an online archive of satellite data. The archive had to manage and store the data, let users interrogate the archive, and allow users to retrieve data from the archive. Practical issues of the system design such as implementation time, cost and operational support were examined in addition to the technical issues. There was a fixed window of opportunity to create an operational system, along with budget and staffing constraints. Therefore, the technical solution had to be designed and implemented subject to constraint imposed by the practical issues. The NOAA/NESDIS Active Archive came online in July of 1994, meeting all of its original objectives.

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

IPAS Implementation Handbook

ERIC Educational Resources Information Center

Brooks, D. Christopher

2014-01-01

While the use of analytics to promote student success is gaining in popularity, basic questions about what IPAS is and the issues institutions face during implementation and integration. The "IPAS Implementation Handbook" catalogs the experiences, observations, and practical advice from 19 institutions engaged in IPAS implementation…

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

PubMed

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

2017-03-01

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

Maximizing the Implementation Quality of Evidence-Based Preventive Interventions in Schools: A Conceptual Framework

PubMed Central

Domitrovich, Celene E.; Bradshaw, Catherine P.; Poduska, Jeanne M.; Hoagwood, Kimberly; Buckley, Jacquelyn A.; Olin, Serene; Romanelli, Lisa Hunter; Leaf, Philip J.; Greenberg, Mark T.; Ialongo, Nicholas S.

2011-01-01

Increased availability of research-supported, school-based prevention programs, coupled with the growing national policy emphasis on use of evidence-based practices, has contributed to a shift in research priorities from efficacy to implementation and dissemination. A critical issue in moving research to practice is ensuring high-quality implementation of both the intervention model and the support system for sustaining it. The paper describes a three-level framework for considering the implementation quality of school-based interventions. Future directions for research on implementation are discussed. PMID:27182282

[On practicability of implementing the speciality "podiatry" in traumatology and orthopedics].

PubMed

2011-01-01

The absence of single opinion concerning the classification of foot and ankle joint pathology does not permit to formulate universal and practical approach to the identification of pathological syndromes in case of patient foot lesion. The situation is aggravated by the unsolved issues related to the terminological definition of podiatry as a direction in orthopedics to solve the issues of foot and ankle joint pathology. In actual conditions the implementation of new technologies into the structure of traumatological orthopedics care is needed. This approach permits to combine the qualities of models of effective and optimized care to patients with foot and ankle joint pathology. The study of issue related to the systematization of podiatric pathology revealed that actually no single universal classification easy-to-use in practice exists. Hence the development of original applied working scheme of foot and ankle joint pathology is proposed.

Initiation of universal tumor screening for Lynch syndrome in colorectal cancer patients as a model for the implementation of genetic information into clinical oncology practice.

PubMed

Cohen, Stacey A; Laurino, Mercy; Bowen, Deborah J; Upton, Melissa P; Pritchard, Colin; Hisama, Fuki; Jarvik, Gail; Fichera, Alessandro; Sjoding, Britta; Bennett, Robin L; Naylor, Lorraine; Jacobson, Angela; Burke, Wylie; Grady, William M

2016-02-01

Lynch syndrome confers a hereditary predisposition to colorectal and other cancers. Universal tumor screening (UTS) for Lynch syndrome is recommended by several professional societies, but the implementation can be complex. This article describes the evaluation, process development, and initiation of Lynch syndrome UTS at a tertiary referral cancer center. A multidisciplinary team developed the new process design. Issues in 5 themes were noted: timing, funding, second-opinion patients, result processing, and the role of genetics providers. A committee approach was used to examine each issue for process-improvement development. The issues related to testing were addressed individually for the successful implementation of UTS at the institutional level. In the conventional-care period, 9 of 30 cases (30%) received Lynch syndrome screening, and 4 cases were referred to medical genetics. During the 6 months following the implementation of UTS, 32 of 44 patients (73%) received Lynch syndrome screening. The 13 unscreened patients all had identified reasons for nonscreening (eg, financial limitations). Ten patients were referred to medical genetics, which identified no new cases of Lynch syndrome, but a low-risk adenomatous polyposis coli (APC) variant was detected in 1 individual. The implementation of effective Lynch syndrome UTS can feasibly alter practice at the institutional level. This experience with the assessment and management of issues relevant to the successful implementation of a new clinical care paradigm based on emerging technology has implications for the uptake of advances across molecular oncology into clinical practice, and this is highly relevant in the current era of rapidly evolving genomic technology. © 2015 American Cancer Society.

Best Practices in Hiring: Addressing Unconscious Bias

NASA Astrophysics Data System (ADS)

Simpson, Caroline E.

2012-01-01

Research has shown that implementing certain hiring practices will increase diversity in the workplace while enhancing academic quality. All of these practices rely on addressing the issue of 'unconscious bias.' A brief overview of unconscious bias--what it is, how it works, and simple measures to counter it--will be presented. Successful strategies, actions, and recommendations for implementing best recruiting and hiring practices, which have been proven to enhance academic excellence by ensuring a deep and diverse applicant pool, will also be presented.

'Virtual' central business office: how UMMS improved revenue cycle performance.

PubMed

Henciak, Bill; Fontaine, Christine; Fields, Keith; Parks, Stacy

2010-06-01

Based on its experience with implementing a virtual central business office, UMMS recommends the following steps to ensure the success of such an initiative: Define the process flow for the organization's day-today revenue cycle operations prior to implementation. Then select best practices and milestones for managing accounts. Identify any possible technology issues that could arise during implementation prior to go live. Hold a midproject debriefing with staff. Develop an organizational chart that details who is responsible for handling issues that arise during implementation and afterward.

Training Effects on Teachers' Feedback Practice: The Mediating Function of Feedback Knowledge and the Moderating Role of Self-Efficacy

ERIC Educational Resources Information Center

Schütze, Birgit; Rakoczy, Katrin; Klieme, Eckhard; Besser, Michael; Leiss, Dominik

2017-01-01

Formative assessment has been identified as a promising intervention to support students' learning. How to successfully implement this means of assessment, however, is still an open issue. This study contributes to the implementation of formative assessment by analyzing the impact of a training measure on teachers' formative feedback practice,…

Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T3 Trial.

PubMed

Craig, Louise E; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A; McInnes, Elizabeth; Phillips, Rosemary; Dale, Simeon; O'Connor, Denise; Levi, Chris; Fitzgerald, Mark; Considine, Julie; Grimshaw, Jeremy M; Gerraty, Richard; Cheung, N Wah; Ward, Jeanette; Middleton, Sandy

2017-07-17

Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T 3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T 3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). The TDF was successfully applied in all steps of developing an implementation intervention for the T 3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings.

Implementation of Audio Computer-Assisted Interviewing Software in HIV/AIDS Research

PubMed Central

Pluhar, Erika; Yeager, Katherine A.; Corkran, Carol; McCarty, Frances; Holstad, Marcia McDonnell; Denzmore-Nwagbara, Pamela; Fielder, Bridget; DiIorio, Colleen

2007-01-01

Computer assisted interviewing (CAI) has begun to play a more prominent role in HIV/AIDS prevention research. Despite the increased popularity of CAI, particularly audio computer assisted self-interviewing (ACASI), some research teams are still reluctant to implement ACASI technology due to lack of familiarity with the practical issues related to using these software packages. The purpose of this paper is to describe the implementation of one particular ACASI software package, the Questionnaire Development System™ (QDS™), in several nursing and HIV/AIDS prevention research settings. We present acceptability and satisfaction data from two large-scale public health studies in which we have used QDS with diverse populations. We also address issues related to developing and programming a questionnaire, discuss practical strategies related to planning for and implementing ACASI in the field, including selecting equipment, training staff, and collecting and transferring data, and summarize advantages and disadvantages of computer assisted research methods. PMID:17662924

The Practical Implementation of Non-Contacting Laser Strain Measurements Systems

NASA Technical Reports Server (NTRS)

Yunis, Isam; Quinn, roger D.; Kadambi, Jaikrishnan R.

2000-01-01

Measurement of stress and strain in rotating turbomachinery is critical to many industries. The search for a non-contacting, non-interfering, non-degrading measurement system is on going and extensive. While several methods seem promising in theory, implementation has proven troublesome. This work uncovers and quantifies these implementation issues in the context of a laser measurement system. Both a Laser Doppler Velocimeter system and a displacement laser system are utilized. It is found that the key issues are signal to noise ratio, rigid body compensation, measurement location, and conversion of intermittent measurements to a continuous signal. Accounting for these factors leads to successful measurements. These results should lead to better ideas and more practical solutions to the non-contacting, non-degrading, non-interfering strain measurement system problem.

A Nationwide Study of Pharmacists' Perception of the Impact of Medicare Part D on the Pharmacist-Patient Relationship.

PubMed

Spooner, Joshua J; Spotts, Harlan; Khan, Shamima

2017-10-01

Medicare Part D was implemented in 2006, introducing change to the community pharmacy marketplace, with profound disruption to independent pharmacy operations across the United States. To understand pharmacist perceptions about Part D and their perceived obligation to address Part D issues on behalf of their beneficiaries. A nationwide, cross-sectional survey of pharmacists was conducted between April and July 2013. The 43-item online survey collected information about demographics, implications of Part D on community pharmacy and patients, and beliefs about ideal pharmacy practice. Pharmacists reported more responsibility to address prior authorization issues (55.3% strongly agree or agree) than dispensing preferred medications (43.5%) or addressing patient copayment issues (38.1%). Predictors of the perceived responsibility to assist patients varied and included practice site, pharmacist age, pharmacy prescription volume, and pharmacy financial performance. Financial concerns continue to be the most significant issue following Part D implementation. The degree to which pharmacists feel responsible for addressing patient Part D concerns is variable and dependent on a variety of factors. Pharmacists who felt a personal responsibility to address patient copayment issues reported a better pharmacy financial performance, a larger increase in prescription volume, and a better pharmacist-patient relationship since Part D implementation. Nationwide, Part D financial concerns remain significant. Pharmacists can assist patients with managing cost issues, which can help alleviate pharmacy financial concerns. Many pharmacists practicing at independent locations do not feel responsible for addressing patient cost concerns, which may inadvertently impart a negative financial effect upon their pharmacy.

Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach

PubMed Central

Mosquera, Paola; Alzate, Juan Pablo; Pottie, Kevin; Welch, Vivian; Akl, Elie A; Jull, Janet; Lang, Eddy; Katikireddi, Srinivasa Vittal; Morton, Rachel; Thabane, Lehana; Shea, Bev; Stein, Airton T; Singh, Jasvinder; Florez, Ivan D; Guyatt, Gordon; Schünemann, Holger; Tugwell, Peter

2017-01-01

Abstract The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines (‘guidelines’) can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation. PMID:29029068

An online forum as a qualitative research method: practical issues.

PubMed

Im, Eun-Ok; Chee, Wonshik

2006-01-01

Despite the positive aspects of online forums as a qualitative research method, very little is known on the practical issues involved in using online forums for data collection, especially for a qualitative research project. The aim of this study was to describe the practical issues encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience. Throughout the study process, the research staff recorded issues ranging from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of the discussions were reviewed and analyzed using content analysis. Two practical issues related to credibility were identified: (a) a high response and retention rate and (b) automatic transcripts. An issue related to dependability was the participants' forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well. The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method.

Professional Practice Schools: Building a Model. Volume II.

ERIC Educational Resources Information Center

Levine, Marsha, Ed.

This collection of papers addresses three important aspects of professional practice schools: student learning, teacher development, and implementation issues related to collaboration among institutions and state policy environment. The first paper, "The Child as Meaning Maker: The Organizing Theme of Professional Practice Schools" (Ellen M.…

Ethics in the minutiae: examining the role of the physical laboratory environment in ethical discourse.

PubMed

Bezuidenhout, Louise

2015-02-01

Responsibility within life science research is a highly scrutinised field. Increasingly, scientists are presented with a range of duties and expectations regarding their conduct within the research setting. In many cases, these duties are presented deontologically, forgoing extensive discussion on how these are practically implemented into the minutiae of daily research practices. This de-contextualized duty has proven problematic when it comes to practical issues of compliance, however it is not often considered as a fundamental aspect of building ethics discourse. This paper examines this issue in detail, particularly focusing on how differences in the contrasts between the ideal and real physical research environments cause conceptual problems for scientists and retard ethical engagement. Such issues are particularly pertinent in low- and middle-income countries. This paper combines theoretical and empirical analyses using the concept of "dual-use" as a focalizing topic. The data show that the research environment acts as an intimate component in the interpretation and implementation of ethical actions.

Evaluation of design and construction issues of thin HMA overlays.

DOT National Transportation Integrated Search

2015-04-01

While the overall implementation of thin HMA overlays in Texas has been successful, some issues need to be addressed: : appropriate blending of SAC A and SAC B aggregate to ensure adequate skid resistance; best practices to achieve adequate bonding :...

Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention.

PubMed

Reeve, Joanne; Cooper, Lucy; Harrington, Sean; Rosbottom, Peter; Watkins, Jane

2016-09-06

Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention. The project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity's model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care. Implementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes. The BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change through scholarship are discussed.

Teachers' Reflections on Cooperative Learning: Issues of Implementation

ERIC Educational Resources Information Center

Gillies, Robyn M.; Boyle, Michael

2010-01-01

Cooperative learning (CL) is a well documented pedagogical practice that promotes academic achievement and socialization, yet many teachers struggle with implementing it in their classes. This study reports on the perceptions of 10, middle-year teachers who implemented cooperative learning in a unit of work across two school terms. Data from the…

A Review of the Change Literature with Implications for ISSOE Dissemination. Second Printing.

ERIC Educational Resources Information Center

Beuke, Vernon; Farrar, Steven

The state of the art in the implementation of education innovation is assessed in three parts: (1) the identification of promising theories, important issues, and proven implementation strategies with emphasis on practical implications; (2) a review of research directly related to the development and implementation of new occupational education…

Veterinary infection control in Australia: is there control?

PubMed

Attard, K; Burrows, E; Kotiranta-Harris, K; Hedlefs, R; Ketheesan, N; Govan, B

2012-11-01

There is little information relating to infection control procedures in Australian veterinary practices. This review summarises the findings of international studies in the area of zoonoses and infection control, and discusses potential reasons for the apparent complacency about these issues in veterinary practice. It is the authors' opinion that legislative changes governing veterinary practice in Australia should be implemented. The curricula in veterinary schools should also emphasise infection control. These measures would significantly improve safety issues associated with the control of zoonoses in veterinary practice. © 2012 The Authors. Australian Veterinary Journal © 2012 Australian Veterinary Association.

Employee Involvement. Issues for Agencies To Consider in Designing and Implementing Programs. Report to the Ranking Minority Member, Subcommittee on Federal Services, Post Office, and Civil Service, Committee on Governmental Affairs, U.S. Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. General Government Div.

An investigation identified issues that are important for federal agencies to consider in designing and implementing employee involvement programs. Employee involvement programs in the private sector and in the federal government were studied. The use of seven involvement practices was examined: suggestion systems, survey feedback, quality…

75 FR 17829 - Motorcyclist Advisory Council to the Federal Highway Administration

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... FHWA, on infrastructure issues of concern to motorcyclists, including: (1) Barrier design; (2) road design, construction, and maintenance practices; and (3) the architecture and implementation of... Administrator on infrastructure issues of concern to motorcyclists, including-- (1) Barrier design; (2) Road...

Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice.

PubMed

Gillen, Jacob R; Ramirez, Adriana G; Farineau, Diane W; Hoke, Tracey R; Schirmer, Bruce D; Williams, Michael D; Lau, Christine L

Meaningful education of residents in systems-based practice is notoriously challenging, despite its recognition as 1 of the 6 Accreditation Council for Graduate Medical Education core competencies. To address this challenge, surgery residents and other members of the health care team were organized into interdisciplinary workgroups that were tasked with developing solutions to "systems issues" confronted on a daily basis. The project's goals included providing more meaningful, hands-on educational experience for residents in system-based practice, while also generating practical solutions to workflow issues through interprofessional collaboration. Project participants included all surgery residents at the University of Virginia in Charlottesville, VA, as well as surgical health care professionals across all disciplines. Participants were organized into workgroups. Over the course of 3 sessions, each of 1-hour, each workgroup identified commonly encountered systems issues, chose 1 issue to address, and determined an implementable solution for this issue. In total, 140 participants were divided among 13 workgroups. Workgroup topics ranged from improving paging etiquette to standardizing interdisciplinary communication. In total, 9 of the 13 proposals have been piloted or fully implemented as standard practice at our institution, either within a single unit or over the entire health system. This project demonstrates an innovative approach toward resident education in system-based practice, providing residents with a hands-on experience in problem solving from a systems perspective. These interdisciplinary workgroups generated effective solutions to issues that were meaningful to frontline health care providers. Interdisciplinary collaboration within the workgroups served as a valuable team-building exercise to improve relations between the disciplines. This project can serve as a model for other institutions desiring meaningful education in the Accreditation Council for Graduate Medical Education competency of systems-based practice. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Non-compliance with the International Code of Marketing of Breast Milk Substitutes is not confined to the infant formula industry.

PubMed

Forsyth, Stewart

2013-06-01

Infant feeding policy and practice continues to be a contentious area of global health care. The infant formula industry is widely considered to be the bête noire with frequent claims that they adopt marketing and sales practices that are not compliant with the WHO Code. However, failure to resolve these issues over three decades suggests that there may be wider systemic failings. Review of published papers, commentaries and reports relating to the implementation and governance of the WHO Code with specific reference to issues of non-compliance. The analysis set out in this paper indicates that there are systemic failings at all levels of the implementation and monitoring process including the failure of WHO to successfully 'urge' governments to implement the Code in its entirety; a lack of political will by Member States to implement and monitor the Code and a lack of formal and transparent governance structures. Non-compliance with the WHO Code is not confined to the infant formula industry and several actions are identified, including the need to address issues of partnership working and the establishment of governance systems that are robust, independent and transparent.

Turning Knowledge Into Action at the Point-of-Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence-Based Practice

PubMed Central

Dogherty, Elizabeth J; Harrison, Margaret B; Graham, Ian D; Vandyk, Amanda Digel; Keeping-Burke, Lisa

2013-01-01

Background: Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AimTo describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. Methods: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses’ facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. Results: A number of factors emerged at various levels associated with the successes and failures of participants’ efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. Conclusions: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake. PMID:23796066

An Online Forum As a Qualitative Research Method: Practical Issues

PubMed Central

Im, Eun-Ok; Chee, Wonshik

2008-01-01

Background Despite positive aspects of online forums as a qualitative research method, very little is known about practical issues involved in using online forums for data collection, especially for a qualitative research project. Objectives The purpose of this paper is to describe the practical issues that the researchers encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience. Method Throughout the study process, the research staff recorded issues ranged from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of discussions were reviewed and analyzed using the content analysis suggested by Weber. Results Two practical issues related to credibility were identified: a high response and retention rate and automatic transcripts. An issue related to dependability was the participants’ easy forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well. Discussion The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method. PMID:16849979

Negotiating roadblocks to IDS-physician equity joint ventures.

PubMed

Dubow, S F; Benoff, M

1998-09-01

Integrated delivery systems (IDSs) may find that forming an equity joint venture relationship with a physician group practice is the best way to integrate physicians into their networks. IDSs have a choice between two basic equity structures: affiliated group practice, in which a management services organization (MSO) handles all practice management infrastructure and the physician group is a physician-only organization; and integrated group practice, in which the physician group encompasses both the physician practice and the administrative infrastructure. The choice of equity structure and how it should be implemented hinge on several legal issues, including the existence of a corporate-practice-of-medicine statute in the IDS's state, compliance with the Federal antikickback statute and Stark laws, and various issues regarding the IDS's tax-exempt status. IDSs also should consider pragmatic issues, particularly those associated with aligning the economic incentives of the two partners.

Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development

PubMed Central

2012-01-01

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this third paper we discuss the issues of: reviewing, reporting, and publishing guidelines; updating guidelines; and the two emerging issues of enhancing guideline implementability and how guideline developers should approach dealing with the issue of patients who will be the subject of guidelines having co-morbid conditions. PMID:22762242

Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations.

PubMed

Patterson, David A; Wolf Adelv Unegv Waya, Silver; Dulmus, Catherine N

2012-06-01

This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization's internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations.

Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations

PubMed Central

Patterson, David A.; Wolf (Adelv unegv Waya), Silver; Dulmus, Catherine N.

2012-01-01

This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization’s internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations. PMID:24634639

The policy context of patient centered medical homes: perspectives of primary care providers.

PubMed

Alexander, Jeffrey A; Cohen, Genna R; Wise, Christopher G; Green, Lee A

2013-01-01

Interest in the patient centered medical home (PCMH) model has increased significantly in recent years. Despite this attention, information is limited regarding the influence of policy context on implementation of the PCMH model. Using comparative, qualitative data, we identify several key policy impediments to PCMH implementation, and propose practical guidelines for addressing these issues. Qualitative, semi-structured in-person interviews with representatives of physician organizations and primary care practices pursuing PCMH. Practitioners and staff at 16 physician practices in Michigan, as well as key leaders of physician organizations. We identified five primary policy issues cited by physicians and physician organization leaders as most impactful on their efforts to adopt PCMH: misalignment of current reimbursement schemes, administrative burden, conflicting criteria for PCMH designation, workforce policy issues, and uncertainty of health care reform. These policies were largely seen as barriers to their ability to implement PCMH. Providers' motivation to embrace PCMH, and their level of confidence regarding the results of such change, are greatly influenced by their perception of the external environment and the control they believe they have over this environment. Having policies in place that shape the path to PCMH in a manner that makes it as easy as possible for providers to accomplish the desired changes could well make the difference in whether successful transformation is achieved.

The Internet in the Workplace: Issues of Implementation and Impact.

ERIC Educational Resources Information Center

Anderson, Byron

1996-01-01

As the Internet (with pluses and minuses) creeps forward, many work environments, business practices, and consumer processes will change significantly. Manufacturing, electronic commerce, health care, education, environmental monitoring, libraries, and government services will be profoundly affected. Fully implementing the Internet will take…

Developing Intranets: Practical Issues for Implementation and Design.

ERIC Educational Resources Information Center

Trowbridge, Dave

1996-01-01

An intranet is a system which has "domesticated" the technologies of the Internet for specific organizational settings and goals. Although the adaptability of Hypertext Markup Language to intranets is sometimes limited, implementing various protocols and technologies enable organizations to share files among heterogeneous computers,…

Implementation of audio computer-assisted interviewing software in HIV/AIDS research.

PubMed

Pluhar, Erika; McDonnell Holstad, Marcia; Yeager, Katherine A; Denzmore-Nwagbara, Pamela; Corkran, Carol; Fielder, Bridget; McCarty, Frances; Diiorio, Colleen

2007-01-01

Computer-assisted interviewing (CAI) has begun to play a more prominent role in HIV/AIDS prevention research. Despite the increased popularity of CAI, particularly audio computer-assisted self-interviewing (ACASI), some research teams are still reluctant to implement ACASI technology because of lack of familiarity with the practical issues related to using these software packages. The purpose of this report is to describe the implementation of one particular ACASI software package, the Questionnaire Development System (QDS; Nova Research Company, Bethesda, MD), in several nursing and HIV/AIDS prevention research settings. The authors present acceptability and satisfaction data from two large-scale public health studies in which they have used QDS with diverse populations. They also address issues related to developing and programming a questionnaire; discuss practical strategies related to planning for and implementing ACASI in the field, including selecting equipment, training staff, and collecting and transferring data; and summarize advantages and disadvantages of computer-assisted research methods.

ISSUES OF BEST MANAGEMENT PRACTICE DESIGN TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). Structural control BMPs involve building a structure of some kind to store stormwater until it can be discharged into a nearby receiving water. Commonly used structural treatment BMPs include...

Creating and Implementing Practices That Promote and Support Quality Student Affairs Professionals

ERIC Educational Resources Information Center

Tyrell, Steve

2014-01-01

In this chapter, the author draws on this volume's chapters to identify prominent issues and challenges facing student affairs professionals. Suggestions for practice are provided that support the work of professionals to create quality educational environments.

Ethical Challenges in Promoting the Implementation of Preventive Interventions: Report of the SPR Task Force.

PubMed

Leadbeater, Bonnie J; Dishion, Tom; Sandler, Irwin; Bradshaw, Catherine P; Dodge, Kenneth; Gottfredson, Denise; Graham, Phillip W; Lindstrom Johnson, Sarah; Maldonado-Molina, Mildred M; Mauricio, Anne M; Smith, Emilie Phillips

2018-06-23

Prevention science researchers and practitioners are increasingly engaged in a wide range of activities and roles to promote evidence-based prevention practices in the community. Ethical concerns invariably arise in these activities and roles that may not be explicitly addressed by university or professional guidelines for ethical conduct. In 2015, the Society for Prevention Research (SPR) Board of Directors commissioned Irwin Sandler and Tom Dishion to organize a series of roundtables and establish a task force to identify salient ethical issues encountered by prevention scientists and community-based practitioners as they collaborate to implement evidence-based prevention practices. This article documents the process and findings of the SPR Ethics Task Force and aims to inform continued efforts to articulate ethical practice. Specifically, the SPR membership and task force identified prevention activities that commonly stemmed from implementation and scale-up efforts. This article presents examples that illustrate typical ethical dilemmas. We present principles and concepts that can be used to frame the discussion of ethical concerns that may be encountered in implementation and scale-up efforts. We summarize value statements that stemmed from our discussion. We also conclude that the field of prevention science in general would benefit from standards and guidelines to promote ethical behavior and social justice in the process of implementing evidence-based prevention practices in community settings. It is our hope that this article serves as an educational resource for students, investigators, and Human Subjects Review Board members regarding some of the complexity of issues of fairness, equality, diversity, and personal rights for implementation of preventive interventions.

European consensus conference on faecal microbiota transplantation in clinical practice

PubMed Central

Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

2017-01-01

Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. PMID:28087657

Advancing the Science of Implementation in Primary Health Care.

PubMed

Bazemore, Andrew; Neale, Anne Victoria; Lupo, Phillip; Seehusen, Dean

2018-01-01

Implementation Science is commonly described as the study of methods and approaches that promote the uptake and use of evidence-based interventions into routine practice and policymaking. In this issue of JABFM , investigators share a wealth of new insights from the frontlines of Implementation Science in primary care: what it is, how we are doing it, and how it is advancing the evidence base of primary care. The breadth of implementation science in primary care is affirmed by the range of topics covered, from thought leader recommendations on future directions for the field, to reports on how best practices in policy and practice are shaping primary care implementation in the United States and Canada. There are also important updates on agents of primary care implementation themselves, such as practice facilitators, geriatric care teams, and family physicians interested in providing obstetric care. Other articles report on novel practice transformation efforts that advance health promotion and disease prevention, and innovative approaches to identifying and addressing social determinants of health in primary care practices and the communities they serve. The articles seem to generate as many new questions as they answer, and highlight the need for continued emphasis on advancing the science of implementation in primary health care. © Copyright 2018 by the American Board of Family Medicine.

Indicators of Effective Policy Development & Implementation. Issue Brief #8

ERIC Educational Resources Information Center

Stonemeier, Jenny; Trader, Barb; Kaloi, Laura; Williams, Gabrielle

2016-01-01

Within the SWIFT framework, the Inclusive Policy Structure and Practice domain addresses the need for a supportive, reciprocal partnership between the school and its district or local educational agency. Therefore, intentional and effective policy decision-making processes are integral to SWIFT implementation. Such processes create opportunities…

Mental health inpatients' and staff members' suggestions for reducing physical restraint: A qualitative study.

PubMed

Wilson, C; Rouse, L; Rae, S; Kar Ray, M

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and staff. Restraint reduction interventions have been developed (e.g., "Safewards"). Limited qualitative research has explored suggestions on how to reduce physical restraint (and feasibility issues with implementing interventions) from those directly involved. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper explores mental health patients' and staff members' suggestions for reducing physical restraint, whilst addressing barriers to implementing these. Findings centred on four themes: improving communication and relationships; staffing factors; environment and space; and activities and distraction. Not all suggestions are addressed by currently available interventions. Barriers to implementation were identified, centring on a lack of time and/or resources; with the provision of more time for staff to spend with patients and implement interventions seen as essential to reducing physical restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. Fundamental issues related to understaffing, high staff turnover, and lack of time and resources need addressing in order for suggestions to be successfully implemented. Introduction Physical restraint has negative consequences for all involved, and international calls for its reduction have emerged. Some restraint reduction interventions have been developed, but limited qualitative research explores suggestions on how to reduce physical restraint (and feasibility issues with implementation) from those directly involved. Aims To explore mental health patients' and staff members' suggestions for reducing physical restraint. Methods Interviews were conducted with 13 inpatients and 22 staff members with experience of restraint on adult mental health inpatient wards in one UK National Health Service Trust. Results Findings centred on four overarching themes: improving communication and relationships between staff/patients; making staff-related changes; improving ward environments/spaces; and having more activities. However, concerns were raised around practicalities/feasibility of their implementation. Discussion Continued research is needed into best ways to reduce physical restraint, with an emphasis on feasibility/practicality and how to make time in busy ward environments. Implications for Practice Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. However, fundamental issues related to understaffing, high staff turnover and lack of time/resources need addressing in order for these suggestions to be successfully implemented. © 2018 John Wiley & Sons Ltd.

Promoting Inclusive Schooling Practices through Practitioner Directed Inquiry.

ERIC Educational Resources Information Center

Salisbury, Christine L.; Wilson, Linda L.; Palombaro, Mary M.

1998-01-01

A study investigated use of practitioner directed inquiry (PDI) by 45 different practitioners who designed, implemented, and evaluated solutions to educational issues affecting the inclusion of students with disabilities. Results indicate positive changes in attitudes and knowledge about inclusive practices and students with disabilities,…

"Change is Hard": What Science Teachers Are Telling Us about Reform and Teacher Learning of Innovative Practices.

ERIC Educational Resources Information Center

Davis, Kathleen S.

2003-01-01

Provides a critical analysis of the implementation of an innovative science curriculum at a middle school site. Explores the issues that surround teacher learning of new practices including the structures, policies, and practices that were in place within the reform context that supported or impeded teacher learning. Identifies parallels between…

Transfer and Articulation Issues between California Community Colleges and California State University

ERIC Educational Resources Information Center

Tucker, Linda

2013-01-01

Purpose: The primary purpose of this study was to discover common transfer and articulation practices and to determine what practices aid in the implementation of the STAR Act between California Community Colleges and the California State University. The review of literature revealed a lack of research on the application of practices in transfer…

Recognizing the Importance of Aging Skills and Knowledge in Generalist Social Work Practice: Effective Strategies for MSW Students

ERIC Educational Resources Information Center

Bonifas, Robin P.; Fredriksen-Goldsen, Karen I.; Bailey, Kathleen A.

2009-01-01

This article examines the impact of a curricular infusion strategy aimed at integrating gerontological practice issues into social work education. Findings (N = 83) illustrate that student interest, knowledge, and skills in aging practice increased immediately following implementation of a three-tiered infusion approach; however, ongoing exposure…

ESD Implementation at the School Organisation Level, Part 1--Investigating the Quality Criteria Guiding School Leaders' Work at Recognized ESD Schools

ERIC Educational Resources Information Center

Mogren, Anna; Gericke, Niklas

2017-01-01

Research on Education for Sustainable Development (ESD) implementation tends to focus primarily on student and teacher outcomes, and there have been few studies on leadership practices at the school organisation level that provide information on how quality in education contributes to ESD implementation. To address this issue, we conducted an…

Ecological policy in oil-gas complexes, HSE MS implementation in oil and gas company

NASA Astrophysics Data System (ADS)

Kochetkova, O. P.; Glyzina, T. S.; Vazim, A. A.; Tugutova, S. S.

2016-09-01

The paper considers the following issues: HSE MS international standard implementation in oil and gas industry, taking into account international practices; implementation of standards in oil and gas companies; policy in the field of environmental protection and occupational health and safety; achievement of planned indicators and targets in environmental protection and occupational health and safety.

ST-segment monitoring: putting standards into practice.

PubMed

Flanders, Sonya A

2007-01-01

ST-segment monitoring is one key reason that continuous electrocardiographic monitoring is performed in hospitals, and can help with early detection of myocardial ischemia for at-risk patients. Although ST-segment monitoring research, guidelines, and expert consensus statements have been published, ST-segment monitoring has not been implemented in all appropriate clinical areas. The purpose of this article is to present relevant research, review the latest practice standards, and discuss issues important to nurses wishing to implement ST-segment monitoring.

Dentistry, amalgam, and pollution prevention.

PubMed

Johnson, W J; Pichay, T J

2001-07-01

California has issued fish consumption advisories because of mercury in lakes, reservoirs, creeks, rivers, and bays. Mercury in these waterways leads to the formation of methylmercury, which is toxic and bioaccumulative. Dental practices and other health care settings contribute a portion of this mercury. Government agencies are implementing programs to reduce mercury pollution. Dentists can reduce their contributions by implementing best management practices. They may also consider using pretreatment technologies as more information becomes available about their use and effectiveness.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

PubMed Central

Laws, Rachel A; Kemp, Lynn A; Harris, Mark F; Davies, Gawaine Powell; Williams, Anna M; Eames-Brown, Rosslyn

2009-01-01

Background Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed. Methods The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. Results The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices. Conclusion The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices. PMID:19825189

Observing Teaching. SEDA Paper 79.

ERIC Educational Resources Information Center

Brown, Sally, Ed.; And Others

This publication offers practical support to those in British higher education implementing the Observation of Teaching governmental directives. It provides discussion of key issues as well as a range of materials on how to carry out teaching observation including 23 checklists. The materials are grouped in four main areas: general issues, self…

Management and Leadership Issues for School Building Leaders

ERIC Educational Resources Information Center

Tobin, James

2014-01-01

School principals are confronted with a variety of issues as they provide leadership and organization to their schools. Evidence is growing that successful school leaders influence achievement through the support and development of effective teachers and the implementation of effective organizational practice (Davis, Darling-Hammond, LaPointe,…

Trends, Issues and Challenges in English Language Education in Pakistan

ERIC Educational Resources Information Center

Shamim, Fauzia

2008-01-01

This paper aims to critically examine the trends, issues and challenges in policy and practice of English language education in Pakistan. This is done first by historically reviewing the English language education policies since Pakistan's independence in 1947, looking particularly at policy objectives, implementation strategies and outcomes, and…

Application of the 1992 AAMR Definition: Issues for Preschool Children.

ERIC Educational Resources Information Center

Vig, Susan; Jedrysek, Eleonora

1996-01-01

Theoretical and practical challenges in implementing a 1992 definition of mental retardation developed by the American Association on Mental Retardation are reviewed, focusing on issues pertaining to preschool children. The definition is found to be problematic with this age group due to elimination of classification levels, limited relevance of…

School Expulsions, Suspensions, and Dropouts: Understanding the Issues. Hot Topics Series.

ERIC Educational Resources Information Center

Gallegos, Arnold, Ed.

This collection of papers examines the causal and contextual issues surrounding the emerging rash of student expulsions, suspensions, and dropouts; discusses legal restrictions that school personnel must consider when establishing and implementing student codes of conduct; and presents promising programs and practices to reduce the number of…

Improving Business-IT Alignment through Business Architecture

ERIC Educational Resources Information Center

Li, Chingmei

2010-01-01

The business and Information Technology (IT) alignment issue has become one of the Top-10 IT management issues since 1980. IT has continually strived to achieve alignment with business goals and objectives. These IT efforts include ERP implementation to benefit from the best practices; data center consolidation and server virtualization to keep…

78 FR 54962 - Approval and Promulgation of Air Quality Implementation Plans; Connecticut; NOX

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-09

... health or environmental effects, using practicable and legally permissible methods, under Executive Order.... 2 issued to Northeast Nuclear Energy Company in Waterford on March 29, 2001. (lii) Trading Agreement and Order No. 8152 issued to Northeast Nuclear Energy Company in Waterford on July 9, 1998. (liii...

Virtual Instruction: Issues and Insights from an International Perspective.

ERIC Educational Resources Information Center

Feyten, Carine M., Ed.; Nutta, Joyce W., Ed.

The essays in this book, by contributors from around the world, clarify predominant theoretical issues that pertain to virtual instruction, and offer practical suggestions for implementing these programs in any setting. Chapters include: "Mapping Space and Time: Virtual Instruction as Global Ritual" (Joyce W. Nutta and Carine M. Feyten);…

Implementing advanced nurse practitioner roles in acute care: an evaluation of organizational change.

PubMed

Cummings, Greta G; Fraser, Kim; Tarlier, Denise S

2003-03-01

Medical shortages are seen as the driving force behind the recent implementation of the advanced nurse practitioner (ANP) role in some Canadian hospitals. The authors analyzed the implementation of the ANP role in one tertiary care teaching hospital from the organizational change perspective. Despite successful implementation, issues of role definition, scope of practice boundaries, and staff reactions remain unresolved. Recommendations are discussed for implementing ANP roles in other acute care facilities.

Discipline of Students with Disabilities: An Update.

ERIC Educational Resources Information Center

Sorensen, Gail

1995-01-01

Practical guidelines are presented for implementing a discipline policy at the local level for students with disabilities, with suggestions for distinguishing policies affecting students in general and students with disabilities. Emphasis is placed on emerging issues and practical consequences. Relevant federal and state court decisions are cited,…

Embedding Personal Development Planning into the Social Sciences

ERIC Educational Resources Information Center

Slight, Audrey; Bloxham, Sue

2005-01-01

This article addresses a number of the theoretical and practical issues raised by using personal development planning (PDP) to enhance employability. It briefly discusses the background, rationale and evidence for PDP. It also considers the problems associated with policy implementation: the practicalities of embedding personal development…

Visual Expertise as Embodied Practice

ERIC Educational Resources Information Center

Ivarsson, Jonas

2017-01-01

This study looks at the practice of thoracic radiology and follows a group of radiologists and radiophysicists in their efforts to find, discuss, and formulate issues or troubles ensuing the implementation of a new radiographic imaging technology. Based in the theoretical tradition of ethnomethodology it examines the local endogenous practices…

Context awareness and sensitivity in SEA implementation

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

Hilding-Rydevik, Tuija; Bjarnadottir, Holmfridur

2007-10-15

The Impact Assessment research community repeatedly asserts that the implementation of Strategic Environmental Assessment (SEA) should take the issue of context into consideration. The primary aim of this paper then is to attempt to give substance to the concept of 'context' in relation to the implementation of SEA. The second aim is to discuss the relevance of context consciousness and sensitivity in relation to one of the main aims given to SEA implementation i.e. to contribute to the 'integration' of environmental perspectives in planning processes. Context must be defined in relation to a certain question. In this paper the questionmore » in focus is the assumption that SEA implementation will contribute to integration of environmental issues in planning processes. Research results relating to the use of environmental tools, like for example SEA, and experiences of integration efforts, strongly indicate that the use of a single tool like SEA is not enough to achieve this integration. The current 'context free' normative and procedural assumptions concerning the aim of SEA implementation and 'best practice' in term of SEA can be criticised on the same grounds as normative and procedural planning theories, as being context free. The assumptions behind the current formulations of the aim and best practice of SEA need to be revisited. A firm empirical and theoretical knowledge and discussion is needed, especially in relation to the issue of context and integration. This paper provides a starting point in this direction.« less

Qualitative and mixed methods research in dissemination and implementation science: introduction to the special issue.

PubMed

Southam-Gerow, Michael A; Dorsey, Shannon

2014-01-01

This special issue provides examples of how qualitative and mixed methods research approaches can be used in dissemination and implementation science. In this introductory article, we provide a brief rationale for why and how qualitative and mixed methods approaches can be useful in moving the field forward. Specifically, we provide a brief primer on common qualitative methods, including a review of guidelines provided by the National Institutes of Health. Next, we introduce the six articles in the issue. The first of the articles by Palinkas represents a more thorough and authoritative discussion related to qualitative methods, using the other five articles in the issue (and other published works) as examples. The remaining five articles are empirical and/or descriptive articles of recently completed or ongoing qualitative or mixed methods studies related to dissemination and implementation of evidence-based practices for children and adolescents.

Management practices used in agricultural drainage ditches to reduce Gulf of Mexico hypoxia

USDA-ARS?s Scientific Manuscript database

Agricultural non-point sources of nutrients and sediments have caused eutrophication and other water quality issues in aquatic and marine ecosystems, such as the annual occurrence of hypoxia in the Gulf of Mexico. Management practices have been implemented adjacent to and in agricultural drainage di...

Critical Issues in Large-Scale Assessment: A Resource Guide.

ERIC Educational Resources Information Center

Redfield, Doris

The purpose of this document is to provide practical guidance and support for the design, development, and implementation of large-scale assessment systems that are grounded in research and best practice. Information is included about existing large-scale testing efforts, including national testing programs, state testing programs, and…

Early Intervention in Natural Environments: Methods and Procedures.

ERIC Educational Resources Information Center

Noonan, Mary Jo; McCormick, Linda

This guide provides precise, detailed descriptions of empirically validated best practices to promote learning in infants and young children with disabilities. It is designed to be a practical and comprehensive, easy-to-read introductory methods text that addresses the fundamental issues associated with implementing the legislative mandates of the…

Evidence-Based Practices in Outpatient Treatment for Eating Disorders

ERIC Educational Resources Information Center

Schaffner, Angela D.; Buchanan, Linda Paulk

2010-01-01

This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…

OpenSearch Status

NASA Technical Reports Server (NTRS)

Newman, Doug; Silva, Sam; Mitchell, Andrew

2016-01-01

We will present an overview of our OpenSearch efforts over the past 6 months. We will discuss our Best Practices and those of CEOS concentrating on the compatibility issues between the two. We will also discuss the state of earth data OpenSearch implementations and their adherence to the standards, extensions and best practices available.

Evidence-Based Practice in Special Education and Cultural Adaptations: Challenges and Implications for Research

ERIC Educational Resources Information Center

Wang, Mian; Lam, Yeana

2017-01-01

Many issues arise in the discussion of the evidence-based practice (EBP) movement and implementation science in special education and specific educational practices for students with severe disabilities. Yet cultural adaptations of EBPs, which have emerged as an area of research in other fields, are being left out as a focus of EBP discourse. The…

Medical home implementation: a sensemaking taxonomy of hard and soft best practices.

PubMed

Hoff, Timothy

2013-12-01

The patient-centered medical home (PCMH) model of care is currently a central focus of U.S. health system reform, but less is known about the model's implementation in the practice of everyday primary care. Understanding its implementation is key to ensuring the approach's continued support and success nationally. This article addresses this gap through a qualitative examination of the best practices associated with PCMH implementation for older adult patients in primary care. I used a multicase, comparative study design that relied on a sensemaking approach and fifty-one in-depth interviews with physicians, nurses, and clinic support staff working in six accredited medical homes located in various geographic areas. My emphasis was on gaining descriptive insights into the staff's experiences delivering medical home care to older adult patients in particular and then analyzing how these experiences shaped the staff's thinking, learning, and future actions in implementing medical home care. I found two distinct taxonomies of implementation best practices, which I labeled "hard" and "soft" because of their differing emphasis and content. Hard implementation practices are normative activities and structural interventions that align well with existing national standards for medical home care. Soft best practices are more relational in nature and derive from the existing practice social structure and everyday interactions between staff and patients. Currently, external stakeholders are less apt to recognize, encourage, or incentivize soft best practices. The results suggest that there may be no standardized, one-size-fits-all approach to making medical home implementation work, particularly for special patient populations such as the elderly. My study also raises the issue of broadening current PCMH assessments and reward systems to include implementation practices that contain heavy social and relational components of care, in addition to the emphasis now placed on building structural supports for medical home work. Further study of these softer implementation practices and a continued call for qualitative methodological approaches that gain insight into everyday practice behavior are warranted. © 2013 Milbank Memorial Fund.

The Aspire Principles and Pedagogy for the Implementation of Social and Emotional Learning and the Development of Whole School Well-Being

ERIC Educational Resources Information Center

Roffey, Sue

2017-01-01

Implementation is the process by which interventions are put into practice and is critical to outcomes. Issues related to implementation for social and emotional learning (SEL) have largely focused on fidelity to the programme, dosage, clarity of guidance and the characteristics of the facilitator, although attention has also been paid to…

Acceptability of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomized controlled trial

PubMed Central

Hill, Keith D.; Brand, Caroline A.; Livingston, Patricia M.; Botti, Mari

2017-01-01

There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; ‘falls alert’ signs; supervision of patients in the bathroom; ensuring patients’ walking aids are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits) was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (>70%). Views were mixed regarding positioning patients’ walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised highlighting issues to be addressed by the implementation plan. PMID:28199376

Practice paper of the Academy of Nutrition and Dietetics abstract: ethical and legal issues of feeding and hydration.

PubMed

Schwartz, Denise Baird; Posthauer, Mary Ellen; O'Sullivan Maillet, Julie

2013-07-01

It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians should work collaboratively as part of an interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. This practice paper provides a proactive, integrated, systematic process to implement the Academy's position. The position and practice papers should be used together to address the history and supporting information of ethical and legal issues of feeding and hydration identified by the Academy. Elements of collaborative ethical deliberation are provided for pediatrics and adults and in different conditions. The process of ethical deliberation is presented with the roles and responsibilities of the registered dietitian and the dietetic technician, registered. Understanding the importance and applying concepts dealing with cultural values and religious diversity is necessary to integrate clinical ethics into nutrition care. Incorporating screening for quality-of-life goals is essential before implementing the Nutrition Care Process and improving health literacy with individual interactions. Developing institution-specific policies and procedures is necessary to accelerate the practice change with artificial nutrition, clinical ethics, and quality improvement projects to determine best practice. This paper supports the "Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues of Feeding and Hydration" published in the June 2013 issue of the Journal of the Academy of Nutrition and Dietetics. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

China-U.S. Trade Issues

DTIC Science & Technology

2008-10-07

practices. In response, it filed a number of trade dispute resolution cases against China in the WTO, including China’s failure to protect IPR and...in China. In addition, the Administration reversed a long-standing policy that countervailing cases (dealing with government subsidies) could not be...13 WTO Implementation Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 U.S. WTO Cases Against China

Factors influencing the development and implementation of advanced radiographer practice in Australia – a qualitative study using an interpretative phenomenological approach

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

Page, Barbara A, E-mail: barbpage09@gmail.com; Bernoth, Maree; Davidson, Rob

2014-09-15

The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs andmore » timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.« less

To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development.

PubMed

Dizon, Janine Margarita; Machingaidze, Shingai; Grimmer, Karen

2016-09-13

Developing new clinical practice guidelines (CPGs) can be time-consuming and expensive. A more efficient approach could be to adopt, adapt or contextualise recommendations from existing good quality CPGs so that the resultant guidance is tailored to the local context. The first steps are to search for international CPGs that have a similar purpose, end-users and patients to your situation. The second step is to critically appraise the methodological quality of the CPGs to ensure that your guidance is based on credible evidence. Then the decisions begin. Can you simply 'adopt' this (parent) clinical practice guidelines, and implement the recommendations in their entirety, without any changes, in your setting? If so, then no further work is required. However this situation is rare. What is more likely, is that even if recommendations from the parent clinical practice guidelines can be adopted, how they are implemented needs to address local issues. Thus you may need to 'contextualise' the guidance, by addressing implementation issues such as local workforce, training, health systems, equipment and/or access to services. Generally this means that additional information is required (Practice/Context Points) to support effective implementation of the clinical practice guidelines recommendations. In some cases, you may need to 'adapt' the guidance, where you will make changes to the recommendations so that care is relevant to your local environments. This may involve additional work to search for local research, or obtain local consensus, regarding how best to adapt recommendations. For example, adaptation might reflect substituting one drug for another (drugs have similar effects, but the alternative drug to the recommended one may be cheaper, more easily obtained or more culturally acceptable). There is lack of standardisation of clinical practice guidelines terminology, leading clinical practice guideline activities often being poorly conceptualised or reported. We provide an approach that would help improve efficiency and standardisation of clinical practice guidelines activities.

A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention.

PubMed

Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Valuck, Robert J

2014-06-01

To enhance the learner's competence with knowledge about a framework of quality improvement (QI) interventions to implement evidence-based practices for pressure ulcer (PrU) prevention. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize the process of creating and initiating the best-practice framework of QI for PrU prevention.2. Identify the domains and QI interventions for the best-practice framework of QI for PrU prevention. Pressure ulcer (PrU) prevention is a priority issue in US hospitals. The National Pressure Ulcer Advisory Panel endorses an evidence-based practice (EBP) protocol to help prevent PrUs. Effective implementation of EBPs requires systematic change of existing care units. Quality improvement interventions offer a mechanism of change to existing structures in order to effectively implement EBPs for PrU prevention. The best-practice framework developed by Nelson et al is a useful model of quality improvement interventions that targets process improvement in 4 domains: leadership, staff, information and information technology, and performance and improvement. At 2 academic medical centers, the best-practice framework was shown to physicians, nurses, and health services researchers. Their insight was used to modify the best-practice framework as a reference tool for quality improvement interventions in PrU prevention. The revised framework includes 25 elements across 4 domains. Many of these elements support EBPs for PrU prevention, such as updates in PrU staging and risk assessment. The best-practice framework offers a reference point to initiating a bundle of quality improvement interventions in support of EBPs. Hospitals and clinicians tasked with quality improvement efforts can use this framework to problem-solve PrU prevention and other critical issues.

Halal Logistics Implementation in Malaysia: A Practical View

NASA Astrophysics Data System (ADS)

Sham, Rohana; Zuraidah Rasi, Raja; Abdamia, Noranita; Mohamed, Suhana; Thahira Bibi, TKM

2017-08-01

Concept of halal is not only acceptable world wide by the Muslim society but also to the non Muslim. However, the implementing of halal logistics in daily operation experience a few difficulties especially on the implementation part. Although there are many academic research paper that highlight the issue of halal logistics and the critical success factor, until today, halal logistics in Malaysia is still experiencing a hiccup. This paper try to highlight a few simple ways of implementation of halal logistics that could enhance the total implementation concept at the very least cost to create benefit to all society. The Paper deals with a few aspect of possible implementation and practice to facilitate the halal logistics approach in daily operation. The main objective is to look at the possible method of implementation and critical success factors towards the implementation of halal logistics operation in daily goods movement in Malaysia.

Implementing person-environment approaches to prevent falls: a qualitative inquiry in applying the Westmead approach to occupational therapy home visits.

PubMed

Clemson, Lindy; Donaldson, Alex; Hill, Keith; Day, Lesley

2014-10-01

Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice. © 2014 Occupational Therapy Australia.

21 CFR 900.22 - Standards for certification agencies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accreditation bodies for issues related to mammography image quality and clinical practice. The certification... interest. The certification agency shall establish and implement measures that FDA has approved in...

How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

PubMed

Lorenzi, Nancy M; Kouroubali, Angelina; Detmer, Don E; Bloomrosen, Meryl

2009-02-23

Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.

Practical Issues in Estimating Classification Accuracy and Consistency with R Package cacIRT

ERIC Educational Resources Information Center

Lathrop, Quinn N.

2015-01-01

There are two main lines of research in estimating classification accuracy (CA) and classification consistency (CC) under Item Response Theory (IRT). The R package cacIRT provides computer implementations of both approaches in an accessible and unified framework. Even with available implementations, there remains decisions a researcher faces when…

Implementing E-Learning in Northern Ireland: Prospects and Challenges

ERIC Educational Resources Information Center

Uhomoibhi, James O.

2006-01-01

Purpose: Aims to examine trends in the development of e-learning in Northern Ireland, report on existing policies, practices and issues affecting its implementation across the sectors. Design/methodology/approach: The present study draws on e-learning policies and strategies that have been developed for Northern Ireland. Examples were drawn from…

LO sources for 1-3 THz: present status and future prospective

NASA Technical Reports Server (NTRS)

Mehdi, Imran

2003-01-01

This talk will present an overview of the current technologies that are available for implementing local oscillator sources for 1-3 THz applications. Progress to date on specific components will be discussed in some detail. Outstanding issues and concerns regarding practical implementation of these new technologies will also be discussed.

Alternative Education for Disruptive Youth: Recommended Parameters and Best Practices for Effective Programs

ERIC Educational Resources Information Center

Pennsylvania Department of Education, 2005

2005-01-01

This document was prepared to serve as an aid in the planning, design, implementation, and ongoing evaluation of Alternative Education for Disruptive Youth Programs in Pennsylvania. School Codes and Public Laws are cited for guidance on mandatory issues. The suggestions and implementation strategies provided in this document are not requirements…

Implementing new care models: learning from the Greater Manchester demonstrator pilot experience.

PubMed

Elvey, Rebecca; Bailey, Simon; Checkland, Kath; McBride, Anne; Parkin, Stephen; Rothwell, Katy; Hodgson, Damian

2018-06-19

Current health policy focuses on improving accessibility, increasing integration and shifting resources from hospitals to community and primary care. Initiatives aimed at achieving these policy aims have supported the implementation of various 'new models of care', including general practice offering 'additional availability' appointments during evenings and at weekends. In Greater Manchester, six 'demonstrator sites' were funded: four sites delivered additional availability appointments, other services included case management and rapid response. The aim of this paper is to explore the factors influencing the implementation of services within a programme designed to improve access to primary care. The paper consists of a qualitative process evaluation undertaken within provider organisations, including general practices, hospitals and care homes. Semi-structured interviews, with the data subjected to thematic analysis. Ninety-one people participated in interviews. Six key factors were identified as important for the establishment and running of the demonstrators: information technology; information governance; workforce and organisational development; communications and engagement; supporting infrastructure; federations and alliances. These factors brought to light challenges in the attempt to provide new or modify existing services. Underpinning all factors was the issue of trust; there was consensus amongst our participants that trusting relationships, particularly between general practices, were vital for collaboration. It was also crucial that general practices trusted in the integrity of anyone external who was to work with the practice, particularly if they were to access data on the practice computer system. A dialogical approach was required, which enabled staff to see themselves as active rather than passive participants. The research highlights various challenges presented by the context within which extended access is implemented. Trust was the fundamental underlying issue; there was consensus amongst participants that trusting relationships were vital for effective collaboration in primary care.

In-situ medical simulation for pre-implementation testing of clinical service in a regional hospital in Hong Kong.

PubMed

Chen, P P; Tsui, N Tk; Fung, A Sw; Chiu, A Hf; Wong, W Cw; Leong, H T; Lee, P Sf; Lau, J Yw

2017-08-01

The implementation of a new clinical service is associated with anxiety and challenges that may prevent smooth and safe execution of the service. Unexpected issues may not be apparent until the actual clinical service commences. We present a novel approach to test the new clinical setting before actual implementation of our endovascular aortic repair service. In-situ simulation at the new clinical location would enable identification of potential process and system issues prior to implementation of the service. After preliminary planning, a simulation test utilising a case scenario with actual simulation of the entire care process was carried out to identify any logistic, equipment, settings or clinical workflow issues, and to trial a contingency plan for a surgical complication. All patient care including anaesthetic, surgical, and nursing procedures and processes were simulated and tested. Overall, 17 vital process and system issues were identified during the simulation as potential clinical concerns. They included difficult patient positioning, draping pattern, unsatisfactory equipment setup, inadequate critical surgical instruments, blood products logistics, and inadequate nursing support during crisis. In-situ simulation provides an innovative method to identify critical deficiencies and unexpected issues before implementation of a new clinical service. Life-threatening and serious practical issues can be identified and corrected before formal service commences. This article describes our experience with the use of simulation in pre-implementation testing of a clinical process or service. We found the method useful and would recommend it to others.

Practical lessons in remote connectivity.

PubMed Central

Kouroubali, A.; Starren, J.; Barrows, R. C.; Clayton, P. D.

1997-01-01

Community Health Information Networks (CHINs) require the ability to provide computer network connections to many remote sites. During the implementation of the Washington Heights and Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC), a number of remote connectivity issues have been encountered. Both technical and non-technical issues were significant during the installation. We developed a work-flow model for this process which may be helpful to any health care institution attempting to provide seamless remote connectivity. This model is presented and implementation lessons are discussed. PMID:9357643

Strategies for teaching object-oriented concepts with Java

NASA Astrophysics Data System (ADS)

Sicilia, Miguel-Ángel

2006-03-01

A considerable amount of experiences in teaching object-oriented concepts using the Java language have been reported to date, some of which describe language pitfalls and concrete learning difficulties. In this paper, a number of additional issues that have been experienced as difficult for students to master, along with approaches intended to overcome them, are addressed. Concretely, practical issues regarding associations, interfaces, genericity and exceptions are described. These issues suggest that more emphasis is required on presenting Java programs as derivations of conceptual models, in order to guarantee that a thorough design of the object structure actually precedes implementation issues. In addition, common student misunderstandings about the uses of interfaces and exceptions point to the necessity of introducing both specific design philosophies and also a clear distinction between design-for-reuse and more specific implementation issues.

Directions in implementation research methods for behavioral and social science.

PubMed

Irwin, Molly; Supplee, Lauren H

2012-10-01

There is a growing interest, by researchers, policymakers, and practitioners, in evidence-based policy and practice. As a result, more dollars are being invested in program evaluation in order to establish "what works," and in some cases, funding is specifically tied to those programs found to be effective. However, reproducing positive effects found in research requires more than simply adopting an evidence-based program. Implementation research can provide guidance on which components of an intervention matter most for program impacts and how implementation components can best be implemented. However, while the body of rigorous research on effective practices continues to grow, research on implementation lags behind. To address these issues, the Administration for Children and Families and federal partners convened a roundtable meeting entitled, Improving Implementation Research Methods for Behavioral and Social Science, in the fall of 2010. This special section of the Journal of Behavioral Health Services & Research includes papers from the roundtable and highlights the role implementation science can play in shedding light on the difficult task of taking evidence-based practices to scale.

Interprofessional Learning of Physiotherapists under Conditions of Higher Education in Great Britain

ERIC Educational Resources Information Center

Guk, Svitlana

2014-01-01

The problems of implementing interprofessional training of physiotherapists in universities and at the bases of the practical training of students in Great Britain have been analyzed. The role of physiotherapists in issues of medical education and practical assistance within their own profession has been defined. The list of leading training bases…

A review on effectiveness of best management practices in improving hydrology and water quality: Needs and opportunities

USDA-ARS?s Scientific Manuscript database

Best management practices (BMPs) have been widely used to address hydrology and water quality issues in both agricultural and urban areas. Increasing numbers of BMPs have been studied in research projects and implemented in watershed management projects, but a gap remains in quantifying their effect...

Leadership, Innovation Climate, and Attitudes toward Evidence-Based Practice during a Statewide Implementation

ERIC Educational Resources Information Center

Aarons, Gregory A.; Sommerfeld, David H.

2012-01-01

Objective: Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader-member exchange (i.e., the relationship between a supervisor and their direct service providers) on…

Designing and Conducting Strong Quasi-Experiments in Education. Version 2

ERIC Educational Resources Information Center

Scher, Lauren; Kisker, Ellen; Dynarski, Mark

2015-01-01

The purpose of this paper is to describe best practices in designing and implementing strong quasi-experimental designs (QED) when assessing the effectiveness of policies, programs or practices. The paper first discusses the issues researchers face when choosing to conduct a QED, as opposed to a more rigorous randomized controlled trial design.…

Music Education for Social Change in the Secondary Public Schools of Costa Rica

ERIC Educational Resources Information Center

Rosabal-Coto, Guillermo

2010-01-01

This article focuses on a recently implemented general music curriculum in secondary public schools, whose main goal is to address social issues in Costa Rica. The author describes and discusses its context, rationale, theoretical tenets, and proposed practices with the purpose of advancing theory-practice reflection on music education practices…

Recess before Lunch Programs in Elementary Schools: Perceptions and Practices of School Professionals

ERIC Educational Resources Information Center

Bounds, Wendy; Nettles, Mary Frances; Johnson, James T.

2009-01-01

Purpose/Objectives: The objectives of this study were to examine the perceptions of school nutrition directors, principals/assistant principals, and teachers regarding issues important to consider when scheduling recess in relation to lunch, and to describe practices related to successfully implementing a recess before lunch program. Methods: A…

The Social Work Ethics Audit: A Risk-Management Strategy.

ERIC Educational Resources Information Center

Reamer, Frederic G.

2000-01-01

Article integrates current knowledge on social work ethics and introduces the concept of a social work ethics audit to aid social workers in their efforts to identify pertinent ethical issues; review and assess the adequacy of their current ethics-related practices; modify their practices as needed; and monitor the implementation of these changes.…

Equality in the Workplace. An Equal Opportunities Handbook for Trainers. Human Resource Management in Action Series.

ERIC Educational Resources Information Center

Collins, Helen

This workbook, which is intended as a practical guide for human resource managers, trainers, and others concerned with developing and implementing equal opportunities training programs in British workplaces, examines issues in and methods for equal opportunities training. The introduction gives an overview of current training trends and issues.…

Evaluation of the Persistent Issues in History Laboratory for Virtual Field Experience (PIH-LVFE)

ERIC Educational Resources Information Center

Brush, Thomas; Saye, John; Kale, Ugur; Hur, Jung Won; Kohlmeier, Jada; Yerasimou, Theano; Guo, Lijiang; Symonette, Simone

2009-01-01

The Persistent Issues in History Laboratory for Virtual Field Experience (PIH-LVFE) combines a database of video cases of authentic classroom practices with multiple resources and tools to enable pre-service social studies teachers to virtually observe teachers implementing problem-based learning activities. In this paper, we present the results…

The Development Mechanism of Financial Resources of the Housing Mortgage Lending in Russia

ERIC Educational Resources Information Center

Savinova, Valentina A.; Solodilova, Marija N.; Zgegalova, Elena V.; Tershukova, Marina B.; Rutkauskas, Tatiana K.

2016-01-01

The urgency of the analyzed issue is due to the priority of state issues of providing the population with affordable and comfortable housing. The purpose of research is to develop the main provisions of the development mechanism of financial resources of the housing mortgage lending and to develop practical recommendations for its implementation.…

Implementing a University-Wide Credit-Bearing English Language Enhancement Programme: Issues Emerging from Practice

ERIC Educational Resources Information Center

Fenton-Smith, Ben; Humphreys, Pamela; Walkinshaw, Ian; Michael, Rowan; Lobo, Ana

2017-01-01

Many nations now enrol large numbers of tertiary students with English as an additional language, raising concerns over academic literacy standards. As a result, calls for whole-institution approaches to enhance language proficiency have grown. This paper describes the issues faced by one university that attempted such an approach. We first…

Applied optimal shape design

NASA Astrophysics Data System (ADS)

Mohammadi, B.; Pironneau, O.

2002-12-01

This paper is a short survey of optimal shape design (OSD) for fluids. OSD is an interesting field both mathematically and for industrial applications. Existence, sensitivity, correct discretization are important theoretical issues. Practical implementation issues for airplane designs are critical too. The paper is also a summary of the material covered in our recent book, Applied Optimal Shape Design, Oxford University Press, 2001.

Student-Centredness: Exploring the Culturally Appropriate Pedagogical Space in Vietnamese Higher Education Classrooms Using Activity Theory

ERIC Educational Resources Information Center

Pham, Thanh

2016-01-01

Recently leaders in many Asian countries have advocated for student-centred reform agendas. However, bringing about pedagogical change is not simply a technical issue of implementing practices designed elsewhere but is a more substantive issue concerned with local cultural values and context. Researchers have claimed that to sustain the reform,…

Evidence, Engagement, and Technology: Themes of and the State of Primary Care Practice-based Network Research.

PubMed

Nease, Donald E

2016-01-01

Practice-based research supported by practice-based research network (PBRN) infrastructure has historically provided an important method for challenging guidelines and evidence arising from secondary and tertiary care settings. This sample of current practice-based research in this issue of the JABFM provides an opportunity to ask whether practice-based research continues to address questions relevant to primary care practices and clinicians and whether a PBRN infrastructure is instrumental to maintaining the relevance and feasibility of practice-based research. Based on this issue's articles, the current state of practice-based research seems to be good, at face value addressing relevant issues for primary care practices. Less clear is the degree to which PBRN infrastructures and relationships informed the questions asked and facilitated the implementation of the studies presented. Practice-based research-related articles that routinely report about how study questions arose-from practices and their clinicians, staff and communities, or elsewhere-could help directly answer questions of relevance. In addition, reporting how practices are recruited to practice-based research studies could inform the degree to which ongoing relationships central to PBRNs facilitate the recruitment and conduct of practice-based research. © Copyright 2016 by the American Board of Family Medicine.

Information Issues and Contexts that Impair Team Based Communication Workflow: A Palliative Sedation Case Study.

PubMed

Cornett, Alex; Kuziemsky, Craig

2015-01-01

Implementing team based workflows can be complex because of the scope of providers involved and the extent of information exchange and communication that needs to occur. While a workflow may represent the ideal structure of communication that needs to occur, information issues and contextual factors may impact how the workflow is implemented in practice. Understanding these issues will help us better design systems to support team based workflows. In this paper we use a case study of palliative sedation therapy (PST) to model a PST workflow and then use it to identify purposes of communication, information issues and contextual factors that impact them. We then suggest how our findings could inform health information technology (HIT) design to support team based communication workflows.

Understanding the Role of Culture and Communication in Implementing Planned Organizational Change: The Case of Compstat in Police Organizations

ERIC Educational Resources Information Center

Yuksel, Yusuf

2013-01-01

Despite the popularity of planned change efforts, the failure rates of implementation are as high as 50 to 70 percent (Lewis & Seibold, 1998). While these efforts are affected by technical issues, the organizations' approach to change, structure, technological capabilities, and organizational culture and communication practices are…

Stakeholder views on pharmacogenomic testing.

PubMed

Patel, Haridarshan N; Ursan, Iulia D; Zueger, Patrick M; Cavallari, Larisa H; Pickard, A Simon

2014-02-01

Pharmacogenomics has an important role in the evolution of personalized medicine, and its widespread uptake may ultimately depend on the interests and perspectives of key players in health care. Our aim was to summarize studies on stakeholder perspectives and attitudes toward pharmacogenomic testing. Thus, we conducted a review of original research studies that reported stakeholder views on pharmacogenomic testing using a structured approach in PubMed, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and EMBASE. A standardized data abstraction form was developed that included stakeholder group of interest-patients, general public, providers, and payers. Stakeholder views regarding barriers to pharmacogenetic implementation were organized into the following themes: ancillary information-related, clinical, economic, educational, ethical or legal, medical mistrust, and practicality. Of 34 studies that met our inclusion criteria, 37 perspectives were reported (15 on providers, 9 on the general public, 9 on patients, and 4 on payers). The most common topics that arose in studies of providers related to clinical usefulness of genetic data (n=11) and educational needs (n=11). Among the general public, the most common concerns were medical mistrust (n=5), insufficient education (n=5), and practicality (n=5). The most prevalent issues from the patient perspective were ethical or legal (n=6) and economic (n=5) issues. Among payers, leading issues were practicality (n=4) and clinical usefulness (n=3). There was overlap in the topics and concerns across stakeholder perspectives, including lack of knowledge about pharmacogenomic testing. Views on issues related to privacy, cost, and test result dissemination varied by stakeholder perspective. Limited research had been conducted in underrepresented groups. Efforts to address the issues raised by stakeholders may facilitate the implementation of pharmacogenomic testing into clinical practice. © 2013 American College of Clinical Pharmacy.

Integrating research, policy, and practice in juvenile justice education.

PubMed

Blomberg, Thomas G; Waldo, Gordon P

2002-06-01

This article provides an overview of the history and context leading to Florida's efforts to implement an evaluation-driven research and associated quality assurance system for its juvenile justice education policies and practices. The Juvenile Justice Educational Enhancement Program began implementing Florida's evaluation research and quality assurance system to juvenile justice education in 1998. The article includes a brief summary of articles comprising this special issue of Evaluation Review that address the Juvenile Justice Educational Enhancement Program's various functions, methodological components, data, preliminary findings, continuing evaluation research efforts, and impediments.

Strategies for Success

ERIC Educational Resources Information Center

Tedrick, Lou; Sumsion, Zach; Smith, Mary; Cutshall, Charlie

2012-01-01

"Training" magazine taps 2012 Training Top 125 winners and Top 10 Hall of Famers to provide their learning and development best practices in each issue. This article looks at strategies to foster technology innovation and implementation and onboarding.

The Role of Special Education Administrators in Addressing Contextual Factors When Implementing Comprehensive School Reform in Response to the Mandate of the No Child Left behind Act of 2001 (P.L. 107-110)

ERIC Educational Resources Information Center

Darensbourg, Kennith Houston

2011-01-01

This study is designed to identify the effective implementation practices that special education administrators enact to alleviate the negative and enforce the positive effects of contextual factors when implementing comprehensive school reform. Two research questions were designed to address this issue. Research Question One sought to identify…

European consensus conference on faecal microbiota transplantation in clinical practice.

PubMed

Cammarota, Giovanni; Ianiro, Gianluca; Tilg, Herbert; Rajilić-Stojanović, Mirjana; Kump, Patrizia; Satokari, Reetta; Sokol, Harry; Arkkila, Perttu; Pintus, Cristina; Hart, Ailsa; Segal, Jonathan; Aloi, Marina; Masucci, Luca; Molinaro, Antonio; Scaldaferri, Franco; Gasbarrini, Giovanni; Lopez-Sanroman, Antonio; Link, Alexander; de Groot, Pieter; de Vos, Willem M; Högenauer, Christoph; Malfertheiner, Peter; Mattila, Eero; Milosavljević, Tomica; Nieuwdorp, Max; Sanguinetti, Maurizio; Simren, Magnus; Gasbarrini, Antonio

2017-04-01

Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Marketing your practice on the Internet.

PubMed

Rothschild, Michael A

2002-12-01

The Internet provides a unique opportunity for marketing a medical practice. By demonstrating a commitment to good doctor-patient communication, by providing helpful background information, and by facilitating office workflow, a Web site can be a cost-effective way to enhance any practice. This chapter examines the basics of implementing an Internet presence; the issues related to online communication with patients; and the ongoing utilization, promotion, and maintenance of a Web site.

Integrating self-help materials into mental health practice.

PubMed

Church, Elizabeth; Cornish, Peter; Callanan, Terrence; Bethune, Cheri

2008-10-01

Patients' mental health issues have become an increasing focus of Canadian family physicians' practices. A self-help approach can help meet this demand, but there are few guidelines for professionals about how to use mental health self-help resources effectively. To aid health professionals in integrating self-help materials into their mental health practices. A resource library of print, audiotape, and videotape self-help materials about common mental health issues was developed for a rural community. The materials were prescreened in order to ensure high quality, and health professionals were given training on how to integrate self-help into their practices. The library was actively used by both health professionals and community members, and most resources were borrowed, particularly the nonprint materials. Health professionals viewed the resources as a way to supplement their mental health practice and reduce demands on their time, as patients generally worked through the resources independently. Some improvements are planned for future implementations of the program, such as providing health professionals with a "prescription pad" of resources and implementing Stages of Change and stepped-care models to maximize the program's effectiveness. Although more evidence is needed regarding the effectiveness of self-help within a family practice context, this program offers a promising way for family physicians to address mild to moderate mental health problems.

Micro sensor node for air pollutant monitoring: hardware and software issues.

PubMed

Choi, Sukwon; Kim, Nakyoung; Cha, Hojung; Ha, Rhan

2009-01-01

Wireless sensor networks equipped with various gas sensors have been actively used for air quality monitoring. Previous studies have typically explored system issues that include middleware or networking performance, but most research has barely considered the details of the hardware and software of the sensor node itself. In this paper, we focus on the design and implementation of a sensor board for air pollutant monitoring applications. Several hardware and software issues are discussed to explore the possibilities of a practical WSN-based air pollution monitoring system. Through extensive experiments and evaluation, we have determined the various characteristics of the gas sensors and their practical implications for air pollutant monitoring systems.

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

PubMed Central

Crosson, Jesse C.; Stroebel, Christine; Scott, John G.; Stello, Brian; Crabtree, Benjamin F.

2005-01-01

PURPOSE Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the financial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine office culture affect the initial implementation of an EMR. METHODS As part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data. RESULTS Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal conflicts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts. CONCLUSIONS Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an office practice and without methods for bringing to the surface and addressing conflicts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs. PMID:16046562

Implementing an electronic medical record in a family medicine practice: communication, decision making, and conflict.

PubMed

Crosson, Jesse C; Stroebel, Christine; Scott, John G; Stello, Brian; Crabtree, Benjamin F

2005-01-01

Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the financial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine office culture affect the initial implementation of an EMR. As part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data. Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal conflicts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts. Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an office practice and without methods for bringing to the surface and addressing conflicts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs.

Medical Home Implementation: A Sensemaking Taxonomy of Hard and Soft Best Practices

PubMed Central

Hoff, Timothy

2013-01-01

Context The patient-centered medical home (PCMH) model of care is currently a central focus of U.S. health system reform, but less is known about the model's implementation in the practice of everyday primary care. Understanding its implementation is key to ensuring the approach's continued support and success nationally. This article addresses this gap through a qualitative examination of the best practices associated with PCMH implementation for older adult patients in primary care. Methods I used a multicase, comparative study design that relied on a sensemaking approach and fifty-one in-depth interviews with physicians, nurses, and clinic support staff working in six accredited medical homes located in various geographic areas. My emphasis was on gaining descriptive insights into the staff's experiences delivering medical home care to older adult patients in particular and then analyzing how these experiences shaped the staff's thinking, learning, and future actions in implementing medical home care. Findings I found two distinct taxonomies of implementation best practices, which I labeled “hard” and “soft” because of their differing emphasis and content. Hard implementation practices are normative activities and structural interventions that align well with existing national standards for medical home care. Soft best practices are more relational in nature and derive from the existing practice social structure and everyday interactions between staff and patients. Currently, external stakeholders are less apt to recognize, encourage, or incentivize soft best practices. Conclusions The results suggest that there may be no standardized, one-size-fits-all approach to making medical home implementation work, particularly for special patient populations such as the elderly. My study also raises the issue of broadening current PCMH assessments and reward systems to include implementation practices that contain heavy social and relational components of care, in addition to the emphasis now placed on building structural supports for medical home work. Further study of these softer implementation practices and a continued call for qualitative methodological approaches that gain insight into everyday practice behavior are warranted. PMID:24320169

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation.

PubMed

Scobbie, Lesley; McLean, Donald; Dixon, Diane; Duncan, Edward; Wyke, Sally

2013-05-24

Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke. G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation. G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient's well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process. G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

Strategies for improving safety performance in construction firms.

PubMed

Alarcón, Luis Fernando; Acuña, Diego; Diethelm, Sven; Pellicer, Eugenio

2016-09-01

Over the years many prevention management practices have been implemented to prevent and mitigate accidents at the construction site. However, there is little evidence of the effectiveness of individual or combined practices used by companies to manage occupational health and safety issues. The authors selected a sample of 1180 construction firms and 221 individual practices applied in these companies to analyze their effectiveness reducing injury rates over a period of four years in Chile. Different methods were used to study this massive database including: visual analyses of graphical information, statistical analyses and classification techniques. Results showed that practices related to safety incentives and rewards are the most effective from the accident rate viewpoint, even though they are seldom used by companies; on the other hand, practices related to accidents and incidents investigation had a slight negative impact on the accident rate because they are frequently used as a reactive measure. In general, the higher the percentage of prevention practices implemented in a strategy, the lower the accident rate. However, the analysis of the combined effect of prevention practices indicated that the choice of the right combination of practices was more important than just the number of practices implemented. Copyright © 2016 Elsevier Ltd. All rights reserved.

Best practices for using geographic data in transit : a location referencing guidebook : defining geographic locations of bus stops, routes and other map data for ITS, GIS and operational efficiencies

DOT National Transportation Integrated Search

2005-04-01

This Guidebook was developed at the request of the transit industry. It provides best practices for both transit managers and technical staff with respect to planning, implementing and using geographic data in transit. The Guidebook discusses issues ...

Practical, Ethical, and Legal Considerations regarding Videocounseling in College and University Counseling Centers: A Response to Quarto's "Influencing College Students' Perceptions of Videocounseling"

ERIC Educational Resources Information Center

Menzano, Silvestro; Goodwin, Alan; Rockett, Geraldine; Morris, Kathy

2011-01-01

There are numerous factors and concerns to take into consideration when implementing new technology into a counseling center's practice. These factors--informed consent, confidentiality, record-keeping, licensure, technical issues, eligibility, emergencies, and staff perceptions--are legitimate and must be addressed and resolved before…

Volcanic Ash Soils: Sustainable Soil Management Practices, With Examples of Harvest Effects and Root Disease Trends

Treesearch

Mike Curran; Pat Green; Doug Maynard

2007-01-01

Sustainability protocols recognize forest soil disturbance as an important issue at national and international levels. At regional levels continual monitoring and testing of standards, practices, and effects are necessary for successful implementation of sustainable soil management. Volcanic ash-cap soils are affected by soil disturbance and changes to soil properties...

Issues to Consider when Implementing Student-Centred Learning Practices at Asian Higher Education Institutions

ERIC Educational Resources Information Center

Thanh, Pham Thi Hong

2011-01-01

A large number of failures in learning reforms at Asian universities have been documented recently in the literature. The main reason is that reformers often import Western-developed practices to Asian classrooms without a careful examination of their appropriateness within the socio-cultural context of these countries. This approach faces a high…

Issues for small businesses with waste management.

PubMed

Redmond, Janice; Walker, Elizabeth; Wang, Calvin

2008-07-01

Participation by small and medium enterprise (SME) in corporate social responsibility issues has been found to be lacking. This is a critical issue, as individually SMEs may have little impact on the environment but their collective footprint is significant. The management style and ethical stance of the owner-manager affects business decision making and therefore has a direct impact on the environmental actions of the business. Although adoption of environmental practices to create competitive advantage has been advocated, many businesses see implementation as a cost which cannot be transferred to their customers. After a brief review of pertinent literature this paper reports on an exploratory investigation into the issue. Results show that whereas owner-managers of small enterprises express concern regarding the environment, this does not then translate into better waste management practices.

Ethically-based clinical decision-making in physical therapy: process and issues.

PubMed

Finch, Elspeth; Geddes, E Lynne; Larin, Hélène

2005-01-01

The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice.

Curriculum Translation and Environmental Education: Considering Issues of Discursive Intentionality, Interpretation, and Validity

ERIC Educational Resources Information Center

Oliveira, Alandeom W.; Colak, Huseyin; Akerson, Valarie L.

2009-01-01

We would like to thank our commentators Reis, Ercikan and Alper for their insightful comments on our research study and respond in brief to a few of their criticisms. More specifically, we would like to address what we consider to be the three main issues they raise with regard to the practices of curriculum translation and implementation across…

Steps to overcome the North-South divide in research relevant to climate change policy and practice

NASA Astrophysics Data System (ADS)

Blicharska, Malgorzata; Smithers, Richard J.; Kuchler, Magdalena; Agrawal, Ganesh K.; Gutiérrez, José M.; Hassanali, Ahmed; Huq, Saleemul; Koller, Silvia H.; Marjit, Sugata; Mshinda, Hassan M.; Masjuki, Hj Hassan; Solomons, Noel W.; Staden, Johannes Van; Mikusiński, Grzegorz

2017-01-01

A global North-South divide in research, and its negative consequences, has been highlighted in various scientific disciplines. Northern domination of science relevant to climate change policy and practice, and limited research led by Southern researchers in Southern countries, may hinder further development and implementation of global climate change agreements and nationally appropriate actions. Despite efforts to address the North-South divide, progress has been slow. In this Perspective, we illustrate the extent of the divide, review underlying issues and analyse their consequences for climate change policy development and implementation. We propose a set of practical steps in both Northern and Southern countries that a wide range of actors should take at global, regional and national scales to span the North-South divide, with examples of some actions already being implemented.

Reforming for "All" or for "Some": Misalignment in the Discourses of Education Reformers and Implementers

ERIC Educational Resources Information Center

Lenhoff, Sarah Winchell; Ulmer, Jasmine B.

2016-01-01

The ways in which the language of reformers intersects with and informs reform implementation is important to our understanding of how education policy impacts practice. To explore this issue, we employed critical discourse analysis (CDA) to analyze the language used by a 21st century skills-focused reform organization to promote its program…

Transfusion in critically ill children: indications, risks, and challenges.

PubMed

Parker, Robert I

2014-03-01

To provide a concise review of transfusion-related issues and practices in the pediatric patient population, with a focus on those issues of particular importance to the care of critically ill children. Electronic search of the PubMed database using the search terms "pediatric transfusion," "transfusion practices," "transfusion risks," "packed red blood cell transfusion," "white blood cell transfusion," "platelet transfusion," "plasma transfusion," and "massive transfusion" either singly or in combination. All identified articles published since 2000 were manually reviewed for study design, content, and support for indicated conclusions, and the bibliographies were scrutinized for pertinent references not identified in the PubMed search. Selected studies from this group were then manually reviewed for possible inclusion in this review. Well-designed studies have demonstrated the benefit of "restrictive" transfusion practices across the entire age spectrum of pediatric patients across a wide spectrum of pediatric illness. However, clinician implementation of the more restrictive transfusion practices supported by these studies is variable. Additionally, the utilization of both platelet and plasma transfusions in either a "prophylactic" or "therapeutic" setting appears to be greater than that supported by published data. The preponderance of prospective, randomized trials and retrospective analyses support the use of a restrictive packed RBC transfusion policy in most clinical conditions in children. Neonatal transfusions guidelines rely largely on "expert opinion" rather than experimental data. Current transfusion practices for both platelets and coagulant products (e.g., fresh-frozen plasma and recombinant-activated factor VII) are poorly aligned with recommended transfusion guidelines. As with adults, current transfusion practices in children often do not reflect implementation of our current knowledge on the need for transfusion. Greater efforts to implement current evidence-based transfusion practices are needed.

Scientific-practical and legal problems of implementation of the personalized medicine.

PubMed

Bezdieniezhnykh, N O; Reznikova, V V; Rossylna, O V

2017-09-01

The article is devoted to the comprehensive analysis of scientific, practical and legal issues of personalized medicine that is a rapidly developing science-driven approach to healthcare. It is concluded that there is lack of general legal framework for the encouragement of scientific researches and practical implementation in this field. The article shows foreign experience and prospects for the introduction of personalized medicine as a key concept of healthcare system, which is based on a selection of diagnostic, therapeutic and preventive measures that would be the most effective for a particular person in view of individual characteristics. The conclusions and proposals to improve the current legislation and development of personalized medicine in Ukraine are suggested.

Ethics and community-based participatory research: perspectives from the field.

PubMed

Bastida, Elena M; Tseng, Tung-Sung; McKeever, Corliss; Jack, Leonard

2010-01-01

Exploring the importance of ethical issues in the conduct of community-based participatory research (CBPR) continues to be an important topic for researchers and practitioners. This article uses the Beyond Sabor Project, a CBPR project implemented in the Lower Rio Grande Valley, as a case example to discuss ethical issues such as the importance of increasing community involvement in research, ensuring that communities benefit from the research, sharing leadership roles, and sensitive issues regarding data collection and sharing. Thereafter, this article concludes with a brief discussion of six principles that can inform the practice of ethical conduct when implementing CBPR studies. This article also lists additional reading resources on the importance of ethics in the conduct of CBPR.

Practical comparison of distributed ledger technologies for IoT

NASA Astrophysics Data System (ADS)

Red, Val A.

2017-05-01

Existing distributed ledger implementations - specifically, several blockchain implementations - embody a cacophony of divergent capabilities augmenting innovations of cryptographic hashes, consensus mechanisms, and asymmetric cryptography in a wide variety of applications. Whether specifically designed for cryptocurrency or otherwise, several distributed ledgers rely upon modular mechanisms such as consensus or smart contracts. These components, however, can vary substantially among implementations; differences involving proof-of-work, practical byzantine fault tolerance, and other consensus approaches exemplify distinct distributed ledger variations. Such divergence results in unique combinations of modules, performance, latency, and fault tolerance. As implementations continue to develop rapidly due to the emerging nature of blockchain technologies, this paper encapsulates a snapshot of sensor and internet of things (IoT) specific implementations of blockchain as of the end of 2016. Several technical risks and divergent approaches preclude standardization of a blockchain for sensors and IoT in the foreseeable future; such issues will be assessed alongside the practicality of IoT applications among Hyperledger, Iota, and Ethereum distributed ledger implementations suggested for IoT. This paper contributes a comparison of existing distributed ledger implementations intended for practical sensor and IoT utilization. A baseline for characterizing distributed ledger implementations in the context of IoT and sensors is proposed. Technical approaches and performance are compared considering IoT size, weight, and power limitations. Consensus and smart contracts, if applied, are also analyzed for the respective implementations' practicality and security. Overall, the maturity of distributed ledgers with respect to sensor and IoT applicability will be analyzed for enterprise interoperability.

Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices.

PubMed

John, Tamara; Morton, Michaela; Weissman, Mark; O'Brien, Ellen; Hamburger, Ellen; Hancock, Yolandra; Moon, Rachel Y

2014-04-01

Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. Prospective cohort. Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.

Need of risk management practice amongst bumiputera contractors in Malaysia construction industries

NASA Astrophysics Data System (ADS)

Syuhada Fadzil, Nur; Noor, Nurazuwa Md; Rahman, Ismail Abdul

2017-11-01

Malaysia construction industry has been growing continuously with double-digit growth for the past two decades. There are many issues surrounded the industry such as delay in delivery, cost overrun, quality and safety. In bumiputera contractor’s context, the literature review found that 32 issues were encountered in the construction project. These issues can be handled properly with the application of risk management. According to previous researchers, application of risk management in Malaysia construction industry is at the low level where it is implemented in traditional ways that are brainstorming and checklist. These were due to lack of knowledge, the high cost of hiring experts and avoiding extra cost. Besides that, this study also intentions to analyse the risk categories in the construction industry as well as identify risk management process to resolve the construction issues. Hence, this paper presents issues engulfed by Bumiputera contractors which can partly be resolved by applying risk management practice in carrying out the construction activity. This may inspire the contractors to apply the risk management practice in ensuring the success of their construction project.

The what, when, and why of implementation frameworks for evidence-based practices in child welfare and child mental health service systems.

PubMed

Hanson, Rochelle F; Self-Brown, Shannon; Rostad, Whitney L; Jackson, Matthew C

2016-03-01

It is widely recognized that children in the child welfare system are particularly vulnerable to the adverse health and mental effects associated with exposure to abuse and neglect, making it imperative to have broad-based availability of evidence-based practices (EBPs) that can prevent child maltreatment and reduce the negative mental health outcomes for youth who are victims. A variety of EBPs exist for reducing child maltreatment risk and addressing the associated negative mental health outcomes, but the reach of these practices is limited. An emerging literature documents factors that can enhance or inhibit the success of EBP implementation in community service agencies, including how the selection of a theory-driven conceptual framework, or model, might facilitate implementation planning by providing guidance for best practices during implementation phases. However, limited research is available to guide decision makers in the selection of implementation frameworks that can boost implementation success for EBPs that focus on preventing child welfare recidivism and serving the mental health needs of maltreated youth. The aims of this conceptual paper are to (1) provide an overview of existing implementation frameworks, beginning with a discussion of definitional issues and the selection criteria for frameworks included in the review; and (2) offer recommendations for practice and policy as applicable for professionals and systems serving victims of child maltreatment and their families. Copyright © 2015 Elsevier Ltd. All rights reserved.

Systems Engineering and Integration for Technology Programs

NASA Technical Reports Server (NTRS)

Kennedy, Kruss J.

2006-01-01

The Architecture, Habitability & Integration group (AH&I) is a system engineering and integration test team within the NASA Crew and Thermal Systems Division (CTSD) at Johnson Space Center. AH&I identifies and resolves system-level integration issues within the research and technology development community. The timely resolution of these integration issues is fundamental to the development of human system requirements and exploration capability. The integration of the many individual components necessary to construct an artificial environment is difficult. The necessary interactions between individual components and systems must be approached in a piece-wise fashion to achieve repeatable results. A formal systems engineering (SE) approach to define, develop, and integrate quality systems within the life support community has been developed. This approach will allow a Research & Technology Program to systematically approach the development, management, and quality of technology deliverables to the various exploration missions. A tiered system engineering structure has been proposed to implement best systems engineering practices across all development levels from basic research to working assemblies. These practices will be implemented through a management plan across all applicable programs, projects, elements and teams. While many of the engineering practices are common to other industries, the implementation is specific to technology development. An accounting of the systems engineering management philosophy will be discussed and the associated programmatic processes will be presented.

Communities of Practice and On-Line Support for Dissemination and Implementation of Innovation.

ERIC Educational Resources Information Center

Stuckey, Bronwyn; Buehring, Anna; Fraser, Sally

New tools, whether developed organizationally, commercially, or within a domain may represent innovation in the workplace and can be part of larger scale reform and change. The focus of this research is on exploring the roster of issues arising as the theory of communities of practice is applied to specific cases of online professional development…

Towards the Development of a New Model for Best Practice and Knowledge Construction in Virtual Campuses

ERIC Educational Resources Information Center

Cartelli, Antonio; Stansfield, Mark; Connolly, Thomas; Jimoyiannis, Athanassios; Magalhaes, Hugo; Maillet, Katherine

2008-01-01

This paper reports on the work of a European Commission DG Education and Culture co-financed project PBP-VC, Promoting Best Practice in Virtual Campuses, which is aimed at providing a deeper understanding of the key issues and critical success factors underlying the implementation of virtual campuses. The paper outlines a tentative model of issues…

Re-Thinking Microbiology/Infection Control Education to Enhance the Practice-Readiness of Health Professional Students: More than Just a Curriculum Issue

ERIC Educational Resources Information Center

Cox, Jennifer L.; Simpson, Maree Donna; Letts, Will; Cavanagh, Heather

2015-01-01

Undergraduate education in the health professions is intended to produce competent health professional graduates. Infection prevention and control (IPC) is a necessary element of daily practice in many health professions, to safeguard patients and staff, however previous research has established poor knowledge and implementation of IPC precautions…

"I Like the Sound of That"--An Evaluation of Providing Audio Feedback via the Virtual Learning Environment for Summative Assessment

ERIC Educational Resources Information Center

Carruthers, Clare; McCarron, Brenda; Bolan, Peter; Devine, Adrian; McMahon-Beattie, Una; Burns, Amy

2015-01-01

This study aims to ascertain student and staff attitudes to and perceptions of audio feedback made available via the virtual learning environment (VLE) for summative assessment. Consistent with action research and reflective practice, this study identifies best practice, highlighting issues in relation to implementation with the intention of…

Whatever Happened to STS? Pre-Service Physics Teachers and the History of Quantum Mechanics

ERIC Educational Resources Information Center

Nashon, Samson; Nielsen, Wendy; Petrina, Stephen

2008-01-01

If issues in the history and philosophy of science and those related to science, technology and society are generally accepted in policy, how ought these be handled in practice? Mandate in policy does not guarantee implementation in practice. Indeed, HPS and STS have for decades been marginalized in the curriculum. Subject areas designated to…

Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study.

PubMed

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes. To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives. A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population. Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes. Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload. Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale. © British Journal of General Practice 2017.

[The implementation of innovations in public health].

PubMed

Systerova, A A; Totskaia, E G

2012-01-01

Nowadays, the innovative activities are considered as the mechanism of implementation of public policy to increase effectiveness of public health system on the basis of achievements of modern medicine and technical sciences. The development, elaboration and implementation of products being in line with corresponding to criteria of innovation, promote the concurrency of medical institutions at the medical services market. The administrators of health departments and medical science professionals are to become aware about the problems of implementation of innovations into medical practice to develop the mechanisms of overcoming these issues.

The local implementation of a chronic disease management model for childhood overweight and obesity.

PubMed

Brink-Melis, Willy J; Derksen, Elze R E; Westerman, Marjan J; Renders, Carry M; Seidell, Jacob C; Visscher, Tommy L S

2012-01-01

The aim of this study is to determine opportunities and barriers regarding the management of overweight and obese children in daily practice, and to show the value of using focus groups when developing an action plan for childhood overweight management in a local context. Seven focus groups and four semi-structured interviews were conducted with 29 professionals from nine different care disciplines and 7 parents of overweight and obese children aged 4-19 years. After thorough analysis of the focus groups, issues concerning finding the most appropriate care and realising a long-term weight management in daily practice have become clear. Some examples of these issues are: lack of awareness, reluctance to discuss and refer, mutual cooperation, contradictory advice and expectations of treatment and lack of effective support strategies. Focus groups deliver important information on local issues that are important for the development and implementation of a childhood overweight management action plan. And, besides delivering necessary information, focus groups lead to an increased awareness and willingness to improve childhood overweight management in a local context. Copyright © 2012 S. Karger GmbH, Freiburg.

Guidelines for the management of hepatitis C in general practice: a semi-qualitative interview survey of GPs' views regarding content and implementation.

PubMed

Cullen, W; O'Leary, M; Langton, D; Stanley, J; Kelly, Y; Bury, G

2005-01-01

Hepatitis C is a common infection among people who attend GPs for methadone maintenance treatment. To determine the views of GPs towards clinical guidelines for the management of hepatitis C among current or former injecting drug users in advance of their implementation. A purposive sample of 14 GPs (10% of the total prescribing methadone at the time the guidelines were developed) was invited to review a pre-publication draft of the guidelines and interviewed regarding content, presentation, perceived barriers to implementation and suggested interventions to facilitate effective implementation of the guidelines. GPs indicated the guidelines were useful but suggested aspects of presentation should be clarified. Organisational issues were identified as the principal barriers to effective implementation, with the provision of additional nursing support the principal intervention suggested to facilitate implementation. Interviewing intended recipients may be an important step in ensuring clinical practice guidelines are effectively implemented.

'Implementation deficit' and 'street-level bureaucracy': policy, practice and change in the development of community nursing issues.

PubMed

Bergen, Ann; While, Alison

2005-01-01

The present paper examines the mechanisms by which health and social care policies put forward by the Government may be translated into community nursing practice. Data from a research project on community nurse case managers were re-examined in the light of two classic theories often cited by policy analysts (i.e. implementation theory and 'street-level bureaucracy'). It was found that the extent to which nurses adopted the case management role, and the model of choice, depended on four major interrelated variables, namely: (1) the clarity of policy guidance; (2) the extent to which it coincided with professional (nursing) values; (3) local practices and policies; and (4) the personal vision of the community nurse. It is argued that this framework may have wider relevance, and this was tested out in two ways. First, major change in one of these variables (Government policy) over time was analysed for its effect on case management practice via the remaining variables. Secondly, an unrelated, but policy-initiated, nursing issue (nurse prescribing) was briefly examined in the light of the framework. It is suggested that this framework may be of some use when considering the likely practice response to policy-related changes in community nursing.

Problem-based learning in public health workforce training: a discussion of educational principles and evidence.

PubMed

Trevena, Lyndal J

2007-01-01

Problem-based learning (PBL) has been implemented within numerous undergraduate health curricula but less so in workforce training. Public health practice requires many of the skills that PBL aims to develop such as teamwork, self-directed learning and the integration of multiple sources of information within problem solving. This paper summarises the historical development of PBL and the educational principles underpinning it. It hypothesises that the public health workforce would benefit from some exposure to this type of learning and highlights some of the practical issues for its implementation.

Implementation of the OECD principles of good laboratory practice in test facilities complying with a quality system accredited to the ISO/IEC 17025 standard.

PubMed

Feller, Etty

2008-01-01

Laboratories with a quality system accredited to the ISO/IEC 17025 standard have a definite advantage, compared to non-accredited laboratories, when preparing their facilities for the implementation of the principles of good laboratory practice (GLP) of the Organisation for Economic Co-operation and Development (OECD). Accredited laboratories have an established quality system covering the administrative and technical issues specified in the standard. The similarities and differences between the ISO/IEC 17025 standard and the OECD principles of GLP are compared and discussed.

Implementation of computer-based patient records in primary care: the societal health economic effects.

PubMed Central

Arias-Vimárlund, V.; Ljunggren, M.; Timpka, T.

1996-01-01

OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland county, Sweden. MAIN OUTCOME MEASURES: Central implementation issues. First-year societal direct normal costs, direct unexpected costs, and indirect costs. Societal benefits. RESULTS: The total societal effect of the CPR implementation was a cost of nearly 250,000 SEK (USD 37,000) per GP team. About 20% of the effect consisted of direct unexpected costs, accured from the reduction of practitioners' leisure time. The main issues in the implementation process were medical informatics knowledge and computer skills, adaptation of the human-computer interaction design to practice routines, and information access through the CPR. CONCLUSIONS: The societal costs exceed the benefits during the first year after CPR implementation at the observed PHC centres. Early investments in requirements engineering and staff training may increase the efficiency. Exploitation of the CPR for disease prevention and clinical quality improvement is necessary to defend the investment in societal terms. The exact calculation of societal costs requires further analysis of the affected groups' willingness to pay. PMID:8947717

Healthcare rationing: issues and implications.

PubMed

Cypher, D P

1997-01-01

What methods, if any, should be used to practice healthcare rationing? This article looks at healthcare rationing in the United States, identifies ethical issues associated with implementing healthcare rationing, and addresses legal implications. The author utilizes sources from published literature and her own experience. Society must recognize that it does not have the resources available to fulfill all healthcare needs of all its members. Resolution will bring conflict and compromise.

Policy Forum Report: Statewide Evaluation of Programs and Services for Students with Disabilities (Arlington, Virginia, August 30-31, 1994). Final Report. Project FORUM.

ERIC Educational Resources Information Center

National Association of State Directors of Special Education, Alexandria, VA.

This report reviews the outcomes of a forum convened to examine policy and practice issues surrounding the annual evaluation of effectiveness of programs and services for students with disabilities. At the forum, alternative approaches being used by states to implement program evaluation were discussed, along with issues in gathering…

People are failing! Something needs to be done: Canadian students' experience with the NCLEX-RN.

PubMed

McGillis Hall, Linda; Lalonde, Michelle; Kashin, Jordana

2016-11-01

Canada's nurse regulators adopted the NCLEX as the entry-to-practice licensing exam for Canada's registered nurses effective January 2015. It is important to determine whether any issues from this change emerged for nursing students in preparing for and taking this new exam. To explore the experiences of Canadian graduate student nurses who were the first to write the NCLEX examination for entry to practice in Canada, determine whether any issues with implementation were identified and how these could be addressed. A qualitative study. Thematic analysis of semi-structured interview data obtained through interviews with 202 graduate Canadian nursing students was the methodology employed in this study. The predominant theme that emerged from the interview data was policy related issues that students identified with preparing for and taking the NCLEX. Sub-themes included: a) temporary test centre concerns, b) perceptions of American context and content on the exam, c) lack of French language resources and translation issues, d) the limited number of opportunities to write the exam, e) communication and engagement with regulators, f) financial costs incurred and g) reputational costs for the Canadian nursing profession. The experiences of study participants with NCLEX implementation in Canada were less than positive. This is of critical importance given the pass rates for first-time NCLEX writers in Canada were reported as 69.7%, substantially lower than pass rates on the previous Canadian entry-to-practice exam. Copyright © 2016 Elsevier Ltd. All rights reserved.

CDS, UX, and System Redesign - Promising Techniques and Tools to Bridge the Evidence Gap.

PubMed

McGinn, Thomas

2015-01-01

In this special issue of eGEMs, we explore the struggles related to bringing evidence into day-to-day practice, what I define as the "evidence gap." We are all aware of high quality evidence in the form of guidelines, randomized clinical trials for treatments and diagnostic tests, and clinical prediction rules, which are all readily available online. We also know that electronic health records (EHRs) are now ubiquitous in health care and in most practices across the country. How we marry this high quality evidence and the practice of medicine through effective decision support is a major challenge. All of the articles in this issue explore, in some fashion, CDS systems and how we can best bring providers and their work environment to the evidence. We are at the very early stages of the science of usability. Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice. While the featured examples, techniques, and tools in the special issue are a promising start to improving usability and CDS, many of the papers highlight current gaps in knowledge and a great need for generalizable approaches. The great promise is for "learning" approaches to generate new evidence and to integrate this evidence in reliable, patient-centered ways at scale using new technology. Closing the evidence gap is a real possibility, but only if the community works together to innovate and invest in research on the best ways to disseminate, communicate, and implement evidence in practice.

Developing Policy and Practice for Implementation of the Individuals with Disabilities Education Act--Innovative Approaches to State and National Issues: Invasive Procedures. Final Report.

ERIC Educational Resources Information Center

Krajicek, Marilyn J.

This final report discusses the activities and outcomes of a federally funded project designed to address the safe and legal implementation of the Individuals with Disabilities Education Act for young children who required invasive health care procedures. To accomplish the project objectives three annual, interdisciplinary conferences were held to…

Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study).

PubMed

Gulliford, Martin C; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Charlton, Judith; Dregan, Alex

2014-06-11

There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for research governance approval and intervention implementation. Pretrial data analyses should inform trial design and analysis plans. Current Controlled Trials ISRCTN 47558792 and ISRCTN 35701810 (both registered on 17 March 2010).

Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study)

PubMed Central

2014-01-01

Background There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Methods Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. Results We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Conclusions Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for research governance approval and intervention implementation. Pretrial data analyses should inform trial design and analysis plans. Trial registration Current Controlled Trials ISRCTN 47558792 and ISRCTN 35701810 (both registered on 17 March 2010). PMID:24919485

Knowledge translation at the macro level: legal and ethical considerations.

PubMed

Larkin, Gregory Luke; Hamann, Cara J; Monico, Edward P; Degutis, Linda; Schuur, Jeremiah; Kantor, Walter; Graffeo, Charles S

2007-11-01

Macro-level legal and ethical issues play a significant role in the successful translation of knowledge into practice. The medicolegal milieu, in particular, can promote clinical inertia and stifle innovation. Embracing new clinical practice guidelines and best practice models has not protected physicians from superfluous torts; in some cases, emerging evidence has been used as the dagger of trial lawyers rather than the scalpel of physicians. Beyond the legal challenges are overarching justice issues that frame the broad goals of knowledge translation (KT) and technology diffusion. Optimal implementation of the latest evidence requires attention to be paid to the context of the candidate community and the key opinion leaders therein, characterized by the "8Ps" (public, patients, press, physicians, policy makers, private sector, payers, and public health). Ethical and equitable KT also accounts for the global burdens and benefits of implementing innovation such that disparities and gaps in health experienced by the least advantaged are prioritized. Researchers and thought leaders must attend to questions of fairness, economics, and legal risk when investigating ways to promote equity-oriented KT.

Quality of herbal medicines: challenges and solutions.

PubMed

Zhang, Junhua; Wider, Barbara; Shang, Hongcai; Li, Xuemei; Ernst, Edzard

2012-01-01

The popularity of herbal medicines has risen worldwide. This increase in usage renders safety issues important. Many adverse events of herbal medicines can be attributed to the poor quality of the raw materials or the finished products. Different types of herbal medicines are associated with different problems. Quality issues of herbal medicines can be classified into two categories: external and internal. In this review, external issues including contamination (e.g. toxic metals, pesticides residues and microbes), adulteration and misidentification are detailed. Complexity and non-uniformity of the ingredients in herbal medicines are the internal issues affecting the quality of herbal medicines. Solutions to the raised problems are discussed. The rigorous implementation of Good Agricultural and Collection Practices (GACP) and Good Manufacturing Practices (GMP) would undoubtedly reduce the risk of external issues. Through the use of modern analytical methods and pharmaceutical techniques, previously unsolved internal issues have become solvable. Standard herbal products can be manufactured from the standard herbal extracts. Copyright © 2011 Elsevier Ltd. All rights reserved.

Listening to food workers: Factors that impact proper health and hygiene practice in food service.

PubMed

Clayton, Megan L; Clegg Smith, Katherine; Neff, Roni A; Pollack, Keshia M; Ensminger, Margaret

2015-01-01

Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. To investigate food workers' perceptions of factors that impact proper food safety practice. Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice.

Efficiency in mental health practice and research.

PubMed

Lagomasino, Isabel T; Zatzick, Douglas F; Chambers, David A

2010-01-01

Limited financial resources, escalating mental health-related costs and opportunities for capitalizing on advances in health information technologies have brought the theme of efficiency to the forefront of mental health services research and clinical practice. In this introductory article to the journal series stemming from the 20th NIMH Mental Health Services Research Conference, we first delineate the need for a new focus on efficiency in both research and clinical practice. Second, we provide preliminary definitions of efficiency for the field and discuss issues related to measurement. Finally, we explore the interface between efficiency in mental health services research and practice and the NIMH strategic objectives of developing improved interventions for diverse populations and enhancing the public health impact of research. Case examples illustrate how perspectives from dissemination and implementation research may be used to maximize efficiencies in the development and implementation of new service delivery models. Allowing findings from the dissemination and implementation field to permeate and inform clinical practice and research may facilitate more efficient development of interventions and enhance the public health impact of research. Copyright © 2010 Elsevier Inc. All rights reserved.

Lessons Learned from Implementing the Patient-Centered Medical Home

PubMed Central

Green, Ellen P.; Wendland, John; Carver, M. Colette; Hughes Rinker, Cortney; Mun, Seong K.

2012-01-01

The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients' needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH. PMID:22969797

Lessons learned from implementing the patient-centered medical home.

PubMed

Green, Ellen P; Wendland, John; Carver, M Colette; Hughes Rinker, Cortney; Mun, Seong K

2012-01-01

The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients' needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.

Review article: practical current issues in perioperative patient safety.

PubMed

Eichhorn, John H

2013-02-01

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

Surviving the Implementation of a New Science Curriculum

NASA Astrophysics Data System (ADS)

Lowe, Beverly; Appleton, Ken

2015-12-01

Queensland schools are currently teaching with the first National Curriculum for Australia. This new curriculum was one of a number of political responses to address the recurring low scores in literacy, mathematics, and science that continue to hold Australia in poor international rankings. Teachers have spent 2 years getting to know the new science curriculum through meetings, training, and exploring the new Australian curriculum documents. This article examines the support and preparation for implementation provided in two regional schools, with a closer look at six specific teachers and their science teaching practices as they attempted to implement the new science curriculum. The use of a survey, field observations, and interviews revealed the schools' preparation practices and the teachers' practices, including the support provided to implement the new science curriculum. A description and analysis of school support and preparation as well as teachers' views of their experiences implementing the new science curriculum reveal both achievements and shortcomings. Problematic issues for the two schools and teachers include time to read and comprehend the curriculum documents and content expectations as well as time to train and change the current processes effectively. The case teachers' experiences reveal implications for the successful and effective implementation of new curriculum and curriculum reform.

Best practices for preventing musculoskeletal disorders in masonry: stakeholder perspectives.

PubMed

Entzel, Pamela; Albers, Jim; Welch, Laura

2007-09-01

Brick masons and mason tenders report a high prevalence of work-related musculoskeletal disorders (WMSDs), many of which can be prevented with changes in materials, work equipment or work practices. To explore the use of "best practices" in the masonry industry, NIOSH organized a 2-day meeting of masonry stakeholders. Attendees included 30 industry representatives, 5 health and safety researchers, 4 health/safety specialists, 2 ergonomic consultants, and 2 representatives of state workers' compensation programs. Small groups discussed ergonomic interventions currently utilized in the masonry industry, including factors affecting intervention implementation and ways to promote diffusion of interventions. Meeting participants also identified various barriers to intervention implementation, including business considerations, quality concerns, design issues, supply problems, jobsite conditions and management practices that can slow or limit intervention diffusion. To be successful, future diffusion efforts must not only raise awareness of available solutions but also address these practical concerns.

The use of EORTC measures in daily clinical practice-A synopsis of a newly developed manual.

PubMed

Wintner, Lisa M; Sztankay, Monika; Aaronson, Neil; Bottomley, Andrew; Giesinger, Johannes M; Groenvold, Mogens; Petersen, Morten Aa; van de Poll-Franse, Lonneke; Velikova, Galina; Verdonck-de Leeuw, Irma; Holzner, Bernhard

2016-11-01

Cancer has increasingly become a chronic condition and the routine collection of patient-reported outcomes (PROs) like quality of life is widely recommended for clinical practice. Nonetheless, the successful implementation of PROs is still a major challenge, although common barriers to and facilitators of their beneficial use are well known. To support health care professionals and other stakeholders in the implementation of the EORTC PRO measures, the EORTC Quality of Life Group provides guidance on issues considered important for their use in daily clinical practice. Herein, we present an outline of the newly developed "'Manual for the use of EORTC measures in daily clinical practice", covering the following issues: * a rationale for using EORTC measures in routine care *selection of EORTC measures, timing of assessments, scoring and presentation of results * aspects of a strategic implementation * electronic data assessment and telemonitoring, and * further use of EORTC measures and ethical considerations. Next to an extensive overview of currently available literature, the manual specifically focuses on knowledge about EORTC measures to give evidence-based recommendations whenever possible and to encourage readers and end-users of EORTC measures to contribute to further needed high-quality research. The manual will be accessible on the EORTC Quality of Life Group website's homepage and will be periodically updated to take into account any new knowledge due to medical, technical, regulatory and scientific advances. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Examining the Multi-level Fit between Work and Technology in a Secure Messaging Implementation.

PubMed

Ozkaynak, Mustafa; Johnson, Sharon; Shimada, Stephanie; Petrakis, Beth Ann; Tulu, Bengisu; Archambeault, Cliona; Fix, Gemmae; Schwartz, Erin; Woods, Susan

2014-01-01

Secure messaging (SM) allows patients to communicate with their providers for non-urgent health issues. Like other health information technologies, the design and implementation of SM should account for workflow to avoid suboptimal outcomes. SM may present unique workflow challenges because patients add a layer of complexity, as they are also direct users of the system. This study explores SM implementation at two Veterans Health Administration facilities. We interviewed twenty-nine members of eight primary care teams using semi-structured interviews. Questions addressed staff opinions about the integration of SM with daily practice, and team members' attitudes and experiences with SM. We describe the clinical workflow for SM, examining complexity and variability. We identified eight workflow issues directly related to efficiency and patient satisfaction, based on an exploration of the technology fit with multilevel factors. These findings inform organizational interventions that will accommodate SM implementation and lead to more patient-centered care.

Feasibility of energy medicine in a community teaching hospital: an exploratory case series.

PubMed

Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill; Julliard, Kell

2015-06-01

Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Feasibility study, including a prospective case series. Inpatient units and emergency department. To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non-pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated with their chief complaint. Substantial practicality issues must be addressed to implement EM clinically in a hospital, however.

Review of Massachusetts Child Care Subsidy Eligibility Policies and Practices: A Report for the Assessment of the Massachusetts Subsidized Child Care System. Research Report

ERIC Educational Resources Information Center

Adams, Gina; Katz, Michael

2015-01-01

This report summarizes findings from a review of Massachusetts' child care subsidy eligibility policies and implementation practices. The review included interviews and focus groups with approximately 60 experts and stakeholders with a broad range of perspectives on the system. It identifies several important issues that, if addressed, could…

Collegiate Aviation Review. September 1995.

ERIC Educational Resources Information Center

Barker, Ballard M., Ed.

This document contains three papers on aviation education. "Aviation/Aerospace Teacher Education Workshops: Program Development and Implementation" (Mavis F. Green) discusses practical issues in the development of an aviation/aerospace teacher education workshop designed to help elementary school teachers promote aviation to their…

Women with epilepsy: clinically relevant issues

PubMed Central

Bangar, Santosh; Shastri, Abhishek; El-Sayeh, Hany; Cavanna, Andrea E.

2016-01-01

Summary Women with epilepsy (WWE) face specific challenges throughout their lifespan due to the effects of seizures and antiepileptic drugs on hormonal function, potentially affecting both sexual and reproductive health. This review article addresses the most common issues of practical relevance to clinicians treating WWE: epidemiology and clinical presentations (including catamenial epilepsy), contraception, reproductive and sexual dysfunction, pregnancy, lactation, menopause-related issues (including bone health), and mental health aspects. Awareness of these gender-specific issues and implementation/adaptation of effective interventions for WWE results in significantly improved health-related quality of life in this patient population. PMID:27678205

Detecting and addressing adolescent issues and concerns: evaluating the efficacy of a primary care previsit questionnaire.

PubMed

Lewin, Warren; Knäuper, Bärbel; Roseman, Michelle; Adler, Perry; Malus, Michael

2009-07-01

To assess the efficacy of a previsit questionnaire (PVQ), implemented without formal training, that was designed to screen for biomedical and psychosocial health issues and concerns among adolescent patients in a hospital-based primary care clinic, and to examine the subsequent action taken for health issues and concerns identified with the PVQ. Retrospective review of adolescent medical charts, using a pre-post design. An outpatient primary care clinic located in an urban teaching hospital in Montreal, Que. A total of 210 adolescent patients aged 13 to 19 who visited the clinic between 2000 and 2004. The type (medical vs psychosocial) and number of issues detected and actions taken by physicians in one-to-one consultations with adolescent patients 2 years before (2000-2002) and 2 years after (2002-2004) PVQ implementation, as noted in the patients' medical charts. In total, 105 charts were reviewed for each group. An increase in the number of psychosocial issues was detected following the introduction of the PVQ. An increase in the frequency of action taken for psychosocial concerns and a decrease in the frequency of medical action taken by physicians were found after PVQ implementation. More notations related to psychosocial concerns were also found in the adolescents' charts after introduction of the PVQ. A PVQ is an effective strategy to improve adolescent screening for psychosocial issues and concerns. Implementing such a questionnaire requires no training and can therefore be easily incorporated into clinical practice.

Preservice teachers' objectives and their experience of practical work

NASA Astrophysics Data System (ADS)

Nivalainen, V.; Asikainen, M. A.; Hirvonen, P. E.

2013-06-01

This study explores third-year preservice physics teachers’ (n=32) views concerning the objectives of practical work at school and university. Content analysis of their essays about practical work revealed not only the objectives of the practical work undertaken but also how they had experienced teaching as school and university students. The objectives most commonly referred to were related to the connections between theory and practice, motivation, understanding phenomena, learning how to observe, and learning how to report. In contrast, some objectives were recognized only rarely, which is an important issue for discussion as a future challenge. Preservice teachers’ positive experiences of practical work resulted from the successful implementation of practical work. According to our findings, practical work can in many cases be regarded as successful, especially when the participants understand the objectives of the teaching. In contrast, negative experiences reflected failures or difficulties in implementation. We conclude by suggesting that preservice teachers should be offered opportunities to reflect on their previous experiences and to see and experience in practice the advantages of practical work.

Making Sense of Standards: Implementation Issues and the Impact on Teaching Practice. Children Achieving: Philadelphia's Education Reform. Progress Report Series 1996-1997.

ERIC Educational Resources Information Center

Simon, Elaine; Foley, Ellen; Passantino, Claire

The focus of this report is the way standards are influencing instruction in Philadelphia classrooms and how the various parts of the system are working together to support standards-driven instruction at the classroom level. The 1996-97 school year was still an early one in the implementation of standards-based instruction in Philadelphia. The…

Implementation of Mamdani Fuzzy Method in Employee Promotion System

NASA Astrophysics Data System (ADS)

Zulfikar, W. B.; Jumadi; Prasetyo, P. K.; Ramdhani, M. A.

2018-01-01

Nowadays, employees are big assets to an institution. Every employee has a different educational background, degree, work skill, attitude and ethic that affect the performance. An institution including government institution implements a promotion system in order to improve the performance of the employees. Pangandaran Tourism, Industry, Trade, and SME Department is one of government agency that implements a promotion system to discover employees who deserve to get promotion. However, there are some practical deficiencies in the promotion system, one of which is the subjectivity issue. This work proposed a classification model that could minimize the subjectivity issue in employee promotion system. This paper reported a classification employee based on their eligibility for promotion. The degree of membership was decided using Mamdani Fuzzy based on determinant factors of the performance of employees. In the evaluation phase, this model had an accuracy of 91.4%. It goes to show that this model may minimize the subjectivity issue in the promotion system, especially at Pangandaran Tourism, Industry, Trade, and SME Department.

Implementation of genetic conservation practices in a muskellunge propagation and stocking program

USGS Publications Warehouse

Jennings, Martin J.; Sloss, Brian L.; Hatzenbeler, Gene R.; Kampa, Jeffrey M.; Simonson, Timothy D.; Avelallemant, Steven P.; Lindenberger, Gary A.; Underwood, Bruce D.

2010-01-01

Conservation of genetic resources is a challenging issue for agencies managing popular sport fishes. To address the ongoing potential for genetic risks, we developed a comprehensive set of recommendations to conserve genetic diversity of muskellunge (Esox masquinongy) in Wisconsin, and evaluated the extent to which the recommendations can be implemented. Although some details are specific to Wisconsin's muskellunge propagation program, many of the practical issues affecting implementation are applicable to other species and production systems. We developed guidelines to restrict future broodstock collection operations to lakes with natural reproduction and to develop a set of brood lakes to use on a rotational basis within regional stock boundaries, but implementation will require considering lakes with variable stocking histories. Maintaining an effective population size sufficient to minimize the risk of losing alleles requires limiting broodstock collection to large lakes. Recommendations to better approximate the temporal distribution of spawning in hatchery operations and randomize selection of brood fish are feasible. Guidelines to modify rearing and distribution procedures face some logistic constraints. An evaluation of genetic diversity of hatchery-produced fish during 2008 demonstrated variable success representing genetic variation of the source population. Continued evaluation of hatchery operations will optimize operational efficiency while moving toward genetic conservation goals.

Implementation of genetic conservation practices in a muskellunge propagation and stocking program

USGS Publications Warehouse

Jennings, Martin J.; Sloss, Brian L.; Hatzenbeler, Gene R.; Kampa, Jeffrey M.; Simonson, Timothy D.; Avelallemant, Steven P.; Lindenberger, Gary A.; Underwood, Bruce D.

2010-01-01

Conservation of genetic resources is a challenging issue for agencies managing popular sport fishes. To address the ongoing potential for genetic risks, we developed a comprehensive set of recommendations to conserve genetic diversity of muskellunge (Esox masquinongy) in Wisconsin, and evaluated the extent to which the recommendations can be implemented. Although some details are specific to Wisconsin's muskellunge propagation program, many of the practical issues affecting implementation are applicable to other species and production systems. We developed guidelines to restrict future brood stock collection operations to lakes with natural reproduction and to develop a set of brood lakes to use on a rotational basis within regional stock boundaries, but implementation will require considering lakes with variable stocking histories. Maintaining an effective population size sufficient to minimize the risk of losing alleles requires limiting brood stock collection to large lakes. Recommendations to better approximate the temporal distribution of spawning in hatchery operations and randomize selection of brood fish are feasible. Guidelines to modify rearing and distribution procedures face some logistic constraints. An evaluation of genetic diversity of hatchery-produced fish during 2008 demonstrated variable success representing genetic variation of the source population. Continued evaluation of hatchery operations will optimize operational efficiency while moving toward genetic conservation goals.

A new, but old business model for family physicians: cash.

PubMed

Weber, J Michael

2013-01-01

The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making.

The Advantages and Challenges of Unannounced Standardized Patients Methodology to Assess Healthcare Communication

PubMed Central

Siminoff, Laura A.; Rogers, Heather L.; Waller, Allison C.; Harris-Haywood, Sonja; Esptein, Ronald M.; Borrell Carrio, Francesc; Gliva-McConvey, Gayle; Longo, Daniel R.

2011-01-01

Objective This paper provides an overview of the implementation of using Unannounced Standardized Patients (USPs) to conduct health communication research in clinical settings. Methods Certain types of health communication situations are difficult to capture because of their rarity or unpredictable nature. In primary care the real reasons for a visit are frequently unknown until the consultation is well under way. Therefore, it is logistically difficult for communication studies to capture many real-time communications between patients and their physicians. Although the USP methodology is ideal for capturing these communication behaviors, challenges to using this method include developing collaborative relationships with clinical practices, logistical issues such as safeguarding the identity of the USP, training USPs and creating their identities, maintaining fidelity to the role, and analyzing the resultant data. Results This paper discusses the challenges and solutions to USP implementation. We provide an example of how to implement a USP study using an on-going study being conducted in primary care practices. Conclusion This paper explores the advantages and challenges as well as strategies to overcome obstacles to implementing a USP study. Practice Implications Despite the challenges, USP methodology can contribute much to our understanding of health communication and practice. PMID:21316182

A lack of standardization: the basis for the ethical issues surrounding quality and performance reports.

PubMed

Suchy, Kirsten

2010-01-01

Consumers in the United States are taking advantage of the proliferation of publicly available, internet-based performance reports and quality appraisals of health plans, healthcare organizations, hospitals, and physicians to aid in their healthcare decision making. However, these appraisal practices have given rise to controversy and debate over certain distinctive ethical issues. This article advocates a standardized ethical framework to guide current and future development and implementation of performance reports. This framework, which would resolve a number of the major issues, includes the following ethical principles to guide the practice of public reporting on the Internet and facilitate enhanced quality improvement in the healthcare industry: legitimacy, data integrity and quality, transparency, informed understanding, equity, privacy and confidentiality, collaboration, accountability, and evaluation and continuous improvement.

HIV Testing and Treatment with Correctional Populations: People, Not Prisoners

PubMed Central

Seal, David Wyatt; Eldridge, Gloria D.; Zack, Barry; Sosman, James

2014-01-01

Institutional policies, practices, and norms can impede the delivery of ethical standard-of-care treatment for people with HIV in correctional settings. In this commentary, we focus on the fundamental issues that must be addressed to create an ethical environment in which best medical practices can be implemented when working with correctional populations. Thus, we consider ethical issues related to access to services, patient privacy, confidentiality, informed consent for testing and treatment, and issues related to the provision of services in an institutional setting in which maintenance of security is the primary mission. Medical providers must understand and navigate the dehumanization inherent in most correctional settings, competing life demands for incarcerated individuals, power dynamics within the correctional system, and the needs of family and significant others who remain in the community. PMID:20693739

Toward Successful Implementation of Speech Recognition Technology: A Survey of SRT Utilization Issues in Healthcare Settings.

PubMed

Clarke, Martina A; King, Joshua L; Kim, Min Soon

2015-07-01

To evaluate physician utilization of speech recognition technology (SRT) for medical documentation in two hospitals. A quantitative survey was used to collect data in the areas of practice, electronic equipment used for documentation, documentation created after providing care, and overall thoughts about and satisfaction with the SRT. The survey sample was from one rural and one urban facility in central Missouri. In addition, qualitative interviews were conducted with a chief medical officer and a physician champion regarding implementation issues, training, choice of SRT, and outcomes from their perspective. Seventy-one (60%) of the anticipated 125 surveys were returned. A total of 16 (23%) participants were practicing in internal medicine and 9 (13%) were practicing in family medicine. Fifty-six (79%) participants used a desktop and 14 (20%) used a laptop (2%) computer. SRT products from Nuance were the dominant SRT used by 59 participants (83%). Windows operating systems (Microsoft, Redmond, WA) was used by more than 58 (82%) of the survey respondents. With regard to user experience, 42 (59%) participants experienced spelling and grammatical errors, 15 (21%) encountered clinical inaccuracy, 9 (13%) experienced word substitution, and 4 (6%) experienced misleading medical information. This study shows critical issues of inconsistency, unreliability, and dissatisfaction in the functionality and usability of SRT. This merits further attention to improve the functionality and usability of SRT for better adoption within varying healthcare settings.

Internationalization: From Concept to Implementation

ERIC Educational Resources Information Center

Billingham, Craig; Gragg, Monica; Bentley, Guy

2013-01-01

Higher education is in a phase of rapid internationalization, with practices and impacts ranging from curriculum reform to satellite campuses to affiliated partner institutions. Internationally, higher education institutions are increasingly engaged with issues pertaining to technology integration. The primary reason for this is a growing…

Accountability to Public Stakeholders in Watershed-Based Restoration

EPA Science Inventory

There is an increasing push at the federal, state, and local levels for watershed-based conservation projects. These projects work to address water quality issues in degraded waterways through the implementation of a suite of best management practices on land throughout a watersh...

Building Better Buildings: Sustainable Building Activities in California Higher Education Systems.

ERIC Educational Resources Information Center

Sowell, Arnold; Eichel, Amanda; Alevantis, Leon; Lovegreen, Maureen

2003-01-01

This article outlines the activities and recommendations of California's sustainable building task force, discusses sustainable building activities in California's higher education systems, and highlights key issues that California is grappling with in its implementation of sustainable building practices. (EV)

Massachusetts Superintendents' Perceptions of Teacher Bargaining Practices

ERIC Educational Resources Information Center

Borstel, Scott L.

2010-01-01

For five decades, collective bargaining has been implemented in American public schools (Loveless, 2000). It has protected the rights of teachers; and teacher work conditions issues and compensation have improved (Hannaway & Rotherham, 2006). However, improvements have created adversarial labor-management relationships, resulted in excessive…

Research and organizational issues for the implementation of family work in community psychiatric services.

PubMed

Jones, Adrian; Scannell, Tony

2002-04-01

The need for evidence-based practice (EBP) to guide and develop mental health services remains fundamental for modern services. Aim. To discuss issues that impact upon implementation of EBP and practice development using family work (FW) as an example. A selection of the FW literature was reviewed drawing on sources including the Cochrane Library, Cinahl and Medline. Keywords used were FW, community mental health team and research design. Centralized policy initiatives and guidelines that are themselves guided by evidence of randomized controlled trials predominantly risk alienating practitioners and clients/carers. Family work has some demonstrable clinical benefits although models differ and the active therapeutic agent remains unclear. Its adoption into routine care is also hindered by a productivity management outlook that seeks to maximize stretched resources and whose values are likely to be internalized by practitioners. The dichotomous position of previous research and practice development make implementation of EBP difficult and highlights the need for strategic planning that embraces both factors. The current drive to increase EBP requires a bi-directional process of influence that allows individual practitioners and clients/carers to become producers of evidence and not simply recipients. The authors support wider adoption of case study research designs to reflect the unpredictable nature of mental health care. Adoption of assertive community treatment models within community services is most likely to promote the excellence management model and accommodate EBP such as FW.

Implementation of real-time ultrasound in a thoracic surgery practice.

PubMed

Coonar, Aman S; Hughes, Jacqueline A; Walker, Susan; dePerrot, Marc; Waddell, Thomas K; Pierre, Andrew F; Darling, Gail E; Johnston, Michael R; Keshavjee, Shaf

2009-05-01

The purpose of this study was to implement real-time transthoracic ultrasound in a thoracic surgery and lung transplant practice. Ultrasound units that are light, small, robust, and portable are now available. Obstacles to use include demarcation issues between specialties, training, and a perception that basic ultrasound may be difficult to use. The experience of implementing this is described. After a training period, 62 studies were performed in 4 months. Patients and clinicians gave positive feedback. The learning time was short, and with ultrasonic guidance, all interventional procedures were successful at the first attempt, without any complications. Basic transthoracic ultrasound was found to be easy to learn and use by thoracic surgeons, fellows, and specialist nurses. Patients were appreciative. Real-time use may have genuine advantages to patient care.

Clinical governance in Scotland: an educational model.

PubMed Central

Lough, Murray; Kelly, Diane; Taylor, Mike; Snadden, David; Patterson, Bill; McNamara, Iain; Murray, Stuart

2002-01-01

The concepts underpinning clinical governance are similar throughout the United Kingdom but models for its implementation will differ widely. This model aims to enable practices to identify areas for further learning and development against specific outcomes. Criteria sets and standards are suggested and a governance plan is used to allow practices to prioritise their objectives. Resourcing will always be a major issue and such a model should be fully evaluated. PMID:11942453

Clinical governance in Scotland: an educational model.

PubMed

Lough, Murray; Kelly, Diane; Taylor, Mike; Snadden, David; Patterson, Bill; McNamara, Iain; Murray, Stuart

2002-04-01

The concepts underpinning clinical governance are similar throughout the United Kingdom but models for its implementation will differ widely. This model aims to enable practices to identify areas for further learning and development against specific outcomes. Criteria sets and standards are suggested and a governance plan is used to allow practices to prioritise their objectives. Resourcing will always be a major issue and such a model should be fully evaluated.

The art of co-production of knowledge in environmental sciences and management: lessons from international practice

NASA Astrophysics Data System (ADS)

Djenontin, Ida Nadia S.; Meadow, Alison M.

2018-06-01

This review paper addresses the challenging question of "how to" design and implement co-production of knowledge in climate science and other environmental and agricultural sciences. Based on a grounded theory review of nine (9) published case studies of transdisciplinary and collaborative research projects, the paper offers a set of common themes regarding specific components and processes for the design, implementation, and achievement of co-production of knowledge work, which represent the "Modus Operandi" of knowledge co-production. The analysis focuses on practical methodological guidance based on lessons from how different research teams have approached the challenges of complex collaborative research. We begin by identifying broad factors or actions that inhibit or facilitate the process, then highlight specific practices associated with co-production of knowledge and necessary competencies for undertaking co-production. We provide insights on issues such as the integration of social and professional cultures, gender and social equity, and power dynamics, and illustrate the different ways in which researchers have addressed these issues. By exploring the specific practices involved in knowledge co-production, this paper provides guidance to researchers on how to navigate different possibilities of the process of conducting transdisciplinary and co-production of knowledge research projects that best fit their research context, stakeholder needs, and research team capacities.

The art of co-production of knowledge in environmental sciences and management: lessons from international practice.

PubMed

Djenontin, Ida Nadia S; Meadow, Alison M

2018-06-01

This review paper addresses the challenging question of "how to" design and implement co-production of knowledge in climate science and other environmental and agricultural sciences. Based on a grounded theory review of nine (9) published case studies of transdisciplinary and collaborative research projects, the paper offers a set of common themes regarding specific components and processes for the design, implementation, and achievement of co-production of knowledge work, which represent the "Modus Operandi" of knowledge co-production. The analysis focuses on practical methodological guidance based on lessons from how different research teams have approached the challenges of complex collaborative research. We begin by identifying broad factors or actions that inhibit or facilitate the process, then highlight specific practices associated with co-production of knowledge and necessary competencies for undertaking co-production. We provide insights on issues such as the integration of social and professional cultures, gender and social equity, and power dynamics, and illustrate the different ways in which researchers have addressed these issues. By exploring the specific practices involved in knowledge co-production, this paper provides guidance to researchers on how to navigate different possibilities of the process of conducting transdisciplinary and co-production of knowledge research projects that best fit their research context, stakeholder needs, and research team capacities.

Eliminating extravasation events: a multidisciplinary approach.

PubMed

Coyle, Christine E; Griffie, Julie; Czaplewski, Lynn M

2014-01-01

Administration of chemotherapy agents can give rise to many safety issues. Extravasation of a vesicant agent causes tissue blistering and necrosis. This complication of chemotherapy administration causes additional pain and suffering in patients who are already suffering with a diagnosis of cancer. Nurses hold key responsibilities for educating patients about administration issues and following practice standards to minimize the risk of extravasation. Defining a path of shared responsibilities among team members is a critical step in assuring the safe administration of drugs classified as vesicants. This article describes a clinical practice change that is used at a large midwestern academic medical cancer center. This practice and policy change has resulted in a 90% reduction in the administration of vesicant agents peripherally, with no occurrence of extravasations in the first 6 months of implementation.

Eliminating Extravasation Events: A Multidisciplinary Approach.

PubMed

Coyle, Christine E; Griffie, Julie; Czaplewski, Lynn M

2015-01-01

Administration of chemotherapy agents can give rise to many safety issues. Extravasation of a vesicant agent causes tissue blistering and necrosis. This complication of chemotherapy administration causes additional pain and suffering in patients who are already suffering with a diagnosis of cancer. Nurses hold key responsibilities for educating patients about administration issues and following practice standards to minimize the risk of extravasation. Defining a path of shared responsibilities among team members is a critical step in assuring the safe administration of drugs classified as vesicants. This article describes a clinical practice change that is used at a large midwestern academic medical cancer center. This practice and policy change has resulted in a 90% reduction in the administration of vesicant agents peripherally, with no occurrence of extravasations in the first 6 months of implementation.

Cerebrospinal fluid protein and glucose examinations and tuberculosis:
Will laboratory safety regulations force a change of practice?

PubMed

Tormey, William P; O'Hagan, Christopher

2015-01-01

Cerebrospinal fluid (CSF) protein and glucose examinations are usually performed in chemical pathology departments on autoanalysers. Tuberculosis (TB) is a group 3 biological agent under Directive 2000/54/EC of the European Parliament but in the biochemistry laboratory, no extra precautions are taken in its analysis in possible TB cases. The issue of laboratory practice and safety in the biochemical analyses of CSF specimens, when tuberculosis infection is in question is addressed in the context of ambiguity in the implementation of current national and international health and safety regulations. Additional protective measures for laboratory staff during the analysis of CSF TB samples should force a change in current laboratory practice and become a regulatory issue under ISO 15189. Annual Mantoux skin test or an interferon-γ release assay for TB should be mandatory for relevant staff. This manuscript addresses the issue of biochemistry laboratory practice and safety in the biochemical analyses of CSF specimens when tuberculosis infection is in question in the context of the ambiguity of statutory health and safety regulations.

Social and environmental sustainability in large-scale coastal zones: Taking an issue-based approach to the implementation of the Prince William Sound sustainable human use framework

Treesearch

Dale J. Blahna; Aaron Poe; Courtney Brown; Clare M. Ryan; H. Randy Gimblett

2017-01-01

Following the grounding of the Exxon Valdez in 1989, a sustainable human use framework (human use framework) for Prince William Sound (PWS), AK was developed by the Chugach National Forest after concerns emerged about the social and environmental impacts of expanding human use due to cleanup activities and increased recreation visitation. A practical, issue-based...

Improving Teacher Quality and Effectiveness. Issues for the '80s. Planning Grant for the Development of an Institutional Grant Proposal to Establish an NIE Research and Development Center for Teacher Quality and Effectiveness.

ERIC Educational Resources Information Center

Hawley, Willis D.; And Others

This paper presents an overview of several of the problems and conditions of the teaching profession and discusses different issues related to the development and implementation of policies, programs, and practices designed to address them. The opening section examines the conditions of teaching--employment opportunities, teacher evaluation,…

Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation.

PubMed

Scott, Ian A; Sullivan, Clair; Staib, Andrew

2018-05-24

Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.

The research evidence published in high impact nursing journals between 2000 and 2006: a quantitative content analysis.

PubMed

Mantzoukas, Stefanos

2009-04-01

Evidence-based practice has become an imperative for efficient, effective and safe practice. Furthermore, evidences emerging from published research are considered as valid knowledge sources to guiding practice. The aim of this paper is to review all research articles published in the top 10 general nursing journals for the years 2000-2006 to identify the methodologies used, the types of evidence these studies produced and the issues upon which they endeavored. Quantitative content analysis was implemented to study all published research papers of the top 10 general nursing journals for the years 2000-2006. The top 10 general nursing journals were included in the study. The abstracts of all research articles were analysed with regards the methodologies of enquiry, the types of evidence produced and the issues of study they endeavored upon. Percentages were developed as to enable conclusions to be drawn. The results for the category methodologies used were 7% experimental, 6% quasi-experimental, 39% non-experimental, 2% ethnographical studies, 7% phenomenological, 4% grounded theory, 1% action research, 1% case study, 15% unspecified, 5.5% other, 0.5% meta-synthesis, 2% meta-analysis, 5% literature reviews and 3% secondary analysis. For the category types of evidence were 4% hypothesis/theory testing, 11% evaluative, 5% comparative, 2% correlational, 46% descriptive, 5% interpretative and 27% exploratory. For the category issues of study were 45% practice/clinical, 8% educational, 11% professional, 3% spiritual/ethical/metaphysical, 26% health promotion and 7% managerial/policy. Published studies can provide adequate evidences for practice if nursing journals conceptualise evidence emerging from non-experimental and qualitative studies as relevant types of evidences for practice and develop appropriate mechanisms for assessing their validity. Also, nursing journals need to increase and encourage the publication of studies that implement RCT methodology, systematic reviews, meta-synthesis and meta-analysis methodologies. Finally, nursing journals need to encourage more high quality research evidence that derive from interpretative, theory testing and evaluative types of studies that are practice relevant.

BIM: Enabling Sustainability and Asset Management through Knowledge Management

PubMed Central

2013-01-01

Building Information Modeling (BIM) is the use of virtual building information models to develop building design solutions and design documentation and to analyse construction processes. Recent advances in IT have enabled advanced knowledge management, which in turn facilitates sustainability and improves asset management in the civil construction industry. There are several important qualifiers and some disadvantages of the current suite of technologies. This paper outlines the benefits, enablers, and barriers associated with BIM and makes suggestions about how these issues may be addressed. The paper highlights the advantages of BIM, particularly the increased utility and speed, enhanced fault finding in all construction phases, and enhanced collaborations and visualisation of data. The paper additionally identifies a range of issues concerning the implementation of BIM as follows: IP, liability, risks, and contracts and the authenticity of users. Implementing BIM requires investment in new technology, skills training, and development of new ways of collaboration and Trade Practices concerns. However, when these challenges are overcome, BIM as a new information technology promises a new level of collaborative engineering knowledge management, designed to facilitate sustainability and asset management issues in design, construction, asset management practices, and eventually decommissioning for the civil engineering industry. PMID:24324392

BIM: enabling sustainability and asset management through knowledge management.

PubMed

Kivits, Robbert Anton; Furneaux, Craig

2013-11-10

Building Information Modeling (BIM) is the use of virtual building information models to develop building design solutions and design documentation and to analyse construction processes. Recent advances in IT have enabled advanced knowledge management, which in turn facilitates sustainability and improves asset management in the civil construction industry. There are several important qualifiers and some disadvantages of the current suite of technologies. This paper outlines the benefits, enablers, and barriers associated with BIM and makes suggestions about how these issues may be addressed. The paper highlights the advantages of BIM, particularly the increased utility and speed, enhanced fault finding in all construction phases, and enhanced collaborations and visualisation of data. The paper additionally identifies a range of issues concerning the implementation of BIM as follows: IP, liability, risks, and contracts and the authenticity of users. Implementing BIM requires investment in new technology, skills training, and development of new ways of collaboration and Trade Practices concerns. However, when these challenges are overcome, BIM as a new information technology promises a new level of collaborative engineering knowledge management, designed to facilitate sustainability and asset management issues in design, construction, asset management practices, and eventually decommissioning for the civil engineering industry.

Safety and health practice among laboratory staff in Malaysian education sector

NASA Astrophysics Data System (ADS)

Husna Che Hassan, Nurul; Rasdan Ismail, Ahmad; Kamilah Makhtar, Nor; Azwadi Sulaiman, Muhammad; Syuhadah Subki, Noor; Adilah Hamzah, Noor

2017-10-01

Safety is the most important issue in industrial sector such as construction and manufacturing. Recently, the increasing number of accident cases reported involving school environment shows the important of safety issues in education sector. Safety awareness among staff in this sector is crucial in order to find out the method to prevent the accident occurred in future. This study was conducted to analyze the knowledge of laboratory staff in term of safety and health practice in laboratory. Survey questionnaires were distributing among 255 of staff laboratory from ten District Education Offices in Kelantan. Descriptive analysis shows that the understanding of safety and health practice are low while doing some job activities in laboratory. Furthermore, some of the staff also did not implemented safety practice that may contribute to unplanned event occur in laboratory. Suggestion that the staff at laboratory need to undergo on Occupational Safety and Health training to maintain and create safe environment in workplaces.

Robust variance estimation with dependent effect sizes: practical considerations including a software tutorial in Stata and spss.

PubMed

Tanner-Smith, Emily E; Tipton, Elizabeth

2014-03-01

Methodologists have recently proposed robust variance estimation as one way to handle dependent effect sizes in meta-analysis. Software macros for robust variance estimation in meta-analysis are currently available for Stata (StataCorp LP, College Station, TX, USA) and spss (IBM, Armonk, NY, USA), yet there is little guidance for authors regarding the practical application and implementation of those macros. This paper provides a brief tutorial on the implementation of the Stata and spss macros and discusses practical issues meta-analysts should consider when estimating meta-regression models with robust variance estimates. Two example databases are used in the tutorial to illustrate the use of meta-analysis with robust variance estimates. Copyright © 2013 John Wiley & Sons, Ltd.

Independence as a practice issue in occupational therapy: the safety clause.

PubMed

Russell, Cherry; Fitzgerald, Maureen H; Williamson, Peter; Manor, Debra; Whybrow, Samantha

2002-01-01

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a "critical incident" interview approach with 12 Australian occupational therapists, we identified the therapists' explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call "the safety clause." That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

What can the past of pay-for-performance tell us about the future of Value-Based Purchasing in Medicare?

PubMed

Ryan, Andrew M; Damberg, Cheryl L

2013-06-01

The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in arthritis care.

PubMed

Lundon, Katie; Kennedy, Carol; Rozmovits, Linda; Sinclair, Lynne; Shupak, Rachel; Warmington, Kelly; Passalent, Laura; Brooks, Sydney; Schneider, Rayfel; Soever, Leslie

2013-09-01

Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthcare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in arthritis care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period. ACPAC graduates work across heterogeneous settings and are on teams of diverse size and composition. Seventy per cent perceived their team as actively working in an interprofessional care model. Mean scores on the Bruyère Clinical Team Self-Assessment on Interprofessional Practice subjective subscales were high (range: 3.66-4.26, scale: 1-5 = better perception of team's interprofessional practice), whereas the objective scale was lower (mean: 4.6, scale: 0-9 = more interprofessional team practices). Data from focus groups (ACPAC graduates) and interviews (stakeholders) provided further illumination of these results at individual, group and system levels. Issues relating to ACPAC graduate role recognition, as well as their deployment, integration and institutional support, including access to medical directives, limitation of scope of practice, remuneration conflicts and tenuous funding arrangements were barriers perceived to affect role implementation and interprofessional working. This study offers the opportunity to reflect on newly introduced roles for health professionals with expectations of collaboration that will challenge traditional healthcare delivery.

It's more complicated than that Comment on "Translating evidence into healthcare policy and practice: single versus multi-faceted implementation strategies - is there a simple answer to a complex question?".

PubMed

Rycroft-Malone, Jo

2015-03-17

In this commentary the findings from a systematic review that concluded there is no compelling evidence to suggest that implementing complicated, multi-faceted interventions is more effective than simple, single component interventions to changing healthcare professional's behaviour are considered through the lens of Harvey and Kitson's editorial. Whilst an appealing conclusion, it is one that hides a myriad of complexities. These include issues concerning how best to tailor interventions and how best to evaluate such efforts. These are complex issues that do not have simple solutions. © 2015 by Kerman University of Medical Sciences.

Reforms in pedagogy and the Confucian tradition: looking below the surface

NASA Astrophysics Data System (ADS)

Ho, Felix M.

2018-03-01

This Forum article addresses some of the issues raised in the article by Ying-Syuan Huang and Anila Asghar's paper entitled: Science education reform in Confucian learning cultures: teachers' perspectives on policy and practice in Taiwan. An attempt is made to highlight the need for a more nuanced approach in considering the Confucian education tradition and its compatibility with education reforms. In particular, the article discusses issues concerning the historical development of the Confucian education tradition, challenges in reform implementation that are in reality tradition-independent, as well as opportunities and points of convergence that the Confucian education tradition presents that can in fact be favorable to implementation of reform-based pedagogies.

Considerations to Enhance the Florida Domestic Security Strategic Plan

DTIC Science & Technology

2011-03-01

In his book, Implementing your Strategic Plan How to Turn “Intent” Into Effective Action for Sustainable Change, C. Davis Fogg suggests that...companies that are long-term, strategic winners faithfully practice 18 keys to strategy implementation (1999). Fogg states to begin, a company must have a...this small group of strategic priority issues will lead one toward an envisioned future ( Fogg , 1999, p. 6). Fogg suggests that it is important

Theoretical and Practical Issues of the Implementation of International Norms on Human Rights to the National Legislation (the Example of the Republic of Azerbaijan)

ERIC Educational Resources Information Center

Aliyev, Subhan F.

2016-01-01

The purpose of the study is to analyze the features of the implementation of international norms on human rights to the national law system of the Republic of Azerbaijan. Using the method of the critical analysis of national legislative framework on human rights, the authors argue that there are some certain problems connected with the application…

Assessment and management of burn pain at the Komfo Anokye Teaching Hospital: a best practice implementation project.

PubMed

Bayuo, Jonathan; Munn, Zachary; Campbell, Jared

2017-09-01

Pain management is a significant issue in health facilities in Ghana. For burn patients, this is even more challenging as burn pain has varied facets. Despite the existence of pharmacological agents for pain management, complaints of pain still persist. The aim of this project was to identify pain management practices in the burns units of Komfo Anokye Teaching Hospital, compare these approaches to best practice, and implement strategies to enhance compliance to standards. Ten evidence-based audit criteria were developed from evidence summaries. Using the Joanna Briggs Institute Practical Application of Clinical Evidence Software (PACES), a baseline audit was undertaken on a convenience sample of ten patients from the day of admission to the seventh day. Thereafter, the Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. After implementation of the strategies, a follow-up audit was undertaken using the same sample size and audit criteria. The baseline results showed poor adherence to best practice. However, following implementation of strategies, including ongoing professional education and provision of assessment tools and protocols, compliance rates improved significantly. Atlhough the success of this project was almost disrupted by an industrial action, collaboration with external bodies enabled the successful completion of the project. Pain management practices in the burns unit improved at the end of the project which reflects the importance of an audit process, education, providing feedback, group efforts and effective collaboration.

5 CFR 724.403 - Advisory guidelines.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Advisory guidelines. 724.403 Section 724... (CONTINUED) IMPLEMENTATION OF TITLE II OF THE NOTIFICATION AND FEDERAL EMPLOYEE ANTIDISCRIMINATION AND RETALIATION ACT OF 2002 Best Practices § 724.403 Advisory guidelines. OPM will issue advisory guidelines to...

5 CFR 724.403 - Advisory guidelines.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Advisory guidelines. 724.403 Section 724... (CONTINUED) IMPLEMENTATION OF TITLE II OF THE NOTIFICATION AND FEDERAL EMPLOYEE ANTIDISCRIMINATION AND RETALIATION ACT OF 2002 Best Practices § 724.403 Advisory guidelines. OPM will issue advisory guidelines to...

5 CFR 724.403 - Advisory guidelines.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Advisory guidelines. 724.403 Section 724... (CONTINUED) IMPLEMENTATION OF TITLE II OF THE NOTIFICATION AND FEDERAL EMPLOYEE ANTIDISCRIMINATION AND RETALIATION ACT OF 2002 Best Practices § 724.403 Advisory guidelines. OPM will issue advisory guidelines to...

5 CFR 724.403 - Advisory guidelines.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Advisory guidelines. 724.403 Section 724... (CONTINUED) IMPLEMENTATION OF TITLE II OF THE NOTIFICATION AND FEDERAL EMPLOYEE ANTIDISCRIMINATION AND RETALIATION ACT OF 2002 Best Practices § 724.403 Advisory guidelines. OPM will issue advisory guidelines to...

Best practices for the implementation of the REAL ID Act.

DOT National Transportation Integrated Search

2015-10-01

The REAL ID Act specifies the minimum standards that must be used to produce and issue drivers license and : identification cards that are REAL ID compliant. Beginning in 2020, if a person does not possess a form of : identification that meets REA...

Preparing Nursing Students for Interprofessional Practice: The Interdisciplinary Curriculum for Oncology Palliative Care Education.

PubMed

Hermann, Carla P; Head, Barbara A; Black, Karen; Singleton, Karen

2016-01-01

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication, collaboration, and team work. Nurse educators are ideally positioned to develop and lead such initiatives. The purpose of this article is to describe the development and implementation of an interprofessional education (IPE) project involving students in nursing, medicine, social work, and chaplaincy. The Interdisciplinary Curriculum for Oncology Palliative Care Education project uses team-based palliative oncology education as the framework for teaching students interprofessional practice skills. The need for IPE is apparent, but there are very few comprehensive, successful projects for nurse educators to use as models. This article describes the development of the curriculum by the interprofessional faculty team. Issues encountered by nursing faculty members as they implemented the IPE experience are discussed. Solutions developed to address the issues and ongoing challenges are presented. This project can serve as a model of a successful IPE initiative involving nursing students. Copyright © 2016 Elsevier Inc. All rights reserved.

Probing the Relationship Between Evidence-Based Practice Implementation Models and Critical Thinking in Applied Nursing Practice.

PubMed

Canada, Amanda N

2016-04-01

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Probing the Relationship Between Evidence-Based Practice Implementation Models and Critical Thinking in Applied Nursing Practice," found on pages 161-168, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until March 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. • Describe the key components and characteristics related to evidence-based practice and critical thinking. • Identify the relationship between evidence-based practice and critical thinking. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. Evidence-based practice is not a new concept to the profession of nursing, yet its application and sustainability is inconsistent in nursing practice. Despite the expansion of efforts to teach evidence-based practice and practically apply evidence at the bedside, a research-practice gap still exists. Several critical factors contribute to the successful application of evidence into practice, including critical thinking. The purpose of this article is to discuss the relationship between critical thinking and the current evidence-based practice implementation models. Understanding this relationship will help nurse educators and clinicians in cultivating critical thinking skills in nursing staff to most effectively apply evidence at the bedside. Critical thinking is a key element and is essential to the learning and implementation of evidence-based practice, as demonstrated by its integration into evidence-based practice implementation models. Copyright 2016, SLACK Incorporated.

Epistemological Syncretism in a Biology Classroom: A Case Study

NASA Astrophysics Data System (ADS)

Bennett, William D.; Park, Soonhye

2011-02-01

In teaching science, the beliefs of teachers may come into conflict and inhibit the implementation of reformed teaching practice. An experienced biology teacher, Mr. Hobbs, was found to have two different sets of epistemological beliefs while his classroom practice was predominantly teacher-centered. A case study was then performed in order to investigate the underlying issues that contributed to his classroom practice. Data sources included preliminary and follow-up interviews and classroom observations. Data analysis indicated that factors that prevented the epistemological conflict from reaching a resolution included Mr. Hobbs' beliefs about learning, contextual teaching factors, personal experiences as a student, and views of the nature of science. The findings from this case indicate that science teachers possess complex belief systems that are not immediately obvious to either the teacher or science teacher educators, and science teacher educators need to address teacher beliefs when they encourage teachers to implement reformed teaching practices.

Practice-based Learning and Improvement (PBLI) in Postgraduate Medical Training: Milestones, Instructional and Assessment strategies.

PubMed

Mahajan, Rajiv; Anshu, -; Gupta, Piyush; Singh, Tejinder

2017-04-15

Patient-safety and quality-improvement are high-priority issues. One of the ways by which this can be implemented is by training residents to gather and appraise scientific evidence, as well as to evaluate their own patient-care practices. This competency is called Practice-based Learning and Improvement (PBLI). Training in PBLI provides residents with skills and knowledge necessary to reflect on their own strengths and deficiencies, identify their own learning needs, and engage in learning for improvement. PBLI also involves teaching residents to access and integrate literature by using scientific evidence and practice experience to make better clinical decisions. Training in PBLI has been found to lead to better health outcomes. We recommend explicitly incorporating elements of PBLI training and assessment in the present residency training curriculum in India. Implementing PBLI training and assessment will also require capacity-building through targeted faculty development programs.

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

PubMed

Geach, Nicole; Moghaddam, Nima G; De Boos, Danielle

2018-06-01

Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice. © 2017 The British Psychological Society.

Developing a policy for paediatric biobanks: principles for good practice

PubMed Central

Hens, Kristien; Van El, Carla E; Borry, Pascal; Cambon-Thomsen, Anne; Cornel, Martina C; Forzano, Francesca; Lucassen, Anneke; Patch, Christine; Tranebjaerg, Lisbeth; Vermeulen, Eric; Salvaterra, Elena; Tibben, Aad; Dierickx, Kris

2013-01-01

The participation of minors in biobank research can offer great benefits for science and health care. However, as minors are a vulnerable population they are also in need of adequate protective measures when they are enrolled in research. Research using biobanked biological samples from children poses additional ethical issues to those raised by research using adult biobanks. For example, small children have only limited capacity, if any, to understand the meaning and implications of the research and to give a documented agreement to it. Older minors are gradually acquiring this capacity. We describe principles for good practice related to the inclusion of minors in biobank research, focusing on issues related to benefits and subsidiarity, consent, proportionality and return of results. Some of these issues are currently heavily debated, and we conclude by providing principles for good practice for policy makers of biobanks, researchers and anyone involved in dealing with stored tissue samples from children. Actual implementation of the principles will vary according to different jurisdictions. PMID:22713814

Launching a Laboratory Testing Process Quality Improvement Toolkit: From the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).

PubMed

Fernald, Douglas; Hamer, Mika; James, Kathy; Tutt, Brandon; West, David

2015-01-01

Family medicine and internal medicine physicians order diagnostic laboratory tests for nearly one-third of patient encounters in an average week, yet among medical errors in primary care, an estimated 15% to 54% are attributed to laboratory testing processes. From a practice improvement perspective, we (1) describe the need for laboratory testing process quality improvements from the perspective of primary care practices, and (2) describe the approaches and resources needed to implement laboratory testing process quality improvements in practice. We applied practice observations, process mapping, and interviews with primary care practices in the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)-affiliated practice-based research networks that field-tested in 2013 a laboratory testing process improvement toolkit. From the data collected in each of the 22 participating practices, common testing quality issues included, but were not limited to, 3 main testing process steps: laboratory test preparation, test tracking, and patient notification. Three overarching qualitative themes emerged: practices readily acknowledge multiple laboratory testing process problems; practices know that they need help addressing the issues; and practices face challenges with finding patient-centered solutions compatible with practice priorities and available resources. While practices were able to get started with guidance and a toolkit to improve laboratory testing processes, most did not seem able to achieve their quality improvement aims unassisted. Providing specific guidance tools with practice facilitation or other rapid-cycle quality improvement support may be an effective approach to improve common laboratory testing issues in primary care. © Copyright 2015 by the American Board of Family Medicine.

Survey of beaver-related restoration practices in rangeland streams of the western USA

USGS Publications Warehouse

Pilliod, David S.; Rohde, Ashley T.; Charnley, Susan; Davee, Rachael R; Dunham, Jason B.; Gosnell, Hannah; Grant, Gordon E.; Hausner, Mark B.; Huntington, Justin L.; Nash, Caroline

2018-01-01

Poor condition of many streams and concerns about future droughts in the arid and semi-arid western USA have motivated novel restoration strategies aimed at accelerating recovery and increasing water resources. Translocation of beavers into formerly occupied habitats, restoration activities encouraging beaver recolonization, and instream structures mimicking the effects of beaver dams are restoration alternatives that have recently gained popularity because of their potential socioeconomic and ecological benefits. However, beaver dams and dam-like structures also harbor a history of social conflict. Hence, we identified a need to assess the use of beaver-related restoration projects in western rangelands to increase awareness and accountability, and identify gaps in scientific knowledge. We inventoried 97 projects implemented by 32 organizations, most in the last 10 years. We found that beaver-related stream restoration projects undertaken mostly involved the relocation of nuisance beavers. The most common goal was to store water, either with beaver dams or artificial structures. Beavers were often moved without regard to genetics, disease, or potential conflicts with nearby landowners. Few projects included post-implementation monitoring or planned for longer term issues, such as what happens when beavers abandon a site or when beaver dams or structures breach. Human dimensions were rarely considered and water rights and other issues were mostly unresolved or addressed through ad-hoc agreements. We conclude that the practice and implementation of beaver-related restoration has outpaced research on its efficacy and best practices. Further scientific research is necessary, especially research that informs the establishment of clear guidelines for best practices.

Survey of Beaver-related Restoration Practices in Rangeland Streams of the Western USA.

PubMed

Pilliod, David S; Rohde, Ashley T; Charnley, Susan; Davee, Rachael R; Dunham, Jason B; Gosnell, Hannah; Grant, Gordon E; Hausner, Mark B; Huntington, Justin L; Nash, Caroline

2018-01-01

Poor condition of many streams and concerns about future droughts in the arid and semi-arid western USA have motivated novel restoration strategies aimed at accelerating recovery and increasing water resources. Translocation of beavers into formerly occupied habitats, restoration activities encouraging beaver recolonization, and instream structures mimicking the effects of beaver dams are restoration alternatives that have recently gained popularity because of their potential socioeconomic and ecological benefits. However, beaver dams and dam-like structures also harbor a history of social conflict. Hence, we identified a need to assess the use of beaver-related restoration projects in western rangelands to increase awareness and accountability, and identify gaps in scientific knowledge. We inventoried 97 projects implemented by 32 organizations, most in the last 10 years. We found that beaver-related stream restoration projects undertaken mostly involved the relocation of nuisance beavers. The most common goal was to store water, either with beaver dams or artificial structures. Beavers were often moved without regard to genetics, disease, or potential conflicts with nearby landowners. Few projects included post-implementation monitoring or planned for longer term issues, such as what happens when beavers abandon a site or when beaver dams or structures breach. Human dimensions were rarely considered and water rights and other issues were mostly unresolved or addressed through ad-hoc agreements. We conclude that the practice and implementation of beaver-related restoration has outpaced research on its efficacy and best practices. Further scientific research is necessary, especially research that informs the establishment of clear guidelines for best practices.

Survey of Beaver-related Restoration Practices in Rangeland Streams of the Western USA

NASA Astrophysics Data System (ADS)

Pilliod, David S.; Rohde, Ashley T.; Charnley, Susan; Davee, Rachael R.; Dunham, Jason B.; Gosnell, Hannah; Grant, Gordon E.; Hausner, Mark B.; Huntington, Justin L.; Nash, Caroline

2018-01-01

Poor condition of many streams and concerns about future droughts in the arid and semi-arid western USA have motivated novel restoration strategies aimed at accelerating recovery and increasing water resources. Translocation of beavers into formerly occupied habitats, restoration activities encouraging beaver recolonization, and instream structures mimicking the effects of beaver dams are restoration alternatives that have recently gained popularity because of their potential socioeconomic and ecological benefits. However, beaver dams and dam-like structures also harbor a history of social conflict. Hence, we identified a need to assess the use of beaver-related restoration projects in western rangelands to increase awareness and accountability, and identify gaps in scientific knowledge. We inventoried 97 projects implemented by 32 organizations, most in the last 10 years. We found that beaver-related stream restoration projects undertaken mostly involved the relocation of nuisance beavers. The most common goal was to store water, either with beaver dams or artificial structures. Beavers were often moved without regard to genetics, disease, or potential conflicts with nearby landowners. Few projects included post-implementation monitoring or planned for longer term issues, such as what happens when beavers abandon a site or when beaver dams or structures breach. Human dimensions were rarely considered and water rights and other issues were mostly unresolved or addressed through ad-hoc agreements. We conclude that the practice and implementation of beaver-related restoration has outpaced research on its efficacy and best practices. Further scientific research is necessary, especially research that informs the establishment of clear guidelines for best practices.

[Sustainable Implementation of Evidence-Based Programmes in Health Promotion: A Theoretical Framework and Concept of Interactive Knowledge to Action].

PubMed

Rütten, A; Wolff, A; Streber, A

2016-03-01

This article discusses 2 current issues in the field of public health research: (i) transfer of scientific knowledge into practice and (ii) sustainable implementation of good practice projects. It also supports integration of scientific and practice-based evidence production. Furthermore, it supports utilisation of interactive models that transcend deductive approaches to the process of knowledge transfer. Existing theoretical approaches, pilot studies and thoughtful conceptual considerations are incorporated into a framework showing the interplay of science, politics and prevention practice, which fosters a more sustainable implementation of health promotion programmes. The framework depicts 4 key processes of interaction between science and prevention practice: interactive knowledge to action, capacity building, programme adaptation and adaptation of the implementation context. Ensuring sustainability of health promotion programmes requires a concentrated process of integrating scientific and practice-based evidence production in the context of implementation. Central to the integration process is the approach of interactive knowledge to action, which especially benefits from capacity building processes that facilitate participation and systematic interaction between relevant stakeholders. Intense cooperation also induces a dynamic interaction between multiple actors and components such as health promotion programmes, target groups, relevant organisations and social, cultural and political contexts. The reciprocal adaptation of programmes and key components of the implementation context can foster effectiveness and sustainability of programmes. Sustainable implementation of evidence-based health promotion programmes requires alternatives to recent deductive models of knowledge transfer. Interactive approaches prove to be promising alternatives. Simultaneously, they change the responsibilities of science, policy and public health practice. Existing boundaries within disciplines and sectors are overcome by arranging transdisciplinary teams as well as by developing common agendas and procedures. Such approaches also require adaptations of the structure of research projects such as extending the length of funding. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of physical activity interventions in youth via the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: A systematic review of randomised and non-randomised trials.

PubMed

McGoey, Tara; Root, Zach; Bruner, Mark W; Law, Barbi

2015-07-01

An identified limitation of existing reviews of physical activity interventions in school-aged youth is the lack of reporting on issues related to the translatability of the research into health promotion practice. This review used the Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance framework to determine the extent to which intervention studies promoting physical activity in youth report on factors that inform generalizability across settings and populations. A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting. Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues. Copyright © 2015 Elsevier Inc. All rights reserved.

Strategy development for the implementation of telenursing in Korea.

PubMed

Yun, Eun Kyoung; Park, Hyeoun-Ae

2007-01-01

This study aimed to evaluate the feasibility of telenursing, to analyze the issues that should be considered for the development of telenursing in the future, and to provide efficient strategies for the implementation of telenursing in Korea. The authors used the Delphi survey method and a strengths, weaknesses, opportunities, and threats analysis. A total of 30 experts and specialists in the field of nursing informatics and telemedicine contributed to a three-round Delphi survey. The results of the study suggest that telenursing can potentially be implemented in Korea. However, to implement telenursing in Korea, it is necessary to identify telenursing specialties, to construct an infrastructure within which telenursing can function, to develop a business model, and to integrate strategies with government plans to develop the e-health industry. The issues that emerged as important requirements for the successful introduction of telenursing were classified as systematic, economic, societal, or technical. Issues such as driving force, target market, and expense sharing were examined in detail from both ideal and realistic points of view. The results of this study will enable health professionals to appreciate the feasibility of implementing telenursing in Korea. In addition, the study suggests that telenursing could be used efficiently in a variety of environments as a practical strategy to improve healthcare in Korea.

Reducing the Risks of Firearm Violence in High Schools: Principals' Perceptions and Practices.

PubMed

Price, James H; Khubchandani, Jagdish; Payton, Erica; Thompson, Amy

2016-04-01

This study assessed the perceptions and practices of a national sample of secondary school principals regarding reducing firearm violence in high schools. Data were collected via three-wave postal mailings. A 59-item valid and reliable questionnaire was mailed to a national random sample of 800 secondary school principals. Of the 349 principals (46 %) that responded, 17 % reported a firearm incident at their school in the past 5 years. Principals perceived inadequate parental monitoring (70 %), inadequate mental health services (64 %), peer harassment/bullying (59 %), and easy access to firearms (50 %) as the main causes of firearm violence in schools. The three barriers to implementing firearm violence prevention practices were: lack of expertise as to which practices to implement (33 %), lack of time (30 %), and lack of research as to which practices are most effective (30 %). Less than half of schools trained school personnel regarding firearm violence issues. The findings indicate that firearm incidents at schools may be more common than previously thought. A significant portion of principals are at a loss as to what to implement because of a lack of empirical evidence on what is effective. More research is needed to find the most effective school interventions for reducing firearm violence.

Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: qualitative comparative case study in primary care.

PubMed

Wiener-Ogilvie, Sharon; Huby, Guro; Pinnock, Hilary; Gillies, John; Sheikh, Aziz

2008-06-04

Although the BTS-SIGN asthma guideline is one of the most well known and widely respected guidelines in the world, implementation in UK primary care remains patchy. Building on extensive earlier descriptive work, we sought to explore the way teamwork and inter-professional relationships impact on the implementation of the BTS-SIGN guideline on asthma in general practice. Qualitative comparative case study using nine in-depth interviews and 2 focus groups with general practitioners and practice nurses, involved in delivering asthma care. Participants were purposively recruited from practices in a Scottish health board with high and low compliance with the BTS-SIGN asthma guideline. There was a marked difference in the way respondents from practices with high compliance and respondents from practices with low compliance spoke about the value of guidelines and the challenges of implementing them. On both accounts, the former were more positive than the latter and were able to be more specific about the strategies they used to overcome barriers to implementation. We explored the reason for this difference in response and identified practice organisation, centring on delegation of work to nurses, as a factor mediating the practice's level of compliance. Effective delegation was underpinned by organisation of asthma work among practice members who have the appropriate level of skills and knowledge, know and understand each others' work and responsibilities, communicate well among themselves and trust each others' skills. It was the combination of these factors which made for successful delegation and guideline implementation, not any one factor in isolation. In our sample of practices, teamwork and organisation of care within practices appeared to impact on guideline implementation and further larger studies are needed to explore this issue further. Isolated interventions such as measures to improve staff's knowledge or increased clinical resource and time, which are currently being considered, are unlikely to be effective unless practices are supported in developing their teams in a way which supports the deployment of these resources.

A Cross-site Qualitative Study of Physician Order Entry

PubMed Central

Ash, Joan S.; Gorman, Paul N.; Lavelle, Mary; Payne, Thomas H.; Massaro, Thomas A.; Frantz, Gerri L.; Lyman, Jason A.

2003-01-01

Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals. Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data. Measurements: Patterns and themes concerning perceptions of POE were identified. Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions. Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied. PMID:12595408

Green related practices for construction procurement

NASA Astrophysics Data System (ADS)

Bidin, Z. A.; Bohari, A. A. M.; Rais, S. L. A.; Saferi, M. M.

2018-04-01

Environment degradation issue has been a worldwide problem and various efforts have been done to minimise the problem. Construction sectors are pointed as one of the major contributors to its construction activities. Green-oriented procurement [GP] is considered as an environmental strategy to integrate the environmental practices into the construction delivery. Thus, this paper reviews the concept of GP and the practices related to it. The outcome of this research findings provides a basis for understanding the concept of GP and the further development of GP. The listed GP practices identified from this paper can serve as guidelines for industry practitioners to design, implement, and benchmarking the green practices in their procurement delivery.

Listening to food workers: Factors that impact proper health and hygiene practice in food service

PubMed Central

Clegg Smith, Katherine; Neff, Roni A.; Pollack, Keshia M.; Ensminger, Margaret

2015-01-01

Background Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. Objective To investigate food workers' perceptions of factors that impact proper food safety practice. Method Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Results Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Conclusion Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice. PMID:26243248

49 CFR 1105.10 - Board procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... endangered species issues will be part of the record considered by the Board in the proceeding involved. The... Interstate Commerce Act. The Board will withhold a decision, stay the effective date of an exemption, or... OF TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR IMPLEMENTATION OF ENVIRONMENTAL LAWS § 1105.10...

49 CFR 1105.10 - Board procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... endangered species issues will be part of the record considered by the Board in the proceeding involved. The... Interstate Commerce Act. The Board will withhold a decision, stay the effective date of an exemption, or... OF TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR IMPLEMENTATION OF ENVIRONMENTAL LAWS § 1105.10...

49 CFR 1105.10 - Board procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... endangered species issues will be part of the record considered by the Board in the proceeding involved. The... Interstate Commerce Act. The Board will withhold a decision, stay the effective date of an exemption, or... OF TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR IMPLEMENTATION OF ENVIRONMENTAL LAWS § 1105.10...

49 CFR 1105.10 - Board procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... endangered species issues will be part of the record considered by the Board in the proceeding involved. The... Interstate Commerce Act. The Board will withhold a decision, stay the effective date of an exemption, or... OF TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR IMPLEMENTATION OF ENVIRONMENTAL LAWS § 1105.10...

49 CFR 1105.10 - Board procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... endangered species issues will be part of the record considered by the Board in the proceeding involved. The... Interstate Commerce Act. The Board will withhold a decision, stay the effective date of an exemption, or... OF TRANSPORTATION RULES OF PRACTICE PROCEDURES FOR IMPLEMENTATION OF ENVIRONMENTAL LAWS § 1105.10...

Radical Education Reforms. The Series on Contemporary Educational Issues.

ERIC Educational Resources Information Center

Finn, Chester E., Jr., Ed.; Walberg, Herbert J., Ed.

This book presents a diverse set of unusual and significant departures from customary educational policies and practices. These "radical" ideas range from calling for national standards, to enacting statewide legislative initiatives, to implementing decentralized local initiatives such as charter schools, local school councils, and privatization.…

Youth and Environment Training Project: Mid-Project Review.

ERIC Educational Resources Information Center

Edbrooke, Jill

The aims of the Youth and Environment Training Project were to: increase youth workers' awareness and understanding of conservation and environmental issues and their relevance to young people; create links between environmental education and youth work practice; develop strategies for implementing conservation and environmental activities within…

Implementation Issues for Cr6+ Free M&P

DTIC Science & Technology

2008-02-27

85582 Performance Range, with Topcoat MIL-PRF-23377 & MIL-PRF-85582 Performance Range, no Topcoat NCAP Data Assessment • Project originally designed to...documented and distributed as part of ESTCP NCAP project report • Initial assessment suggests that a standard practice to assess coating systems can be

Social Studies in the Formative Years.

ERIC Educational Resources Information Center

Wooster, Judith S., Ed.

1986-01-01

This collection of eight articles was written to assist schools in rethinking and strengthening social studies programs, grades K-6. The articles offer practical suggestions for classroom teachers, social studies supervisors, and other professionals who have responsibility for planning and implementing programs. The issue begins with an article by…

Guidelines for Consumer Education. Revised.

ERIC Educational Resources Information Center

Illinois State Office of Education, Springfield.

This guide is intended to assist school personnel by clarifying issues, provide directions in basic information, and stimulate practical considerations for the learner in the area of consumer education. Its objectives are to (1) assist school administrators in the implementation of consumer education, and (2) assist secondary teachers in planning…

Contemporary Music Education: Trends and Implications.

ERIC Educational Resources Information Center

Sironen, Dorthea May

This document investigates issues, principles, and practices in music education programs in elementary schools. Objectives were to determine how music education programs meet the intellectual, cultural, and artistic needs of children in a changing society and to provide direction in planning and implementing more realistic and comprehensive music…

Problems in Implementing Gifted/Talented Programs in 11 Rural Maine Schools.

ERIC Educational Resources Information Center

Hamrin, Jeannie M.

To identify promising practices, issues, and problems concerning education for the gifted in Maine, 239 classroom teachers and 14 administrators from 11 school districts geographically distributed throughout the state responded to questionnaires which profiled teacher personal characteristics and styles, described the educational setting and…

Critical issues using brain-computer interfaces for augmentative and alternative communication.

PubMed

Hill, Katya; Kovacs, Thomas; Shin, Sangeun

2015-03-01

Brain-computer interfaces (BCIs) may potentially be of significant practical value to patients in advanced stages of amyotrophic lateral sclerosis and locked-in syndrome for whom conventional augmentative and alternative communication (AAC) systems, which require some measure of consistent voluntary muscle control, are not satisfactory options. However, BCIs have primarily been used for communication in laboratory research settings. This article discusses 4 critical issues that should be addressed as BCIs are translated out of laboratory settings to become fully functional BCI/AAC systems that may be implemented clinically. These issues include (1) identification of primary, secondary, and tertiary system features; (2) integrating BCI/AAC systems in the World Health Organization's International Classification of Functioning, Disability and Health framework; (3) implementing language-based assessment and intervention; and (4) performance measurement. A clinical demonstration project is presented as an example of research beginning to address these critical issues. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Unpacking action research and implementation science: Implications for nursing.

PubMed

Casey, Mary; O' Leary, Denise; Coghlan, David

2018-05-01

The aim of this study was to unpack the key concepts of action research and implementation science thereby enabling appropriate use of these methods in nursing. A key issue in action research is not so much the methodology employed to gather data/evidence but who decides the research agenda and who benefits from it. Implementation science is a way to ensure that evidence is translated into practice. The question arises as to how action research and implementation may be understood in relation to one another in nursing. Discussion Paper DATA SOURCES: This discussion paper is based on our own experiences and offers an exploration of action research and implementation science with the aim of clarifying what each involves and what synergies, if any, exist between them. Using action research to secure the voice of patients in their own care is essential to delivering quality nursing care. Using implementation science frameworks to get research evidence into practice is effective. Familiarity with both these concepts may enable their improved use and have a positive impact on quality of care. There is a tension between action researchers and the protagonists of implementation science related to perceived "trade offs" between what constitutes "science" and the necessity of community participation. Nevertheless, the use of an implementation science framework in an action research approach can reduce the research practice time lag and action research provides sound theoretical and philosophical underpinnings that can be used by those in the implementation science field. © 2017 John Wiley & Sons Ltd.

Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model.

PubMed

Freeman, Dennis S; Hudgins, Cathy; Hornberger, Joel

2018-06-01

The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.

The Design of a Practical Enterprise Safety Management System

NASA Astrophysics Data System (ADS)

Gabbar, Hossam A.; Suzuki, Kazuhiko

This book presents design guidelines and implementation approaches for enterprise safety management system as integrated within enterprise integrated systems. It shows new model-based safety management where process design automation is integrated with enterprise business functions and components. It proposes new system engineering approach addressed to new generation chemical industry. It will help both the undergraduate and professional readers to build basic knowledge about issues and problems of designing practical enterprise safety management system, while presenting in clear way, the system and information engineering practices to design enterprise integrated solution.

Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management.

PubMed

Hoying, Cheryl; Farra, Sharon; Mainous, Rosalie; Baute, Rebecca; Gneuhs, Matthew

2017-02-01

An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large midwestern children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations.

Dissemination of psychosocial treatments for anxiety: the importance of taking a broad perspective.

PubMed

Taylor, Steven; Abramowitz, Jonathan S

2013-12-01

Dissemination methods are used to increase the likelihood that a given treatment or form of clinical practice is implemented by clinicians in the community. Therapist training in treatment methods is an important component of dissemination. Successful dissemination also requires that roadblocks to treatment implementation are identified and circumvented, such as misconceptions that clinicians might hold about a given treatment. The present article offers a commentary on the papers included in the special issue on treatment dissemination for anxiety disorders. Most papers focus on issues concerning the training and education of clinicians with regard to exposure therapy. Training and education is an important step but should be part of a broad, multifaceted approach. There are several other important methods of treatment dissemination, including methods developed and implemented with success by the pharmaceutical industry, might also be used to disseminate psychosocial therapies. Optimal dissemination likely requires a broad perspective in which multiple dissemination methods are considered for implementation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Picture Archiving and Communication System (PACS) implementation, integration & benefits in an integrated health system.

PubMed

Mansoori, Bahar; Erhard, Karen K; Sunshine, Jeffrey L

2012-02-01

The availability of the Picture Archiving and Communication System (PACS) has revolutionized the practice of radiology in the past two decades and has shown to eventually increase productivity in radiology and medicine. PACS implementation and integration may bring along numerous unexpected issues, particularly in a large-scale enterprise. To achieve a successful PACS implementation, identifying the critical success and failure factors is essential. This article provides an overview of the process of implementing and integrating PACS in a comprehensive health system comprising an academic core hospital and numerous community hospitals. Important issues are addressed, touching all stages from planning to operation and training. The impact of an enterprise-wide radiology information system and PACS at the academic medical center (four specialty hospitals), in six additional community hospitals, and in all associated outpatient clinics as well as the implications on the productivity and efficiency of the entire enterprise are presented. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions.

PubMed

Becker, Sara J

2015-03-01

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed.

Leadership, Innovation Climate, and Attitudes toward Evidence-Based Practice during a Statewide Implementation

PubMed Central

Aarons, Gregory A.; Sommerfeld, David H.

2013-01-01

Objective Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Methods Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader member exchange with innovation climate and attitudes toward adoption and use of EBP. Results Transformational leadership predicted higher innovation climate during implementation while leader member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Conclusions Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. PMID:22449648

From policy to practice: implementing frontline community health services for substance dependence--study protocol.

PubMed

Gill, Kathryn J; Campbell, Emily; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara; Macaulay, Ann C

2014-08-20

Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada, issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2). Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health. Findings from this research program will contribute to the understanding of factors associated with implementation of frontline services for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

Staff Training on the Use of Health Information Systems: What Do We Know?

PubMed

Bygholm, Ann

2018-01-01

Staff training is acknowledged as an important activity when implementing health information systems (HISs). This paper reviews the literature on staff training in connection with HIS implementation. The aim is to identify critical issues to reflect on when planning or evaluating this type of training. Searches were conducted in three research databases, resulting in 423 hits. Sixty-four papers were retrieved for more detailed examination, and 12 papers were selected for analysis. The analysis focused on the content, organization and pedagogical approach. In general, the review revealed minor primarily descriptive studies focused on aspects of staff training rather than strategies for staff training. The review revealed specific agreed-upon issues that are considered important for the success of the training. The issues identified are transfer of knowledge and skills is not enough, ongoing training is important, training should be related to practice and address individual learning needs, and super-users are important facilitators.

Evaluation of Secure Computation in a Distributed Healthcare Setting.

PubMed

Kimura, Eizen; Hamada, Koki; Kikuchi, Ryo; Chida, Koji; Okamoto, Kazuya; Manabe, Shirou; Kuroda, Tomohiko; Matsumura, Yasushi; Takeda, Toshihiro; Mihara, Naoki

2016-01-01

Issues related to ensuring patient privacy and data ownership in clinical repositories prevent the growth of translational research. Previous studies have used an aggregator agent to obscure clinical repositories from the data user, and to ensure the privacy of output using statistical disclosure control. However, there remain several issues that must be considered. One such issue is that a data breach may occur when multiple nodes conspire. Another is that the agent may eavesdrop on or leak a user's queries and their results. We have implemented a secure computing method so that the data used by each party can be kept confidential even if all of the other parties conspire to crack the data. We deployed our implementation at three geographically distributed nodes connected to a high-speed layer two network. The performance of our method, with respect to processing times, suggests suitability for practical use.

Performance issues for iterative solvers in device simulation

NASA Technical Reports Server (NTRS)

Fan, Qing; Forsyth, P. A.; Mcmacken, J. R. F.; Tang, Wei-Pai

1994-01-01

Due to memory limitations, iterative methods have become the method of choice for large scale semiconductor device simulation. However, it is well known that these methods still suffer from reliability problems. The linear systems which appear in numerical simulation of semiconductor devices are notoriously ill-conditioned. In order to produce robust algorithms for practical problems, careful attention must be given to many implementation issues. This paper concentrates on strategies for developing robust preconditioners. In addition, effective data structures and convergence check issues are also discussed. These algorithms are compared with a standard direct sparse matrix solver on a variety of problems.

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

PubMed

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

2017-12-01

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

Implementing falls prevention research into policy and practice in Australia: past, present and future.

PubMed

Lord, Stephen R; Sherrington, Catherine; Cameron, Ian D; Close, Jacqueline C T

2011-12-01

Falls in older Australians are a significant public health issue with one in three older people falling one or more times each year. Many fall prevention randomized controlled trials have been conducted in Australia as well as across the world. The findings of these studies now constitute a substantial evidence base that can provide direction for health and lifestyle interventions for preventing falls in older people. This research evidence has contributed to health policy in Australia to some extent, but is yet to be widely implemented into practice. This opinion piece overviews previous policy initiatives and describes a new Partnership research program funded by the Australian National Health and Medical Research Council (NHMRC), which seeks to further influence health policy and address the ongoing research-practice gap. Copyright © 2011. Published by Elsevier Ltd.

Experimenting Design and Implementation of an Educational Services Management System Based on ISO/IEC 20000 Standard

NASA Astrophysics Data System (ADS)

Lezcano, Jean-Marc; Adachihara, Hatsuo; Prunier, Marc

European higher education organizations are encouraged to implement quality management practices. Existing quality standards and frameworks do not capitalize an important set of best practices addressing educational services delivery. The ISO/IEC 20000 standard, elaborated from IT service management issues, is widening its field of application and may represent an interesting alternative. A specific approach is needed to apprehend the particular nature of educational services, consider the systemic cooperating roles of educational system and learning system, and define ISO/IEC 20000 vocabulary and concepts adapted to the domain. ISO/IEC 20000 may provide an answer to European Standard Guideline compliance and improve educational services management. The current experimentation is expected to cast light on the complexity, practicality and effectiveness of the use of ISO/IEC 20000 in a first field of "non IT" services.

What Counts as Inclusion?

ERIC Educational Resources Information Center

Walton, E.; Nel, N.

2012-01-01

In the years since the publication in South Africa of White Paper Six: Special needs education (Department of Education (DoE) 2001) various schools in the state and independent sectors have begun to implement inclusive policies and practices. With reference to the Guidelines for full-service/inclusive schools issued in 2009, and by discussing a…

Scale Up in Education: Volume 2: Issues in Practice

ERIC Educational Resources Information Center

Schneider, Barbara, Ed.; McDonald, Sarah-Kathryn, Ed.

2006-01-01

This book explores the challenges of implementing and assessing educational interventions in varied classroom contexts. Included are reflections on the challenges of designing studies for improving the instructional core of schools, guidelines for establishing evidence of interventions' impacts across a wide range of settings, and an assessment of…

Cost Optimization in E-Learning-Based Education Systems: Implementation and Learning Sequence

ERIC Educational Resources Information Center

Fazlollahtabar, Hamed; Yousefpoor, Narges

2009-01-01

Increasing the effectiveness of e-learning has become one of the most practically and theoretically important issues within both educational engineering and information system fields. The development of information technologies has contributed to growth in online training as an important education method. The online training environment enables…

Critical Performative Pedagogy: Emergent Bilingual Learners Challenge Local Immigration Issues

ERIC Educational Resources Information Center

Harman, Ruth; Varga-Dobai, Kinga

2012-01-01

Recent anti-immigration policies and practices in the Southeast of the United States have presented difficult challenges for newly arrived bilingual learners and their families. To validate student voices within this socio-political context, our school/university collaboration implemented an arts-based participatory approach to English Language…

Sociocultural Influences and Issues in an Art Class for Brazilian Preservice Teachers.

ERIC Educational Resources Information Center

Stokrocki, Mary; Coutinho, Regina

This paper looks at how a Brazilian educator implemented Paolo Freire's notion of critical pedagogy. The study describes Brazil's historical background, previous educational conditions, Freire's educational ideas translated into art education, and preservice education. Through participant observation, the study documents the practice of an art…

Structuring a Clinical Learning Environment for a Hybrid-PBL Dental Curriculum.

ERIC Educational Resources Information Center

MacNeil, M. A. J.; Walton, Joanne N.; Clark, D. Christopher; Tobias, David L.; Harrison, Rosamund L.

1998-01-01

Describes the evolution and implementation of a joint medical-dental problem-based learning (PBL) curriculum at the University of British Columbia's medical and dental schools, featuring development of an integrated care clinic. Issues in structuring the new curriculum are discussed, including management of the clinic's group practices, affective…

Issues and Solutions of International Understanding Education in China

ERIC Educational Resources Information Center

Qin, Li

2013-01-01

School in China has actively implemented International Understanding Education to foster a cosmopolitan perspective. The educational principle is to respect people of various socio-cultural backgrounds through comparing China's culture with that of other countries. However, my survey revealed that such education in practice is limited to…

Marketing Higher Education Means Organizational Change. AIR Forum 1981 Paper.

ERIC Educational Resources Information Center

Miklich, Beverly

The issues, organizational changes, and institutional reactions that colleges and universities perceive as associated with implementation of new marketing practices were identified in a review of the literature and interviews with officials from 25 institutions primarily in or near Los Angeles, California. Several trends were revealed: successful…

Providing for Student Voice in Classroom Management: Teachers' Views

ERIC Educational Resources Information Center

Lewis, Ramon; Burman, Eva

2008-01-01

Recent research indicates that teachers would prefer to allow for more student voice in classroom discipline decision-making than is currently the case. This paper identifies factors that teachers suggest inhibit them from implementing their ideas of best disciplinary practice. It also examines which classroom discipline issues teachers are…

Edward W. Jennings | NREL

Science.gov Websites

practices promoting a safe and supportive working environment. His research interests include environmental, safety, and health (ESH) and facility issues, he is responsible for implementing safe work plan; working directly with awardees by performing on-site validations to collect and analyze enzyme

Why Doesn't This Feel Empowering? The Challenges of Web-Based Intercultural Dialogue

ERIC Educational Resources Information Center

Bali, Maha

2014-01-01

Ellsworth's article entitled "Why doesn't this feel empowering? Working through the repressive myths of critical pedagogy" raises issues about the complex dynamics of implementing critical pedagogy in real classrooms, and the difficulties and paradoxes of putting the empowerment rhetoric into practice. This article analyses the…

Innovative Schools in Michigan. Connect: Making Learning Personal

ERIC Educational Resources Information Center

Page, Stephen F., Ed.

2015-01-01

This second issue of "Connect" highlights innovative teaching as practiced by teachers and administrators in Michigan schools as they seek to provide greater personalization for every student's learning. Nicholas Provenzano and Ben Gilpin give field reports from their schools, which have implemented a version of 20-Time--a concept…

Identification of salmonella enterica serovar Kentucky genes involved in attachment to chicken skin

USDA-ARS?s Scientific Manuscript database

Background: Regardless of sanitation practices implemented to reduce Salmonella prevalence in poultry processing plants, the problem continues to be an issue. To gain an understanding of the attachment mechanism of Salmonella to broiler skin, a bioluminescent-based mutant screening assay was used. A...

Educating for Peace? Citizenship Education in Quebec and Northern Ireland

ERIC Educational Resources Information Center

Niens, Ulrike; Chastenay, Marie-Helene

2008-01-01

This article explores the theoretical underpinnings of citizenship education as well as issues relating to educational practice to identify and discuss challenges that divided societies, which are characterized by conflicting national or cultural identities, may face in the development and implementation of such programs. Formal education…

77 FR 73 - Cooperative Conservation Partnership Initiative and Wetlands Reserve Enhancement Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

... WREP. Arkansas Lower White-Bayou Des 08020301 CCPI and/or WREP. Arc. Arkansas Lower Arkansas... partners will help producers to voluntarily implement conservation practices that avoid, control, and trap... there groups of producers who may submit joint applications to address resource issues of common...

Implementing Positive Behavior Support with Chinese American Families: Enhancing Cultural Competence

ERIC Educational Resources Information Center

Wang, Mian; McCart, Amy; Turnbull, Ann P.

2007-01-01

In positive behavior support (PBS) practices, one critical issue involves helping professionals understand and respect the values of families from culturally diverse backgrounds. This article summarizes embedded cultural values of PBS represented in four key features of the PBS process: collaborative partnerships, functional assessment, contextual…

Educational Leadership and Planning for Technology. Third Edition.

ERIC Educational Resources Information Center

Picciano, Anthony G.

The purpose of this book is to provide educators with both the theoretical and the practical considerations for planning and implementing technology, particularly computer applications, in schools. Section I provides the basic concepts and foundation material for an overall understanding of the themes and major issues related to planning for…

Examining the Impediments to Indigenous Strategy and Approaches in Mainstream Secondary Schools

ERIC Educational Resources Information Center

Hynds, Anne; Averill, Robin; Penetito, Wally; Meyer, Luanna; Hindle, Rawiri; Faircloth, Susan

2016-01-01

Noted Maori scholar Russell Bishop identified three impediments to developing Indigenous principles and practices in schools within colonized countries. These include confusion about the culture of Indigenous children, uneven programme implementation and issues with measuring student achievement. In this article, we present results from a mixed…

The Logic of Equity Practice in "Queensland State Education"--2010

ERIC Educational Resources Information Center

Taylor, Sandra; Singh, Parlo

2005-01-01

This paper reports on an interview-based study which explored the implementation of a major policy initiative in Queensland, Australia, with particular attention to social justice issues. Interviews were conducted with key policy actors in three sections of the bureaucracy: strategic directions, performance and measurement; curriculum and…

School Absenteeism and the Implementation of Truancy-Related Penalty Notices

ERIC Educational Resources Information Center

Zhang, Ming

2007-01-01

This paper derives from the author's recent research into disadvantaged children's access to compulsory education in England. Examining the national attendance strategies and practice, the author interrogates the current trend towards a more punitive approach to addressing the problem of school absenteeism while debating the issue of irresponsible…

Microcomputers in Transit: A Needs Assessment and Implementation Handbook. Final Report.

ERIC Educational Resources Information Center

Wyatt, Eve; Smerk, George

This handbook describes a practical step-by-step process for introducing microcomputers to small- and medium-sized transit operating agencies. The introductory chapter deals with the objective of buying a microcomputer system, the characteristics of microcomputers, microcomputer software, microcomputer system components, and issues faced in…

Synthesis of public-private partnerships : potential issues and best practices for program and project implementation and administration.

DOT National Transportation Integrated Search

2015-08-01

Public-private partnerships (P3s or PPPs) offer an innovative procurement method for the public sector. : P3s involve collaborations between the public and private sectors to finance, develop or maintain transportation : infrastructure. In an era of ...

Developing a general practice library: a collaborative project between a GP and librarian.

PubMed

Pearson, D; Rossall, H

2001-12-01

The authors report on a self-completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work.

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

PubMed Central

2013-01-01

Background Goal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke. Methods G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation. Results G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient’s well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process. Conclusions G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings. PMID:23705824

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-02-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-12-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

PubMed Central

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. PMID:25018637

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives.

PubMed

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Technical note: Open-paleo-data implementation pilot - the PAGES 2k special issue

NASA Astrophysics Data System (ADS)

Kaufman, Darrell S.; Pages 2k Special-Issue Editorial Team

2018-05-01

Data stewardship is an essential element of the publication process. Knowing how to enact data polices that are described only in general terms can be difficult, however. Examples are needed to model the implementation of open-data polices in actual studies. Here we explain the procedure used to attain a high and consistent level of data stewardship across a special issue of the journal Climate of the Past. We discuss the challenges related to (1) determining which data are essential for public archival, (2) using data generated by others, and (3) understanding data citations. We anticipate that open-data sharing in paleo sciences will accelerate as the advantages become more evident and as practices that reduce data loss become the accepted convention.

[Challenges to implementation of the ECG reading center in ELSA-Brasil].

PubMed

Ribeiro, Antonio Luiz; Pereira, Samuel Vianney da Cunha; Bergmann, Kaiser; Ladeira, Roberto Marini; Oliveira, Rackel Aguiar Mendes; Lotufo, Paulo A; Mill, José Geraldo; Barreto, Sandhi Maria

2013-06-01

Electrocardiography is an established low-cost method of cardiovascular assessment, utilized for decades large epidemiological studies. Nonetheless, its use in large epidemiological studies presents challenges, especially when seeking to develop a reading center. This article describes the process, difficulties and challenges of implementing an electrocardiogram reading center in Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Among the issues discussed, we have emphasized: the criteria for selection of the electrocardiography machine and the central for storage and management of the machines; the required personnel; the procedures for acquisition and transmission of electrocardiographs to the Reading Center; coding systems, with emphasis on the Minnesota code; ethical and practical issues regarding the delivery of reports to study participants; and aspects related to quality control.

Feasibility of Energy Medicine in a Community Teaching Hospital: An Exploratory Case Series

PubMed Central

Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J.; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill

2015-01-01

Abstract Background: Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. Objective: This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Design: Feasibility study, including a prospective case series. Settings: Inpatient units and emergency department. Outcome measures: To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Participants: Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. Results: EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non–pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. Conclusions: This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated with their chief complaint. Substantial practicality issues must be addressed to implement EM clinically in a hospital, however. PMID:26035025

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY PROTOCOL FOR STANDARDIZED PRODUCTION OF CLINICAL PRACTICE GUIDELINES, ALGORITHMS, AND CHECKLISTS - 2017 UPDATE.

PubMed

Mechanick, Jeffrey I; Pessah-Pollack, Rachel; Camacho, Pauline; Correa, Ricardo; Figaro, M Kathleen; Garber, Jeffrey R; Jasim, Sina; Pantalone, Kevin M; Trence, Dace; Upala, Sikarin

2017-08-01

Clinical practice guideline (CPG), clinical practice algorithm (CPA), and clinical checklist (CC, collectively CPGAC) development is a high priority of the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE). This 2017 update in CPG development consists of (1) a paradigm change wherein first, environmental scans identify important clinical issues and needs, second, CPA construction focuses on these clinical issues and needs, and third, CPG provide CPA node/edge-specific scientific substantiation and appended CC; (2) inclusion of new technical semantic and numerical descriptors for evidence types, subjective factors, and qualifiers; and (3) incorporation of patient-centered care components such as economics and transcultural adaptations, as well as implementation, validation, and evaluation strategies. This third point highlights the dominating factors of personal finances, governmental influences, and third-party payer dictates on CPGAC implementation, which ultimately impact CPGAC development. The AACE/ACE guidelines for the CPGAC program is a successful and ongoing iterative exercise to optimize endocrine care in a changing and challenging healthcare environment. AACE = American Association of Clinical Endocrinologists ACC = American College of Cardiology ACE = American College of Endocrinology ASeRT = ACE Scientific Referencing Team BEL = best evidence level CC = clinical checklist CPA = clinical practice algorithm CPG = clinical practice guideline CPGAC = clinical practice guideline, algorithm, and checklist EBM = evidence-based medicine EHR = electronic health record EL = evidence level G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GAC = guidelines, algorithms, and checklists HCP = healthcare professional(s) POEMS = patient-oriented evidence that matters PRCT = prospective randomized controlled trial.

Facilitators and barriers to implementation of the AIDES initiative, a social innovation for participative assessment of children in need and for coordination of services.

PubMed

Dufour, Sarah; Lessard, Danielle; Chamberland, Claire

2014-12-01

As part of an implementation evaluation, this study aims to identify the conditions of practice that facilitated or hindered implementation of the AIDES initiative, a social innovation to support collaboration between partners involved with vulnerable children. Evaluators conducted qualitative telephone interviews with 36 respondents (19 practitioners and 17 managers) who participated in the AIDES initiative trial. Respondents were chosen to include all participating organisations (child protection services, prevention social services). Participants' comments were submitted to descriptive content analysis. Conditions facilitating or hindering implementation of the initiative included the following dimensions: (1) implementation quality; (2) organisational elements (organisational functioning, cooperation between organisations); (3) socio-political issues; and (4) personal and professional characteristics. The study highlights critical elements to consider in implementing and maintaining significant changes in practice in organisations providing assistance to vulnerable children and their families. Social innovations that do not consider such elements are likely to compromise their implementation and sustainability. We must prevent promising social changes from being considered unrealistic or inappropriate due to contextual barriers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Openness in participation, assessment, and policy making upon issues of environment and environmental health: a review of literature and recent project results.

PubMed

Pohjola, Mikko V; Tuomisto, Jouni T

2011-06-16

Issues of environment and environmental health involve multiple interests regarding e.g. political, societal, economical, and public concerns represented by different kinds of organizations and individuals. Not surprisingly, stakeholder and public participation has become a major issue in environmental and environmental health policy and assessment. The need for participation has been discussed and reasoned by many, including environmental legislators around the world. In principle, participation is generally considered as desirable and the focus of most scholars and practitioners is on carrying out participation, and making participation more effective. In practice also doubts regarding the effectiveness and importance of participation exist among policy makers, assessors, and public, leading even to undermining participatory practices in policy making and assessment.There are many possible purposes for participation, and different possible models of interaction between assessment and policy. A solid conceptual understanding of the interrelations between participation, assessment, and policy making is necessary in order to design and implement effective participatory practices. In this paper we ask, do current common conceptions of assessment, policy making and participation provide a sufficient framework for achieving effective participation? This question is addresses by reviewing the range of approaches to participation in assessment and policy making upon issues of environment and environmental health and some related insights from recent research projects, INTARESE and BENERIS.Openness, considered e.g. in terms of a) scope of participation, b) access to information, c) scope of contribution, d) timing of openness, and e) impact of contribution, provides a new perspective to the relationships between participation, assessment and policy making. Participation, assessment, and policy making form an inherently intertwined complex with interrelated objectives and outcomes. Based on experiences from implementing openness, we suggest complete openness as the new default, deviation from which should be explicitly argued, in assessment and policy making upon issues of environment and environmental health. Openness does not undermine the existing participatory models and techniques, but provides conceptual means for their more effective application, and opens up avenues for developing new kinds of effective participatory practices that aim for societal development through collaborative creation of knowledge.

Openness in participation, assessment, and policy making upon issues of environment and environmental health: a review of literature and recent project results

PubMed Central

2011-01-01

Issues of environment and environmental health involve multiple interests regarding e.g. political, societal, economical, and public concerns represented by different kinds of organizations and individuals. Not surprisingly, stakeholder and public participation has become a major issue in environmental and environmental health policy and assessment. The need for participation has been discussed and reasoned by many, including environmental legislators around the world. In principle, participation is generally considered as desirable and the focus of most scholars and practitioners is on carrying out participation, and making participation more effective. In practice also doubts regarding the effectiveness and importance of participation exist among policy makers, assessors, and public, leading even to undermining participatory practices in policy making and assessment. There are many possible purposes for participation, and different possible models of interaction between assessment and policy. A solid conceptual understanding of the interrelations between participation, assessment, and policy making is necessary in order to design and implement effective participatory practices. In this paper we ask, do current common conceptions of assessment, policy making and participation provide a sufficient framework for achieving effective participation? This question is addresses by reviewing the range of approaches to participation in assessment and policy making upon issues of environment and environmental health and some related insights from recent research projects, INTARESE and BENERIS. Openness, considered e.g. in terms of a) scope of participation, b) access to information, c) scope of contribution, d) timing of openness, and e) impact of contribution, provides a new perspective to the relationships between participation, assessment and policy making. Participation, assessment, and policy making form an inherently intertwined complex with interrelated objectives and outcomes. Based on experiences from implementing openness, we suggest complete openness as the new default, deviation from which should be explicitly argued, in assessment and policy making upon issues of environment and environmental health. Openness does not undermine the existing participatory models and techniques, but provides conceptual means for their more effective application, and opens up avenues for developing new kinds of effective participatory practices that aim for societal development through collaborative creation of knowledge. PMID:21679456

Wheelchair transportation safety on school buses: stakeholder recommendations for priority issues and actions.

PubMed

Buning, Mary Ellen; Karg, Patricia E

2011-01-01

This paper presents results from and provides discussion of a state-of-the-science workshop in which highly informed stakeholders in wheelchair transportation safety for students on school buses were participants. The Nominal Group Technique was used to create a process in which the main issues preventing safe transportation of wheelchair-seated students and key strategies to overcome these issues were identified and ranked. These results, along with a synthesis of group discussion and recommendations for action, are presented along with consideration of current policies, regulations, and political realities. Critical safety shortcomings exist in this highly specialized enterprise that varies from state to state. Recommended strategies include implementing wheelchair requirements in federal transportation safety standards, creation of a clearinghouse for wheelchair transportation best practices and education, creation of national standards for training, practices, and monitoring, and increased "buy-in" to voluntary wheelchair standards by wheelchair manufacturers.

Business ethics: the materiel/manufacturing perspective.

PubMed

Marucheck, A S; Robbins, L B

1990-08-01

The discussion of purchasing practices and product integrity, which have ethical implications for materiel/manufacturing management, serves to illustrate how routine decisions can have larger implications for the firm as a whole. Management needs to take a proactive role in confronting ethical issues by (1) demonstrating a corporate commitment to sound ethics in business practices, (2) providing written policies where appropriate to provide a basis for sound ethical conducts, (3) educating various functional areas to understand their responsibility in seeming unrelated ethical problems, (4) delegating authority in ethical issues where such issues are considered in decision making, and (5) fostering interfunctional communication as a means in establishing corporatewide responsibility. The basic philosophical principles of JIT serve as a blueprint for recognizing and managing ethical responsibility. The unexpected by-products of a JIT implementation may be vendor/customer good will and an excellent reputation for the firm.

How are evidence and knowledge used in orthopaedic decision-making? Three comparative case studies of different approaches to implementation of clinical guidance in practice.

PubMed

Grove, Amy; Clarke, Aileen; Currie, Graeme

2018-05-31

The uptake and use of clinical guidelines is often insufficient to change clinical behaviour and reduce variation in practice. As a consequence of diverse organisational contexts, the simple provision of guidelines cannot ensure fidelity or guarantee their use when making decisions. Implementation research in surgery has focused on understanding what evidence exists for clinical practice decisions but limits understanding to the technical, educational and accessibility issues. This research aims to identify where, when and how evidence and knowledge are used in orthopaedic decision-making and how variation in these factors contributes to different approaches to implementation of clinical guidance in practice. We used in-depth case studies to examine guideline implementation in real-life surgical practice. We conducted comparative case studies in three English National Health Service hospitals over a 12-month period. Each in-depth case study consisted of a mix of qualitative methods including interviews, observations and document analysis. Data included field notes from observations of day-to-day practice, 64 interviews with NHS surgeons and staff and the collection of 121 supplementary documents. Case studies identified 17 sources of knowledge and evidence which influenced clinical decisions in elective orthopaedic surgery. A comparative analysis across cases revealed that each hospital had distinct approaches to decision-making. Decision-making is described as occurring as a result of how 17 types of knowledge and evidence were privileged and of how they interacted and changed in context. Guideline implementation was contingent and mediated through four distinct contextual levels. Implementation could be assessed for individual surgeons, groups of surgeons or the organisation as a whole, but it could also differ between these levels. Differences in how evidence and knowledge were used contributed to variations in practice from guidelines. A range of complex and competing sources of evidence and knowledge exists which influence the working practices of healthcare professionals. The dynamic selection, combination and use of each type of knowledge and evidence influence the implementation and use of clinical guidance in practice. Clinical guidelines are a fundamental part of practice, but represent only one type of evidence influencing clinical decisions. In the orthopaedic speciality, other distinct sources of evidence and knowledge are selected and used which impact on how guidelines are implemented. New approaches to guideline implementation need to appreciate and incorporate this diverse range of knowledge and evidence which influences clinical decisions and to take account of the changing contexts in which decisions are made.

The Cumbria Rural Health Forum: initiating change and moving forward with technology.

PubMed

Ditchburn, Jae-Llane; Marshall, Alison

2016-01-01

The Cumbria Rural Health Forum was formed by a number of public, private and voluntary sector organisations to collaboratively work on rural health and social care in the county of Cumbria, England. The aim of the forum is to improve health and social care delivery for rural communities, and share practical ideas and evidence-based best practice that can be implemented in Cumbria. The forum currently consists of approximately 50 organisations interested in and responsible for delivery of health and social care in Cumbria. An exploration of digital technologies for health and care was recognised as an initial priority. This article describes a hands-on approach undertaken within the forum, including its current progress and development. The forum used a modified Delphi technique to facilitate its work on discussing ideas and reaching consensus to formulate the Cumbria Strategy for Digital Technologies in Health and Social Care. The group communication process took place over meetings and workshops held at various locations in the county. A roadmap for the implementation of digital technologies into health and social care was developed. The roadmap recommends the following: (i) to improve the health outcomes for targeted groups, within a unit, department or care pathway; (ii) to explain, clarify, share good (and bad) practice, assess impact and value through information sharing through conferences and events, influencing and advocacy for Cumbria; and (iii) to develop a digital-health-ready workforce where health and social care professionals can be supported to use digital technologies, and enhance recruitment and retention of staff. The forum experienced issues consistent with those in other Delphi studies, such as the repetition of ideas. Attendance was variable due to the unavailability of key people at times. Although the forum facilitated collective effort to address rural health issues, its power is limited to influencing and supporting implementation of change. Within the implementation phase, the forum has engaged in advising and facilitating policy change at all levels. Thus, the forum has become a voice to influence change towards the advancement of health and social care through digital technologies. The forum continues to serve as a think tank and influencer for change in rural health and social care issues in Cumbria. The forum has increased awareness of digital health and social care solutions, mapped best practice and developed a digital strategy for health and social care in Cumbria.

Complementary filter implementation in the dynamic language Lua

NASA Astrophysics Data System (ADS)

Sadowski, Damian; Sawicki, Aleksander; Lukšys, Donatas; Slanina, Zdenek

2017-08-01

The article presents the complementary filter implementation, that is used for the estimation of the pitch angle, in Lua script language. Inertial sensors as accelerometer and gyroscope were used in the study. Methods of angles estimation using acceleration and angular velocity sensors were presented in the theoretical part of the article. The operating principle of complementary filter has been presented. The prototype of Butterworth's analogue filter and its digital equivalent have been designed. Practical implementation of the issue was performed with the use of PC and DISCOVERY evaluation board equipped with STM32F01 processor, L3GD20 gyroscope and LS303DLHC accelerometer. Measurement data was transmitted by UART serial interface, then processed with the use of Lua software and luaRS232 programming library. Practical implementation was divided into two stages. In the first part, measurement data has been recorded and then processed with help of a complementary filter. In the second step, coroutines mechanism was used to filter data in real time.

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.

Trends in dermatology practices and the implications for the workforce.

PubMed

Ehrlich, Alison; Kostecki, James; Olkaba, Helen

2017-10-01

The American Academy of Dermatology (AAD) practice profile surveys have been conducted for more than a decade to gauge trends in our workforce supply and demand. To update the trends and current workforce issues for the field of dermatology. The AAD Practice Profile Survey is sent by both e-mail and postal mail to a random sample of practicing dermatologists who are AAD members. Shifts are noted in the primary practice setting; fewer dermatologists are in solo practice and more are in group practices than in previous years. Teledermatology use trended upward from 7% to 11% between 2012 and 2014. The implementation of electronic health records increased from 51% in 2011 to 70% in 2014. There is potential for response bias and inaccurate self-reporting. Survey responses collected may not be representative of all geographic areas. The demand for dermatology services remains strong. Shifts in the practice setting may be related to increases in overhead costs that are partially associated with the implementation of technology-based medical records. Integration of electronic health records and utilization of telemedicine are increasing. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Independent community care gerontological nursing: becoming an entrepreneur.

PubMed

Caffrey, Rosalie A

2005-08-01

Few nurses have the experience of developing an independent practice. This ethnographic study explores the process and challenges of becoming an entrepreneur as described by nurses developing independent practices in community care gerontologic nursing. The process included developing a legal contract, marketing strategies, and reimbursement amounts and strategies. Major barriers to implementing this role identified by the nurses included ignorance and confusion by others about their role, financial issues related to an uncertain income, time management, and legal concerns especially around delegation. These were experienced and dedicated nurses who were also risk-takers and enjoyed the independence of practicing nursing because they believed it was meant to be practiced. Suggestions for research, education, and practice are included.

Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review.

PubMed

Cresswell, Kathrin; Sheikh, Aziz

2013-05-01

Implementations of health information technologies are notoriously difficult, which is due to a range of inter-related technical, social and organizational factors that need to be considered. In the light of an apparent lack of empirically based integrated accounts surrounding these issues, this interpretative review aims to provide an overview and extract potentially generalizable findings across settings. We conducted a systematic search and critique of the empirical literature published between 1997 and 2010. In doing so, we searched a range of medical databases to identify review papers that related to the implementation and adoption of eHealth applications in organizational settings. We qualitatively synthesized this literature extracting data relating to technologies, contexts, stakeholders, and their inter-relationships. From a total body of 121 systematic reviews, we identified 13 systematic reviews encompassing organizational issues surrounding health information technology implementations. By and large, the evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes. However, these dimensions are inter-related, requiring a careful balancing act of strategic implementation decisions in order to ensure that unintended consequences resulting from technology introduction do not pose a threat to patients. Organizational issues surrounding technology implementations in healthcare settings are crucially important, but have as yet not received adequate research attention. This may in part be due to the subjective nature of factors, but also due to a lack of coordinated efforts toward more theoretically-informed work. Our findings may be used as the basis for the development of best practice guidelines in this area. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Measuring Racial/Ethnic Disparities in Health Care: Methods and Practical Issues

PubMed Central

Cook, Benjamin Lê; McGuire, Thomas G; Zaslavsky,, Alan M

2012-01-01

Objective To review methods of measuring racial/ethnic health care disparities. Study Design Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. Empirical Application We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004–2008 Medical Expenditure Panel Survey. Conclusion Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition. PMID:22353147

Specific issues, exact locations: case study of a community mapping project to improve safety in a disadvantaged community.

PubMed

Qummouh, Rana; Rose, Vanessa; Hall, Pat

2012-12-01

Safety is a health issue and a significant concern in disadvantaged communities. This paper describes an example of community-initiated action to address perceptions of fear and safety in a suburb in south-west Sydney which led to the development of a local, community-driven research project. As a first step in developing community capacity to take action on issues of safety, a joint resident-agency group implemented a community safety mapping project to identify the extent of safety issues in the community and their exact geographical location. Two aerial maps of the suburb, measuring one metre by two metres, were placed on display at different locations for four months. Residents used coloured stickers to identify specific issues and exact locations where crime and safety were a concern. Residents identified 294 specific safety issues in the suburb, 41.9% (n=123) associated with public infrastructure, such as poor lighting and pathways, and 31.9% (n=94) associated with drug-related issues such as drug activity and discarded syringes. Good health promotion practice reflects community need. In a very practical sense, this project responded to community calls for action by mapping resident knowledge on specific safety issues and exact locations and presenting these maps to local decision makers for further action.

Practices implemented by a Texas charter school system to overcome science teacher shortage

NASA Astrophysics Data System (ADS)

Yasar, Bilgehan M.

The purpose of this study was to examine practices used by a charter school system to hire and retain science teachers. The research design for this study was a qualitative case study. This single instrumental case study explored the issue within a bounded system. Purposeful sampling strategy was used to identify the participants who were interviewed individually. Findings of the case study supported that using online resources, advertising in the newspaper, attending job fairs, using alternative certification programs, attracting alumni, contacting the college of educations and hiring internationally helped the charter school system with hiring science teachers. Improving teacher salary scale, implementing teacher mentorship programs, reimbursing teachers for certification and master's programs, providing professional development and supporting teachers helped to retain science teachers. Therefore, this study contributes to determining strategies and techniques, selecting methods and programs, training administrators, and monitoring for successful hiring and retaining science teacher implementation.

Successful practices in title III implementation. Chemical Emergency Preparedness and Prevention Technical Assistance Bulletin. Cameron County, Texas; Bucks County, Pennsylvania; Harford County, Maryland; Dallas County, Texas. Series 6, Number 7

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

Not Available

This is another in a series of bulletins EPA is issuing to provide examples of implementation programs and strategies of the Emergency Planning and Community Right-to-Know Act of 1986, known as Title III, that are innovative or have proven effective. The purpose of these bulletins is to share information on successful practices with Local Emergency Planning Committees (LEPCs), State Emergency Response Commissions (SERCs), fire departments, and other Title III implementing agencies throughout the country in the hope that such information will prove useful to other SERCs and LEPCs as their programs develop and evolve. The bulletin discusses Title III implementationmore » for Cameron County in Texas, Bucks County in Pennsylvania, Harford County in Maryland, and Dallas County in Texas.« less

Languages for artificial intelligence: Implementing a scheduler in LISP and in Ada

NASA Technical Reports Server (NTRS)

Hays, Dan

1988-01-01

A prototype scheduler for space experiments originally programmed in a dialect of LISP using some of the more traditional techniques of that language, was recast using an object-oriented LISP, Common LISP with Flavors on the Symbolics. This object-structured version was in turn partially implemented in Ada. The Flavors version showed a decided improvement in both speed of execution and readability of code. The recasting into Ada involved various practical problems of implementation as well as certain challenges of reconceptualization in going from one language to the other. Advantages were realized, however, in greater clarity of the code, especially where more standard flow of control was used. This exercise raised issues about the influence of programming language on the design of flexible and sensitive programs such as schedule planners, and called attention to the importance of factors external to the languages themselves such as system embeddedness, hardware context, and programmer practice.

Partnerships for the Design, Conduct, and Analysis of Effectiveness, and Implementation Research: Experiences of the Prevention Science and Methodology Group

PubMed Central

Brown, C. Hendricks; Kellam, Sheppard G.; Kaupert, Sheila; Muthén, Bengt O.; Wang, Wei; Muthén, Linda K.; Chamberlain, Patricia; PoVey, Craig L.; Cady, Rick; Valente, Thomas W.; Ogihara, Mitsunori; Prado, Guillermo J.; Pantin, Hilda M.; Gallo, Carlos G.; Szapocznik, José; Czaja, Sara J.; McManus, John W.

2012-01-01

What progress prevention research has made comes through strategic partnerships with communities and institutions that host this research, as well as professional and practice networks that facilitate the diffusion of knowledge about prevention. We discuss partnership issues related to the design, analysis, and implementation of prevention research and especially how rigorous designs, including random assignment, get resolved through a partnership between community stakeholders, institutions, and researchers. These partnerships shape not only study design, but they determine the data that can be collected and how results and new methods are disseminated. We also examine a second type of partnership to improve the implementation of effective prevention programs into practice. We draw on social networks to studying partnership formation and function. The experience of the Prevention Science and Methodology Group, which itself is a networked partnership between scientists and methodologists, is highlighted. PMID:22160786

Partnerships for the design, conduct, and analysis of effectiveness, and implementation research: experiences of the prevention science and methodology group.

PubMed

Brown, C Hendricks; Kellam, Sheppard G; Kaupert, Sheila; Muthén, Bengt O; Wang, Wei; Muthén, Linda K; Chamberlain, Patricia; PoVey, Craig L; Cady, Rick; Valente, Thomas W; Ogihara, Mitsunori; Prado, Guillermo J; Pantin, Hilda M; Gallo, Carlos G; Szapocznik, José; Czaja, Sara J; McManus, John W

2012-07-01

What progress prevention research has made comes through strategic partnerships with communities and institutions that host this research, as well as professional and practice networks that facilitate the diffusion of knowledge about prevention. We discuss partnership issues related to the design, analysis, and implementation of prevention research and especially how rigorous designs, including random assignment, get resolved through a partnership between community stakeholders, institutions, and researchers. These partnerships shape not only study design, but they determine the data that can be collected and how results and new methods are disseminated. We also examine a second type of partnership to improve the implementation of effective prevention programs into practice. We draw on social networks to studying partnership formation and function. The experience of the Prevention Science and Methodology Group, which itself is a networked partnership between scientists and methodologists, is highlighted.

Equity in Science at South African Schools: A pious platitude or an achievable goal?

NASA Astrophysics Data System (ADS)

Dewnarain Ramnarain, Umesh

2011-07-01

The apartheid policies in South Africa had a marked influence on the accessibility and quality of school science experienced by the different race groups. African learners in particular were seriously disadvantaged in this regard. The issues of equity and redress were foremost in transformation of the education system, and the accompanying curriculum reform. This paper reports on equity in terms of equality of outputs and equality of inputs in South African school science, with a particular focus on the implementation of practical science investigations. This was a qualitative case study of two teachers on their implementation of science investigations at two schools, one a township school, previously designated for black children, and the other a former Model C school, previously reserved for white children. My study was guided by the curriculum implementation framework by Rogan and Grayson in trying to understand the practice of these teachers at schools located in contextually diverse communities. The framework helped profile the implementation of science investigations and also enabled me to explore the factors which are able to support or hinder this implementation.

Issues in Developing and Evaluating a Culturally Tailored Internet Cancer Support Group

PubMed Central

Im, Eun-Ok; Ji, Xiaopeng; Zhang, Jingwen; Kim, Sangmi; Lee, Yaelim; Chee, Eunice; Chee, Wonshik; Tsai, Hsiu-Min; Nishigaki, Masakazu; Yeo, Seon Ae; Schapira, Marilyn; Mao, Jun James

2016-01-01

The purpose of this paper is to explore practical issues in developing and implementing a culturally tailored Internet Cancer Support Group for a group of ethnic minority cancer patients—Asian American cancer patients. Throughout the research process of the original study testing the Internet cancer support group, research team made written records of practical issues and plausible rationales for the issues. Weekly group discussion among research team members was conducted, and the discussion records were evaluated and analyzed using a content analysis (with individual words as the unit of analysis). The codes from the analysis process were categorized into idea themes, through which the issues were extracted. The issues included those in: (a) difficulties in using multiple languages; (b) collaboration with the IT department and technical challenges (c) difficulties in recruitment; (d) difficulties in retention; (e) optimal timing; and (f) characteristics of the users. Based on the findings, we suggested researchers to plan a workable translation process, check technical needs in advance, use multiple strategies to recruit and retain research participants, plan the right time for data collection, and consider characteristics of the users in the study design. PMID:27379523

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions

PubMed Central

Becker, Sara J.

2014-01-01

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed. PMID:25937710

Mathematics lecturing in the digital age

NASA Astrophysics Data System (ADS)

Trenholm, Sven; Alcock, Lara; Robinson, Carol L.

2012-09-01

In this article, we consider the transformation of tertiary mathematics lecture practice. We undertake a focused examination of the related research with two goals in mind. First, we document this research, reviewing the findings of key studies and noting that reflective pieces on individual practice as well as surveys are more prevalent than empirical studies. Second, we investigate issues related to the transformation of lecture practice by the emergence of e-lectures. We discuss the latter in terms of claims about the efficiencies offered by new technologies and contrast these with possible disadvantages in terms of student engagement in a learning community. Overall findings indicate that while survey results appear to trumpet the value of e-lecture provision, empirical study results appear to call that value into question. Two explanatory theoretical frameworks are presented. Issues concerning the instructional context (e.g. the nature of mathematical thinking), inherent complexities and recommendations for implementation are discussed.

Effectiveness and Implementation of Evidence-Based Practices in Residential Care Settings

PubMed Central

James, Sigrid; Alemi, Qais; Zepeda, Veronica

2013-01-01

Purpose Prompted by calls to implement evidence-based practices (EBPs) into residential care settings (RCS), this review addresses three questions: (1) Which EBPs have been tested with children and youth within the context of RCS? (2) What is the evidence for their effectiveness within such settings? (3) What implementation issues arise when transporting EBPs into RCS? Methods Evidence-based psychosocial interventions and respective outcome studies, published from 1990–2012, were identified through a multi-phase search process, involving the review of four major clearinghouse websites and relevant electronic databases. To be included, effectiveness had to have been previously established through a comparison group design regardless of the setting, and interventions tested subsequently with youth in RCS. All outcome studies were evaluated for quality and bias using a structured appraisal tool. Results Ten interventions matching a priori criteria were identified: Adolescent Community Reinforcement Approach, Aggression Replacement Training, Dialectical Behavioral Therapy, Ecologically-Based Family Therapy, Eye Movement and Desensitization Therapy, Functional Family Therapy, Multimodal Substance Abuse Prevention, Residential Student Assistance Program, Solution-Focused Brief Therapy, and Trauma Intervention Program for Adjudicated and At-Risk Youth. Interventions were tested in 13 studies, which were conducted in different types of RCS, using a variety of study methods. Outcomes were generally positive, establishing the relative effectiveness of the interventions with youth in RCS across a range of psychosocial outcomes. However, concerns about methodological bias and confounding factors remain. Most studies addressed implementation issues, reporting on treatment adaptations, training and supervision, treatment fidelity and implementation barriers. Conclusion The review unearthed a small but important body of knowledge that demonstrates that EBPs can be implemented in RCS with encouraging results. PMID:23606781

Effectiveness and Implementation of Evidence-Based Practices in Residential Care Settings.

PubMed

James, Sigrid; Alemi, Qais; Zepeda, Veronica

2013-04-01

Prompted by calls to implement evidence-based practices (EBPs) into residential care settings (RCS), this review addresses three questions: (1) Which EBPs have been tested with children and youth within the context of RCS? (2) What is the evidence for their effectiveness within such settings? (3) What implementation issues arise when transporting EBPs into RCS? Evidence-based psychosocial interventions and respective outcome studies, published from 1990-2012, were identified through a multi-phase search process, involving the review of four major clearinghouse websites and relevant electronic databases. To be included, effectiveness had to have been previously established through a comparison group design regardless of the setting, and interventions tested subsequently with youth in RCS. All outcome studies were evaluated for quality and bias using a structured appraisal tool. Ten interventions matching a priori criteria were identified: Adolescent Community Reinforcement Approach, Aggression Replacement Training, Dialectical Behavioral Therapy, Ecologically-Based Family Therapy, Eye Movement and Desensitization Therapy, Functional Family Therapy, Multimodal Substance Abuse Prevention, Residential Student Assistance Program, Solution-Focused Brief Therapy, and Trauma Intervention Program for Adjudicated and At-Risk Youth. Interventions were tested in 13 studies, which were conducted in different types of RCS, using a variety of study methods. Outcomes were generally positive, establishing the relative effectiveness of the interventions with youth in RCS across a range of psychosocial outcomes. However, concerns about methodological bias and confounding factors remain. Most studies addressed implementation issues, reporting on treatment adaptations, training and supervision, treatment fidelity and implementation barriers. The review unearthed a small but important body of knowledge that demonstrates that EBPs can be implemented in RCS with encouraging results.

Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework.

PubMed

Campbell, Stephen M; Kontopantelis, Evangelos; Hannon, Kerin; Burke, Martyn; Barber, Annette; Lester, Helen E

2011-08-10

Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes.

Acceptability Among Community Healthcare Nurses of Intelligent Wireless Sensor-system Technology for the Rapid Detection of Health Issues in Home-dwelling Older Adults.

PubMed

Cohen, Christine; Kampel, Thomas; Verloo, Henk

2017-01-01

The effective care and support of community healthcare nurses (CHNs) contribute greatly to the healthy aging of older adults living at home. Integrating innovative technologies into CHNs' daily practice offers new opportunities and perspectives for early detection of health issues and interventions among home-dwelling older adults. To explore the perception of acceptability among CHNs of an intelligent wireless sensor system (IWSS) for use in daily practice for the detection of health issues in home-dwelling older adults receiving home healthcare. Descriptive and qualitative data were sourced from a pilot randomized controlled trial involving 17 CHNs using an IWSS in their daily practice to rapidly detect falls and other health issues in patients' homes. IWSS alerts indicating behavior changes were sent to CHNs. Their perceived usefulness (PU) and perceived ease of use (PEOU) were assessed. The acceptability of IWSS technology was explored using a questionnaire and focus group discussions. The PU and PEOU of the IWSS technology were low to moderate. A majority of the CHNs were dissatisfied with its performance and intrusiveness; they reported multiple obstacles in the usefulness and ease of use of the IWSS technology in daily practice. To improve the IWSS technology's low to moderate acceptability among CHNs, we recommend a more user-centered implementation strategy and an embedded model of nursing care.

[Implementation of a Clinical Practice Guidelines for the Management of Adults With Schizophrenia in Colombia].

PubMed

Sánchez Díaz, Natalia; Duarte Osorio, Andrés; Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia

2016-01-01

To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPC_E) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPC_E, and develop a monitoring and evaluation system for the key recommendations. The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. the conclusions and final adjustments were discussed with the GPC_E leaders. The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2)outcome indicators. The GPC_E implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Estimating Legacy Soil Phosphorus Impacts on Phosphorus Loss in The Chesapeake Bay Watershed

USDA-ARS?s Scientific Manuscript database

Agricultural nutrient management is an issue due to phosphorus (P) loss from fields and water quality degradation. This is especially true in watersheds where a history of P application in excess of crop needs has resulted in elevated soil P (legacy P). As practices and policy are implemented in suc...

Establishing and Sustaining Networked Improvement Communities: Lessons from Michigan and Minnesota. REL 2017-264

ERIC Educational Resources Information Center

Proger, Amy R.; Bhatt, Monica P.; Cirks, Victoria; Gurke, Deb

2017-01-01

There is growing interest in the ability of improvement science--the systematic study of improvement strategies to identify promising practices for addressing issues in complex systems (Improvement Science Research Network, 2016)--to spur innovation and address complex problems. In education this methodology is often implemented through…

Interventions to Promote Young People's Physical Activity: Issues, Implications and Recommendations for Practice

ERIC Educational Resources Information Center

Cale, Lorraine; Harris, Jo

2006-01-01

There has been increased interest in the development and implementation of physical activity interventions designed to increase young people's physical activity participation in recent years. This is perhaps founded on concerns over youngsters' physical activity levels and the possible health consequences. School-based interventions are the most…

Teachers' Epistemic Cognition in the Context of Dialogic Practice: A Question of Calibration?

ERIC Educational Resources Information Center

Bråten, Ivar; Muis, Krista R.; Reznitskaya, Alina

2017-01-01

In this article, we argue that teachers' epistemic cognition, in particular their thinking about epistemic aims and reliable processes for achieving those aims, may impact students' understanding of complex, controversial issues. This is because teachers' epistemic cognition may facilitate or constrain their implementation of instruction aiming to…

Teacher (In)Competence: An Analysis and Comparison of the Educational, Legal, and Practical Definitions

ERIC Educational Resources Information Center

Ferchen, Megan Hollingsworth

2012-01-01

Teacher incompetence and the identification of incompetent teachers have become major educational issues. With the implementation of No Child Left Behind (NCLB), every student is expected to be taught by a "highly qualified" teacher. Although "highly qualified" does not guarantee competent teaching, the two often go…

Early Years Education Resource Guide. Early Education Support Series.

ERIC Educational Resources Information Center

Dunlop, Aline-Wendy, Comp.

The aim of this resource guide is to provide practitioners in preschool settings with information to help them plan, implement, augment with resources, and review practice based on the "Curriculum Framework for Children in Their Pre-School Year" issued by the Scottish Office Education and Industry Department. The guide presents a…

Designing for Success in STEM Communities of Practice: Philosophy and Personal Interactions

ERIC Educational Resources Information Center

Kezar, Adrianna; Gehrke, Sean; Bernstein-Sierra, Samantha

2017-01-01

For the past 20 years, countless reports have been issued calling for reform of undergraduate education to improve student learning, persistence, and graduation rates for students in science, technology, engineering, and mathematics (STEM) majors. However, by many measures, recommendations in these reports have not been widely implemented. While…

Formation of Practical Activity Competence of Future Professionals in Higher Educational Establishments of Ukraine and Germany

ERIC Educational Resources Information Center

Gritchenko, Iryna

2014-01-01

The article discusses topical issues of implementation competency-based approach in the modern educational system of Ukraine and Germany. A comparative characterization of competency models in these countries is given. The essence of "organizational pedagogical conditions" concept is enlightened. Its author's interpretation is presented.…

Re-Imagining Inclusive Education for Young Children: A Kaleidoscope of Bourdieuian Theorisation

ERIC Educational Resources Information Center

Klibthong, Sunanta

2012-01-01

This article discusses critical issues related to the development and practice of inclusive education of young children, from the perspective of Bourdieu's conceptual lenses of habitus, capital and field. The target question is: How can Bourdieu's lenses of critical social theory be applied to the development and implementation of early childhood…

Flexible Learning, Human Resource and Organisational Development: Putting Theory To Work.

ERIC Educational Resources Information Center

Jakupec, Viktor, Ed.; Garrick, John, Ed.

This book addresses contemporary contexts of flexible learning and its practices and provides insights about directions that education and training providers may be required to follow to implement flexible learning in a variety of settings. Key issues and debates include the following: social and economic dimensions of flexible learning and…

State Laws and Guidelines for RTI: Additional Implementation Features

ERIC Educational Resources Information Center

Zirkel, Perry A.

2011-01-01

Response to intervention (RTI) remains a major issue in both the professional literature and school practice. A series of previous "snapshot" studies traced the development of RTI in state laws concerning identification of students with specific learning disability (SLD). In the last article in this series, Zirkel and Thomas (2010) reported that…

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…

78 FR 38028 - Notice of Petition for Enforcement and Declaratory Order

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-25

... 1978 (PURPA), 16 USC 824a-3(h) (2011) and Rule 207 of the Rules of Practice and Procedure of the... PURPA, or in the alternative, issue a declaratory order finding that the Montana Public Service... to implement PURPA and the Commission's regulations insofar as the MPSC Rule eliminates the rights of...

Introducing Sustainability into Business Education Contexts Using Active Learning

ERIC Educational Resources Information Center

MacVaugh, Jason; Norton, Mike

2012-01-01

Purpose: The purpose of this paper is to explore how active learning may help address the legitimacy and practicability issues inherent in introducing education for sustainability into business-related degree programs. Design/methodology/approach: The focus of this study is the experience of the authors in the development and implementation of…

A Framework for the Governance of Information Security

ERIC Educational Resources Information Center

Edwards, Charles K.

2013-01-01

Information security is a complex issue, which is very critical for success of modern businesses. It can be implemented with the help of well-tested global standards and best practices. However, it has been studied that the human aspects of information security compliance pose significant challenge to its practitioners. There has been significant…

Volunteerism in Special Education through Industry-Education Cooperation: A Program Development Handbook for Coordinators of Volunteer Recruitment.

ERIC Educational Resources Information Center

Hughes, James H.

Intended for coordinators of volunteer recruitment, the booklet examines practical issues in developing and implementing programs in which industry employees serve as volunteers in special education. Introductory material briefly addresses volunteerism in America, and considers the need for industry-education cooperation as well as advantages to…

An International Study in Competency Education: Postcards from Abroad. CompetencyWorks Issue Brief

ERIC Educational Resources Information Center

Bristow, Sara Frank; Patrick, Susan

2014-01-01

"An International Study in Competency Education: Postcards from Abroad" seeks to highlight components of competency education in international practice, to inform US policymakers and decision makers seeking to implement high-quality competency pathways at the state or local level. Other countries are studying our innovations, and we are…

Authentic and Self-Directed Learning in Vocational Education: Challenges to Vocational Educators

ERIC Educational Resources Information Center

de Bruijn, Elly; Leeman, Yvonne

2011-01-01

This article analyses the dilemmas and practical tensions in implementing competence-based vocational education. Eleven case studies were conducted, including observation of lessons and interviews with teachers and students. The results show that schools meet various fundamental issues in realising this approach. A crucial question is how to…

Leveraging Evidence-Based Practices: From Policy to Action

ERIC Educational Resources Information Center

Detrich, Ronnie; Keyworth, Randy; States, Jack

2016-01-01

Education is a public health issue. Poor educational outcomes are correlated with many health and social ills. To improve the quality of education, it will be necessary to take advantage of the leverage points of policy, evidence, and implementation science. The idea of evidence informing policy may be non-controversial, but a closer examination…

Character Education: Controversy and Consensus. Controversial Issues in Education Series.

ERIC Educational Resources Information Center

Lockwood, Anne Turnbaugh

This book draws on conversations with six individuals, each of whom offers a distinct approach to character education and speaks to the problems and the practical side of designing, implementing, and evaluating character education. The text opens with an overview of character education, exploring what it is, moral dilemmas, goals, and criticisms.…

Pilot Study and Evaluation of Postgraduate Course on "The Interface Between Spirituality, Religion and Psychiatry"

ERIC Educational Resources Information Center

Grabovac, Andrea; Clark, Nancy; McKenna, Mario

2008-01-01

Objectives: Understanding the role of religion and spirituality is significant for psychiatric practice. Implementation of formal education and training on religious and spiritual issues, however, is lacking. Few psychiatric residencies offer mandatory courses or evaluation of course utility. The authors present findings from a pilot study of a…

Impacts of a Redesigned Virtual Internship Program on Preservice Teachers' Skills and Attitudes

ERIC Educational Resources Information Center

Faucette, Nell; Nugent, Peg

2015-01-01

An important issue in teacher education is how to design and implement effective virtual internships for future educators. Today, these experiences should reflect best practices (as found in more traditional programs) by infusing constructivist values and strategies into the process. Interns can develop needed content knowledge and delivery skills…

Evidence-Based Professional Development Considerations along the School-to-Prison Pipeline

ERIC Educational Resources Information Center

Houchins, David E.; Shippen, Margaret E.; Murphy, Kristin M.

2012-01-01

This article addresses professional development (PD) issues for those who provide services to students in the school-to-prison pipeline (STPP). Emphasis is on implementing evidence-based practices. The authors use a modified version of Desimone's PD framework for the structure of this article involving (a) collective participation and common…

The lens of the eye: exposures in the UK medical sector and mechanistic studies of radiation effects.

PubMed

Bouffler, S D; Peters, S; Gilvin, P; Slack, K; Markiewicz, E; Quinlan, R A; Gillan, J; Coster, M; Barnard, S; Rothkamm, K; Ainsbury, E

2015-06-01

The recommendation from the International Commission on Radiological Protection that the occupational equivalent dose limit for the lens of the eye should be reduced to 20 mSv year(-1), averaged over 5 years with no year exceeding 50 mSv, has stimulated a discussion on the practicalities of implementation of this revised dose limit, and the most appropriate risk and protection framework to adopt. This brief paper provides an overview of some of the drivers behind the move to a lower recommended dose limit. The issue of implementation in the medical sector in the UK has been addressed through a small-scale survey of doses to the lens of the eye amongst interventional cardiologists and radiologists. In addition, a mechanistic study of early and late post-irradiation changes in the lens of the eye in in-vivo-exposed mice is outlined. Surveys and studies such as those described can contribute to a deeper understanding of fundamental and practical issues, and therefore contribute to a robust evidence base for ensuring adequate protection of the eye while avoiding undesirable restrictions to working practices. © The International Society for Prosthetics and Orthotics Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Shifting from presumptive to test-based management of malaria - technical basis and implications for malaria control in Ghana.

PubMed

Baiden, F; Malm, K; Bart-Plange, C; Hodgson, A; Chandramohan, D; Webster, J; Owusu-Agyei, S

2014-06-01

The presumptive approach was the World Health Organisation (WHO) recommended to the management of malaria for many years and this was incorporated into syndromic guidelines such as the Integrated Management of Childhood Illnesses (IMCI). In early 2010 however, WHO issued revised treatment guidelines that call for a shift from the presumptive to the test-based approach. Practically, this implies that in all suspected cases, the diagnosis of uncomplicated malaria should be confirmed using rapid test before treatment is initiated. This revision effectively brings to an end an era of clinical practice that span several years. Its implementation has important implications for the health systems in malaria-endemic countries. On the basis of research in Ghana and other countries, and evidence from program work, the Ghana National Malaria Control Program has issued revised national treatment guidelines that call for implementation of test-based management of malaria in all cases, and across all age groups. This article reviews the evidence and the technical basis for the shift to test-based management and examines the implications for malaria control in Ghana.

The role of training in IBA implementation beyond primary health care settings in the UK

PubMed Central

Thom, Betsy; Herring, Rachel; Bayley, Mariana

2016-01-01

Abstract There has been a considerable drive to encourage a wide range of professional groups to incorporate alcohol screening (or identification) and brief advice (IBA) into their everyday practice. This article aims to examine the role of training in promoting IBA delivery in contexts outside primary care and other health settings. The data are drawn mainly from a structured online survey supplemented by illustrative material from nine qualitative interviews and insights from an expert workshop. Findings support the results from other research that issues relating to role relevance and role security continue to act as barriers to professional change. Furthermore, issues of organisational commitment and organisational barriers are insufficiently addressed in strategy to promote wider use of IBA. The article concludes that development of appropriate training for alcohol IBA needs to take account of the role of IBA within a complex interactive system of related services and help seeking pathways and consider how training can contribute to changing both professional attitudes and behaviours and organisational approaches to implementing and sustaining IBA in everyday professional practice. PMID:28018054

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics

PubMed Central

Maynard, Serge; Campbell, Emily; Boodhoo, Katie; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara A.

2015-01-01

Background and Objectives: In 2007, the Québec Ministry of Health issued a policy document that specifically mandated the development of addiction treatment services including screening, brief interventions and referral (SBIR) to be delivered by primary healthcare clinics throughout Québec. The current study examined the level of implementation of SBIR one year following the end of the mandate (2007–2012). Approach: Semi-structured interviews were conducted with 45 participants from 21 primary health and social service centres throughout the province. Qualitative analysis was used to evaluate the level of success each centre had in implementing SBIR and to identify organizational measures that contributed to successful implementation. Results: The results show that Québec primary health and social service centres had limited success in their efforts to integrate SBIR into their services. A comparative analysis of the centres, categorized according to their level of implementation, revealed the presence of significant organizational- and staff-level factors, including the creation of formal action plans that were conducive to the successful implementation of SBIR in primary care. Conclusion: The findings highlight the importance of offering support and guidance, as well as a menu of specific practices that are likely to assist primary health and social services centres to implement SBIR. At the organizational level, the adoption of local action plans and formal service trajectories offers a framework that allows for horizontal and vertical integration of new practices. PMID:26742118

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics.

PubMed

Maynard, Serge; Campbell, Emily; Boodhoo, Katie; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara A; Gill, Kathryn

2015-11-01

In 2007, the Québec Ministry of Health issued a policy document that specifically mandated the development of addiction treatment services including screening, brief interventions and referral (SBIR) to be delivered by primary healthcare clinics throughout Québec. The current study examined the level of implementation of SBIR one year following the end of the mandate (2007-2012). Semi-structured interviews were conducted with 45 participants from 21 primary health and social service centres throughout the province. Qualitative analysis was used to evaluate the level of success each centre had in implementing SBIR and to identify organizational measures that contributed to successful implementation. The results show that Québec primary health and social service centres had limited success in their efforts to integrate SBIR into their services. A comparative analysis of the centres, categorized according to their level of implementation, revealed the presence of significant organizational- and staff-level factors, including the creation of formal action plans that were conducive to the successful implementation of SBIR in primary care. The findings highlight the importance of offering support and guidance, as well as a menu of specific practices that are likely to assist primary health and social services centres to implement SBIR. At the organizational level, the adoption of local action plans and formal service trajectories offers a framework that allows for horizontal and vertical integration of new practices. Copyright © 2015 Longwoods Publishing.

Vision for a treasured resource. Part 2. Nurse manager learning needs.

PubMed

Horvath, K J; Aroian, J F; Secatore, J A; Alpert, H; Costa, M J; Powers, E; Stengrevics, S S

1997-04-01

Part 1 in this two-part series focused on the meaning of significant incidents in nurse managers' practice related to role implementation. Explanation of the authors' application of the Manager as Developer Model (MADM) as a useful model for organizing and understanding some of the data was also discussed. Part 2 describes significant incidents in nurse managers' practice related to their ongoing learning needs. The authors address issues of performance counseling and intervention versus coaching and make recommendations for management development programs.

Establishing intensivist-driven ultrasound at the PICU bedside--it's about time*.

PubMed

Su, Erik; Pustavoitau, Aliaksei; Hirshberg, Elliotte L; Nishisaki, Akira; Conlon, Thomas; Kantor, David B; Weber, Mark D; Godshall, Aaron J; Burzynski, Jeffrey H; Thompson, Ann E

2014-09-01

To discuss pediatric intensivist-driven ultrasound and the exigent need for research and practice definitions pertaining to its implementation within pediatric critical care, specifically addressing issues in ultrasound-guided vascular access and intensivist-driven echocardiography. Intensivist-driven ultrasound improves procedure safety and reduces time to diagnosis in clinical ultrasound applications, as demonstrated primarily in adult patients. Translating these applications to the PICU requires thoughtful integration of the technology into practice and would best be informed by dedicated ultrasound research in critically ill children.

Telerehabilitation store and forward applications: a review of applications and privacy considerations in physical and occupational therapy practice.

PubMed

Peterson, Christopher; Watzlaf, Valerie

2014-01-01

An overview of store and forward applications commonly used in physical and occupational therapy practice is reviewed with respect to regulation, privacy, security, and clinical applications. A privacy and security checklist provides a clear reference of pertinent regulatory issues regarding these software applications. A case study format is used to highlight clinical applications of store and forward software features. Important considerations of successful implementation of store and forward applications are also identified and discussed.

Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting.

PubMed

Smith, Katherine; Firth, Kimberly; Smeeding, Sandra; Wolever, Ruth; Kaufman, Joanna; Delgado, Roxana; Bellanti, Dawn; Xenakis, Lea

2016-01-01

Research suggests that the development of mind-body skills can improve individual and family resilience, particularly related to the stresses of illness, trauma, and caregiving. To operationalize the research evidence that mind-body skills help with health and recovery, Samueli Institute, in partnership with experts in mind-body programming, created a set of guidelines for developing and evaluating mind-body programs for service members, veterans, and their families. The Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting outline key strategies and issues to consider when developing, implementing, and evaluating a mind-body focused family empowerment approach in a military healthcare setting. Although these guidelines were developed specifically for a military setting, most of the same principles can be applied to the development of programs in the civilian setting as well. The guidelines particularly address issues unique to mind-body programs, such as choosing evidence-based modalities, licensure and credentialing, safety and contraindications, and choosing evaluation measures that capture the holistic nature of these types of programs. The guidelines are practical, practice-based guidelines, developed by experts in the fields of program development and evaluation, mind-body therapies, patient- and family-centered care, as well as, experts in military and veteran's health systems. They provide a flexible framework to create mind-body family empowerment programs and describe important issues that program developers and evaluators are encouraged to address to ensure the development of the most impactful, successful, evidence-supported programs possible. Copyright © 2016 Elsevier Inc. All rights reserved.

The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.

PubMed

Coulam, Robert; Kralewski, John; Dowd, Bryan; Gans, David

2016-01-01

Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management. Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if supported by more useful forms of quality reporting.

Integrating virtual reality video games into practice: clinicians' experiences.

PubMed

Levac, Danielle E; Miller, Patricia A

2013-10-01

The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

JHPPL workshop on Medicaid fiscal and governance issues: objectives and themes.

PubMed

Long, Peter V; Campbell, Andrea Louise

2013-08-01

At a November 2012 workshop, state health policy officials, other Medicaid and insurance exchange practitioners, and health policy researchers discussed issues surrounding the implementation and sustainability of Medicaid expansion and insurance exchange coordination under the Patient Protection and Affordable Care Act (PPACA). Foremost were concerns about (1) intergovernmental relations (states experiencing uncertain information, lack of coordination among federal agencies, and limited resources to take on new responsibilities under the PPACA), and (2) policy design (new issues such as Medicaid exchange coordination on top of preexisting Medicaid challenges). JHPPL has proposed the creation of a research network to develop policy options and share strategies and best practices.

The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework.

PubMed

Rycroft-Malone, Jo; Seers, Kate; Chandler, Jackie; Hawkes, Claire A; Crichton, Nicola; Allen, Claire; Bullock, Ian; Strunin, Leo

2013-03-09

The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets. A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes. This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework. We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice. This proposal will enhance the potential of the PARIHS framework for explanation, and ensure theoretical development both informs and responds to the evidence base for implementation.

Mapping for the management of diffuse pollution risks related to agricultural plant protection practices: case of the Etang de l'Or catchment area in France.

PubMed

Mghirbi, Oussama; Bord, Jean-Paul; Le Grusse, Philippe; Mandart, Elisabeth; Fabre, Jacques

2018-03-08

Faced with health, environmental, and socio-economic issues related to the heavy use of pesticides, diffuse phytosanitary pollution becomes a major concern shared by all the field actors. These actors, namely the farmers and territorial managers, have expressed the need to implement decision support tools for the territorial management of diffuse pollution resulting from the plant protection practices and their impacts. To meet these steadily increasing requests, a cartographic analysis approach was implemented based on GIS which allows the spatialization of the diffuse pollution impacts related to plant protection practices on the Etang de l'Or catchment area in the South of France. Risk mapping represents a support-decision tool that enables the different field actors to identify and locate vulnerable areas, so as to determine action plans and agri-environmental measures depending on the context of the natural environment. This work shows that mapping is helpful for managing risks related to the use of pesticides in agriculture by employing indicators of pressure (TFI) and risk on the applicator's health (IRSA) and on the environment (IRTE). These indicators were designed to assess the impact of plant protection practices at various spatial scales (field, farm, etc.). The cartographic analysis of risks related to plant protection practices shows that diffuse pollution is unequally located in the North (known for its abundant garrigues and vineyards) and in the South of the Etang de l'Or catchment area (the Mauguio-Lunel agricultural plain known for its diversified cropping systems). This spatial inequity is essentially related to land use and agricultural production system. Indeed, the agricultural lands cover about 60% of the total catchment area. Consequently, this cartographic analysis helps the territorial actors with the implementation of strategies for managing risks of diffuse pollution related to pesticides use in agriculture, based on environmental and socio-economic issues and the characteristics of the natural environment.

Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation.

PubMed

Aarons, Gregory A; Sommerfeld, David H

2012-04-01

Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader-member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader-member exchange with innovation climate and attitudes toward adoption and use of EBP. Transformational leadership predicted higher innovation climate during implementation, whereas leader-member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

A proposal of an architecture for the coordination level of intelligent machines

NASA Technical Reports Server (NTRS)

Beard, Randall; Farah, Jeff; Lima, Pedro

1993-01-01

The issue of obtaining a practical, structured, and detailed description of an architecture for the Coordination Level of Center for Intelligent Robotic Systems for Sapce Exploration (CIRSSE) Testbed Intelligent Controller is addressed. Previous theoretical and implementation works were the departure point for the discussion. The document is organized as follows: after this introductory section, section 2 summarizes the overall view of the Intelligent Machine (IM) as a control system, proposing a performance measure on which to base its design. Section 3 addresses with some detail implementation issues. An hierarchic petri-net with feedback-based learning capabilities is proposed. Finally, section 4 is an attempt to address the feedback problem. Feedback is used for two functions: error recovery and reinforcement learning of the correct translations for the petri-net transitions.

Chinese hotel general managers' perspectives on energy-saving practices

NASA Astrophysics Data System (ADS)

Zhu, Yidan

As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

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.

Barriers to ESC guideline implementation: results of a survey from the European Council on Cardiovascular Nursing and Allied Professions (CCNAP).

PubMed

McKee, Gabrielle; Kerins, Mary; Hamilton, Glenys; Hansen, Tina; Hendriks, Jeroen; Kletsiou, Eleni; Lambrinou, Ekaterini; Jennings, Catriona; Fitzsimons, Donna

2017-12-01

The European Society of Cardiology (ESC) has a comprehensive clinical guideline development programme, relevant for all clinicians. However, implementation of guidelines is not always optimal. The aim of this study was to determine nurses' and allied professionals' awareness and barriers regarding clinical guideline implementation. A cross-sectional survey was administrated online and in print at EuroHeartCare 2015. A questionnaire was developed which examined awareness and barriers to implementation of ESC guidelines on cardiovascular disease prevention in clinical practice (2012) and ESC guidelines in general. Of the 298 respondents, 12% reported that the prevention guidelines were used in their practice area. Respondents identified, in order of magnitude, that lack of leadership, workload, time, resources and a perception that they were unable to influence current practice were barriers to the use of the prevention guidelines. When asked to rank barriers to use of any ESC guidelines, time (22%) and leadership (23%) were ranked highest. Implementation of ESC guidelines by nurses, the majority responders in this survey, is a serious problem, requiring urgent improvement to ensure patients receive optimal evidence based care. Issues of leadership, workload, time and resources are significant barriers to guideline implementation. It is of concern that these professionals perceive both that they have little influence on implementation decisions and lack of leadership regarding guideline implementation. Educational and organisational strategies to improve leadership skills are imperative. These will build self-efficacy and empower nurses and allied professionals to advocate for evidence-based care in the clinical environment.

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2014-06-01

The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as 'baby friendly'. This variance has persisted regardless of BFHI implementation in Australia gaining 'in principle' support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices. Identify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia. Knowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia. Australian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review.

PubMed

Hurlimann, Thierry; Peña-Rosas, Juan Pablo; Saxena, Abha; Zamora, Gerardo; Godard, Béatrice

2017-01-01

The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. The goal of this scoping review is to delineate and "map" the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O'Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions. General ethical frameworks or recommendations-although useful-cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.

Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

PubMed Central

Segelman, Josefin; Nygren, Jonas

2014-01-01

Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies. PMID:25469030

A prioritization of generic safety issues. Supplement 19, Revision insertion instructions

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

None

1995-11-01

The report presents the safety priority ranking for generic safety issues related to nuclear power plants. The purpose of these rankings is to assist in the timely and efficient allocation of NRC resources for the resolution of those safety issues that have a significant potential for reducing risk. The safety priority rankings are HIGH, MEDIUM, LOW, and DROP, and have been assigned on the basis of risk significance estimates, the ratio of risk to costs and other impacts estimated to result if resolution of the safety issues were implemented, and the consideration of uncertainties and other quantitative or qualitative factors.more » To the extent practical, estimates are quantitative. This document provides revisions and amendments to the report.« less

Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement

PubMed Central

Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna

2016-01-01

Objectives Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. Methods We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. Results 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. Conclusions There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results. PMID:27473953

Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar.

PubMed

Honda, Ayako

2015-02-04

There are large gaps in the literature relating to the implementation of user fee policy and fee exemption measures for the poor, particularly on how such schemes are implemented and why many have not produced expected outcomes. In October 2003, Madagascar instituted a user fee exemption policy which established "equity funds" at public health centres, and used medicine sales revenue to subsidise the cost of medicine for the poor. This study examines the policy design and implementation process of the equity fund in Madagascar in an attempt to explore factors influencing the poor equity outcomes of the scheme. This study applied an agency-incentive framework to investigate the equity fund policy design and implementation practices. It analysed agency relationships established during implementation; examined incentive structures given to the agency relationships in the policy design; and considered how incentive structures were shaped and how agents responded in practice. The study employed a case-study approach with in-depth analysis of three equity fund cases in Madagascar's Boeny region. Policy design problems, triggering implementation problems, caused poor equity performance. These problems were compounded by the re-direction of policy objectives by health administrators and strong involvement of the administrators in the implementation of policy. The source of the policy design and implementation failure was identified as a set of principal-agent problems concerning: monitoring mechanisms; facility-based fund management; and the nature and level of community participation. These factors all contributed to the financial performance of the fund receiving greater attention than its ability to financially protect the poor. The ability of exemption policies to protect the poor from user fees can be found in the details of the policy design and implementation; and implications of the policy design and implementation in a specific context determine whether a policy can realise its objectives. The equity fund experience in Madagascar, which illustrates the challenges of beneficiary identification, casts doubts on the application of the 'targeting' approach in health financing and raises issues to be considered in universal health policy formulation. The agency framework provides a useful lens through which to examine policy process issues.

From concept to content: assessing the implementation fidelity of a chronic care model for frail, older people who live at home.

PubMed

Muntinga, Maaike E; Van Leeuwen, Karen M; Schellevis, François G; Nijpels, Giel; Jansen, Aaltje P D

2015-01-22

Implementation fidelity, the degree to which a care program is implemented as intended, can influence program impact. Since results of trials that aim to implement comprehensive care programs for frail, older people have been conflicting, assessing implementation fidelity alongside these trials is essential to differentiate between flaws inherent to the program and implementation issues. This study demonstrates how a theory-based assessment of fidelity can increase insight in the implementation process of a complex intervention in primary elderly care. The Geriatric Care Model was implemented among 35 primary care practices in the Netherlands. During home visits, practice nurses conducted a comprehensive geriatric assessment and wrote a tailored care plan. Multidisciplinary team consultations were organized with the aim to enhance the coordination between professionals caring for a single patient with complex needs. To assess fidelity, we identified 5 key intervention components and formulated corresponding research questions using Carroll's framework for fidelity. Adherence (coverage, frequency, duration, content) was assessed per intervention component during and at the end of the intervention period. Two moderating factors (participant responsiveness and facilitation strategies) were assessed at the end of the intervention. Adherence to the geriatric assessments and care plans was high, but decreased over time. Adherence to multidisciplinary consultations was initially poor, but increased over time. We found that individual differences in adherence between practice nurses and primary care physicians were moderate, while differences in participant responsiveness (satisfaction, involvement) were more distinct. Nurses deviated from protocol due to contextual factors and personal work routines. Adherence to the Geriatric Care Model was high for most of the essential intervention components. Study limitations include the limited number of assessed moderating factors. We argue that a longitudinal investigation of adherence per intervention component is essential for a complete understanding of the implementation process, but that such investigations may be complicated by practical and methodological challenges. The Netherlands National Trial Register (NTR). 2160 .

Research ethics consultation: ethical and professional practice challenges and recommendations.

PubMed

Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

2015-05-01

The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.

Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

PubMed Central

Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

2015-01-01

The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

Implementation of customized health information technology in diabetes self management programs.

PubMed

Alexander, Susan; Frith, Karen H; O'Keefe, Louise; Hennigan, Michael A

2011-01-01

The project was a nurse-led implementation of a software application, designed to combine clinical and demographic records for a diabetes education program, which would result in secure, long-term record storage. Clinical information systems may be prohibitively expensive for small practices and require extensive training for implementation. A review of the literature suggests that the use of simple, practice-based registries offer an economical method of monitoring the outcomes of diabetic patients. The database was designed using a common software application, Microsoft Access. The theory used to guide implementation and staff training was Rogers' Diffusion of Innovations theory (1995). Outcomes after a 3-month period included incorporation of 100% of new clinical and demographic patient records into the database and positive changes in staff attitudes regarding software applications used in diabetes self-management training. These objectives were met while keeping project costs under budgeted amounts. As a function of the clinical nurse specialist (CNS) researcher role, there is a need for CNSs to identify innovative and economical methods of data collection. The success of this nurse-led project reinforces suggestions in the literature for less costly methods of data maintenance in small practice settings. Ongoing utilization and enhancement have resulted in the creation of a robust database that could aid in the research of multiple clinical issues. Clinical nurse specialists can use existing evidence to guide and improve both their own practice and outcomes for patients and organizations. Further research regarding specific factors that predict efficient transition of informatics applications, how these factors vary according to practice settings, and the role of the CNS in implementation of such applications is needed.

Scope of Policy Issues in eHealth: Results From a Structured Literature Review

PubMed Central

Durrani, Hammad; Nayani, Parvez; Fahim, Ammad

2012-01-01

Background eHealth is widely used as a tool for improving health care delivery and information. However, distinct policies and strategies are required for its proper implementation and integration at national and international levels. Objective To determine the scope of policy issues faced by individuals, institutions, or governments in implementing eHealth programs. Methods We conducted a structured review of both peer-reviewed and gray literature from 1998–2008. A Medline search for peer-reviewed articles found 40 papers focusing on different aspects of eHealth policy. In addition, a Google search found 20 national- and international-level policy papers and documents. We reviewed these articles to extract policy issues and solutions described at different levels of care. Results The literature search found 99 policy issues related to eHealth. We grouped these issues under the following themes: (1) networked care, (2) interjurisdictional practice, (3) diffusion of eHealth/digital divide, (4) eHealth integration with existing systems, (5) response to new initiatives, (6) goal-setting for eHealth policy, (7) evaluation and research, (8) investment, and (9) ethics in eHealth. Conclusions We provide a list of policy issues that should be understood and addressed by policy makers at global, jurisdictional, and institutional levels, to facilitate smooth and reliable planning of eHealth programs. PMID:22343270

Information technology, the internet, and the future of neurology.

PubMed

Maulden, Sarah A

2003-05-01

This review addresses the impact of information technology and the Internet on the current and future practice of neurology. Information technology is influencing medical practice in ways that could be both beneficial and harmful. Scenarios are presented to depict some of the ways in which the practice of neurology is being influenced by the growth of technology. First, the advantages and disadvantages of e-mail as a means of doctor-patient communication are presented. Some of the ethical and legal issues arising in this context are discussed.Second, the Internet is changing neurologists' relationships to other professionals in the health care industry. Geographical isolation is less problematic than in the past. Telemedicine, including remote consulting via the Web, has special implications for neurologists in several areas, including stroke management, movement disorders, and epilepsy.Third, the growing availability of large databases, powerful search engines, and online full-text journals is discussed. Skill in navigating and managing these resources will become increasingly important. New computer-assisted decision support systems will continue to be implemented. Applications exist or are being developed for use by clinicians for many specific neurologic disorders.Finally, some of the problematic issues concerning medical use of the Internet are discussed, including availability, portability, security, quality, and outcomes. Medical information systems, with their attendant advantages and limitations, will become increasingly significant in the practice of neurology. Despite overall improvement in access to information, major barriers still exist to the proper implementation and utilization of truly integrated information systems.

Curriculum translation and environmental education: considering issues of discursive intentionality, interpretation, and validity

NASA Astrophysics Data System (ADS)

Oliveira, Alandeom W.; Colak, Huseyin; Akerson, Valarie L.

2009-03-01

We would like to thank our commentators Reis, Ercikan and Alper for their insightful comments on our research study and respond in brief to a few of their criticisms. More specifically, we would like to address what we consider to be the three main issues they raise with regard to the practices of curriculum translation and implementation across languages, namely viewing speakers' intentions as a mode of signification in discourse analysis, exploring curriculum translation through an interpretive research approach, and establishing the validity of research on curriculum translation.

Nurse managers' strategies for feeling less drained by their work: an action research and reflection project for developing emotional intelligence.

PubMed

Taylor, Bev; Roberts, Sue; Smyth, Therese; Tulloch, Moira

2015-10-01

To raise nurse managers' critical awareness of practice problems; uncover practice constraints and improve work effectiveness. Nurse management requires skills and knowledge, underscored by emotional intelligence. The research improved participants' practice and personal insights. Purposive sampling targeted nurse managers interested in improving their practice. Three experienced female nurse managers met fortnightly in a group, for 1 hour, for 10 meetings. The methods included: writing and sharing de-identified journal reflections; critically analysing practice stories; identifying a thematic concern; generating action strategies; and instituting and revising the action plan. Phase One resulted in the identification of the issue of 'being drained by the intensity of nurse managers' work'. The participants adopted five strategies: debriefing problematic situations; deflecting multiple requests; diffusing issues; naming dysfunctional behaviours; and regrouping. In Phase Two, participants implemented and revised the action plan strategies, which resulted in them feeling less drained by their work. Strategies can lessen nurse managers' sense of personal depletion. However, strategies cannot guarantee success every time because the emotional intelligence is integral to nurse management. Action research and reflection assist nurse managers to improve their practice and develop their emotional intelligence. © 2014 John Wiley & Sons Ltd.

Hydrolysis of ammonia borane as a hydrogen source: fundamental issues and potential solutions towards implementation.

PubMed

Sanyal, Udishnu; Demirci, Umit B; Jagirdar, Balaji R; Miele, Philippe

2011-12-16

In today's era of energy crisis and global warming, hydrogen has been projected as a sustainable alternative to depleting CO(2)-emitting fossil fuels. However, its deployment as an energy source is impeded by many issues, one of the most important being storage. Chemical hydrogen storage materials, in particular B-N compounds such as ammonia borane, with a potential storage capacity of 19.6 wt % H(2) and 0.145 kg(H2)L(-1), have been intensively studied from the standpoint of addressing the storage issues. Ammonia borane undergoes dehydrogenation through hydrolysis at room temperature in the presence of a catalyst, but its practical implementation is hindered by several problems affecting all of the chemical compounds in the reaction scheme, including ammonia borane, water, borate byproducts, and hydrogen. In this Minireview, we exhaustively survey the state of the art, discuss the fundamental problems, and, where applicable, propose solutions with the prospect of technological applications. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Building Research Relationships With Managed Care Organizations: Issues and Strategies.

PubMed

Lein, Catherine; Collins, Clare; Lyles, Judith S; Hillman, Donald; Smith, Robert C

2003-06-01

Managed care is now the dominant form of healthcare in the United States. The need for clinical research about the organization, delivery, and outcomes of primary care services in managed care models is high, yet access to managed care organizations as sites for clinical research may be problematic. The purpose of this article is to describe issues involved in obtaining access to managed care settings for clinical research and practical strategies for successful collaboration using literature review and case description. Three steps for developing collaborative relationships with managed care organizations (MCOs) are presented: 1) assessment of organizational structure, history, and culture; 2) finding common ground; and 3) project implementation. These steps are discussed within the context of MCO systems issues and a relationship-centered approach to communication between researchers and individuals from the MCO. Successful relationships with MCOs for clinical research are possible when careful attention is paid to inclusion of MCOs as collaborators in the development of the research questions and design, and as partners in the research implementation process.

Computer-Based Testing in the Medical Curriculum: A Decade of Experiences at One School

ERIC Educational Resources Information Center

McNulty, John; Chandrasekhar, Arcot; Hoyt, Amy; Gruener, Gregory; Espiritu, Baltazar; Price, Ron, Jr.

2011-01-01

This report summarizes more than a decade of experiences with implementing computer-based testing across a 4-year medical curriculum. Practical considerations are given to the fields incorporated within an item database and their use in the creation and analysis of examinations, security issues in the delivery and integrity of examinations,…

The Pitfalls of Mobile Devices in Learning: A Different View and Implications for Pedagogical Design

ERIC Educational Resources Information Center

Ting, Yu-Liang

2012-01-01

Studies have been devoted to the design, implementation, and evaluation of mobile learning in practice. A common issue among students' responses toward this type of learning concerns the pitfalls of mobile devices, including small screen, limited input options, and low computational power. As a result, mobile devices are not always perceived by…

Effectiveness and Quality in Continuing Professional Education: A Critical Examination of the Interface between Policy and Practice in UK Universities.

ERIC Educational Resources Information Center

Day, Christopher; And Others

This 2-year study of the effectiveness and quality of continuing professional education (CPE) in the United Kingdom identified policy implementation issues resulting from recent government policies and economic imperatives which have given rise to a "new managerialism" which is changing the organizational culture of higher education…

The Journal of Staff, Program, & Organization Development, Volume 12. Summer 1994-Spring 1995.

ERIC Educational Resources Information Center

Lewis, Karron G., Ed.

1995-01-01

This quarterly publication serves as a medium for the exchange of ideas regarding the planning, design, implementation, and evaluation of professional development practices at two- and four-year colleges. The four issues in volume 12 feature the following articles: (1) "The Course Syllabus Reexamined," by James O. Hammons and Jackson R. Shock; (2)…

Implementing Quality Assurance at Royal University of Phnom Penh, Cambodia: Perceptions, Practices and Challenges

ERIC Educational Resources Information Center

Ros, Soveacha

2010-01-01

Quality Assurance in higher education has been an ongoing international issue for discussion. As higher education institutions move toward an era of accountability and accreditation, groups of stakeholders require proof of high-quality academic programs and services from higher education providers. Since the mid-1990s, most providers have strived…

Public Engagement and Nanotechnology in Australia.

PubMed

Dalton-Brown, Sally

2016-07-01

Upstream engagement is commonly regarded as necessary for the smooth implementation of new technologies, particularly when there is an impact on health. Is the healthcare context in Australia geared toward such public engagement? There are established engagement practices for issues of healthcare resourcing, for example; however, the situation becomes more complex with the introduction of a new technology such as nanomedicine.

Understanding the Early Transition Needs of Diverse Commencing University Students in a Health Faculty: Informing Effective Intervention Practices

ERIC Educational Resources Information Center

Wilson, Keithia L.; Murphy, Karen A.; Pearson, Andrew G.; Wallace, Barbara M.; Reher, Vanessa G. S.; Buys, Nicholas

2016-01-01

The engagement and retention of commencing students is a longstanding issue in higher education, particularly with the implementation of the widening student participation agenda. The early weeks of the first semester are especially critical to student engagement and early attrition. This study investigated the perceived early transition needs of…

Ethics and Accreditation in Addictions Counselor Training: Possible Field Placement Issues for CACREP-Accredited Addictions Counseling Programs

ERIC Educational Resources Information Center

Linton, Jeremy M.

2012-01-01

Professional counselors have long been practicing in alcohol and drug treatment settings. However, only recently has the counseling field offered formal recognition of addictions counseling as a specialization through the implementation of accreditation standards for addiction counseling training programs. With the passage of the 2009 standards,…

School-University Partnerships: A Means for the Inclusion of Policy Studies in Music Teacher Education

ERIC Educational Resources Information Center

Hunter, Lisa R.

2011-01-01

The need for music educators to become more actively involved in policy issues, including analysis, design, implementation, and research, is critical to the future of music education. Bridging the gap between policy and practice requires a collaborative effort among music professionals. This article explores the inclusive use of policy studies in…

Key issues in diagnosing and treating hepatitis C infection.

PubMed

Hainsworth, Terry

A strategy and action plan is in place for the management of hepatitis C. However, recent evidence suggests that this is not being implemented and hepatitis C remains a significant public health concern. This article summarises the condition and potential problems, highlights data from the recent audit of practice and outlines the latest recommendations for managing hepatitis C.

Practical Implementation of Global Citizenship Education at the Slovak University of Agriculture

ERIC Educational Resources Information Center

Mravcová, Anna

2016-01-01

Global citizenship is still a relatively new concept concerned mainly with the growing prominence of global and development education issues. The importance of this phenomenon is increasing in the area of education, which must be able to respond to the interconnection and interdependency of the current world. There is an effort to support…

Educational Choice--Thinking It Through. Insights on Educational Policy and Practice Number 8.

ERIC Educational Resources Information Center

Pollard, Joyce S.

Before charging blindly into the issues of implementing educational choice programs, states and local districts need to stop and think about direction for efforts to improve and restructure education. Recent research shows that the most successful choice systems are tailored to their community's needs. Among the plans that have been implemented…

Integrating Graphic Nonfiction into Classroom Reading and Content Area Instruction: A Critical Literacy Focus on Selection Issues

ERIC Educational Resources Information Center

Möller, Karla J.

2015-01-01

An understanding of the importance of nonfiction literature in classroom instruction is not new within the field of education. The recent implementation of the Common Core State Standards (National Governors Association Center for Best Practices & Council of Chief State School Officers, 2010) has brought an increased policy focus. The Common…

Lesson Study, Improvement, and the Importing of Cultural Routines

ERIC Educational Resources Information Center

Stigler, James W.; Hiebert, James

2016-01-01

Originating in Asia, lesson study is gradually spreading around the globe. As evident from the papers in this issue, we have much to learn as it is implemented in a variety of cultural contexts. In this article we reflect on the goals of lesson study, the organizational supports required to sustain the practice in various contexts, and the…

The Creativity-in-Progress Rubric on Proving: Two Teaching Implementations and Students' Reported Usage

ERIC Educational Resources Information Center

El Turkey, Houssein; Tang, Gail; Savic, Milos; Karakok, Gulden; Cilli-Turner, Emily; Plaxco, David

2018-01-01

A growing body of mathematics education research points to the importance of fostering students' mathematical creativity in undergraduate mathematics courses. However, there are not many research-based instructional practices that aim to accomplish this task. Our research group has been working to address this issue and created a formative…

The Development and Implementation of a Teaching and Learning Strategy at a Modern Military Academy

ERIC Educational Resources Information Center

Thain, Richard Holman; McDonough, Ambrose; Priestley, Alan Duncan

2008-01-01

A strategy for teaching and learning was developed at Britannia Royal Naval College during 2006 in order to address several key issues. These included improving professional knowledge and skills retention, enhancing pedagogical practices to increase levels of student motivation, and adapting the training and educational package to an extremely…

Defense Acquisitions: Assessments of Selected Weapon Programs

DTIC Science & Technology

2015-03-01

offices on technology, design , and manufacturing knowledge; the use of knowledge- based acquisition practices; and the implementation of acquisition...and production maturity using two data-collection instruments, including a questionnaire on issues such as systems engineering reviews, design ...Demonstrating technology maturity is a prerequisite for moving forward into system development, during which the focus should be on design and

Education for Sustainable Development in Chemistry--Challenges, Possibilities and Pedagogical Models in Finland and Elsewhere

ERIC Educational Resources Information Center

Juntunen, M. K.; Aksela, M. K.

2014-01-01

This article analyses Education for Sustainable Development (ESD) in chemistry by reviewing existing challenges and future possibilities on the levels of the teacher and the student. Pedagogical frameworks that are found eligible in practice are reviewed. Lesson themes that are suitable for implementing socioscientific issues (SSI) related to ESD…

Approaches in the Treatment of Adolescents with Emotional and Substance Abuse Problems. Technical Assistance Publication Series Number 1.

ERIC Educational Resources Information Center

Fleisch, Brahm

This report reviews the impact of substance abuse and mental health problems among the adolescent population, examines the research issues and treatment delivery system, identifies model modalities and programs to address the needs of adolescents, and makes practical recommendations on the implementation of effective treatment methods for youths.…

Developing an Occupational Drug Abuse Program: Considerations and Approaches. Services Research Monograph Series.

ERIC Educational Resources Information Center

Stephen, Mae; Prentice, Robert

This monograph, developed as a guide for companies interested in establishing drug abuse programs, begins with a brief summary of studies assessing the extent and costs of employee drug use. The next section addresses some practical and conceptual issues about establishing a drug abuse program. Suggestions for implementing a drug abuse program are…

Cultural Issues in Adventure Programming: Applying Hofstede's Five Dimensions to Assessment and Practice

ERIC Educational Resources Information Center

Chang, Te-Hsin; Tucker, Anita R.; Norton, Christine Lynn; Gass, Michael A.; Javorski, Stephen E.

2017-01-01

Adventure programming has seen considerable growth throughout the world. While newly established programs aim to meet the needs of their prospective clients, failing to account for cultural differences when conducting or designing programs may impede this goal. Non-western approaches to implementing adventure programs have rarely been discussed,…

Implementing Flipped Classroom in Blended Learning Environments: A Proposal Based on the Cognitive Flexibility Theory

ERIC Educational Resources Information Center

Andrade, Mariel; Coutinho, Clara

2017-01-01

Flipped Classroom is an issue that gains increased attention in Blended Learning models. Generally, in the traditional classroom, the teacher uses the time in the classroom to explain the theoretical and conceptual body content and leaves the practices and exercises as extracurricular activities. In the Flipped Classroom, students study at home…

Creating a Multicultural Curriculum in Han-Dominant Schools: The Policy and Practice of Ethnic Solidarity Education in China

ERIC Educational Resources Information Center

Zhang, Donghui; Chen, Lipeng

2014-01-01

In response to the recent heightened interethnic conflicts that were regarded as threatening national unity and stability, the Chinese government issued "ethnic solidarity education" as a top-down, centrally administered mandate to be implemented "correctly" and in a standardised way by schools throughout China. This paper…

Public School Practices for Violence Prevention and Reduction: 2003-04. Issue Brief. NCES 2007-010

ERIC Educational Resources Information Center

Jekielek, Susan; Brown, Brett; Marin, Pilar; Lippman, Laura

2007-01-01

School violence can lead to a disruptive and threatening environment, physical injury, and emotional stress, all of which can be obstacles to student achievement. Educators have responded to the perceived threat of school violence by implementing programs designed to prevent, deter, and respond to the potential for violence in schools. In…

Cultural competency training for public health students: integrating self, social, and global awareness into a master of public health curriculum.

PubMed

Cushman, Linda F; Delva, Marlyn; Franks, Cheryl L; Jimenez-Bautista, Ana; Moon-Howard, Joyce; Glover, Jim; Begg, Melissa D

2015-03-01

Cultural competency training in public health, medicine, social work, nursing, dental medicine, and other health professions has been a topic of increasing interest and significance. Despite the now burgeoning literature that describes specific knowledge, attitudes, and skills that promote cultural "competence," fully defining this complex, multidimensional term and implementing activities to enhance it remain a challenge. We describe our experiences in introducing a mandatory, full-day workshop to incoming Master of Public Health students, called "Self, Social, and Global Awareness: Personal Capacity Building for Professional Education and Practice." The purpose of the program is to provide a meaningful, structured environment to explore issues of culture, power, privilege, and social justice, emphasizing the centrality of these issues in effective public health education and practice.

Regional Transmission Planning: A review of practices following FERC Order Nos. 890 and 1000

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

Eto, Joseph H.; Gallo, Guilia

Federal Energy Regulatory Commission (FERC) Order Nos. 890 and 10001 established requirements that transmission planning regions must follow in regional transmission planning and allocating the costs of new transmission facilities. Order No. 890, issued in 2007, outlined general requirements for local as well as regional transmission planning practices and procedures. Order No. 1000, issued in 2011, laid out specific requirements for: (1) regional transmission planning; (2) consideration of transmission needs driven by public policy requirements; (3) non-incumbent transmission development; (4) interregional transmission coordination; and (5) cost allocation for transmission facilities that have been selected in a regional transmission plan formore » purposes of cost allocation. This report reviews how these FERC orders are being implemented by the 12 transmission planning regions recognized by FERC.« less

Ring-array processor distribution topology for optical interconnects

NASA Technical Reports Server (NTRS)

Li, Yao; Ha, Berlin; Wang, Ting; Wang, Sunyu; Katz, A.; Lu, X. J.; Kanterakis, E.

1992-01-01

The existing linear and rectangular processor distribution topologies for optical interconnects, although promising in many respects, cannot solve problems such as clock skews, the lack of supporting elements for efficient optical implementation, etc. The use of a ring-array processor distribution topology, however, can overcome these problems. Here, a study of the ring-array topology is conducted with an aim of implementing various fast clock rate, high-performance, compact optical networks for digital electronic multiprocessor computers. Practical design issues are addressed. Some proof-of-principle experimental results are included.

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.

Supporting students with disabilities--promoting understanding amongst mentors in practice.

PubMed

Tee, Stephen; Cowen, Michelle

2012-01-01

Good practice demands a clinical practice culture positively disposed to students with disabilities. Equality legislation seeks to protect those with a disability from either direct or indirect discrimination. The balance between providing "reasonable adjustments" for the student, whilst ensuring "Fitness to Practice", and ultimate employability, requires a close partnership between higher education and practice mentors. This paper reports on the development and evaluation of a range of interactive resources, used in the preparation of mentors to help them address the specific learning needs of disabled students. The evaluation revealed the benefit of student 'stories' in helping mentors to understand the support needs of disabled students and ensure reasonable adjustments are implemented in compliance with disability legislation. The interactive resources have been helpful in promoting positive action towards disabled students' learning, empathic understanding of mental health issues and knowledge and skills acquisition in support of dyslexic students. Implementing reasonable adjustments in practice requires a close working partnership between HEI's and mentors who appreciate support in understanding the development and application of coping strategies to overcome disabilities. Effective preparation of mentors is essential to ensure that opportunities for disabled students to succeed are maximised. Copyright © 2011. Published by Elsevier Ltd.

Policy and regulatory responses to dual practice in the health sector.

PubMed

García-Prado, Ariadna; González, Paula

2007-12-01

Physician dual practice is a widespread phenomenon which has implications for the equity, efficiency and quality of health care provision. Central to the analysis of physician dual practice is the trade-off between its benefits and costs, as well as the convenience of regulating it to undermine its adverse consequences. In this paper, we study and analyze different governmental responses to this activity. We find that internationally, there are wide variations in how governments tackle this issue. While some governments fully prohibit this practice, others regulate or restrict dual job holding with different intensities and regulatory instruments. The measures implemented include limiting the income physicians can earn through dual job holding, offering work benefits to physicians in exchange for their working exclusively in the public sector, raising public salaries, and allowing physicians to perform private practice at public facilities. We present the pros and cons of each of these alternatives and show how the health care market and institutional arrangements are crucial for the design and implementation of each of these strategies. The paper also identifies the need for empirical evidence on the effect of different government strategies on dual practice.

Clinical Implementation of Pharmacogenomics for Personalized Precision Medicine: Barriers and Solutions.

PubMed

Klein, Michelle E; Parvez, Md Masud; Shin, Jae-Gook

2017-09-01

Clinical implementation of pharmacogenomics (PGx) leads to personalized medicine, which improves the efficacy, safety, and cost-effectiveness of treatments. Although PGx-based research has been conducted for more than a decade, several barriers have slowed down its widespread implementation in clinical practice. Globally, there is an imbalance in programs and solutions required to empower the clinical implementation of PGx between countries. Therefore, we aimed to review these issues comprehensively, determine the major barriers, and find the best solutions. Through an extensive review of ongoing clinical implementation programs, scientific, educational, ethical, legal, and social issues, information technology, and reimbursement were identified as the key barriers. The pace of global implementation of genomic medicine coincided with the resource limitations of each country. The key solutions identified for the earlier mentioned barriers are as follows: building of secure and suitable information technology infrastructure with integrated clinical decision support systems along with increasing PGx evidence, more regulations, reimbursement strategies for stakeholder's acceptance, incorporation of PGx education in all institutions and clinics, and PGx promotion to all health care professionals and patients. In conclusion, this review will be helpful for the better understanding of common barriers and solutions pertaining to the clinical application of PGx. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Problem-based learning in undergraduate medical education: can we really implement it in the West African subregion?

PubMed

Gukas, I D

2007-01-01

A major global pedagogical shift has occurred in the way medicine is taught over the last half a century. Problem-based learning (PBL) has emerged as one of the most popular, of these learner-centred new methods. To examine the evolution and educational principles of PBL and the feasibility of implementing it in the West African subregion. Key literature detailing the history, educational value and principle behind PBL were reviewed. Issues regarding the implication of implementing PBL to West Africa were deduced and suggestions made for the way forward. Since its introduction in McMaster University in Canada in the 60s, PBL has spread all over world. It is rooted in sound educational theories like the Kolb's experiential learning, adult education, collaborative learning, contextual learning and constructivism. Compared to traditionally trained students, PBL students find learning more enjoyable and develop better relational and professional skills. They show more causal reasoning in diagnosis and become better lifelong learners. Issues that may affect its implementation in West Africa include high start up costs, lack of supporting educational technology and relative lack of medical school managers with appropriate medical education background to assess and evaluate such innovations. The evidence for the need for a change from the traditional method of training is overwhelming. Implementation of PBL as an educational method in medical training in the West African subregion is both desirable and practicable if we address some of the issues outlined above.

Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices.

PubMed

Hardefeldt, Laura Y; Gilkerson, J R; Billman-Jacobe, H; Stevenson, M A; Thursky, K; Bailey, K E; Browning, G F

2018-03-23

Antimicrobial stewardship (AMS) programs are yet to be widely implemented in veterinary practice and medical programs are unlikely to be directly applicable to veterinary settings. To gain an in-depth understanding of the factors that influence effective AMS in veterinary practices in Australia. A concurrent explanatory mixed methods design was used. The quantitative phase of the study consisted of an online questionnaire to assess veterinarians' attitudes to antimicrobial resistance (AMR) and antimicrobial use in animals, and the extent to which AMS currently is implemented (knowingly or unknowingly). The qualitative phase used semi-structured interviews to gain an understanding of the barriers to and enablers of AMS in veterinary practices. Data were collected and entered into NVivo v.11, openly coded and analyzed according to mixed methods data analysis principles. Companion animal, equine, and bovine veterinarians participated in the study. Veterinary practices rarely had antimicrobial prescribing policies. The key barriers were a lack of AMS governance structures, client expectations and competition between practices, cost of microbiological testing, and lack of access to education, training and AMS resources. The enablers were concern for the role of veterinary antimicrobial use in development of AMR in humans, a sense of pride in the service provided, and preparedness to change prescribing practices. Our study can guide development and establishment of AMS programs in veterinary practices by defining the major issues that influence the prescribing behavior of veterinarians. © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review.

PubMed

Leider, Jonathon P; DeBruin, Debra; Reynolds, Nicole; Koch, Angelica; Seaberg, Judy

2017-09-01

Terrorism, disease outbreaks, and other natural disasters and mass casualty events have pushed health care and public health systems to identify and refine emergency preparedness protocols for disaster response. Ethical guidance, alongside legal and medical frameworks, are increasingly common components of disaster response plans. To systematically review the prevalence and content of ethical guidance offered for disaster response, specifically around crisis standards of care (CSCs). We systematically indexed academic literature from PubMed, Google Scholar, and ISI Web of Science from 2012 to 2016. We searched for peer-reviewed articles that substantively engaged in discussion of ethical guidance for CSCs. Researchers screened potential articles for identification and discussion of ethical issues in CSC planning. We categorized and cataloged ethical concepts and principles. Of 580 peer-reviewed articles mentioning ethics and CSCs or disaster planning, 38 (6%) met selection criteria. The systematic review of the CSC ethics literature since 2012 showed that authors were primarily focused on the ethical justifications for CSC (n = 20) as well as a need for ethics guidelines for implementing CSCs; the ethical justifications for triage (n = 19), both as to which criteria to use and the appropriate processes by which to employ triage; and international issues (n = 17). In addition to these areas of focus, the scholarly literature included discussion of a number of other ethical issues, including duty to care (n = 11), concepts of a duty to plan (n = 8), utilitarianism (n = 5), moral distress (n = 4), professional norms (n = 3), reciprocity (n = 2), allocation criteria (n = 4), equity (n = 4), research ethics (n = 2), duty to steward resources (n = 2), social utility and social worth (n = 2), and a number of others (n = 20). Although public health preparedness efforts have paid increasing attention to CSCs in recent years, CSC plans have rarely been implemented within the United States to date, although some components are common (e.g., triage is used in US emergency departments regularly). Conversely, countries outside the United States more commonly implement CSCs within a natural disaster or humanitarian crisis response, and may offer significant insight into ethics and disaster response for US-based practitioners. This systematic review identifies the most oft-used and -discussed ethical concepts and principles used in disaster planning around CSCs. Although discussion of more nuanced issues (e.g., health equity) are present, the majority of items substantively engaging in ethical discussion around disaster planning do so regarding triage and why ethics is needed in disaster response generally. Public health implications. A significant evolution in disaster planning has occurred within the past decade; ethical theories and frameworks have been put to work. For ethical guidance to be useful, it must be practical and implementable. Although high-level, abstract frameworks were once prevalent in disaster planning-especially in the early days of pandemic planning-concerns about the ethically difficult concept of CSCs pervade scholarly articles. Ethical norms must be clearly stated and justified and practical guidelines ought to follow from them. Ethical frameworks should guide clinical protocols, but this requires that ethical analysis clarifies what strategies to use to honor ethical commitments and achieve ethical objectives. Such implementation issues must be considered well ahead of a disaster. As governments and health care systems plan for mass casualty events, ethical guidance that is theoretically sound and practically useful can-and should-form an important foundation from which to build practical guidance for responding to disasters with morally appropriate means.

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic.

PubMed

Chen, Chen Amy; Park, Ryan J; Hegde, John V; Jun, Tomi; Christman, Mitalee P; Yoo, Sun M; Yamasaki, Alisa; Berhanu, Aaron; Vohra-Khullar, Pamela; Remus, Kristin; Schwartzstein, Richard M; Weinstein, Amy R

2016-01-01

Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student-Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

Toward a procedure for integrating moral issues in health technology assessment.

PubMed

Hofmann, Bjørn

2005-01-01

Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA. Literature review of existing approaches together with application of various theories in moral philosophy and axiology. The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs. The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.

Influences on the adoption of patient safety innovation in primary care: a qualitative exploration of staff perspectives.

PubMed

Litchfield, Ian; Gill, Paramjit; Avery, Tony; Campbell, Stephen; Perryman, Katherine; Marsden, Kate; Greenfield, Sheila

2018-05-22

Primary care is changing rapidly to meet the needs of an ageing and chronically ill population. New ways of working are called for yet the introduction of innovative service interventions is complicated by organisational challenges arising from its scale and diversity and the growing complexity of patients and their care. One such intervention is the multi-strand, single platform, Patient Safety Toolkit developed to help practices provide safer care in this dynamic and pressured environment where the likelihood of adverse incidents is increasing. Here we describe the attitudes of staff toward these tools and how their implementation was shaped by a number of contextual factors specific to each practice. The Patient Safety Toolkit comprised six tools; a system of rapid note review, an online staff survey, a patient safety questionnaire, prescribing safety indicators, a medicines reconciliation tool, and a safe systems checklist. We implemented these tools at practices across the Midlands, the North West, and the South Coast of England and conducted semi-structured interviews to determine staff perspectives on their effectiveness and applicability. The Toolkit was used in 46 practices and a total of 39 follow-up interviews were conducted. Three key influences emerged on the implementation of the Toolkit these related to their ease of use and the novelty of the information they provide; whether their implementation required additional staff training or practice resource; and finally factors specific to the practice's local environment such as overlapping initiatives orchestrated by their CCG. The concept of a balanced toolkit to address a range of safety issues proved popular. A number of barriers and facilitators emerged in particular those tools that provided relevant information with a minimum impact on practice resource were favoured. Individual practice circumstances also played a role. Practices with IT aware staff were at an advantage and those previously utilising patient safety initiatives were less likely to adopt additional tools with overlapping outputs. By acknowledging these influences we can better interpret reaction to and adoption of individual elements of the toolkit and optimise future implementation.

Patient and family psychoeducation: Service development and implementation in a center in Iran.

PubMed

Mirsepassi, Zahra; Tabatabaee, Maryam; Sharifi, Vandad; Mottaghipour, Yasaman

2018-02-01

Family and patient psychoeducation have demonstrated significant improvement in clinical and social outcomes for patients suffering from severe mental disorders and their families. However, these evidence-based practices are not widely implemented at service delivery level and into routine clinical practice, especially in less developed countries. The aim of this article is to report the processes of development and implementation of a psychoeducational service for patients with severe mental illnesses and their families in Iran. The program was developed at Roozbeh Hospital in Tehran, Iran. A group of clinicians worked on the development phase of the program and drafting the manuals. Then, a series of workshops and supervision sessions were held to train group leaders for implementation of the group psychoeducation for patients and families. In the pilot phase, the services were delivered to two groups of patients and families, and then the manual was revised based on the feedback from group leaders and participants. The program consisted of eight 90-minute weekly patient group sessions and 6 weekly multiple family group sessions. Two manuals for patient education (schizophrenia and bipolar disorder) were developed. Several information sheets were developed and distributed during different sessions of family and patient psychoeducation related to the content of each session. Despite providing the hospital clinicians with the information regarding these new services, less than 10% of the admitted patients were referred by their clinicians. Feasibility and sustainability of the program are affected by a number of factors. Low referral rate of clinicians, limited resources of the hospital, issues related to stigma and logistic issues are barriers in implementation of these services. Administrators' and clinicians' understanding of the importance of patient and family psychoeducation seems to be crucial in sustainability of such programs in routine service delivery.

When trust defies common security sense.

PubMed

Williams, Patricia A H

2008-09-01

Primary care medical practices fail to recognize the seriousness of security threats to their patient and practice information. This can be attributed to a lack of understanding of security concepts, underestimation of potential threats and the difficulty in configuration of security technology countermeasures. To appreciate the factors contributing to such problems, research into general practitioner security practice and perceptions of security was undertaken. The investigation focused on demographics, actual practice, issues and barriers, and practitioner perception. Poor implementation, lack of relevant knowledge and inconsistencies between principles and practice were identified as key themes. Also the results revealed an overwhelming reliance on trust in staff and in computer information systems. This clearly identified that both cultural and technical attributes contribute to the deficiencies in information security practice. The aim of this research is to understand user needs and problems when dealing with information security practice.

How to implement live video recording in the clinical environment: A practical guide for clinical services.

PubMed

Lloyd, Adam; Dewar, Alistair; Edgar, Simon; Caesar, Dave; Gowens, Paul; Clegg, Gareth

2017-06-01

The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. To provide a practical guide for clinical services to embed live video recording. Using Kotter's 8-step process for leading change, we provide a 'how to' guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care. © 2017 John Wiley & Sons Ltd.

Why do certain primary health care teams respond better to intimate partner violence than others? A multiple case study.

PubMed

Goicolea, Isabel; Marchal, Bruno; Hurtig, Anna-Karin; Vives-Cases, Carmen; Briones-Vozmediano, Erica; San Sebastián, Miguel

2017-12-09

To analyse how team level conditions influenced health care professionals' responses to intimate partner violence. We used a multiple embedded case study. The cases were four primary health care teams located in a southern region of Spain; two of them considered "good" and two s "average". The two teams considered good had scored highest in practice issues for intimate partner violence, measured via a questionnaire (PREMIS - Physicians Readiness to Respond to Intimate Partner Violence Survey) applied to professionals working in the four primary health care teams. In each case quantitative and qualitative data were collected using a social network questionnaire, interviews and observations. The two "good" cases showed dynamics and structures that promoted team working and team learning on intimate partner violence, had committed social workers and an enabling environment for their work, and had put into practice explicit strategies to implement a women-centred approach. Better individual responses to intimate partner violence were implemented in the teams which: 1) had social workers who were knowledgeable and motivated to engage with others; 2) sustained a structure of regular meetings during which issues of violence were discussed; 3) encouraged a friendly team climate; and 4) implemented concrete actions towards women-centred care. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Prognostic modelling options for remaining useful life estimation by industry

NASA Astrophysics Data System (ADS)

Sikorska, J. Z.; Hodkiewicz, M.; Ma, L.

2011-07-01

Over recent years a significant amount of research has been undertaken to develop prognostic models that can be used to predict the remaining useful life of engineering assets. Implementations by industry have only had limited success. By design, models are subject to specific assumptions and approximations, some of which are mathematical, while others relate to practical implementation issues such as the amount of data required to validate and verify a proposed model. Therefore, appropriate model selection for successful practical implementation requires not only a mathematical understanding of each model type, but also an appreciation of how a particular business intends to utilise a model and its outputs. This paper discusses business issues that need to be considered when selecting an appropriate modelling approach for trial. It also presents classification tables and process flow diagrams to assist industry and research personnel select appropriate prognostic models for predicting the remaining useful life of engineering assets within their specific business environment. The paper then explores the strengths and weaknesses of the main prognostics model classes to establish what makes them better suited to certain applications than to others and summarises how each have been applied to engineering prognostics. Consequently, this paper should provide a starting point for young researchers first considering options for remaining useful life prediction. The models described in this paper are Knowledge-based (expert and fuzzy), Life expectancy (stochastic and statistical), Artificial Neural Networks, and Physical models.

Toward Dynamic Adaptation of Psychological Interventions for Child and Adolescent Development and Mental Health.

PubMed

Malti, Tina; Noam, Gil G; Beelmann, Andreas; Sommer, Simon

2016-01-01

Children's and adolescents' mental health needs emphasize the necessity of a new era of translational research to enhance development and yield better lives for children, families, and communities. Developmental, clinical, and translational research serves as a powerful tool for managing the inevitable complexities in pursuit of these goals. This article proposes key ideas that will strengthen current evidence-based intervention practices by creating stronger links between research, practice, and complex systems contexts, with the potential of extending applicability, replicability, and impact. As exemplified in some of the articles throughout this special issue, new research and innovative implementation models will likely contribute to better ways of assessing and dynamically adapting structure and intervention practice within mental health systems. We contend that future models for effective interventions with children and adolescents will involve increased attention to (a) the connection of research on the developmental needs of children and adolescents to practice models; (b) consideration of informed contextual and cultural adaptation in implementation; and (c) a rational model of evidence-based planning, using a dynamic, inclusive approach with high support for adaptation, flexibility, and implementation fidelity. We discuss future directions for translational research for researchers, practitioners, and administrators in the field to continue and transform these ideas and their illustrations.

Clinical trial design in the neurocritical care unit.

PubMed

Hall, C E; Mirski, M; Palesch, Y Y; Diringer, M N; Qureshi, A I; Robertson, C S; Geocadin, R; Wijman, C A C; Le Roux, P D; Suarez, Jose I

2012-02-01

Clinical trials provide a robust mechanism to advance science and change clinical practice across the widest possible spectrum. Fundamental in the Neurocritical Care Society's mission is to promote Quality Patient Care by identifying and implementing best medical practices for acute neurological disorders that are consistent with the current scientific knowledge. The next logical step will be to foster rapid growth of our scientific body of evidence, to establish and disseminate these best practices. In this manuscript, five invited experts were impaneled to address questions, identified by the conference organizing committee as fundamental issues for the design of clinical trials in the neurological intensive care unit setting.

Midwifery and health disparities: theories and intersections.

PubMed

Cox, Kim J

2009-01-01

In the past decade, the reduction of health disparities has become an important policy agenda in the United States. Clinicians in practice, however, may be unfamiliar with the prevailing causal theories and uncertain about what they can do to help to reduce inequalities in health. The purpose of this article is to provide women's health care clinicians with an overview of the definitions, measurement issues, and theories that fall under the rubric of health disparities. The intersecting roles of genetics, race/ethnicity, environment, and gender are discussed. The article also provides practical suggestions for interventions and health policy change that can be implemented by clinicians in practice.

Returning nurses to the workforce: developing a fast track back program.

PubMed

Burns, Helen K; Sakraida, Teresa J; Englert, Nadine C; Hoffmann, Rosemary L; Tuite, Patricia; Foley, Susan M

2006-01-01

Fast Track Back: Re-entry into Nursing Practice program. Describes the development, implementation, and evaluation of a state-of-the-art re-entry program facilitating the return of licensed nonpracticing RNs to the workforce through a quality education program that retools them for the workforce in the areas of pharmacology, skill development using the latest technology, practice standards, and nursing issues. The program consists of didactic content taught via classroom, Internet, skills laboratory, and high fidelity human simulated technology and a clinical component. The program is a mechanism that enables re-entry nurses to improve skills and competencies necessary to practice in today's healthcare environment.

Implementing a pressure ulcer prevention bundle in an adult intensive care.

PubMed

Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2016-12-01

The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Ten Year Retrospective on Environmental Justice: What Have We Learned?

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

Scott, Michael J.; Jaksch, John A.; Cort, Katherine A.

2005-03-01

Beginning in 1994, Executive Order 12898 has directed federal executive agencies to identify and address, as appropriate, disproportionately high and adverse health or environmental effects of their programs, policies, and activities on minority and low income populations. The policy behind the Executive Order was to prevent minority and low income groups from bearing disproportionate adverse environmental consequences of federal actions. During the last ten years, federal agencies have implemented Executive Order 12898, and some also have developed explicit procedures or guidance for the steps that need to be taken during the preparation of environmental impact statements. Based on the authors’more » experience, the paper examines how environmental justice practice has evolved in the ten years since the original Executive Order was issued. This evolution has been both procedural and substantive. The paper examines how the actual practice of environmental justice analysis has progressed in federal agencies that deal with waste management issues. Reference is made to changes in case law and agency practice. The 2000 Census of Population and the ongoing development of geographic information systems in particular have made it easier to identify minority and low-income populations at risk. At the same time, a number of stakeholder groups have taken positions over specific federal actions that have given rise to novel issues and challenges for analysts. The paper discusses how NEPA practice is evolving to deal with these issues and challenges.« less

Acceptability Among Community Healthcare Nurses of Intelligent Wireless Sensor-system Technology for the Rapid Detection of Health Issues in Home-dwelling Older Adults

PubMed Central

Cohen, Christine; Kampel, Thomas; Verloo, Henk

2017-01-01

Background: The effective care and support of community healthcare nurses (CHNs) contribute greatly to the healthy aging of older adults living at home. Integrating innovative technologies into CHNs’ daily practice offers new opportunities and perspectives for early detection of health issues and interventions among home-dwelling older adults. Aim: To explore the perception of acceptability among CHNs of an intelligent wireless sensor system (IWSS) for use in daily practice for the detection of health issues in home-dwelling older adults receiving home healthcare. Method: Descriptive and qualitative data were sourced from a pilot randomized controlled trial involving 17 CHNs using an IWSS in their daily practice to rapidly detect falls and other health issues in patients’ homes. IWSS alerts indicating behavior changes were sent to CHNs. Their perceived usefulness (PU) and perceived ease of use (PEOU) were assessed. The acceptability of IWSS technology was explored using a questionnaire and focus group discussions. Results: The PU and PEOU of the IWSS technology were low to moderate. A majority of the CHNs were dissatisfied with its performance and intrusiveness; they reported multiple obstacles in the usefulness and ease of use of the IWSS technology in daily practice. Conclusion: To improve the IWSS technology’s low to moderate acceptability among CHNs, we recommend a more user-centered implementation strategy and an embedded model of nursing care. PMID:28567170

Barriers to telemedicine: survey of current users in acute care units.

PubMed

Rogove, Herbert J; McArthur, David; Demaerschalk, Bart M; Vespa, Paul M

2012-01-01

The present study of current telemedicine users is a unique attempt to understand the barriers and motivational factors related to the utilization of telemedicine. A survey of emergency and critical care remote presence telemedicine users was conducted to determine the factors that motivate and the barriers that impede the acceptance and maintenance of a robotic telemedicine (RTM) program. The majority of the survey users were in the Emergency Department or in the Intensive Care Unit. E-mail invitations were sent to 483 individuals representing 63 healthcare institutions and groups in North America and Europe. Respondents were directed to a Web-based survey. The survey consisted of 96 separate questions, addressing user familiarity and 5-point Likert scales, addressing issues spanning the conceptual and practical issues surrounding adoption of telemedicine. A total of 106 surveys were completed, representing an individual response rate of 21.9% but an institutional response rate of 60.3%. More than two-thirds of the respondents were physicians who participated in active RTM programs. Across seven different topics related to barriers to implementing RTM, the majority of all respondents indicated that cultural issues did not constitute meaningful hurdles, technological matters were generally favorable, and that most personnel were agreeable to both achieving the buy-in to start an RTM program and to maintaining RTM once started. However, respondents proclaimed that RTM's success was still hampered by licensing, credentialing, and malpractice protection, as well as costs, billing, and reimbursement issues. Achieving immediate patient access, overcoming service gaps, improving quality, providing clinical support, maintaining patient satisfaction, and adhering to practice guidelines were viewed as significant motives for RTM implementation. The leading applications of RTM included emergency response and consultation. The patients, physicians, nurses, nor hospital executives served as barriers to implementation. However, licensing, costs for technology, and reimbursement for RTM continue to impede progress.

Management and non-supervisory perceptions surrounding the implementation and significance of high-performance work practices in a nuclear power plant

NASA Astrophysics Data System (ADS)

Ashbridge, Gayle Ann

Change management has become an imperative for organizations as they move into the 21st century; up to 75 percent of change initiatives fail. Nuclear power plants face the same challenges as industrial firms with the added challenge of deregulation. Faced with this challenge, restructuring the electric utility has raised a number of complex issues. Under traditional cost-of-service regulation, electric utilities were able to pass on their costs to consumers who absorbed them. In the new competitive environment, customers will now choose their suppliers based on the most competitive price. The purpose of this study is to determine the degree of congruence between non-supervisory and supervisory personnel regarding the perceived implementation of high performance workplace practices at a nuclear power plant. This study used as its foundation the practices identified in the Road to High Performance Workplaces: A Guide to Better Jobs and Better Business Results by the U.S. Department of Labor's Office of the American Workplace (1994). The population for this study consisted of organizational members at one nuclear power plant. Over 300 individuals completed surveys on high performance workplace practices. Two surveys were administered, one to non-supervisory personnel and one to first line supervisors and above. The determination of implementation levels was accomplished through descriptive statistical analysis. Results of the study revealed 32 areas of noncongruence between non-supervisory and supervisory personnel in regard to the perceived implementation level of the high performance workplace practices. Factor analysis further revealed that the order in which the respondents place emphasis on the variables varies between the two groups. This study provides recommendations that may improve the nuclear power plants alignment of activities. Recommendations are also provided for additional research on high-performance work practices.

Implementation of Sustainable Soil Management Practices to Improve Crop Production in the Different Ethiopian Agro Systems

NASA Astrophysics Data System (ADS)

García Moreno, R.; Gameda, S.; Diaz Alvarez, M. C.; Selasie, Y. G.

2012-04-01

Agriculture in Ethiopia is one of first priority since close to 10 In this context, the Ethiopian crop production faces to the following soil management challenges: lack of updated soil data, macro and micro nutrient depletion, acidity, salinity and soil surface erosion and crusting. One of the biggest issues is the loss of arable land, above 137 T/yr, reaching during some particularly dried periods until 300 T/yr. In this context, the authors constituted a working group of experts from Spanish and Ethiopian universities, local producers and international and governmental organisms to analyse the problems related to the different agro ecological zones found in Ethiopia and the management practices of different local producers. The study produced the trends to implement in the different areas to improve soil management practices in order to contribute to increase the crop production mainly to achieve food security problems. The analyse produced different working fields for the next years for addressing soil degradation, improving land resources management practices, increasing agricultural productivity, updating the available soil data, developing an international program of education, transferring of knowledge from similar study cases and implementing economical tools to help producers to assure income after severe edapho-climatic events. The practical work and the projects developed for the next period is addressed to smallholder farms belonging to the different 34 agro ecological zones identified in Ethiopia, each of them with very specific environmental, cultural and soil management practices.

The impact of a private group practice of converting to an automated medical information system.

PubMed

Templeton, J; Bernes, M; Ostrowski, M

1983-08-01

As hardware and software developments make medical information systems increasingly available to physicians office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official "live" data had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.

Methodological Issues in Trials of Complementary and Alternative Medicine Interventions

PubMed Central

Sikorskii, Alla; Wyatt, Gwen; Victorson, David; Faulkner, Gwen; Rahbar, Mohammad Hossein

2010-01-01

Background Complementary and alternative medicine (CAM) use is widespread among cancer patients. Information on safety and efficacy of CAM therapies is needed for both patients and health care providers. Well-designed randomized clinical trials (RCTs) of CAM therapy interventions can inform both clinical research and practice. Objectives To review important issues that affect the design of RCTs for CAM interventions. Methods Using the methods component of the Consolidated Standards for Reporting Trials (CONSORT) as a guiding framework, and a National Cancer Institute-funded reflexology study as an exemplar, methodological issues related to participants, intervention, objectives, outcomes, sample size, randomization, blinding, and statistical methods were reviewed. Discussion Trials of CAM interventions designed and implemented according to appropriate methodological standards will facilitate the needed scientific rigor in CAM research. Interventions in CAM can be tested using proposed methodology, and the results of testing will inform nursing practice in providing safe and effective supportive care and improving the well-being of patients. PMID:19918155

Informed consent: clinical and legal issues in family practice.

PubMed

Searight, H R; Barbarash, R A

1994-04-01

While patient informed consent is an important clinical and legal dimension of specialty medical care, many important issues arise in primary care. Family physicians are in a unique position to implement informed consent discussions in the ethical spirit in which the doctrine was intended. Because of their long-term relationships with patients and sensitivity to psychosocial issues, family physicians can engage patients in collaborative health care decision making. Primary care physicians are optimally suited to assess patients' understanding of medical information and their competence. Instead of viewing the informed consent process simply as a necessary legal requirement, it should be a method for educating patients and allowing them to participate in their health care decision making.

The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework

PubMed Central

2013-01-01

Background The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Methods The PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets. Results A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes. Conclusions This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework. We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice. This proposal will enhance the potential of the PARIHS framework for explanation, and ensure theoretical development both informs and responds to the evidence base for implementation. Trial registration ISRCTN18046709 - Peri-operative Implementation Study Evaluation (PoISE). PMID:23497438

HIV serodiscordant relationships in India: translating science to practice.

PubMed

Solomon, Sunil Suhas; Solomon, Suniti

2011-12-01

Over the past 30 years, several interventions have been identified to prevent HIV transmission from HIV-infected persons to uninfected persons in discordant relationships. Yet, transmissions continue to occur. Interventions such as voluntary counselling and testing, condom promotion and risk reduction counselling are very effective in preventing transmission among serodiscordant couples but are underutilized in India despite their widespread availability. New interventions such as pre-risk exposure prophylaxis and universal antiretroviral therapy (irrespective of CD4 count) have been newly identified but face several challenges that impede their widespread implementation in India. Discordant couples in India also face certain unique socio-cultural issues such as marital and fertility pressure. We briefly review the various interventions (existing and novel) available for persons in discordant relationships in India and socio-cultural issues faced by these individuals and make recommendations to maximize their implementation.

Implementing a video-based intervention to empower staff members in an autism care organization: a qualitative study.

PubMed

Hall, Alex; Finch, Tracy; Kolehmainen, Niina; James, Deborah

2016-10-21

Implementing good-quality health and social care requires empowerment of staff members within organizations delivering care. Video Interaction Guidance (VIG) is an intervention using positive video feedback to empower staff through reflection on practice. This qualitative study explored the implementation of VIG within an autism care organization in England, from the perspective of staff members undergoing training to deliver VIG. Semi-structured interviews were conducted with a purposive sample of 7 participants working within the organization (5 staff undergoing training to deliver VIG; 2 senior managers influencing co-ordination of training). Participants were asked about their views of VIG and its implementation. The topic guide was informed by Normalization Process Theory (NPT). Data were analysed inductively and emerging issues were related to NPT. Five broad themes were identified: (1) participants reported that they and other staff did not understand VIG until they became involved, initially believing it would highlight negative rather than positive practice; (2) enthusiastic feedback from staff who had been involved seemed to encourage other staff to become involved; (3) key implementation challenges included demands of daily work and securing managers' support; (4) ideas for future practice arising from empowerment through VIG seemed difficult to realise within an organizational culture reportedly unreceptive to creative ideas from staff; (5) individuals' emotional responses to implementation seemed beyond the reach of NPT, which focused more upon collective processes. Implementation of VIG may require recognition that it is not a 'quick fix'. Peer advocacy may be a fruitful implementation strategy. Senior managers may need to experience VIG to develop their understanding so that they can provide appropriate implementation support. NPT may lack specificity to explain how individual agency weaves with collective processes and social systems to embed innovation in routine practice. This exploratory study has provided broad insights into facilitators and barriers to the implementation of an intervention to empower staff within an autism care organization. Further research is needed into similar interventions, including a focus upon staff members' emotional responses and resources, and how such interventions may relate to the culture of the organization in which implementation occurs.

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.

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

NASA Astrophysics Data System (ADS)

ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

Mind maps and network analysis to evaluate conceptualization of complex issues: A case example evaluating systems science workshops for childhood obesity prevention.

PubMed

Frerichs, Leah; Young, Tiffany L; Dave, Gaurav; Stith, Doris; Corbie-Smith, Giselle; Hassmiller Lich, Kristen

2018-06-01

Across disciplines, it is common practice to bring together groups to solve complex problems. Facilitators are often asked to help groups organize information about and better understand the problem in order to develop and prioritize solutions. However, despite existence of several methods to elicit and characterize how individuals and groups think about and conceptualize an issue, many are difficult to implement in practice-based settings where resources such as technology and participant time are limited and research questions shift over time. This paper describes an easy-to-implement diagramming technique for eliciting conceptualization and a flexible network analysis method for characterizing changes in both individual and group conceptualization. We use a case example to illustrate how we used the methods to evaluate African American adolescent's conceptual understanding of obesity before and after participating in a series of four systems thinking workshops. The methods produced results that were sensitive to changes in conceptualization that were likely driven by the specific activities employed during the workshop sessions. The methods appear strong for capturing salient levels of conceptualization at both individual and collective levels. The paper concludes with a critical examination of strengths and weaknesses of the methods and implications for future practice and research. Copyright © 2018 Elsevier Ltd. All rights reserved.

Guideline implementation strategies for specialist mental healthcare.

PubMed

Girlanda, Francesca; Fiedler, Ines; Ay, Esra; Barbui, Corrado; Koesters, Markus

2013-07-01

Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.

Stakeholder attitudes and needs regarding cell-free fetal DNA testing.

PubMed

Hill, Melissa; Lewis, Celine; Chitty, Lyn S

2016-04-01

To explore stakeholder views on cell-free DNA testing and highlight findings important for successful implementation and the provision of best practice in counseling. Noninvasive tests based on the analysis of cell-free fetal DNA are now widely available in clinical practice and applications are expanding rapidly. It is essential that stakeholder views are considered in order to identify and address any ethical and social issues. We provide an overview of stakeholder viewpoints and then focus on the key issues of informed decision making, test uptake, service delivery and information sources. Stakeholders are positive about the introduction of cell-free fetal DNA testing into clinical practice. They describe both practical and psychological benefits arising from tests that are safe and can potentially be performed earlier in pregnancy. Key concerns, which include the potential for these tests to have a negative impact on informed decision making and increased societal pressure to have testing, can be addressed through careful parent-directed counseling. As applications for these tests expand it is increasingly important to develop innovative approaches to facilitate good understanding for parents who are offered noninvasive prenatal testing.

Factors influencing performance of health workers in the management of seriously sick children at a Kenyan tertiary hospital--participatory action research.

PubMed

Irimu, Grace W; Greene, Alexandra; Gathara, David; Kihara, Harrison; Maina, Christopher; Mbori-Ngacha, Dorothy; Zurovac, Dejan; Migiro, Santau; English, Mike

2014-02-07

Implementation of World Health Organization case management guidelines for serious childhood illnesses remains a challenge in hospitals in low-income countries. Facilitators of and barriers to implementation of locally adapted clinical practice guidelines (CPGs) have not been explored. This ethnographic study based on the theory of participatory action research (PAR) was conducted in Kenyatta National Hospital, Kenya's largest teaching hospital. The primary intervention consisted of dissemination of locally adapted CPGs. The PRECEDE-PROCEED health education model was used as the conceptual framework to guide and examine further reinforcement activities to improve the uptake of the CPGs. Activities focussed on introduction of routine clinical audits and tailored educational sessions. Data were collected by a participant observer who also facilitated the PAR over an eighteen-month period. Naturalistic inquiry was utilized to obtain information from all hospital staff encountered while theoretical sampling allowed in-depth exploration of emerging issues. Data were analysed using interpretive description. Relevance of the CPGs to routine work and emergence of a champion of change facilitated uptake of best-practices. Mobilization of basic resources was relatively easily undertaken while activities that required real intellectual and professional engagement of the senior staff were a challenge. Accomplishments of the PAR were largely with the passive rather than active involvement of the hospital management. Barriers to implementation of best-practices included i) mismatch between the hospital's vision and reality, ii) poor communication, iii) lack of objective mechanisms for monitoring and evaluating quality of clinical care, iv) limited capacity for planning strategic change, v) limited management skills to introduce and manage change, vi) hierarchical relationships, and vii) inadequate adaptation of the interventions to the local context. Educational interventions, often regarded as 'quick-fixes' to improve care in low-income countries, may be necessary but are unlikely to be sufficient to deliver improved services. We propose that an understanding of organizational issues that influence the behaviour of individual health professionals should guide and inform the implementation of best-practices.

An assessment of maternal, newborn and child health implementation studies in Nigeria: implications for evidence informed policymaking and practice.

PubMed

Uneke, Chigozie Jesse; Sombie, Issiaka; Keita, Namoudou; Lokossou, Virgil; Johnson, Ermel; Ongolo-Zogo, Pierre

2016-01-01

The introduction of implementation science into maternal, newborn and child health (MNCH) research has facilitated better methods to improve uptake of research findings into practices. With increase in implementation research related to MNCH world-wide, stronger scientific evidence are now available and have improved MNCH policies in many countries including Nigeria. The purpose of this study was to review MNCH implementation studies undertaken in Nigeria in order to understand the extent the evidence generated informed better policy. This study was a systematic review. A MEDLINE Entrez PubMed search was performed in August 2015 and implementation studies that investigated MNCH in Nigeria from 1966 to 2015 in relation to health policy were sought. Search key words included Nigeria, health policy, maternal, newborn, and child health. Only policy relevant studies that were implementation or intervention research which generated evidence to improve MNCH in Nigeria were eligible and were selected. A total of 18 relevant studies that fulfilled the study inclusion criteria were identified out of 471 studies found. These studies generated high quality policy relevance evidence relating to task shifting, breastfeeding practices, maternal nutrition, childhood immunization, kangaroo mother care (KMC), prevention of maternal to child transmission of HIV, etc. These indicated significant improvements in maternal health outcomes in localities and health facilities where the studies were undertaken. There is a dire need for more implementation research related to MNCH in low income settings because the priority for improved MNCH outcome is not so much the development of new technologies but solving implementation issues, such as how to scale up and evaluate interventions within complex health systems.

Potential of best practice to reduce impacts from oil and gas projects in the Amazon.

PubMed

Finer, Matt; Jenkins, Clinton N; Powers, Bill

2013-01-01

The western Amazon continues to be an active and controversial zone of hydrocarbon exploration and production. We argue for the urgent need to implement best practices to reduce the negative environmental and social impacts associated with the sector. Here, we present a three-part study aimed at resolving the major obstacles impeding the advancement of best practice in the region. Our focus is on Loreto, Peru, one of the largest and most dynamic hydrocarbon zones in the Amazon. First, we develop a set of specific best practice guidelines to address the lack of clarity surrounding the issue. These guidelines incorporate both engineering-based criteria and key ecological and social factors. Second, we provide a detailed analysis of existing and planned hydrocarbon activities and infrastructure, overcoming the lack of information that typically hampers large-scale impact analysis. Third, we evaluate the planned activities and infrastructure with respect to the best practice guidelines. We show that Loreto is an extremely active hydrocarbon front, highlighted by a number of recent oil and gas discoveries and a sustained government push for increased exploration. Our analyses reveal that the use of technical best practice could minimize future impacts by greatly reducing the amount of required infrastructure such as drilling platforms and access roads. We also document a critical need to consider more fully the ecological and social factors, as the vast majority of planned infrastructure overlaps sensitive areas such as protected areas, indigenous territories, and key ecosystems and watersheds. Lastly, our cost analysis indicates that following best practice does not impose substantially greater costs than conventional practice, and may in fact reduce overall costs. Barriers to the widespread implementation of best practice in the Amazon clearly exist, but our findings show that there can be great benefits to its implementation.

An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?

PubMed

Grant, Aileen; Sullivan, Frank; Dowell, Jon

2013-06-21

Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary).Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients. General practitioners in the higher prescribing quality practices made two different 'types' of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence.

An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?

PubMed Central

2013-01-01

Background Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. Methods An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Results Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary). Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients. Conclusion General practitioners in the higher prescribing quality practices made two different ‘types’ of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence. PMID:23799906

Inclusive practices for children and youths with communication disorders. Ad Hoc Committee on Inclusion for students with Communication Disorders.

PubMed

1996-01-01

An array of inclusive service delivery models is recommended for the implementation of services to children and youths with communication disorders. Inclusive practices are intervention services that are based on the unique and specific needs of the individual, and provided in a context that is least restrictive. There are a variety of models through which inclusive practices can be provided, including a direct (pull-out) program, in classroom-based service delivery, community-based models, and consultative interventions. These models should be seen as flexible options that may change depending on student needs. The speech-language pathologist, in collaboration with parents, the student, teachers, support personnel, and administrators, is in the ideal position to decide the model or combination of models that best serves each individual student's communication needs. Implementation of inclusive practices requires consideration of multiple issues, including general education reform, cost effectiveness, and program efficacy. In addition, administrative and school system support, personnel qualifications, staff development, flexible scheduling, and the effects of inclusive practices on all learners need to be considered. At present, available research suggests guarded optimism for the effectiveness of inclusive practices. However, many critical questions have not yet been addressed and additional research is needed to assess the full impact of inclusive practices for students with communication disorders.

Utility Green-Pricing Programs: What Defines Success? (Topical Issues Brief)

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

Swezey, B.; Bird, L.

2001-09-13

''Green pricing'' is an optional service through which customers can support a greater level of investment by their electric utility in renewable energy technologies. Electric utilities in 29 states are now implementing green-pricing programs. This report examines important elements of green-pricing programs, including the different types of programs offered, the premiums charged, customer response, and additional factors that experience indicates are key to the development of successful programs. The best-performing programs tend to share a number of common attributes related to product design, value creation, product pricing, and program implementation. The report ends with a list of ''best practices'' formore » utilities to follow when developing and implementing programs.« less

Trends in State Implementation of the Common Core State Standards: Educator Effectiveness. Issue Brief

ERIC Educational Resources Information Center

National Governors Association, 2018

2018-01-01

In 2010, the National Governors Association Center for Best Practices (NGA Center) and the Council of Chief State School Officers (CCSSO) released the Common Core State Standards (CCSS) for K-12 English language arts/literacy and mathematics. CCSS are a state-led effort to define the knowledge and skills students need to graduate from high school…

Confronting Equity Issues on Campus: Implementing the Equity Scorecard in Theory and Practice

ERIC Educational Resources Information Center

Bensimon, Estela Mara, Ed.; Malcom, Lindsey, Ed.

2012-01-01

How can it be that 50 years after the passage of the Civil Rights Act, our institutions of higher education have still not found ways of reducing the higher education gaps for racial and ethnic groups? That is the question that informs and animates the Equity Scorecard model of organizational change. It shifts institutions' focus from what…

[Hygiene and care, when the wedding ring becomes nosocomial!

PubMed

Martin, Agnès

In the care setting, hand washing constitutes an essential measure for preventing hand-transmitted infections. Best practices also recommend the principle of zero jewellery. Not so easy to implement, especially when it comes to the removal of wedding rings. A nurse shares her thoughts on this sensitive issue regarding the safety of care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

An Instructional Model to Support Problem-Based Historical Inquiry: The Persistent Issues in History Network

ERIC Educational Resources Information Center

Brush, Thomas; Saye, John

2014-01-01

For over a decade, we have collaborated with secondary school history teachers in an evolving line of inquiry that applies research-based propositions to the design and testing of a problem-based learning framework and a set of wise practices that represent a professional teaching knowledge base for implementing a particular model of instruction,…

A Model to Operate an On-Campus Retail Store for Workplace Experiential Learning

ERIC Educational Resources Information Center

Truman, Kiru; Mason, Roger B.; Venter, Petrus

2017-01-01

Many retailers argue that university students do not have the practical experience and skills required in the workplace when graduating. This paper reports on research undertaken to address this issue and to identify a model to guide development and implementation of a retail store, on a university campus, to be used for work-integrated learning.…

Clinical Consultation Systems: Designing for the Physician as Computer User

PubMed Central

Shortliffe, Edward H.

1981-01-01

The barriers to successful implementation of consultation systems for physicians have been frequently discussed. Our research has been directed at the development of computer techniques that will heighten the acceptance of high performance decision making tools. We discuss two current projects at Stanford Medical School that address both practical and theoretical issues in the design and construction of clinically useful systems.

Helping the Most Vulnerable Infants, Toddlers, and Their Families. Pathways to Early School Success. Issue Brief No. 1

ERIC Educational Resources Information Center

Knitzer, Jane; Lefkowitz, Jill

2006-01-01

Compelling evidence from neuroscience about how early relationships and experience influence the architecture of the brain, and in turn early school success, has led to increasing policy and practice attention to implementing child development and family support programs like Early Head Start for infants and toddlers. But, there is also a group of…

Digging Up: A Five-Year Journey to Instructional-Design Stability in a Postsecondary Distance Education Unit

ERIC Educational Resources Information Center

Epp, Jordan; McKee, Jeanette

2015-01-01

This report of practice describes a five-year process to establish and implement quality standards for a substantial portfolio of distance delivered courses at the Centre for Continuing and Distance Education, University of Saskatchewan. The report describes an analysis of the issues and the solutions found that led to our current curriculum…

Strategies for integrating computer-based activities into your educational environment: a practical guide.

PubMed Central

Miller, J G; Wolf, F M

1996-01-01

Strategies for implementing instructional technology are based on recent experiences at the University of Michigan Medical Center. The issues covered include 1) addressing facilities, hardware, and staffing needs, 2) determining learners' skill requirements and appropriate training activities, and 3) selecting and customizing educational software. Many examples are provided, and nine key points for success are emphasized. PMID:8653447

Fuels planning: science synthesis and integration; social issues fact sheet 13: Strategies for managing fuels and visual quality

Treesearch

Christine Esposito

2006-01-01

The public's acceptance of forest management practices, including fuels reduction, is heavily based on how forests look. Fuels managers can improve their chances of success by considering aesthetics when making management decisions. This fact sheet reviews a three-part general strategy for managing fuels and visual quality: planning, implementation, and monitoring...

School Leadership Practices That Promote Effective Whole School Behaviour Management: A Study of Australian Primary Schools

ERIC Educational Resources Information Center

De Nobile, John; El Baba, Mariam; London, Teola

2016-01-01

When considering the management of student behaviour issues, a substantial body of literature, as well as logical common sense, points to the advantages of whole school policy over the individual efforts of teachers. Less is known, however, about the direct or indirect role school leadership plays in the development of well-implemented whole…

Towards the Reform of Science Teaching in Spain: The Social and Personal Relevance of Junior Secondary School Science Projects for a Socially Responsible Understanding of Science.

ERIC Educational Resources Information Center

Membiela, Pedro

1999-01-01

Discusses aspects of more than a decade of research and implementation of cross-curriculum themes as part of the curriculum for secondary school students in Spain. Comments on theoretical and practical issues encountered in developing similar projects. Contains 45 references. (Author/WRM)

Precision-Based Item Selection for Exposure Control in Computerized Adaptive Testing

ERIC Educational Resources Information Center

Carroll, Ian A.

2017-01-01

Item exposure control is, relative to adaptive testing, a nascent concept that has emerged only in the last two to three decades on an academic basis as a practical issue in high-stakes computerized adaptive tests. This study aims to implement a new strategy in item exposure control by incorporating the standard error of the ability estimate into…

The Journal of Staff, Program, & Organization Development, Volume 14, Numbers 1-4, 1996-97. New Forums Faculty Development Series.

ERIC Educational Resources Information Center

Neal, Edward, Ed.

1997-01-01

This quarterly publication serves as a medium for the exchange of ideas regarding the planning, design, implementation, and evaluation of professional development practices at two- and four-year colleges. The four issues in volume 14 feature the following articles: (1) "A Home-Grown Faculty Development Program," (Jane T. Rauton); (2) "Creating…

Modern educational information technologies in formation of communicative competency in a foreign language in the process of training postgraduates at the aerospace university

NASA Astrophysics Data System (ADS)

Savelyeva, M. V.; Shumakova, N. A.

2016-04-01

The research analyses the issues of competency-based approach implementation in connection with practical experience gained in SibSAU in teaching English for scientific purposes to postgraduate students. The article focuses on IT application for the objectives of both class room and independent work of post graduates organization.

Children's Rights-Based Approaches: The Challenges of Listening to Taboo/Discriminatory Issues and Moving beyond Children's Participation

ERIC Educational Resources Information Center

Konstantoni, Kristina

2013-01-01

Young children's active participation is high on the UK's political, research and policy agendas; at least in rhetoric. However, critiques have emerged regarding the extent to which this rhetoric has been translated into practice and whether participatory rights are linked to the implementation of other human rights. Drawing on an ethnographic…