Sample records for specific implementation strategies

  1. A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions.

    PubMed

    Huynh, Alexis K; Hamilton, Alison B; Farmer, Melissa M; Bean-Mayberry, Bevanne; Stirman, Shannon Wiltsey; Moin, Tannaz; Finley, Erin P

    2018-01-01

    Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women's engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation. We conducted a process of strategy mapping to apply Proctor and colleagues' rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation. Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities. We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research.

  2. Implementation strategies: recommendations for specifying and reporting

    PubMed Central

    2013-01-01

    Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies. PMID:24289295

  3. Implementation strategies: recommendations for specifying and reporting.

    PubMed

    Proctor, Enola K; Powell, Byron J; McMillen, J Curtis

    2013-12-01

    Implementation strategies have unparalleled importance in implementation science, as they constitute the 'how to' component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of 'packaged' approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and 'reproducibility.' We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.

  4. Tracking implementation strategies: a description of a practical approach and early findings.

    PubMed

    Bunger, Alicia C; Powell, Byron J; Robertson, Hillary A; MacDowell, Hannah; Birken, Sarah A; Shea, Christopher

    2017-02-23

    Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children's access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.'s (Med Care Res Rev 69:123-57, 2012) taxonomy of implementation strategies. Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.

  5. Nurses' Perceptions of Implementing Fall Prevention Interventions to Mitigate Patient-Specific Fall Risk Factors.

    PubMed

    Wilson, Deleise S; Montie, Mary; Conlon, Paul; Reynolds, Margaret; Ripley, Robert; Titler, Marita G

    2016-08-01

    Evidence-based (EB) fall prevention interventions to mitigate patient-specific fall risk factors are readily available but not routinely used in practice. Few studies have examined nurses' perceptions about both the use of these EB interventions and implementation strategies designed to promote their adoption. This article reports qualitative findings of nurses' perceptions about use of EB fall prevention interventions to mitigate patient-specific fall risks, and implementation strategies to promote use of these interventions. The findings revealed five major themes: before-study fall prevention practices, use of EB fall prevention interventions tailored to patient-specific fall risk factors, beneficial implementation strategies, overall impact on approach to fall prevention, and challenges These findings are useful to guide nurses' engagement and use of EB fall prevention practices tailored to patient-specific fall risk factors. © The Author(s) 2016.

  6. Exploring Coaching Strategies in a Parent-Implemented Intervention for Toddlers

    ERIC Educational Resources Information Center

    Brown, Jennifer A.

    2012-01-01

    Purpose: This study examined the triadic relationships between the early interventionist, the parent and the child in a parent-implemented communication intervention for toddlers. Specifically, relationships between coaching strategies used by interventionists, parents' implementation of communication intervention strategies, child…

  7. A stitch in time saves nine? A repeated cross-sectional case study on the implementation of the intersectoral community approach Youth At a Healthy Weight.

    PubMed

    van der Kleij, Rianne M J J; Crone, Mathilde R; Paulussen, Theo G W M; van de Gaar, Vivan M; Reis, Ria

    2015-10-08

    The implementation of programs complex in design, such as the intersectoral community approach Youth At a Healthy Weight (JOGG), often deviates from their application as intended. There is limited knowledge of their implementation processes, making it difficult to formulate sound implementation strategies. For two years, we performed a repeated cross-sectional case study on the implementation of a JOGG fruit and water campaign targeting children age 0-12. Semi-structured observations, interviews, field notes and professionals' logs entries were used to evaluate implementation process. Data was analyzed via a framework approach; within-case and cross-case displays were formulated and key determinants identified. Principles from Qualitative Comparative Analysis (QCA) were used to identify causal configurations of determinants per sector and implementation phase. Implementation completeness differed, but was highest in the educational and health care sector, and higher for key than additional activities. Determinants and causal configurations of determinants were mostly sector- and implementation phase specific. High campaign ownership and possibilities for campaign adaptation were most frequently mentioned as facilitators. A lack of reinforcement strategies, low priority for campaign use and incompatibility of own goals with campaign goals were most often indicated as barriers. We advise multiple 'stitches in time'; tailoring implementation strategies to specific implementation phases and sectors using both the results from this study and a mutual adaptation strategy in which professionals are involved in the development of implementation strategies. The results of this study show that the implementation process of IACOs is complex and sustainable implementation is difficult to achieve. Moreover, this study reveals that the implementation process is influenced by predominantly sector and implementation phase specific (causal configurations of) determinants.

  8. A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol

    PubMed Central

    2013-01-01

    Background Improving quality in children’s mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders’ perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders’ perceptions of implementation strategies. Methods/design This study is a mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. Discussion This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city. PMID:23961701

  9. Large-scale fortification of condiments and seasonings as a public health strategy: equity considerations for implementation.

    PubMed

    Zamora, Gerardo; Flores-Urrutia, Mónica Crissel; Mayén, Ana-Lucia

    2016-09-01

    Fortification of staple foods with vitamins and minerals is an effective approach to increase micronutrient intake and improve nutritional status. The specific use of condiments and seasonings as vehicles in large-scale fortification programs is a relatively new public health strategy. This paper underscores equity considerations for the implementation of large-scale fortification of condiments and seasonings as a public health strategy by examining nonexhaustive examples of programmatic experiences and pilot projects in various settings. An overview of conceptual elements in implementation research and equity is presented, followed by an examination of equity considerations for five implementation strategies: (1) enhancing the capabilities of the public sector, (2) improving the performance of implementing agencies, (3) strengthening the capabilities and performance of frontline workers, (3) empowering communities and individuals, and (4) supporting multiple stakeholders engaged in improving health. Finally, specific considerations related to intersectoral action are considered. Large-scale fortification of condiments and seasonings cannot be a standalone strategy and needs to be implemented with concurrent and coordinated public health strategies, which should be informed by a health equity lens. © 2016 New York Academy of Sciences.

  10. Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions.

    PubMed

    Seidling, Hanna M; Stützle, Marion; Hoppe-Tichy, Torsten; Allenet, Benoît; Bedouch, Pierrick; Bonnabry, Pascal; Coleman, Jamie J; Fernandez-Llimos, Fernando; Lovis, Christian; Rei, Maria Jose; Störzinger, Dominic; Taylor, Lenka A; Pontefract, Sarah K; van den Bemt, Patricia M L A; van der Sijs, Heleen; Haefeli, Walter E

    2016-04-01

    While evidence on implementation of medication safety strategies is increasing, reasons for selecting and relinquishing distinct strategies and details on implementation are typically not shared in published literature. We aimed to collect and structure expert information resulting from implementing medication safety strategies to provide advice for decision-makers. Medication safety experts with clinical expertise from thirteen hospitals throughout twelve European and North American countries shared their experience in workshop meetings, on-site-visits and remote structured interviews. We performed an expert-based, in-depth assessment of implementation of best-practice strategies to improve drug prescribing and drug administration. Workflow, variability and recommended medication safety strategies in drug prescribing and drug administration processes. According to the experts, institutions chose strategies that targeted process steps known to be particularly error-prone in the respective setting. Often, the selection was channeled by local constraints such as the e-health equipment and critically modulated by national context factors. In our study, the experts favored electronic prescribing with clinical decision support and medication reconciliation as most promising interventions. They agreed that self-assessment and introduction of medication safety boards were crucial to satisfy the setting-specific differences and foster successful implementation. While general evidence for implementation of strategies to improve medication safety exists, successful selection and adaptation of a distinct strategy requires a thorough knowledge of the institute-specific constraints and an ongoing monitoring and adjustment of the implemented measures.

  11. What Are the Effects of Implementing Learning-Focused Strategies in Biology and Physical Science Classrooms?

    ERIC Educational Resources Information Center

    Simmons, Robin

    2013-01-01

    The objective of this study was to determine if Learning-Focused Strategies (LFS) implemented in high school science courses would affect student achievement and the pass rate of biology and physical science Common District Assessments (CDAs). The LFS, specific teaching strategies contained in the Learning-Focused Strategies Model (LFSM) Program…

  12. In and across bureaucracy: structural and administrative issues for the tobacco endgame.

    PubMed

    Isett, Kimberley R

    2013-05-01

    This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I discuss issues related to implementation of the endgame within a specific single agency, and issues related to a more widespread, broad implementation involving several agencies. Where appropriate, I provide examples of how the dynamics discussed would apply to particular endgame strategies. Issues related to design, administration, authority and finances are raised.

  13. In and across bureaucracy: structural and administrative issues for the tobacco endgame

    PubMed Central

    Isett, Kimberley R

    2013-01-01

    This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I discuss issues related to implementation of the endgame within a specific single agency, and issues related to a more widespread, broad implementation involving several agencies. Where appropriate, I provide examples of how the dynamics discussed would apply to particular endgame strategies. Issues related to design, administration, authority and finances are raised. PMID:23591514

  14. Implementation Planning and Progress on Physical Activity Goals: The Mediating Role of Life-Management Strategies

    ERIC Educational Resources Information Center

    Dugas, Michelle; Gaudreau, Patrick; Carraro, Natasha

    2012-01-01

    This 4-week prospective study examined whether the use of life-management strategies mediates the relationship between implementation planning and short-term progress on physical activity goals. In particular, the strategies of elective selection, compensation, and loss-based selection were disentangled to assess their specific mediating effects.…

  15. Management strategies for trace organic chemicals in water - A review of international approaches.

    PubMed

    Bieber, Stefan; Snyder, Shane A; Dagnino, Sonia; Rauch-Williams, Tanja; Drewes, Jörg E

    2018-03-01

    To ensure an appropriate management of potential health risks and uncertainties from the release of trace organic chemicals (TOrCs) into the aqueous environment, many countries have evaluated and implemented strategies to manage TOrCs. The aim of this study was to evaluate existing management strategies for TOrCs in different countries to derive and compare underlying core principles and paradigms and to develop suggestions for more holistic management strategies to protect the environment and drinking water supplies from the discharge of undesired TOrCs. The strategies in different industrial countries were summarized and subsequently compared with regards to three particular questions: 1) Do the approaches different countries have implemented manage all or only specific portions of the universe of chemicals; 2) What implementation and compliance strategies are used to manage aquatic and human health risk and what are their pros and cons; and 3) How are site-specific watershed differences being addressed? While management strategies of the different countries target similar TOrCs, the programs differ in several important aspects, including underlying principles, the balance between aquatic or human health protection, implementation methods, and financing mechanisms used to fund regulatory programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. State Energy Conservation Program Measure Directory. Sourcebook: Volume 8. Part 2 of 2 books

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

    Not Available

    DOE prepared an 8-volume Sourcebook to provide useful information for states in development and implementation of their Energy Conservation Plans. The purpose of Vol. 8, a 2-book set, is to facilitate exchange of information among states concerning program measures of common interest. DOE/CS--0159/1, Vol. 8, Book 1, announced in EAPA 6: abst. 3475, covered states Alabama through Missouri; this report, Vol. 8, Book 2 begins with Montana and completes the alphabet. Information is summarized also for American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin Islands in the two books. Information on the various programs in each statemore » includes identification data; narrative description of program measure; program measure information; and annual energy savings reported. A cross-reference index is included for agriculture, industry, transportation, buildings, government, legislative/regulatory implementation strategies, general education implementation strategies, specific information implementation strategies, demonstration implementation strategies, administration implementation strategies, and renewable-resource implementation strategies.« less

  17. Issues in Planning and Implementing National Literacy Programmes.

    ERIC Educational Resources Information Center

    Carron, G., Ed.; Bordia, A., Ed.

    The following papers were produced by participants and resource persons on specific issues of planning, management and implementation of literacy and post-literacy strategies: "People's Participation and Mobilization: Characteristics of the Literacy Campaigns in China" (Yanwei); "Strategies for Mobilization and Participation of…

  18. Factors Associated with South Korean Early Childhood Educators' Observed Behavior Support Strategies

    ERIC Educational Resources Information Center

    Kim, Yeon Ha; Stormont, Melissa

    2012-01-01

    This study was an exploratory study of 34 South Korean early childhood educators' strategies for addressing behavior problems in natural settings. Factors related to teachers' strategy implementation were also explored. Four specific teacher behaviors were observed: precorrection, behavioral-specific praise, redirection, and reprimand/punishment.…

  19. Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care: a systematic review.

    PubMed

    Suman, Arnela; Dikkers, Marije F; Schaafsma, Frederieke G; van Tulder, Maurits W; Anema, Johannes R

    2016-09-20

    For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care. The following electronic databases were searched from inception to June 1, 2015: MEDLINE, Embase, PsycInfo, the Cochrane Library, and CINAHL. The search strategy was restricted to low back pain, neck pain, and implementation research. Studies were included if their design was a randomized controlled trial, reporting on patients (age ≥18 years) with non-specific low back pain or neck pain (with or without radiating pain). Trials were eligible if they reported patient outcomes, measures of healthcare professional behaviour, and/or outcomes on healthcare level. The primary outcome was professional behaviour. Guidelines that were evaluated in the studies had to be implemented in a healthcare setting. No language restrictions were applied, and studies had to be published full-text in peer-reviewed journals, thus excluding abstract only publications, conference abstracts, and dissertation articles. Two researchers independently screened titles and abstract, extracted data from included studies, and performed risk of bias assessments. After removal of duplicates, the search resulted in 4750 abstracts to be screened. Of 43 full-text articles assessed for eligibility, 12 were included in this review, reporting on 9 individual studies, and separate cost-effectiveness analyses of 3 included studies. Implementation strategies varied between studies. Meta-analyses did not reveal any differences in effect between multifaceted strategies and controls. This review showed that multifaceted strategies for the implementation of neck and/or back pain guidelines in health care do not significantly improve professional behaviour outcomes. No effects on patient outcomes or cost of care could be found. More research is necessary to determine whether multifaceted implementation strategies are conducted as planned and whether these strategies are effective in changing professional behaviour and thereby clinical practice.

  20. Expert recommendations for implementing change (ERIC): protocol for a mixed methods study

    PubMed Central

    2014-01-01

    Background Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services. Methods/Design This study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web-based facilitated expert recommendation process will be employed to establish expert recommendations about which implementations strategies are essential for each phase of implementation in each scenario. Discussion Using a novel method of selecting implementation strategies for use within specific contexts, this study contributes to our understanding of implementation science and practice by sharpening conceptual distinctions among a comprehensive collection of implementation strategies. PMID:24669765

  1. Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice.

    PubMed

    Leeman, Jennifer; Birken, Sarah A; Powell, Byron J; Rohweder, Catherine; Shea, Christopher M

    2017-11-03

    Strategies are central to the National Institutes of Health's definition of implementation research as "the study of strategies to integrate evidence-based interventions into specific settings." Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term "implementation strategies." We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues' (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets). We build on Wandersman and colleagues' Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague's Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to assess strategy effectiveness. We illustrate how each class would apply to efforts to improve colorectal cancer screening rates in Federally Qualified Health Centers. Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings. Organizing strategies into classes also will assist users in locating the strategies that best match their needs.

  2. Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder.

    PubMed

    Aldao, Amelia; Mennin, Douglas S

    2012-02-01

    Recent models of generalized anxiety disorder (GAD) have expanded on Borkovec's avoidance theory by delineating emotion regulation deficits associated with the excessive worry characteristic of this disorder (see Behar, DiMarco, Hekler, Mohlman, & Staples, 2009). However, it has been difficult to determine whether emotion regulation is simply a useful heuristic for the avoidant properties of worry or an important extension to conceptualizations of GAD. Some of this difficulty may arise from a focus on purported maladaptive regulation strategies, which may be confounded with symptomatic distress components of the disorder (such as worry). We examined the implementation of adaptive regulation strategies by participants with and without a diagnosis of GAD while watching emotion-eliciting film clips. In a between-subjects design, participants were randomly assigned to accept, reappraise, or were not given specific regulation instructions. Implementation of adaptive regulation strategies produced differential effects in the physiological (but not subjective) domain across diagnostic groups. Whereas participants with GAD demonstrated lower cardiac flexibility when implementing adaptive regulation strategies than when not given specific instructions on how to regulate, healthy controls showed the opposite pattern, suggesting they benefited from the use of adaptive regulation strategies. We discuss the implications of these findings for the delineation of emotion regulation deficits in psychopathology. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Training Adult ESL Learners in Metacognitive Reading Strategies

    ERIC Educational Resources Information Center

    Huang, Jiuhan; Nisbet, Deanna

    2012-01-01

    This article is written as a practical guide to aid teachers in metacognitive reading strategy instruction. The nature of metacognitive strategies is explored, followed by specific procedures for implementing effective metacognitive strategy instruction in the adult ESL classroom. Chamot and O'Malley's (1994) five-phase strategy instruction…

  4. 76 FR 10530 - Supplemental Proposed Rule of Source Specific Federal Implementation Plan for Implementing Best...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-25

    ... proposed post-control BART limit of 0.012 lb/MMBtu on Units 1-3. C. Modeling and Demonstrating Reasonable... a different alternative emissions control strategy would achieve more progress than EPA's BART... Background for Proposing To Approve an Alternative Emissions Control Strategy as Achieving Better Progress...

  5. Central station market development strategies for photovoltaics

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Federal market development strategies designed to accelerate the market penetration of central station applications of photovoltaic energy system are analyzed. Since no specific goals were set for the commercialization of central station applications, strategic principles are explored which, when coupled with specific objectives for central stations, can produce a market development implementation plan. The study includes (1) background information on the National Photovoltaic Program, photovoltaic technology, and central stations; (2) a brief market assessment; (3) a discussion of the viewpoints of the electric utility industry with respect to solar energy; (4) a discussion of commercialization issues; and (5) strategy principles. It is recommended that a set of specific goals and objectives be defined for the photovoltaic central station program, and that these goals and objectives evolve into an implementation plan that identifies the appropriate federal role.

  6. Central station market development strategies for photovoltaics

    NASA Astrophysics Data System (ADS)

    1980-11-01

    Federal market development strategies designed to accelerate the market penetration of central station applications of photovoltaic energy system are analyzed. Since no specific goals were set for the commercialization of central station applications, strategic principles are explored which, when coupled with specific objectives for central stations, can produce a market development implementation plan. The study includes (1) background information on the National Photovoltaic Program, photovoltaic technology, and central stations; (2) a brief market assessment; (3) a discussion of the viewpoints of the electric utility industry with respect to solar energy; (4) a discussion of commercialization issues; and (5) strategy principles. It is recommended that a set of specific goals and objectives be defined for the photovoltaic central station program, and that these goals and objectives evolve into an implementation plan that identifies the appropriate federal role.

  7. Reporting on the Strategies Needed to Implement Proven Interventions: An Example From a "Real-World" Cross-Setting Implementation Study.

    PubMed

    Gold, Rachel; Bunce, Arwen E; Cohen, Deborah J; Hollombe, Celine; Nelson, Christine A; Proctor, Enola K; Pope, Jill A; DeVoe, Jennifer E

    2016-08-01

    The objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings. clinicaltrials.gov Identifier: NCT02299791. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  8. 78 FR 60700 - Source Specific Federal Implementation Plan for Implementing Best Available Retrofit Technology...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... operator of FCPP must notify EPA of its selected BART compliance strategy. On June 19, 2013, APS requested... related to the potential deregulation of the retail electricity market in Arizona that complicate its... one of two strategies for BART compliance: (1) Compliance with a facility-wide BART emission limit for...

  9. Agency responses to a system-driven implementation of multiple evidence-based practices in children's mental health services.

    PubMed

    Regan, Jennifer; Lau, Anna S; Barnett, Miya; Stadnick, Nicole; Hamilton, Alison; Pesanti, Keri; Bando, Lillian; Brookman-Frazee, Lauren

    2017-09-19

    Large mental health systems are increasingly using fiscal policies to encourage the implementation of multiple evidence-based practices (EBPs). Although many implementation strategies have been identified, little is known about the types and impacts of strategies that are used by organizations within implementation as usual. This study examined organizational-level responses to a fiscally-driven, rapid, and large scale EBP implementation in children's mental health within the Los Angeles County Department of Mental Health. Qualitative methods using the principles of grounded theory were used to characterize the responses of 83 community-based agencies to the implementation effort using documentation from site visits conducted 2 years post reform. Findings indicated that agencies perceived the rapid system-driven implementation to have both positive and negative organizational impacts. Identified challenges were primarily related to system implementation requirements rather than to characteristics of specific EBPs. Agencies employed a variety of implementation strategies in response to the system-driven implementation, with agency size associated with implementation strategies used. Moderate- and large-sized agencies were more likely than small agencies to have employed systematic strategies at multiple levels (i.e., organization, therapist, client) to support implementation. These findings are among the first to characterize organizational variability in response to system-driven implementation and suggest ways that implementation interventions might be tailored by organizational characteristics.

  10. Chesapeake Bay Tributary Strategies

    EPA Pesticide Factsheets

    Chesapeake Bay Tributary Strategies were developed by the seven watershed jurisdictions and outlined the river basin-specific implementation activities to reduce nutrient and sediment pollutant loads from point and nonpoint sources.

  11. Implementation Strategies for Gender-Sensitive Public Health Practice: A European Workshop.

    PubMed

    Oertelt-Prigione, Sabine; Dalibert, Lucie; Verdonk, Petra; Stutz, Elisabeth Zemp; Klinge, Ineke

    2017-11-01

    Providing a robust scientific background for the focus on gender-sensitive public health and a systematic approach to its implementation. Within the FP7-EUGenMed project ( http://eugenmed.eu ) a workshop on sex and gender in public health was convened on February 2-3, 2015. The experts participated in moderated discussion rounds to (1) assemble available knowledge and (2) identify structural influences on practice implementation. The findings were summarized and analyzed in iterative rounds to define overarching strategies and principles. The participants discussed the rationale for implementing gender-sensitive public health and identified priorities and key stakeholders to engage in the process. Communication strategies and specific promotion strategies with distinct stakeholders were defined. A comprehensive list of gender-sensitive practices was established using the recently published taxonomy of the Expert Recommendations for Implementing Change (ERIC) project as a blueprint. A clearly defined implementation strategy should be mandated for all new projects in the field of gender-sensitive public health. Our tool can support researchers and practitioners with the analysis of current and past research as well as with the planning of new projects.

  12. Barriers and Strategies in Guideline Implementation—A Scoping Review

    PubMed Central

    Fischer, Florian; Lange, Kerstin; Klose, Kristina; Greiner, Wolfgang; Kraemer, Alexander

    2016-01-01

    Research indicates that clinical guidelines are often not applied. The success of their implementation depends on the consideration of a variety of barriers and the use of adequate strategies to overcome them. Therefore, this scoping review aims to describe and categorize the most important barriers to guideline implementation. Furthermore, it provides an overview of different kinds of suitable strategies that are tailored to overcome these barriers. The search algorithm led to the identification of 1659 articles in PubMed. Overall, 69 articles were included in the data synthesis. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and strategies. The barriers to guideline implementation can be differentiated into personal factors, guideline-related factors, and external factors. The scoping review revealed the following aspects as central elements of successful strategies for guideline implementation: dissemination, education and training, social interaction, decision support systems and standing orders. Available evidence indicates that a structured implementation can improve adherence to guidelines. Therefore, the barriers to guideline implementation and adherence need to be analysed in advance so that strategies that are tailored to the specific setting and target groups can be developed. PMID:27417624

  13. The Balanced Scorecard of acute settings: development process, definition of 20 strategic objectives and implementation.

    PubMed

    Groene, Oliver; Brandt, Elimer; Schmidt, Werner; Moeller, Johannes

    2009-08-01

    Strategy development and implementation in acute care settings is often restricted by competing challenges, the pace of policy reform and the existence of parallel hierarchies. To describe a generic approach to strategy development, illustrate the use of the Balanced Scorecard as a tool to facilitate strategy implementation and demonstrate how to break down strategic goals into measurable elements. Multi-method approach using three different conceptual models: Health Promoting Hospitals Standards and Strategies, the European Foundation for Quality Management (EFQM) Model and the Balanced Scorecard. A bundle of qualitative and quantitative methods were used including in-depth interviews, standardized organization-wide surveys on organizational values, staff satisfaction and patient experience. Three acute care hospitals in four different locations belonging to a German holding group. Chief executive officer, senior medical officers, working group leaders and hospital staff. Development and implementation of the Balanced Scorecard. Twenty strategic objectives with corresponding Balanced Scorecard measures. A stepped approach from strategy development to implementation is presented to identify key themes for strategy development, drafting a strategy map and developing strategic objectives and measures. The Balanced Scorecard, in combination with the EFQM model, is a useful tool to guide strategy development and implementation in health care organizations. As for other quality improvement and management tools not specifically developed for health care organizations, some adaptations are required to improve acceptability among professionals. The step-wise approach of strategy development and implementation presented here may support similar processes in comparable organizations.

  14. Implementing Dementia Care Mapping to develop person-centred care: results of a process evaluation within the Leben-QD II trial.

    PubMed

    Quasdorf, Tina; Riesner, Christine; Dichter, Martin Nikolaus; Dortmann, Olga; Bartholomeyczik, Sabine; Halek, Margareta

    2017-03-01

    To evaluate Dementia Care Mapping implementation in nursing homes. Dementia Care Mapping, an internationally applied method for supporting and enhancing person-centred care for people with dementia, must be successfully implemented into care practice for its effective use. Various factors influence the implementation of complex interventions such as Dementia Care Mapping; few studies have examined the specific factors influencing Dementia Care Mapping implementation. A convergent parallel mixed-methods design embedded in a quasi-experimental trial was used to assess Dementia Care Mapping implementation success and influential factors. From 2011-2013, nine nursing units in nine different nursing homes implemented either Dementia Care Mapping (n = 6) or a periodic quality of life measurement using the dementia-specific instrument QUALIDEM (n = 3). Diverse data (interviews, n = 27; questionnaires, n = 112; resident records, n = 81; and process documents) were collected. Each data set was separately analysed and then merged to comprehensively portray the implementation process. Four nursing units implemented the particular intervention without deviating from the preplanned intervention. Translating Dementia Care Mapping results into practice was challenging. Necessary organisational preconditions for Dementia Care Mapping implementation included well-functioning networks, a dementia-friendly culture and flexible organisational structures. Involved individuals' positive attitudes towards Dementia Care Mapping also facilitated implementation. Precisely planning the intervention and its implementation, recruiting champions who supported Dementia Care Mapping implementation and having well-qualified, experienced project coordinators were essential to the implementation process. For successful Dementia Care Mapping implementation, it must be embedded in a systematic implementation strategy considering the specific setting. Organisational preconditions may need to be developed before Dementia Care Mapping implementation. Necessary steps may include team building, developing and realising a person-centred care-based mission statement or educating staff regarding general dementia care. The implementation strategy may include attracting and involving individuals on different hierarchical levels in Dementia Care Mapping implementation and supporting staff to translate Dementia Care Mapping results into practice. The identified facilitating factors can guide Dementia Care Mapping implementation strategy development. © 2016 John Wiley & Sons Ltd.

  15. Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients.

    PubMed

    Naldemirci, Öncel; Wolf, Axel; Elam, Mark; Lydahl, Doris; Moore, Lucy; Britten, Nicky

    2017-08-04

    The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients' perceptions to evaluate outcomes.

  16. Strategies for patient empowerment through the promotion of medicines in Israel: regulatory framework for the pharmaceutical industry.

    PubMed

    Schwartzberg, Eyal; Barnett-Itzhaki, Zohar; Grotto, Itamar; Marom, Eli

    2017-09-29

    The correct and rational use of medications can have a positive direct impact on disease outcomes, as well on the utilization of the health system resources. Unfortunately, 50% of the patients do not take their medications as prescribed, largely due to lack of patients' understanding of their medical condition, as well as the lack of reliable medicine information.There are multiple strategies implemented in many countries to tackle this challenge including: disease awareness campaigns (DAC) to raise the public awareness to specific diseases, direct-to-consumer advertisement (DTCA) to raise the public awareness to prescription medicines, specific treatments and over-the-counter (OTC) products to improve the accessibility of patients to specific medicines.Prior to 2013, the Israeli policy prohibited prescribing medication advertising and prevented the flow of information from pharmaceutical companies to the patient. In the last five years, the Pharmaceutical division in the Israeli Ministry of Health, as part of the "empowering the patient" agenda, has taken new innovative approaches to raise public awareness to diseases, medications and appropriate usage, as well as promotion of information to improve patient adherence to the prescribed medication.This paper elaborates on the aforementioned strategies implemented in developed countries, and specifically focuses on newly implemented strategies and regulations in Israel regarding pre- and post-prescription information, to improve patient appropriate utilization and adherence to medication.

  17. Implementing interorganizational cooperation in labour market reintegration: a case study.

    PubMed

    Ståhl, Christian

    2012-06-01

    To bring people with complex medical, social and vocational needs back to the labour market, interorganizational cooperation is often needed. Yet, studies of processes and strategies for achieving sustainable interorganizational cooperation are sparse. The aim of this study was to analyse the implementation processes of Swedish legislation on financial coordination, with specific focus on different strategies for and perspectives on implementing interorganizational cooperation. A multiple-case study was used, where two local associations for financial coordination were studied in order to elucidate and compare the development of cooperative work in two settings. The material, collected during a 3-year period, consisted of documents, individual interviews with managers, and focus groups with officials. Two different implementation strategies were identified. In case 1, a linear strategy was used to implement cooperative projects, which led to difficulties in maintaining cooperative work forms due to a fragmented and time-limited implementation process. In case 2, an interactive strategy was used, where managers and politicians were continuously involved in developing a central cooperation team that became a central part of a developing structure for interorganizational cooperation. An interactive cooperation strategy with long-term joint financing was here shown to be successful in overcoming organizational barriers to cooperation. It is suggested that a strategy based on adaptation to local conditions, flexibility and constant evaluation is preferred for developing sustainable interorganizational cooperation when implementing policies or legislation affecting interorganizational relationships.

  18. Riding Elvis's Motorcycle: Using Self-Regulated Strategy Development To PLAN and WRITE for a State Writing Exam.

    ERIC Educational Resources Information Center

    De La Paz, Susan; Owen, Bonnie; Harris, Karen R.; Graham, Steve

    2000-01-01

    This article describes implementation of the Self-Regulated Strategy Development (SRSD) approach to help students learn a specific essay writing strategy in preparation for a state writing test. It also reviews the theoretical and research bases for using SRSD to teaching writing strategies. (Contains references.) (DB)

  19. Improving customer satisfaction: emerging lessons about strategy and implementation, Part 2.

    PubMed

    Morton, J

    1995-01-01

    This article describes a six-phase strategy designed to systematically improve customer satisfaction across an entire managed care system. Part 1 (Spring 1995) of this two-part series summarized the theoretical underpinnings of the approach and highlighted the first two phases of the improvement strategy. Those phases involve systematically listening to the organization's customers and using customer information to strategically target key areas for improvement. This article describes the specifics of the last four phases of the strategy; these phases involve achieving and sustaining unprecedented levels of improvement in targeted areas. Initial results and emerging lessons associated with the implementation of this strategy are summarized.

  20. Models, Strategies, and Tools: Theory in Implementing Evidence-Based Findings into Health Care Practice

    PubMed Central

    Sales, Anne; Smith, Jeffrey; Curran, Geoffrey; Kochevar, Laura

    2006-01-01

    This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventions and/or intervention components to be implemented, and the choice of tools should match the interventions and overall strategy, linking back to the original theory and framework. The thesis advanced is that in most studies where there is an attempt to implement planned change in clinical processes, theory is used loosely. An example of linking theory to intervention design is presented from a Mental Health Quality Enhancement Research Initiative effort to increase appropriate use of antipsychotic medication among patients with schizophrenia in the Veterans Health Administration. PMID:16637960

  1. Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice.

    PubMed

    Sales, Anne; Smith, Jeffrey; Curran, Geoffrey; Kochevar, Laura

    2006-02-01

    This paper presents a case for careful consideration of theory in planning to implement evidence-based practices into clinical care. As described, theory should be tightly linked to strategic planning through careful choice or creation of an implementation framework. Strategies should be linked to specific interventions and/or intervention components to be implemented, and the choice of tools should match the interventions and overall strategy, linking back to the original theory and framework. The thesis advanced is that in most studies where there is an attempt to implement planned change in clinical processes, theory is used loosely. An example of linking theory to intervention design is presented from a Mental Health Quality Enhancement Research Initiative effort to increase appropriate use of antipsychotic medication among patients with schizophrenia in the Veterans Health Administration.

  2. 40 CFR 52.2585 - Control strategy: Ozone.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 5 2014-07-01 2014-07-01 false Control strategy: Ozone. 52.2585... strategy: Ozone. (a) Disapproval—On November 6, 1986, the Wisconsin Department of Natural Resources submitted as a proposed revision to the State's ozone State Implementation Plan a site-specific reasonably...

  3. 40 CFR 52.2585 - Control strategy: Ozone.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Control strategy: Ozone. 52.2585... strategy: Ozone. (a) Disapproval—On November 6, 1986, the Wisconsin Department of Natural Resources submitted as a proposed revision to the State's ozone State Implementation Plan a site-specific reasonably...

  4. 40 CFR 52.2585 - Control strategy: Ozone.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 5 2013-07-01 2013-07-01 false Control strategy: Ozone. 52.2585... strategy: Ozone. (a) Disapproval—On November 6, 1986, the Wisconsin Department of Natural Resources submitted as a proposed revision to the State's ozone State Implementation Plan a site-specific reasonably...

  5. 40 CFR 52.2585 - Control strategy: Ozone.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 5 2012-07-01 2012-07-01 false Control strategy: Ozone. 52.2585... strategy: Ozone. (a) Disapproval—On November 6, 1986, the Wisconsin Department of Natural Resources submitted as a proposed revision to the State's ozone State Implementation Plan a site-specific reasonably...

  6. Preventing Challenging Behaviors in Preschool: Effective Strategies for Classroom Teachers

    ERIC Educational Resources Information Center

    Coleman, Janelle C.; Crosby, Megan G.; Irwin, Heather K.; Dennis, Lindsay R.; Simpson, Cynthia G.; Rose, Chad A.

    2013-01-01

    This article provides practical strategies and techniques that early childhood educators can implement in their classrooms to effectively manage challenging behaviors. The specific strategies addressed fall under the following categories: (a) classroom management, (b) reinforcement, and (c) communication. Suggestions are made for how parents can…

  7. Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.

    PubMed

    Cotner, Bridget A; Ottomanelli, Lisa; O'Connor, Danielle R; Trainor, John K

    2018-06-01

    In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified. Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes. Some barriers to implementation occurred throughout the study, such as Veterans' lack of motivation and providers' difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team. Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities. Implications for Rehabilitation Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support. Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns. Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

  8. User involvement in the implementation of clinical guidelines for common mental health disorders: a review and compilation of strategies and resources.

    PubMed

    Moreno, Eliana M; Moriana, Juan Antonio

    2016-08-09

    There is now broad consensus regarding the importance of involving users in the process of implementing guidelines. Few studies, however, have addressed this issue, let alone the implementation of guidelines for common mental health disorders. The aim of this study is to compile and describe implementation strategies and resources related to common clinical mental health disorders targeted at service users. The literature was reviewed and resources for the implementation of clinical guidelines were compiled using the PRISMA model. A mixed qualitative and quantitative analysis was performed based on a series of categories developed ad hoc. A total of 263 items were included in the preliminary analysis and 64 implementation resources aimed at users were analysed in depth. A wide variety of types, sources and formats were identified, including guides (40%), websites (29%), videos and leaflets, as well as instruments for the implementation of strategies regarding information and education (64%), self-care, or users' assessment of service quality. The results reveal the need to establish clear criteria for assessing the quality of implementation materials in general and standardising systems to classify user-targeted strategies. The compilation and description of key elements of strategies and resources for users can be of interest in designing materials and specific actions for this target audience, as well as improving the implementation of clinical guidelines.

  9. Integrated corridor management : implementation guide and lessons learned.

    DOT National Transportation Integrated Search

    2012-02-01

    This implementation guide is intended for use by adopters of integrated corridor management (ICM) approaches and strategies to address congestion and travel time reliability issues within specific travel corridors. It introduces the topic of ICM and ...

  10. 40 CFR 52.729 - Control strategy: Carbon monoxide.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 3 2013-07-01 2013-07-01 false Control strategy: Carbon monoxide. 52.729 Section 52.729 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Illinois> § 52.729 Control strategy: Carbon monoxide. The following source specific...

  11. 40 CFR 52.729 - Control strategy: Carbon monoxide.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 3 2014-07-01 2014-07-01 false Control strategy: Carbon monoxide. 52.729 Section 52.729 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Illinois> § 52.729 Control strategy: Carbon monoxide. The following source specific...

  12. 40 CFR 52.729 - Control strategy: Carbon monoxide.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 3 2012-07-01 2012-07-01 false Control strategy: Carbon monoxide. 52.729 Section 52.729 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Illinois> § 52.729 Control strategy: Carbon monoxide. The following source specific...

  13. Strategies for Mentoring Pedagogical Knowledge

    ERIC Educational Resources Information Center

    Hudson, Peter

    2013-01-01

    Fundamental for mentoring a preservice teacher is the mentor's articulation of pedagogical knowledge, which in this research draws upon specific practices, viz.: planning, timetabling lessons, preparation, teaching strategies, content knowledge, problem solving, questioning, classroom management, implementation, assessment and viewpoints for…

  14. Internal quality control: planning and implementation strategies.

    PubMed

    Westgard, James O

    2003-11-01

    The first essential in setting up internal quality control (IQC) of a test procedure in the clinical laboratory is to select the proper IQC procedure to implement, i.e. choosing the statistical criteria or control rules, and the number of control measurements, according to the quality required for the test and the observed performance of the method. Then the right IQC procedure must be properly implemented. This review focuses on strategies for planning and implementing IQC procedures in order to improve the quality of the IQC. A quantitative planning process is described that can be implemented with graphical tools such as power function or critical-error graphs and charts of operating specifications. Finally, a total QC strategy is formulated to minimize cost and maximize quality. A general strategy for IQC implementation is recommended that employs a three-stage design in which the first stage provides high error detection, the second stage low false rejection and the third stage prescribes the length of the analytical run, making use of an algorithm involving the average of normal patients' data.

  15. Milestone-specific, Observed data points for evaluating levels of performance (MODEL) assessment strategy for anesthesiology residency programs.

    PubMed

    Nagy, Christopher J; Fitzgerald, Brian M; Kraus, Gregory P

    2014-01-01

    Anesthesiology residency programs will be expected to have Milestones-based evaluation systems in place by July 2014 as part of the Next Accreditation System. The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) anesthesiology residency program developed and implemented a Milestones-based feedback and evaluation system a year ahead of schedule. It has been named the Milestone-specific, Observed Data points for Evaluating Levels of performance (MODEL) assessment strategy. The "MODEL Menu" and the "MODEL Blueprint" are tools that other anesthesiology residency programs can use in developing their own Milestones-based feedback and evaluation systems prior to ACGME-required implementation. Data from our early experience with the streamlined MODEL blueprint assessment strategy showed substantially improved faculty compliance with reporting requirements. The MODEL assessment strategy provides programs with a workable assessment method for residents, and important Milestones data points to programs for ACGME reporting.

  16. Race to the Top. Hawaii Report. Year 4: School Year 2013-2014. [State-Specific Summary Report

    ERIC Educational Resources Information Center

    US Department of Education, 2015

    2015-01-01

    This State-specific summary report serves as an assessment of Hawaii's Year 4 Race to the Top implementation. Hawaii made tremendous progress over the course of the grant period in implementing its Strategic Plan and six priority strategies and creating an aligned organization focused on increasing student outcomes. Among some of the other…

  17. Healthcare provider education to support integration of pharmacogenomics in practice: the eMERGE Network experience

    PubMed Central

    Rohrer Vitek, Carolyn R; Abul-Husn, Noura S; Connolly, John J; Hartzler, Andrea L; Kitchner, Terrie; Peterson, Josh F; Rasmussen, Luke V; Smith, Maureen E; Stallings, Sarah; Williams, Marc S; Wolf, Wendy A; Prows, Cynthia A

    2017-01-01

    Ten organizations within the Electronic Medical Records and Genomics Network developed programs to implement pharmacogenomic sequencing and clinical decision support into clinical settings. Recognizing the importance of informed prescribers, a variety of strategies were used to incorporate provider education to support implementation. Education experiences with pharmacogenomics are described within the context of each organization's prior involvement, including the scope and scale of implementation specific to their Electronic Medical Records and Genomics projects. We describe common and distinct education strategies, provide exemplars and share challenges. Lessons learned inform future perspectives. Future pharmacogenomics clinical implementation initiatives need to include funding toward implementing provider education and evaluating outcomes. PMID:28639489

  18. Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

    PubMed

    Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles

    2014-11-25

    Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies. Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

  19. It's Not the Law--It's the Implementation That Matters.

    ERIC Educational Resources Information Center

    Vergon, Chuck; Broderick, Lauren

    This short report--part of a collection of 54 papers from the 48th annual conference of the Education Law Association held in November 2002--discusses implementation of inclusion policy. Specifically, it reports on a study of administrative strategies and organizational processes that promote policy implementation and achievement of the objectives…

  20. Brief Report: Caregiver Strategy Implementation--Advancing Spoken Communication in Children Who Are Minimally Verbal

    ERIC Educational Resources Information Center

    Shire, Stephanie Y.; Shih, Wendy; Kasari, Connie

    2018-01-01

    Research has demonstrated that caregivers' use of intervention strategies can support their children's social engagement and communication. However, it is not clear to what degree caregivers must master the strategies to effectively support gains in social communication, specifically, core challenges such as joint attention language (comments).…

  1. R&D Implementation in a Department of Laboratory Medicine and Pathology: A Systematic Review Based on Pharmaceutical Companies

    PubMed Central

    Feulefack, Joseph; Sergi, Consolato

    2015-01-01

    A systematic literature review on pharmaceutical companies may be a tool for guiding some procedures of R&D implementation in a department of Laboratory Medicine and Pathology. The use of pharmaceutical companies for this specific analysis arises from less variability of standards than healthcare facilities. In this qualitative and quantitative analysis, we focused on three useful areas of implementation, including R&D productivity, commercialization strategies, and expenditures determinants of pharmaceutical companies. Studies and reports of online databases from 1965 to 2014 were reviewed according to specific search terms. Initially, 218 articles and reports were found and examined, but only 91 were considered appropriate and used for further analysis. We identified some suggested implementation strategies relevant for marketing to enhance companies’ own R&D strategies; such as reliability of companies on “sourcing-in” R&D facilities and “think-tank” events. Regardless of the study and of the country, cash flow and profitability always positively influenced R&D expenditure, while sales and firm size did not. We consider that handling R&D determinants should require caution. It seems critical that implementation of R&D systems is directly related with productivity, if it reflects dual embodiment of efficiency and effectiveness. Scrutinizing the determinants of R&D expenditures emphasizes significant factors that are worth to highlight when planning an R&D investment strategy. Although there is no receipt fitting every situation, we think that health care plan makers may find relevant data in this systematic review in creating an initial implementation framework. PMID:25946935

  2. R&D implementation in a department of laboratory medicine and pathology: a systematic review based on pharmaceutical companies.

    PubMed

    Feulefack, Joseph; Sergi, Consolato

    2015-01-01

    A systematic literature review on pharmaceutical companies may be a tool for guiding some procedures of R&D implementation in a department of Laboratory Medicine and Pathology. The use of pharmaceutical companies for this specific analysis arises from less variability of standards than healthcare facilities. In this qualitative and quantitative analysis, we focused on three useful areas of implementation, including R&D productivity, commercialization strategies, and expenditures determinants of pharmaceutical companies. Studies and reports of online databases from 1965 to 2014 were reviewed according to specific search terms. Initially, 218 articles and reports were found and examined, but only 91 were considered appropriate and used for further analysis.  We identified some suggested implementation strategies relevant for marketing to enhance companies' own R&D strategies; such as reliability of companies on "sourcing-in" R&D facilities and "think-tank" events. Regardless of the study and of the country, cash flow and profitability always positively influenced R&D expenditure, while sales and firm size did not. We consider that handling R&D determinants should require caution. It seems critical that implementation of R&D systems is directly related with productivity, if it reflects dual embodiment of efficiency and effectiveness. Scrutinizing the determinants of R&D expenditures emphasizes significant factors that are worth to highlight when planning an R&D investment strategy. Although there is no receipt fitting every situation, we think that health care plan makers may find relevant data in this systematic review in creating an initial implementation framework.

  3. Integrated corridor management : implementation guide and lessons learned (final report version 2.0).

    DOT National Transportation Integrated Search

    2015-09-01

    This implementation guide is intended for use by adopters of integrated corridor management (ICM) approaches and strategies to address congestion and travel time reliability issues within specific travel corridors. It introduces the topic of ICM and ...

  4. An implementation science perspective on psychological science and cancer: what is known and opportunities for research, policy, and practice.

    PubMed

    Rabin, Borsika; Glasgow, Russell E

    2015-01-01

    We discuss the role of implementation science in cancer and summarize the need for this perspective. Following a summary of key implementation science principles and lessons learned, we review the literature on implementation of cancer prevention and control activities across the continuum from prevention to palliative care. We identified 10 unique relevant reviews, four of which were specific to cancer. Multicomponent implementation strategies were found to be superior to single-component interventions, but it was not possible to draw conclusions about specific strategies or the range of conditions across which strategies were effective. Particular gaps identified include the need for more studies of health policies and reports of cost, cost-effectiveness, and resources required. Following this review, we summarize the types of evidence needed to make research findings more actionable and discuss emerging implementation science opportunities for psychological research on cancer prevention and control. These include innovative study designs (i.e., rapid learning designs, simulation modeling, comparative effectiveness, pragmatic studies, mixed-methods research) and measurement science (i.e., development of context-relevant measures; practical, longitudinal measures to gauge improvement; cost-effectiveness data; and harmonized patient report data). We conclude by identifying a few grand challenges for psychologists that if successfully addressed would accelerate integration of evidence into cancer practice and policy more consistently and rapidly. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  5. A Qualitative Study of HR/OHS Stress Interventions in Australian Universities.

    PubMed

    Pignata, Silvia; Winefield, Anthony H; Boyd, Carolyn M; Provis, Chris

    2018-01-09

    To enhance the understanding of psychosocial factors and extend research on work stress interventions, we investigated the key human resource (HR)/occupational health and safety (OHS) stress interventions implemented at five Australian universities over a three-year period. Five senior HR Directors completed an online survey to identify the intervention strategies taken at their university in order to reduce stress and enhance employee well-being and morale. We also explored the types of individual-, organization-, and individual/organization-directed interventions that were implemented, and the strategies that were prioritized at each university. Across universities, the dominant interventions were strategies that aimed to balance the social exchange in the work contract between employee-organization with an emphasis on initiatives to: enhance training, career development and promotional opportunities; improve remuneration and recognition practices; and to enhance the fairness of organizational policies and procedures. Strategies to improve work-life balance were also prominent. The interventions implemented were predominantly proactive (primary) strategies focused at the organizational level and aimed at eliminating or reducing or altering work stressors. The findings contribute to the improved management of people at work by identifying university-specific HR/OHS initiatives, specifically leadership development and management skills programs which were identified as priorities at three universities.

  6. A Qualitative Study of HR/OHS Stress Interventions in Australian Universities

    PubMed Central

    Winefield, Anthony H.; Boyd, Carolyn M.

    2018-01-01

    To enhance the understanding of psychosocial factors and extend research on work stress interventions, we investigated the key human resource (HR)/occupational health and safety (OHS) stress interventions implemented at five Australian universities over a three-year period. Five senior HR Directors completed an online survey to identify the intervention strategies taken at their university in order to reduce stress and enhance employee well-being and morale. We also explored the types of individual-, organization-, and individual/organization-directed interventions that were implemented, and the strategies that were prioritized at each university. Across universities, the dominant interventions were strategies that aimed to balance the social exchange in the work contract between employee-organization with an emphasis on initiatives to: enhance training, career development and promotional opportunities; improve remuneration and recognition practices; and to enhance the fairness of organizational policies and procedures. Strategies to improve work-life balance were also prominent. The interventions implemented were predominantly proactive (primary) strategies focused at the organizational level and aimed at eliminating or reducing or altering work stressors. The findings contribute to the improved management of people at work by identifying university-specific HR/OHS initiatives, specifically leadership development and management skills programs which were identified as priorities at three universities. PMID:29315278

  7. A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

    NASA Astrophysics Data System (ADS)

    Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

    The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

  8. Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

    PubMed Central

    Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

    2007-01-01

    Background The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. PMID:17355583

  9. A four-phase strategy for the implementation of reflectance confocal microscopy in dermatology.

    PubMed

    Hoogedoorn, L; Gerritsen, M J P; Wolberink, E A W; Peppelman, M; van de Kerkhof, P C M; van Erp, P E J

    2016-08-01

    Reflectance confocal microscopy (RCM) is gradually implemented in dermatology. Strategies for further implementation and practical 'hands on' guidelines are lacking. The primary outcome was to conduct a general strategy for further implementation of RCM. The secondary outcome was the diagnosis of psoriasis and differentiation of stable from unstable psoriatic plaques by means of the 'hands on' protocol, derived from the strategy. We used a four-phased model; an exploring phase, a systematic literature search, a clinical approach and, finally, an integration phase to develop a clinical guideline for RCM in psoriasis. Receiver operating characteristic curve statistics was applied to define the accuracy for the diagnosis of unstable psoriasis. A general strategy for further implementation of RCM and practical approach was developed to examine psoriasis by RCM and to distinguish stable from unstable psoriasis. Unstable psoriasis was diagnosed by epidermal inflammatory cell counts with a sensitivity and specificity of 91.7% and 98.3%, respectively, and with an accuracy of 0.92 (area under the curve). In addition, a monitoring model was proposed. This is the first study that shows a method for implementation of RCM in dermatology. The strategy and hands on protocol for psoriasis may serve as a model for other dermatological entities and additionally may lead to specialized ready-to-use RCM protocols for clinical dermatological practice. © 2016 European Academy of Dermatology and Venereology.

  10. A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial

    PubMed Central

    2011-01-01

    Background Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI) strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED) strategy. Methods In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service), have been allocated randomly to either the intervention group (CI strategy) or the control group (ED strategy). The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program. Discussion Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes. Clinical trials registration NCT01117285 PMID:21450063

  11. Quality of life of coronary artery disease patients after the implementation of planning strategies for medication adherence 1

    PubMed Central

    Lourenço, Laura Bacelar de Araujo; Rodrigues, Roberta Cunha Matheus; São-João, Thaís Moreira; Gallani, Maria Cecilia; Cornélio, Marilia Estevam

    2015-01-01

    OBJECTIVE: to compare the general and specific health-related quality of life (HRQoL) between the Intervention (IG) and Control (CG) groups of coronary artery disease patients after the implementation of Action Planning and Coping Planning strategies for medication adherence and to verify the relationship between adherence and HRQoL. METHOD: this was a controlled and randomized study. RESULTS: the sample (n=115) was randomized into two groups, IG (n=59) and CG (n=56). Measures of medication adherence and general and specific HRQoL were obtained in the baseline and after two months of monitoring. CONCLUSION: the findings showed that the combination of intervention strategies - Action Planning and Coping Planning for medication adherence did not affect the HRQoL of coronary artery disease patients in outpatient monitoring. PMID:25806626

  12. Fitting Computers into the Curriculum.

    ERIC Educational Resources Information Center

    Rodgers, Robert J.; And Others

    This paper provides strategies and insights that should be weighed and perhaps included in any proposal for integrating computers into a comprehensive school curriculum. The strategies include six basic stages: Initiation, Needs Assessment, Master Plan, Logistic-Specifics, Implementation, and Evaluation. The New Brunswick (New Jersey) Public…

  13. 3 CFR - Implementation of the National HIV/AIDS Strategy

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... status updates on achieving specific quantitative targets established by the Strategy, with relevant...-departmental coordination and collaboration on HIV/AIDS care, research, and prevention services. (b... and research priorities in the areas of highest impact. (c) Presidential Advisory Council on HIV/AIDS...

  14. Inspect, Detect, Correct: Structural Integrated Pest Management Strategies at School.

    ERIC Educational Resources Information Center

    Jochim, Jerry

    2003-01-01

    Describes a model integrated pest management (IPM) program for schools used in Monroe County, Indiana. Addresses how to implement an IPM program, specific school problem areas, specific pest problems and solutions, and common questions. (EV)

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

    PubMed Central

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

    2014-01-01

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

  16. Optimization as a Reasoning Strategy for Dealing with Socioscientific Decision-Making Situations

    ERIC Educational Resources Information Center

    Papadouris, Nicos

    2012-01-01

    This paper reports on an attempt to help 12-year-old students develop a specific optimization strategy for selecting among possible solutions in socioscientific decision-making situations. We have developed teaching and learning materials for elaborating this strategy, and we have implemented them in two intact classes (N = 48). Prior to and after…

  17. Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy

    ERIC Educational Resources Information Center

    Binford, Roslyn B.; Mussell, Melissa Pederson; Crosby, Ross D.; Peterson, Carol B.; Crow, Scott J.; Mitchell, James E.

    2005-01-01

    This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1-and 6-month follow-up. Frequency of…

  18. Smart Discipline for the Classroom: Respect and Cooperation Restored. Third Edition.

    ERIC Educational Resources Information Center

    Koenig, Larry

    This book helps teachers develop personal plans of action to handle classroom discipline, offering progressive Plan A and Plan B strategies. Plan A strategies take seconds to implement. Plan B strategies take more time but are designed to turn around specific attitudes and behaviors. After an introduction, there are 9 chapters: (1) "Misbehaviors…

  19. Strategies to balance fidelity to Housing First principles with local realities: lessons from a large urban centre.

    PubMed

    O'Campo, Patricia; Zerger, Suzanne; Gozdzik, Agnes; Jeyaratnam, Jeyagobi; Stergiopoulos, Vicky

    2015-05-01

    The importance of program implementation in achieving desired outcomes is well-documented, but there remains a need for concrete guidance on how to achieve fidelity to evidence-based models within dynamic local contexts. Housing First (HF), an evidence-based model for people experiencing homelessness and mental illness, provides an important test-case for such guidance; it targets a uniquely underserved subpopulation with complex needs, and is delivered by practitioners with varying knowledge and skill levels. Scientific evidence affirms HF's effectiveness, but its rapid dissemination has outpaced the ability to monitor not only whether it is being implemented with fidelity, but also how this can be achieved within variable local contexts and challenges. This qualitative study contributes to this need by capturing insights from practitioners on implementation challenges and specific strategies developed to overcome them. Findings reinforce the importance of developing HF-specific implementation guidelines, and of engaging relevant stakeholders throughout all phases of that development.

  20. Effectively engaging stakeholders and the public in developing violence prevention messages.

    PubMed

    Boyko, Jennifer A; Wathen, C Nadine; Kothari, Anita

    2017-05-11

    Preventing family violence requires that stakeholders and the broader public be involved in developing evidence-based violence prevention strategies. However, gaps exist in between what we know (knowledge), what we do (action), and the structures supporting practice (policy). We discuss the broad challenge of mobilizing knowledge-for-action in family violence, with a primary focus on the issue of how stakeholders and the public can be effectively engaged when developing and communicating evidence-based violence prevention messages. We suggest that a comprehensive approach to stakeholder and public engagement in developing violence prevention messages includes: 1) clear and consistent messaging; 2) identifying and using, as appropriate, lessons from campaigns that show evidence of reducing specific types of violence; and 3) evidence-informed approaches for communicating to specific groups. Components of a comprehensive approach must take into account the available research evidence, implementation feasibility, and the context-specific nature of family violence. While strategies exist for engaging stakeholders and the public in messaging about family violence prevention, knowledge mobilization must be informed by evidence, dialogue with stakeholders, and proactive media strategies. This paper will be of interest to public health practitioners or others involved in planning and implementing violence prevention programs because it highlights what is known about the issue, potential solutions, and implementation considerations.

  1. Promoting Retention through the Implementation of Integrated Multicultural Instructional Design

    ERIC Educational Resources Information Center

    Higbee, Jeanne L.; Goff, Emily; Schultz, Jennifer L.

    2013-01-01

    This article introduces the guiding principles of integrated multicultural instructional design (IMID), a new pedagogical model created to promote retention by addressing multicultural perspectives and social justice issues across the curriculum. To illustrate the model, specific strategies for implementing IMID in a content-based,…

  2. The impact of the principal in the implementation of promoting science among English language learners (P-SELL)

    NASA Astrophysics Data System (ADS)

    Kittrell, Resma

    School organizations are in a constant state of change. One of the major changes that all schools encounter is adopting new curriculum. It is important to look at the role of the principal during the implementation of a new curriculum so that we can identify specific strategies that might be useful in other areas of school change. This study focuses on the role of the principal during the adoption of a new science curriculum, Promoting Science Among English Language Learners (P-SELL), within six elementary schools. This multiple case study included teacher focus group interviews, principal interviews, and teacher and principal written surveys to identify specific roles and strategies that principals illustrated during implementation of P-SELL. The overarching themes uncovered included (a) distributive leadership, (b) clear communication, and (c) supportive conditions. These findings can be used to understand the process of change within an organization.

  3. Carpool incentives: analysis of transportation and energy impacts

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

    Not Available

    1976-06-01

    The report quantitatively analyzes the impacts of carpooling strategies on travel behavior and energy consumption. It details the effects of 18 candidate strategies on the utilization of different transport modes for work trips and the resultant effects on non-work travel patterns, household auto ownership, and total fuel consumption. Five specific objectives governed the work performed: (1) To collect information on carpooling behavior and analyze existing experience with strategies that may encourage ride-sharing; (2) to predict, by using behavioral travel-demand models, the changes in travel patterns that might result from implementation of such strategies; (3) to translate increased carpooling (or othermore » changes in travel patterns) into decreased fuel consumption; (4) to evaluate the feasibility of implementing particular strategies; (5) to recommend strategies for increasing carpooling and reducing fuel consumption that will be both feasible and effective.« less

  4. Integrated knowledge translation strategies in the acute care of older people: a scoping review protocol.

    PubMed

    McCormick, Loretta; Godfrey, Christina M; Muscedere, John; Hendrikx, Shawn

    2016-09-01

    The objective of this review is to identify the evidence on the use of integrated knowledge translation (iKT) strategies in acute care. This information will assist in the identification of the strategies used to engage stakeholders, such as patients and decision makers, in the research process and how their involvement has influenced the implementation or integration of research into practice. The extent to which these iKT activities have occurred in the context of care of the elderly, intensively ill patient will be examined. The question that will guide this review is: What iKT strategies have been used within the acute care environment for the care of an older person, specifically: (a) where have these strategies been used, and (b) how have iKT strategies been implemented?

  5. A Strategy for Promoting Educational Reform in Developing Countries.

    ERIC Educational Resources Information Center

    Abdel-Halim, A. El-Mahdi; Shaker, Paul

    Educational reform in developing countries, specifically in Saudi Arabia, will be facilitated if certain strategies are employed when implementing educational change. Problems which restrict reform tend to be a culture which opposes change, staffing, finances, a shortage of relevant learning materials, excessive centralization of authority,…

  6. Empowering Teachers: Characteristics, Strategies, and Practices of Successful Principals

    ERIC Educational Resources Information Center

    Ellis, Cailin Patrice

    2012-01-01

    This study implemented an exploratory mixed-methods design to better understand how the characteristics of a principal, specifically the strategies, behaviors, and actions, lead to the perception of empowerment as perceived by the teachers themselves. An expert panel identified three "highly successful" principals assigned to elementary…

  7. Management Strategies for Positive Mental Health Outcomes: What Early Childhood Administrators Need to Know

    ERIC Educational Resources Information Center

    Green, Beth; Everhart, Maria C.; Gordon, Lynwood; Friesen, Barbara

    2004-01-01

    The focus of this training is on understanding ways to design and implement an overall mental health strategy in your program. The authors are not going to talk about specific intervention strategies, such as how to deal with challenging behavior in the classroom, or how to identify and screen children with possible mental health issues. Instead,…

  8. Stop! Look & Lesson: A Guide to Identifying and Correcting Common Mathematical Errors Strategies.

    ERIC Educational Resources Information Center

    Palmer, Don; And Others

    This book provides a comprehensive collection of 66 teaching strategies and ideas to help overcome problems with number, each linked to a specific kind of error described in the related manual. Most of these strategies are classroom-ready and easily implemented. Some are notes for the teacher to read and then plan activities accordingly, and many…

  9. Context-specific energy strategies: coupling energy system visions with feasible implementation scenarios.

    PubMed

    Trutnevyte, Evelina; Stauffacher, Michael; Schlegel, Matthias; Scholz, Roland W

    2012-09-04

    Conventional energy strategy defines an energy system vision (the goal), energy scenarios with technical choices and an implementation mechanism (such as economic incentives). Due to the lead of a generic vision, when applied in a specific regional context, such a strategy can deviate from the optimal one with, for instance, the lowest environmental impacts. This paper proposes an approach for developing energy strategies by simultaneously, rather than sequentially, combining multiple energy system visions and technically feasible, cost-effective energy scenarios that meet environmental constraints at a given place. The approach is illustrated by developing a residential heat supply strategy for a Swiss region. In the analyzed case, urban municipalities should focus on reducing heat demand, and rural municipalities should focus on harvesting local energy sources, primarily wood. Solar thermal units are cost-competitive in all municipalities, and their deployment should be fostered by information campaigns. Heat pumps and building refurbishment are not competitive; thus, economic incentives are essential, especially for urban municipalities. In rural municipalities, wood is cost-competitive, and community-based initiatives are likely to be most successful. Thus, the paper shows that energy strategies should be spatially differentiated. The suggested approach can be transferred to other regions and spatial scales.

  10. Reducing Energy Burden with Solar: Colorado's Strategy and Roadmap for States

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

    Cook, Jeffrey J.; Shah, Monisha

    The Colorado Energy Office (CEO) recently implemented a multi-pronged strategy to reduce energy burden for low-income (LI) Colorado residents through the deployment of solar electricity generation. Due to these efforts, approximately 20 MW of photovoltaic (PV) solar may be deployed in Colorado by the end of 2019 specifically for low-income households. Relying on interviews with ten subject-matter experts and other research, this report outlines the details of the CEO strategy including why the agency pursued this strategy, how it was carried out, and lessons learned from implementation. Though CEO's strategy is unique and tailored to the needs of Colorado, itmore » is possible that other states might learn from CEO's experiences when designing their own LI strategies. As a result, the report concludes by outlining six primary steps for designing a comprehensive low-income solar strategy.« less

  11. Towards the Implementation of the GEOSS Water Strategy

    NASA Astrophysics Data System (ADS)

    Lawford, R. G.; Cripe, D.

    2014-12-01

    Early in 2014, the Group on Earth Observations (GEO) adopted the GEOSS (Global Earth Observation System of Systems) Water Strategy as a potential guide for GEO-related water activities over the next decade. The Water Strategy outlines water-related issues and opportunities that fit within the general GEOSS framework that will be developed over the next decade (2016-2025). Implementation of a water strategy within the GEOSS framework can be complex because GEO Members and Participating Organizations contribute to GEO on a voluntary basis. In spite of these limitations efforts to consolidate an implementation plan have made significant advances during the past nine months. Progress towards the final GEOSS Water Strategy Implementation Plan will be reported and gaps in the plan will be identified. Specific responses to the strategy will address the need for user engagement, the development of integrated of data products, model hierarchies and user support systems, and the research that will be needed to expand the capabilities of GEOSS and its water services. One challenge for the implementation plan involves building a framework from the diverse and wide range of activities and opportunities presented by GEO Members and Participating Organizations. The priority themes within the GEO Water Strategy are being used to provide more focus for new initiatives. New activities related to these priority areas involving projects that link water and other GEO Societal Benefit Areas, as well as initiatives related to the Water-Energy-Food nexus and the Sustainable Development Goals will be described. The presentation will also explore the needs and opportunities for new satellites and other observational and information technologies to advance the implementation of the GEOSS water strategy objectives.

  12. Implementation plans included in World Health Organisation guidelines.

    PubMed

    Wang, Zhicheng; Norris, Susan L; Bero, Lisa

    2016-05-20

    The implementation of high-quality guidelines is essential to improve clinical practice and public health. The World Health Organisation (WHO) develops evidence-based public health and other guidelines that are used or adapted by countries around the world. Detailed implementation plans are often necessary for local policymakers to properly use the guidelines developed by WHO. This paper describes the plans for guideline implementation reported in WHO guidelines and indicates which of these plans are evidence-based. We conducted a content analysis of the implementation sections of WHO guidelines approved by the WHO guideline review committee between December 2007 and May 2015. The implementation techniques reported in each guideline were coded according to the Cochrane Collaboration's Effective Practice and Organisation of Care (EPOC) taxonomy and classified as passive, active or policy strategies. The frequencies of implementation techniques are reported. The WHO guidelines (n = 123) analysed mentioned implementation techniques 800 times, although most mentioned implementation techniques very briefly, if at all. Passive strategies (21 %, 167/800) and general policy strategies (62 %, 496/800) occurred most often. Evidence-based active implementation methods were generally neglected with no guideline mentioning reminders (computerised or paper) and only one mentioning a multifaceted approach. Many guidelines contained implementation sections that were identical to those used in older guidelines produced by the same WHO technical unit. The prevalence of passive and policy-based implementation techniques as opposed to evidence-based active techniques suggests that WHO guidelines should contain stronger guidance for implementation. This could include structured and increased detail on implementation considerations, accompanying or linked documents that provide information on what is needed to contextualise or adapt a guideline and specific options from among evidence-based implementation strategies.

  13. Professional Development with Video Modeling: Effects on Behavior Specific Praise in General Education Classrooms

    ERIC Educational Resources Information Center

    Barry, Colleen

    2016-01-01

    Federal mandates require teachers to implement evidence-based strategies in their classrooms; however, due to gaps between research and practice, these evidence-based practices are inconsistently implemented across educational settings. Although intended to address this, teacher professional developments are most commonly delivered in a…

  14. Common Core Implementation Decisions Made by Principals in Elementary Schools

    ERIC Educational Resources Information Center

    Norman, Alexis Cienfuegos

    2016-01-01

    The purpose of this study was to understand the decisions elementary principals have made during the Common Core State Standards reform. Specifically, (a) what decisions principals have made to support Common Core implementation, (b) what strategies elementary principals have employed to communicate with stakeholders about Common Core State…

  15. Using Positive Behavior Support to Design Effective Classrooms

    ERIC Educational Resources Information Center

    Anderson, Cynthia M.; Spaulding, Scott A.

    2007-01-01

    A number of evidence-based classroom management approaches, procedures, and programs have been developed and presented over the years. In this article the authors synthesize recommendations from various sources, focusing on evidence-based strategies that can be implemented in a systematic manner. They focus specifically on universal strategies,…

  16. Health benefit modelling and optimization of vehicular pollution control strategies

    NASA Astrophysics Data System (ADS)

    Sonawane, Nayan V.; Patil, Rashmi S.; Sethi, Virendra

    2012-12-01

    This study asserts that the evaluation of pollution reduction strategies should be approached on the basis of health benefits. The framework presented could be used for decision making on the basis of cost effectiveness when the strategies are applied concurrently. Several vehicular pollution control strategies have been proposed in literature for effective management of urban air pollution. The effectiveness of these strategies has been mostly studied as a one at a time approach on the basis of change in pollution concentration. The adequacy and practicality of such an approach is studied in the present work. Also, the assessment of respective benefits of these strategies has been carried out when they are implemented simultaneously. An integrated model has been developed which can be used as a tool for optimal prioritization of various pollution management strategies. The model estimates health benefits associated with specific control strategies. ISC-AERMOD View has been used to provide the cause-effect relation between control options and change in ambient air quality. BenMAP, developed by U.S. EPA, has been applied for estimation of health and economic benefits associated with various management strategies. Valuation of health benefits has been done for impact indicators of premature mortality, hospital admissions and respiratory syndrome. An optimization model has been developed to maximize overall social benefits with determination of optimized percentage implementations for multiple strategies. The model has been applied for sub-urban region of Mumbai city for vehicular sector. Several control scenarios have been considered like revised emission standards, electric, CNG, LPG and hybrid vehicles. Reduction in concentration and resultant health benefits for the pollutants CO, NOx and particulate matter are estimated for different control scenarios. Finally, an optimization model has been applied to determine optimized percentage implementation of specific control strategies with maximization of social benefits, when these strategies are applied simultaneously.

  17. How Should I Study for the Exam? Self-Regulated Learning Strategies and Achievement in Introductory Biology

    PubMed Central

    Sebesta, Amanda J.; Bray Speth, Elena

    2017-01-01

    In college introductory science courses, students are challenged with mastering large amounts of disciplinary content while developing as autonomous and effective learners. Self-regulated learning (SRL) is the process of setting learning goals, monitoring progress toward them, and applying appropriate study strategies. SRL characterizes successful, “expert” learners, and develops with time and practice. In a large, undergraduate introductory biology course, we investigated: 1) what SRL strategies students reported using the most when studying for exams, 2) which strategies were associated with higher achievement and with grade improvement on exams, and 3) what study approaches students proposed to use for future exams. Higher-achieving students, and students whose exam grades improved in the first half of the semester, reported using specific cognitive and metacognitive strategies significantly more frequently than their lower-achieving peers. Lower-achieving students more frequently reported that they did not implement their planned strategies or, if they did, still did not improve their outcomes. These results suggest that many students entering introductory biology have limited knowledge of SRL strategies and/or limited ability to implement them, which can impact their achievement. Course-specific interventions that promote SRL development should be considered as integral pedagogical tools, aimed at fostering development of students’ lifelong learning skills. PMID:28495934

  18. [Women-and Child-Friendly Institutional Strategies with an integral approach in Colombia].

    PubMed

    Farías-Jiménez, Patricia; Arocha-Zuluaga, Gina Paola; Trujillo-Ramírez, Kenny Margarita; Botero-Uribe, Inés

    2014-01-01

    It is uncommon to implement and document a maternal and child healthcare strategy on a territorial and institutional level is infrequent. Therefore, we aimed to describe the experience of a consulting team composed of two physicians, two nurses and two nutritionists, whose purpose was to support the introduction of the Women- and Child-Friendly Institutional Strategy with an integral approach in 25 healthcare institutions in three Colombian departments (Cauca, Huila and Nariño), according to unmet basic needs. The Women- and Child-Friendly Institutional Strategy, considered a senior management strategy, promotes a specific method that allows monitoring of institutions during the implementation of a health and nutritional care strategy for women and children, and offers them the possibility of voluntarily becoming accredited as a Women- and Child-Friendly Institutions. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  19. regioneR: an R/Bioconductor package for the association analysis of genomic regions based on permutation tests.

    PubMed

    Gel, Bernat; Díez-Villanueva, Anna; Serra, Eduard; Buschbeck, Marcus; Peinado, Miguel A; Malinverni, Roberto

    2016-01-15

    Statistically assessing the relation between a set of genomic regions and other genomic features is a common challenging task in genomic and epigenomic analyses. Randomization based approaches implicitly take into account the complexity of the genome without the need of assuming an underlying statistical model. regioneR is an R package that implements a permutation test framework specifically designed to work with genomic regions. In addition to the predefined randomization and evaluation strategies, regioneR is fully customizable allowing the use of custom strategies to adapt it to specific questions. Finally, it also implements a novel function to evaluate the local specificity of the detected association. regioneR is an R package released under Artistic-2.0 License. The source code and documents are freely available through Bioconductor (http://www.bioconductor.org/packages/regioneR). rmalinverni@carrerasresearch.org. © The Author 2015. Published by Oxford University Press.

  20. Stakeholders' participatory diagnosis of climate change impacts on subsistence agriculture in Sikkim, India, for identifying adaptation strategies

    NASA Astrophysics Data System (ADS)

    Azhoni, A.; Goyal, M. K.

    2017-12-01

    Narrowing the gap between research, policy making and implementing adaptation remains a challenge in many parts of the world where climate change is likely to severely impact subsistence agriculture. This research aims to narrow this gap by matching the adaptation strategies being framed by policy makers and perspectives of consultants and researchers which are expected to be implemented by development agencies farmers in the state of Sikkim in India. Our case study examined the framing and implementation of State Action Plan on Climate Change through semi-structured interviews carried out with decision makers in the State Government, Scientific Organisations, consultants, local academia, implementing and development agencies, and farmers for whom the adaptation strategies are targeted. Using Social Network and Stakeholder Analysis approach, this research unravels the complexities of perceiving climate change impacts, identifying adaptation strategies, and implementing climate change adaptation strategies. While farmers are less aware about the global phenomenon of climate change impacts for their subsistence livelihood, their knowledge of the local conditions and their close interaction with the State Government Agriculture Department provides them an access to new and high value crops. Although important steps are initiated through the Sikkim State Action Plan on Climate Change it is yet to deliver effective means of adaptation implementation and identifying the networks of close coordination between the various implementing agencies will likely to pay rich dividends. While Sikkim being a small and hilly state with specific contextual challenges of climate change impacts, the results from this study highlights how the internal and external networks between various types of stakeholders informs decision makers in identifying local impacts of climate change and plan adaptation strategies.

  1. When Students Say "I Just Couldn't Think": Challenges in Teaching Skilful Thinking

    ERIC Educational Resources Information Center

    Row, Bavani Nageswana; Subramaniam, Selvaranee; Sathasivam, Renuka V.

    2016-01-01

    This paper discusses challenges encountered by selected Year Four science teachers regarding their knowledge and implementation of skilful thinking (ST) in their classrooms. ST is a complex concept comprising three elements; specific thinking strategies, habits of mind and metacognitive thinking. Due of the complexity of ST, the implementation of…

  2. Implementing Positive Behavior Support in Preschools: An Exploratory Study of CW-FIT Tier 1

    ERIC Educational Resources Information Center

    Jolstead, Krystine A.; Caldarella, Paul; Hansen, Blake; Korth, Byran B.; Williams, Leslie; Kamps, Debra

    2017-01-01

    Challenging behavior in preschool is a serious concern for teachers. Positive behavior interventions and supports (PBIS) have been shown to be effective in reducing such behaviors. Class-Wide Function-Related Intervention Teams (CW-FIT) is a specific multi-tiered intervention for implementing effective classroom management strategies using PBIS…

  3. Implementing Positive Behavior Support in Preschools: An Exploratory Study of CW-FIT Tier 1

    ERIC Educational Resources Information Center

    Jolstead, Krystine A.; Caldarella, Paul; Hansen, Blake D.; Korth, Byran B.; Williams, Leslie; Kamps, Debra M.

    2017-01-01

    Challenging behavior in preschool is a serious concern for teachers. Positive behavior interventions and supports (PBIS) has been shown to be effective in reducing such behaviors. Class-Wide Function-Related Intervention Teams (CW-FIT) is a specific multi-tiered intervention for implementing effective classroom management strategies using PBIS…

  4. How Do District Management and Implementation Strategies Relate to the Quality of the Professional Development That Districts Provide to Teachers?

    ERIC Educational Resources Information Center

    Desimone, Laura; Porter, Andrew C.; Birman, Beatrice F.; Garet, Michael S.; Yoon, Kwang Suk

    2002-01-01

    Examined policy mechanisms and processes that districts used to provide high quality inservice professional development to teachers. Data from a national probability sample of professional development coordinators in districts that received federal funding for professional development highlighted specific management and implementation strategies…

  5. The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework.

    PubMed

    Boersma, Petra; van Weert, Julia C M; Lakerveld, Jeroen; Dröes, Rose-Marie

    2015-01-01

    In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined. A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance). This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.

  6. Oral Vocabulary and Language Acquisition Strategies to Increase Literacy

    ERIC Educational Resources Information Center

    Green, Grace

    2017-01-01

    This study addresses low literacy achievement in students in kindergarten and first grades. The study was designed to help identify how general education teachers can use specific daily research-based oral vocabulary acquisition strategies to close the literacy gap. This quantitative research helped to determine if the implementation of an oral…

  7. Team-Based Learning in Anatomy: An Efficient, Effective, and Economical Strategy

    ERIC Educational Resources Information Center

    Vasan, Nagaswami S.; DeFouw, David O.; Compton, Scott

    2011-01-01

    Team-based learning (TBL) strategy is being adopted in medical education to implement interactive small group learning. We have modified classical TBL to fit our curricular needs and approach. Anatomy lectures were replaced with TBL that required preparation of assigned content specific discussion topics (in the text referred as "discussion…

  8. Enhancing Role-Play Activities with Pocket Camcorder Technology: Strategies for Counselor-Educators

    ERIC Educational Resources Information Center

    Walter, Sara Meghan; Thanasiu, Page L.

    2011-01-01

    Counselor-educators can benefit from specific guidelines and creative suggestions when implementing role-play and technology-related teaching strategies in counseling training programs. Therefore, the purpose of this article is to: (a) discuss the use of role-play and video recording in counselor education; (b) introduce counselor-educators to…

  9. Advancing Evidence-Based Practice in Physical Therapy Settings: Multinational Perspectives on Implementation Strategies and Interventions.

    PubMed

    Bernhardsson, Susanne; Lynch, Elizabeth; Dizon, Janine Margarita; Fernandes, Jasmin; Gonzalez-Suarez, Consuelo; Lizarondo, Lucylynn; Luker, Julie; Wiles, Louise; Grimmer, Karen

    2017-01-01

    It is of critical importance that findings from the wealth of clinical physical therapist research are transferred into clinical practice without unnecessary delays. There is a lack of knowledge about strategies that can be used to effectively implement physical therapist research findings and evidence-based practice (EBP) into everyday clinical practice in different national settings and contexts. The purpose of this article is to contribute to knowledge about effective strategies for implementing EBP that have been studied in different national physical therapy settings. The specific aims of this article are to share experiences and provide a current multinational perspective on different approaches and strategies for implementing EBP and to highlight important considerations and implications for both research and practice. Six research studies from various settings in 3 countries are described and synthesized. Key characteristics of the studies and intervention components are tabulated and mapped to the Cochrane Effective Practice and Organisation of Care taxonomy. Commonalities and differences are presented. The implementation strategies described were: a theory-based guideline implementation tailored to identified barriers and facilitators; a multifaceted EBP training package; journal clubs; a multifaceted strategy comprising contextualized procedures, protocols, and standardized resources; barrier identification, education, audit, feedback, and reminders; and contextualized guidelines. Commonalities were the use of a multifaceted approach, educational measures, and clinical guidelines. Key outcomes across the studies were improved attitudes and increased awareness, knowledge, skills, and confidence in EBP; better access to clinical practice guidelines and other EBP resources; identification of barriers that could be targeted in future implementation activities; earlier referrals; and use of recommended outcome measures. The article can serve as a template for other physical therapist researchers in designing implementation studies, as well as to inform policies and practice for health care managers and decision makers who are looking for ways to implement research findings in their organizations. © 2017 American Physical Therapy Association.

  10. Provider Adherence to Implementation of Clinical Practice Guidelines for Neurogenic Bowel in Adults With Spinal Cord Injury

    PubMed Central

    Goetz, Lance L; Nelson, Audrey L; Guihan, Marylou; Bosshart, Helen T; Harrow, Jeffrey J; Gerhart, Kevin D; Krasnicka, Barbara; Burns, Stephen P

    2005-01-01

    Background/Objectives: Clinical Practice Guidelines (CPGs) have been published on a number of topics in spinal cord injury (SCI) medicine. Research in the general medical literature shows that the distribution of CPGs has a minimal effect on physician practice without targeted implementation strategies. The purpose of this study was to determine (a) whether dissemination of an SCI CPG improved the likelihood that patients would receive CPG recommended care and (b) whether adherence to CPG recommendations could be improved through a targeted implementation strategy. Specifically, this study addressed the “Neurogenic Bowel Management in Adults with Spinal Cord Injury” Clinical Practice Guideline published in March 1998 by the Consortium for Spinal Cord Medicine Methods: CPG adherence was determined from medical record review at 6 Veterans Affairs SCI centers for 3 time periods: before guideline publication (T1), after guideline publication but before CPG implementation (T2), and after targeted CPG implementation (T3). Specific implementation strategies to enhance guideline adherence were chosen to address the barriers identified by SCI providers in focus groups before the intervention. Results: Overall adherence to recommendations related to neurogenic bowel did not change between T1 and T2 (P = not significant) but increased significantly between T2 and T3 (P < 0.001) for 3 of 6 guideline recommendations. For the other 3 guideline recommendations, adherence rates were noted to be high at T1. Conclusions: While publication of the CPG alone did not alter rates of provider adherence, the use of a targeted implementation plan resulted in increases in adherence rates with some (3 of 6) CPG recommendations for neurogenic bowel management. PMID:16869086

  11. 40 CFR 51.210 - General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PREPARATION, ADOPTION, AND SUBMITTAL OF IMPLEMENTATION PLANS Source Survelliance § 51.210 General. Each plan... portion of the control strategy. Specifically, the plan must meet the requirements of this subpart. ...

  12. Is the DOTS strategy sufficient to achieve tuberculosis control in low- and middle-income countries? 1. Need for interventions in universities and medical schools.

    PubMed

    Caminero, J A

    2003-06-01

    Now that progress is gradually being made in the implementation of the DOTS strategy in low-income countries, we must take into account the fact that nearly 30% of all tuberculosis (TB) cases worldwide occur in middle-income countries, which usually have an adequate health infrastructure and sufficient economic resources for TB control. These countries nevertheless have other limitations that make it necessary to develop other aspects in addition to the DOTS strategy. These can be summarised in three main themes: 1) adequate coordination of all health structures involved in TB management, ensuring that they follow the basic norms of the National Tuberculosis Programme (NTP), 2) direct intervention in universities and medical schools, which are ubiquitous in such countries, and 3) specific collaboration with specialists and physicians in private practice, an important obstacle to the success of NTPs in several countries. A detailed analysis is presented of strategies that need to be implemented in different countries depending on their economic resources and their TB situation. The need to carry out specific interventions in addition to training in DOTS in universities and medical schools in order to improve TB control is discussed. A specific project in this area developed by the IUATLD in Latin America is described.

  13. Implementing a WIC-Based Intervention to Promote Exclusive Breastfeeding: Challenges, Facilitators, and Adaptive Strategies.

    PubMed

    Eldridge, Johanna D; Hartnett, Josette O; Lee, Furrina F; Sekhobo, Jackson P; Edmunds, Lynn S

    Understand factors that contributed to the implementation of a successful multicomponent intervention to promote exclusive breastfeeding (EBF) within Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) clinics. Qualitative study of staff implementers' experiences using implementation status reports, facilitated group discussion immediately after implementation, and WIC administrative data. WIC staff from 12 clinics participated in an EBF Learning Community composed of 8 intervention trainings and ongoing support from trainers and peers. A total of 47 WIC staff including 11 directors, 20 other administrators, 8 nutritionists, and 6 peer counselors. A WIC-integrated EBF promotion initiative, supported through a Learning Community, composed of prenatal screening, tailored trimester-specific counseling, and timely postpartum follow-up. Challenges and facilitators to implementation within clinics. Iterative qualitative analysis using directed, emergent, and thematic coding. Implementation experiences were characterized by (1) perceived benefits of implementation, including improved EBF knowledge and counseling confidence among staff; and (2) managing implementation, including responding to challenges posed by clinic settings (resources, routine practices, values, and perceptions of mothers) through strategies such as adapting clinic practices and intervention components. Implementation was shaped by clinic setting and adaptive strategies. Future WIC interventions may benefit from formal consideration of intervention fit with local clinic setting and allowable adaptations. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  14. Ontario's daily physical activity policy for elementary schools: is everything in place for success?

    PubMed

    Robertson-Wilson, Jennifer E; Lévesque, Lucie

    2009-01-01

    The development, implementation, and evaluation of policies may play an important role in promoting health behaviours such as physical activity. The Ontario Ministry of Education (OME) recently mandated Memorandum No. 138 requiring daily physical activity (DPA) for Ontario elementary students in grades one through eight. The purpose of this paper is to examine implementation strategies. Hogwood and Gunn's 10 preconditions for "perfect implementation" are used to examine publicly available Ministry DPA policy documents to assess whether these implementation strategies have been considered in the policy documents. Several preconditions (e.g., allocation of resources, task specification) appear to have been considered, however a number of preconditions (e.g., the sustainability of resources, extent to which the policy is valued, and evaluation plans) thought to be important require additional attention to ensure optimal DPA implementation. Additional reflection upon Hogwood and Gunn's implementation preconditions would, in our opinion, assist in facilitating optimal DPA implementation as per Memorandum No. 138.

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

    PubMed Central

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

    2014-01-01

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

  16. Evaluating Community Readiness to Implement Environmental and Policy-Based Alcohol Abuse Prevention Strategies in Wisconsin

    PubMed Central

    Paltzer, Jason; Black, Penny; Moberg, D. Paul

    2013-01-01

    Background Matching evidence-based alcohol prevention strategies with a community’s readiness to support those strategies is the basis for the Tri-Ethnic Community Readiness Model (CRM). The purpose of this evaluation was to assess the association of a community’s readiness to address alcohol abuse in their community with the implementation of environmental and policy-based strategies. Methods Twenty-one substance abuse prevention coalitions in Wisconsin participated in a pre-post intervention group-only evaluation using the CRM. As part of a Substance Abuse and Mental Health Services Administration (SAMHSA) grant, all grantees were obligated by the Wisconsin Department of Health Services to implement environmental and policy-based strategies focused on one of three priority areas: young adult binge drinking, underage drinking, and alcohol-related motor-vehicle injuries and fatalities. Results At baseline, all communities (n=21) scored at or below a Stage 4 (on a scale of 1–9) readiness level (“preparedness”). The mean change in community readiness over the three-year period (2009–2011) was significant, but was less than one complete CRM stage (0.77, p=<0.001; 95% CI: 0.49, 1.05). Conclusion These findings suggest that implementation of environmental and policy-based strategies may improve a community’s progression in perceived readiness to address alcohol abuse regardless of the community’s baseline level of readiness to address alcohol abuse. Recommendation An assessment specific for measuring community readiness for policy-related strategies should be developed. The assessment would include community-level factors (e.g. community climate) for implementing policy-related prevention strategies, and not assume a linear readiness model. PMID:25346555

  17. Implementation of case studies in undergraduate didactic nursing courses: a qualitative study.

    PubMed

    Dutra, Danette K

    2013-07-04

    The implementation of unfolding scenario-based case studies in the didactic classroom is associated with learner-centered education. The utilization of learner-centered pedagogies, such as case studies, removes the focus from the instructor and instead places it on the student. Learner-centered pedagogies are believed to improve students' levels of cognition. The purpose of this study was to examine how nurse educators are implementing the pedagogies of case studies in their undergraduate didactic courses. The goal was to examine, document, report, and, ultimately, implement the strategies. Purposeful sampling was utilized in this qualitative, multisite-designed study. For each of the four participants, three separate site visits were completed. Observations and post-observational interviews took place at each site visit. Transcribed data from interviews, observations, and course documents were imported into the computer program Nvivo8. Repetitive comparative analysis was utilized to complete the data coding process. The guiding research question of this study sought to investigate the implementation strategies of case studies in didactic nursing courses. The implementation of case studies by the participants reflected two primary patterns: Formal Implementation (FI) and Informal Implementation (II) of case studies. The FI of case studies was further divided into two subcategories: Formal Implementation of case studies used Inside the Classroom setting (FIIC) and Formal Implementation of cases studies used Outside of the Classroom (FIOC). Results of this investigation have led to an increased understanding of implementation strategies of unfolding scenario-based case studies in undergraduate nursing didactic courses. Data collected were rich in the description of specific methodologies for utilization of case studies and may serve as a resource for faculty in development of creative strategies to enhance the didactic classroom experience.

  18. Implementation of case studies in undergraduate didactic nursing courses: a qualitative study

    PubMed Central

    2013-01-01

    Background The implementation of unfolding scenario-based case studies in the didactic classroom is associated with learner-centered education. The utilization of learner-centered pedagogies, such as case studies, removes the focus from the instructor and instead places it on the student. Learner-centered pedagogies are believed to improve students’ levels of cognition. The purpose of this study was to examine how nurse educators are implementing the pedagogies of case studies in their undergraduate didactic courses. The goal was to examine, document, report, and, ultimately, implement the strategies. Methods Purposeful sampling was utilized in this qualitative, multisite-designed study. For each of the four participants, three separate site visits were completed. Observations and post-observational interviews took place at each site visit. Transcribed data from interviews, observations, and course documents were imported into the computer program Nvivo8. Repetitive comparative analysis was utilized to complete the data coding process. Results The guiding research question of this study sought to investigate the implementation strategies of case studies in didactic nursing courses. The implementation of case studies by the participants reflected two primary patterns: Formal Implementation (FI) and Informal Implementation (II) of case studies. The FI of case studies was further divided into two subcategories: Formal Implementation of case studies used Inside the Classroom setting (FIIC) and Formal Implementation of cases studies used Outside of the Classroom (FIOC). Conclusion Results of this investigation have led to an increased understanding of implementation strategies of unfolding scenario-based case studies in undergraduate nursing didactic courses. Data collected were rich in the description of specific methodologies for utilization of case studies and may serve as a resource for faculty in development of creative strategies to enhance the didactic classroom experience. PMID:23826925

  19. When does a strategy intervention overcome a failure of inhibition? Evidence from two left frontal brain tumour cases.

    PubMed

    Robinson, Gail A; Walker, David G; Biggs, Vivien; Shallice, Tim

    2016-06-01

    Initiation and inhibition of responses are crucial for appropriate behaviour across different settings. Initiation and inhibition difficulties are well documented following frontal damage, although task differences have limited our understanding. The Hayling Sentence Completion Test was designed to assess verbal initiation and inhibition within the same task. This study investigates the ability of two patients with left frontal tumours (KI: high grade glioma; PM: meningioma) to use a strategy to overcome profound suppression failures on the Hayling Test. KI and PM completed the Hayling Test and two experimental tasks. The Selection Investigation assessed verbal initiation on a sentence completion task that varied selection demands (high/low). The Suppression and Strategy Investigation assessed ability to implement four strategies aimed to override a suppression failure and facilitate production of an unconnected word. On the Hayling Test, KI and PM initiated responses to complete high constraint sentences, in contrast to impaired suppression. KI benefitted minimally from strategies to overcome suppression failure although one strategy (object naming) was partially successful. KI's errors revealed fast suppression errors, in contrast to slow no responses, and selection ability was also impaired for verbal initiation. PM, however, implemented each strategy 100% to overcome a suppression failure and had no difficulty completing sentences meaningfully, regardless of selection demands. This first investigation of strategy implementation to overcome profound suppression impairments provides insights into verbal initiation, inhibition, selection and strategy mechanisms, which has implications for neurorehabilitation. Specifically, both patients had profound inhibition deficits but KI also presented with a selection deficit and was unable to implement a strategy. By contrast, PM's selection ability was intact but she was unable to generate, rather than implement, a strategy. We suggest that KI has both fast, uncontrolled semantic output and response inhibition difficulty, whereas PM's difficulty is underpinned by motivational factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention.

    PubMed

    Finley, Cara; Suellentrop, Katherine; Griesse, Rebecca; House, Lawrence Duane; Brittain, Anna

    2018-01-01

    Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

  1. Current methods of monitoring radiation exposure from CT.

    PubMed

    Talati, Ronak K; Dunkin, Jared; Parikh, Shrujal; Moore, William H

    2013-09-01

    Increased public and regulatory scrutiny of imaging-related radiation exposure requires familiarity with current dose-monitoring techniques and best practices. CT-related ionizing radiation exposure has been cited as the largest and fastest growing source of population-wide iatrogenic ionizing radiation exposure. Upcoming federal regulations require imaging centers to familiarize themselves with available dose-monitoring techniques and implement comprehensive strategies to track patient dose, with particular emphasis on CT. Because of institution-specific and vendor-specific technologies, there are significant barriers to adoption and implementation. In this article, the authors outline the core components of a universal dose-monitoring strategy and detail a few of the many available commercial platforms. In addition, the authors introduce a cloud-based hybrid model dose-tracking system with the goal of rapid implementation, multicenter scalability, real-time dose feedback for technologists, cumulative dose monitoring, and optional dose communication to patients and into the record; doing so results in improved patient loyalty, referring physician satisfaction, and opportunity for repeat business. Copyright © 2013 American College of Radiology. All rights reserved.

  2. Hospital electronic medical record enterprise application strategies: do they matter?

    PubMed

    Fareed, Naleef; Ozcan, Yasar A; DeShazo, Jonathan P

    2012-01-01

    Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance. This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses. A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics. The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy. This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward an enterprise application strategy.

  3. How to Implement Rigorous Computer Science Education in K-12 Schools? Some Answers and Many Questions

    ERIC Educational Resources Information Center

    Hubwieser, Peter; Armoni, Michal; Giannakos, Michail N.

    2015-01-01

    Aiming to collect various concepts, approaches, and strategies for improving computer science education in K-12 schools, we edited this second special issue of the "ACM TOCE" journal. Our intention was to collect a set of case studies from different countries that would describe all relevant aspects of specific implementations of…

  4. Community College Faculty Perceptions of the Implementation of the Universal Design for Instruction Concept

    ERIC Educational Resources Information Center

    Rao-Delgado, Antoinette Toni C.

    2010-01-01

    Purpose: The purpose of this study was to explore the perceptions of community college faculty regarding their experiences in learning and implementing a new pedagogical concept, Universal Design for Instruction (UDI). Specifically, I explored (a) their perceptions regarding the utilization of the UDI concept on their teaching strategies, (b)…

  5. The New CETA; A Sensible Approach to Making the Jobs Program Work.

    ERIC Educational Resources Information Center

    Employment and Training Administration (DOL), Washington, DC.

    This booklet describes specific proposed and/or implemented strategies for dealing with some of the problems encountered in the CETA program. These strategies are directed toward four goals: (1) helping those who need help most; (2) creating a jobs program that goes where the jobs are: the private sector; (3) better management, delivering more job…

  6. Computer Applications in Science Education. The Illinois Series on Educational Application of Computers, No. 17e.

    ERIC Educational Resources Information Center

    Gaede, Owen F.; Singletary, Ted J.

    This paper provides a summary of information and ideas relevant to the use of computers in science education, describes a variety of uses and strategies, discusses advantages and disadvantages of specific applications, and explores the decision-making process surrounding computer instruction implementation. Uses and strategies which are described…

  7. Implementation strategies for health systems in low-income countries: an overview of systematic reviews.

    PubMed

    Pantoja, Tomas; Opiyo, Newton; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Wiysonge, Charles S; Herrera, Cristian A; Rada, Gabriel; Peñaloza, Blanca; Dudley, Lilian; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Oxman, Andrew D

    2017-09-12

    A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories - strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support. Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.

  8. [Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

    PubMed

    Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

    2015-01-01

    Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

  9. Implementation strategies for health systems in low-income countries: an overview of systematic reviews

    PubMed Central

    Pantoja, Tomas; Opiyo, Newton; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Wiysonge, Charles S; Herrera, Cristian A; Rada, Gabriel; Peñaloza, Blanca; Dudley, Lilian; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Oxman, Andrew D

    2017-01-01

    Background A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. Objectives To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. Methods We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. Main results We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews. Implementation strategies addressed in the reviews were grouped into four categories – strategies targeting: 1. healthcare organisations (e.g. strategies to change organisational culture; 1 review); 2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews); 3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews); 4. healthcare recipients (e.g. medication adherence; 15 reviews). Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. 1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions. 2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training. 3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support. Authors' conclusions Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce. Implementation strategies for health systems in low-income countries What is the aim of this overview? The aim of this Cochrane Overview is to provide a broad summary of what is known about the effects of strategies for implementing interventions to improve health in low-income countries. This overview is based on 39 relevant systematic reviews. Each of these reviews searched for studies that evaluated the different types of implementation strategies within the scope of the question addressed by the review. The reviews included a total of 1332 studies. This overview is one of a series of four Cochrane Overviews that evaluate different health system arrangements. What was studied in the overview? A key function of health systems is implementing interventions to improve health. Coverage of essential health interventions remains low in low-income countries. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. What are the main results of the overview? The following implementation strategies had desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Strategies targeted at healthcare workers - Educational meetings. - Nutrition training of health workers. - Educational outreach (vs. no intervention). - Practice facilitation. - Local opinion leaders. - Audit and feedback. - Tailored interventions (vs. no intervention). Strategies targeted at healthcare workers for specific types of problems - Training healthcare workers to be more patient-centred in clinical consultations. - Use of birth kits. - Clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings. - In-service neonatal emergency care training. Strategies targeted at healthcare recipients - Mass media interventions to increase immediate uptake of HIV testing (leaflets and gain-framed videos). - Intensive self-management and adherence, intensive disease management to improve health literacy. - Behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy. - A one-time incentive to start or continue tuberculosis prophylaxis. - Default reminders for patients being treated for active tuberculosis. - Use of sectioned polythene bags for adherence to malaria medication. - Community-based health education, and reminders and recall strategies for vaccination uptake. - Providing free insecticide-treated bednets. - Interventions to improve uptake of cervical screening (invitations, education, counselling, access to health promotion nurse, and intensive recruitment). - Health insurance information and application support. The following implementation strategies had low- or very low-certainty evidence (or no studies available) for all the outcomes that were considered. Strategies targeted at healthcare organisations - Strategies to improve organisational culture. Strategies targeted at healthcare workers - Printed educational materials. - Internet-based learning. - Interprofessional education. - Teaching critical appraisal. - Educational outreach (vs. another intervention). - Pharmacist-provided services. - Safety checklists for use by medical care teams in acute hospital settings. - Tailored interventions (vs. non-tailored interventions, and interventions targeted at organisational and individual barriers vs. interventions targeted at individual barriers only). - Interventions to encourage the use of systematic reviews in clinical decision-making. Strategies targeted at healthcare workers for specific types of problems - Interventions to improve handwashing. - Interventions to reduce unnecessary caesarean section rates. - Training of traditional birth attendants. - Skilled birth attendance. - Training of traditional healers about STD and HIV medicine. Strategies targeted at healthcare recipients - Providing information/education for promoting HIV testing (multimedia). - Providing written medicine information. - Single interventions to improve health literacy. - Interventions to improve medication adherence. - Adherence – TB (immediate versus deferred incentives; cash vs. non-cash incentive; different levels of cash incentives; incentives vs. other interventions). - Adherence – malarial medication (blister packed tablets and capsules compared to tablets and capsules in paper envelopes; tablets in sectioned polythene bags compared to bottled syrup). - Training of healthcare workers, home visits, and monetary incentives to improve immunisation coverage. - Risk factor assessment to improve the uptake of cervical cancer screening. How up to date is this overview? The overview authors searched for systematic reviews that had been published up to 17 December 2016. PMID:28895659

  10. Bringing automatic stereotyping under control: implementation intentions as efficient means of thought control.

    PubMed

    Stewart, Brandon D; Payne, B Keith

    2008-10-01

    The evidence for whether intentional control strategies can reduce automatic stereotyping is mixed. Therefore, the authors tested the utility of implementation intentions--specific plans linking a behavioral opportunity to a specific response--in reducing automatic bias. In three experiments, automatic stereotyping was reduced when participants made an intention to think specific counterstereotypical thoughts whenever they encountered a Black individual. The authors used two implicit tasks and process dissociation analysis, which allowed them to separate contributions of automatic and controlled thinking to task performance. Of importance, the reduction in stereotyping was driven by a change in automatic stereotyping and not controlled thinking. This benefit was acquired with little practice and generalized to novel faces. Thus, implementation intentions may be an effective and efficient means for controlling automatic aspects of thought.

  11. Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application.

    PubMed

    Turner, Kea; Renfro, Chelsea; Ferreri, Stefanie; Roberts, Kim; Pfeiffenberger, Trista; Shea, Christopher M

    2018-04-01

     Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies.  Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC).  Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality.  Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance. Schattauer.

  12. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects.

    PubMed

    Perry, Henry B; Sacks, Emma; Schleiff, Meike; Kumapley, Richard; Gupta, Sundeep; Rassekh, Bahie M; Freeman, Paul A

    2017-06-01

    As part of our review of the evidence of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. We screened 12 166 published reports in PubMed of community-based approaches to improving maternal, neonatal and child health in high-mortality, resource-constrained settings from 1950-2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community-level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community-level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator-led participatory women's groups, and (d) health service provision at outreach sites by mobile health teams. The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH.

  13. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

    PubMed Central

    Perry, Henry B; Sacks, Emma; Schleiff, Meike; Kumapley, Richard; Gupta, Sundeep; Rassekh, Bahie M; Freeman, Paul A

    2017-01-01

    Background As part of our review of the evidence of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. Methods We screened 12 166 published reports in PubMed of community–based approaches to improving maternal, neonatal and child health in high–mortality, resource–constrained settings from 1950–2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. Results Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community–level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community–level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator–led participatory women’s groups, and (d) health service provision at outreach sites by mobile health teams. Conclusions The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH. PMID:28685044

  14. Fault Management Design Strategies

    NASA Technical Reports Server (NTRS)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  15. Implementing enhanced recovery pathways: a literature review with realist synthesis.

    PubMed

    Coxon, Astrid; Nielsen, Karina; Cross, Jane; Fox, Chris

    2017-10-01

    Enhanced Recovery Pathways (ERPs) are an increasingly popular, evidenced-based approach to surgery, designed to improve patient outcomes and reduce costs. Despite evidence demonstrating the benefits of these pathways, implementation and adherence have been inconsistent. Using realist synthesis, this review explored the current literature surrounding the implementation of ERPs in the UK. Knowledge consolidation between authors and consulting with field experts helped to guide the search strategy. Relevant medical and social science databases were searched from 2000 to 2016, as well as a general web search. A total of 17 papers were identified, including original research, reviews, case studies and guideline documents. Full texts were analysed, cross-examined, and data extracted and synthesised. Several implementation strategies were identified, including the contexts in which these operated, the subsequent mechanisms of action that were triggered, and the outcome patterns they produced. Context-Mechanism-Outcome (CMO) configurations were generated, tested, and refined. These were grouped to develop two programme theories concerning ERP implementation, one related to the strategy of consulting with staff, the other with appointing a change agent to coordinate and drive the implementation process. These theories highlight instances in which implementation could be improved. Current literature in ERP research is primarily focussed on measuring patient outcomes and cost effectiveness, and as a result, important detail regarding the implementation process is often not reported or described robustly. This review not only provides recommendations for future improvements in ERP implementation, but also highlights specific areas of focus for furthering ERP implementation research.

  16. Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

    PubMed

    Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

    2016-12-08

    Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

  17. Approved Clinical Instructors' Perspectives on Implementation Strategies in Evidence-Based Practice for Athletic Training Students

    PubMed Central

    Hankemeier, Dorice A.; Van Lunen, Bonnie L.

    2011-01-01

    Context: Understanding implementation strategies of Approved Clinical Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice. Objective: To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data. Results: The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP. Conclusions: Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking. PMID:22488192

  18. Discussing Terrorism: A Pupil-Inspired Guide to UK Counter-Terrorism Policy Implementation in Religious Education Classrooms in England

    ERIC Educational Resources Information Center

    Quartermaine, Angela

    2016-01-01

    My research into pupils' perceptions of terrorism and current UK counter-terrorism policy highlights the need for more detailed and accurate discussions about the implementation of the educational aims, in particular those laid out by the Prevent Strategy. Religious education (RE) in England is affected by these aims, specifically the challenging…

  19. Use of community engagement strategies to increase research participation in practice-based research networks (PBRNs).

    PubMed

    Spears, William; Tsoh, Janice Y; Potter, Michael B; Weller, Nancy; Brown, Anthony E; Campbell-Voytal, Kimberly; Getrich, Christina M; Sussman, Andrew L; Pascoe, John; Neale, Anne Victoria

    2014-01-01

    Practice-based research networks (PBRNs) are increasingly encouraged to use community engagement approaches. The extent to which PBRNs engage clinic and community partners in strategies to recruit and retain participants from their local communities (specifically racial/ethnic communities) is the focus of this study. The design was a cross-sectional survey of PBRN directors in the United States. Survey respondents indicated whether their research network planned for, implemented, and has capacity for activities that engage clinic and community partners in 7 recommended strategies organized into study phases, called the cycle of trust. The objectives of the national survey were to (1) describe the extent to which PBRNs across the United States routinely implement the strategies recommended for recruiting diverse patient groups and (2) identify factors associated with implementing the recommended strategies. The survey response rate was 63%. Activities that build trust often are used more with clinic partners than with community partners. PBRNs that adopt engagement strategies when working with clinic and community partners have less difficulty in recruiting diverse populations. Multivariate analysis showed that the targeting racial/ethnic communities for study recruitment, Clinical and Translational Science Award affiliation, and planning to use community engagement strategies were independent correlates of PBRN implementation of the recommended strategies. PBRNs that successfully engage racial/ethnic communities as research partners use community engagement strategies. New commitments are needed to support PBRN researchers in developing relationships with the communities in which their patients live. Stable PBRN infrastructure funding that appreciates the value of maintaining community engagement between funded studies is critical to the research enterprise that values translating research findings into generalizable care models for patients in the community. © Copyright 2014 by the American Board of Family Medicine.

  20. Enhancing Capacity for Success in the Creative Industries: Undergraduate Student Reflections on the Implementation of Work-Integrated Learning Strategies

    ERIC Educational Resources Information Center

    Daniel, Ryan; Daniel, Leah

    2015-01-01

    This article reflects on ongoing research-led teaching in the area of creative industries in higher education. Specifically it reports on key work-integrated learning strategies designed to better prepare graduates for the employment sector. The creative industries sector is complex and competitive, characterized by non-linear career paths driven…

  1. Watch This! A Guide to Implementing Video Modeling in the Classroom

    ERIC Educational Resources Information Center

    Wynkoop, Kaylee Stahr

    2016-01-01

    The video modeling (VM) teaching strategy is one in which a student watches a video of someone performing a specific behavior, skill, or task and is then expected to complete the behavior, skill, or task. This column discusses the variety of ways in which VM has been documented within the literature and supports teacher interest in the strategy by…

  2. From teachers' perspective: Implementation of literacy materials in middle school science

    NASA Astrophysics Data System (ADS)

    Weingartner, Judith A.

    Documentation of adolescents' difficulty in comprehending textbooks spans a century. For just as long, researchers have advocated that explicit instruction of reading strategies can help students' comprehension of text; many have recommended that the best place to teach these strategies is within the content classroom (science, math, etc.), and taught by the content teacher. Despite this research, reading strategy instruction in content classrooms is not a common occurrence. In a large district with 300 middle school science teachers, some science teachers expressed concern about their students' reading difficulties with the district's science text. In response to those concerns, the middle school science coordinator organized a small committee to develop the Reading Strategies Handbook for Middle School Science for Teachers (the Handbook), believing that this tool would guide teachers' in implementing the Handbook's reading strategies and improve students' comprehension of the text. This was a qualitative study that explored 11 middle school science teachers' responses to implementing the Handbook. Data for this study were gathered through an e-mailed questionnaire, a classroom visitation, and one interview with each teacher participant. The study found that teachers' varied backgrounds influenced their beliefs about teaching and learning, and impacted their classroom practices. Teachers faced their district's expectations to implement reading strategies in the Handbook with minimal support and cited influences beyond their control that created tension with their decision whether to implement the Handbook. Teachers commented that a "one size fits all" curriculum and textbook-specific issues influenced their degree of using the Handbook's reading strategies. In addition, teachers identified time and pressure to cover curriculum as obstacles to implementing the Handbook. Implications of these findings include: (a) Professional development studies related to content literacy are needed that include attention to teachers' beliefs and attitudes, and (b) Policy makers need to direct funding for the professional development needs of content-area teachers.

  3. The Balanced Scorecard as a management tool for assessing and monitoring strategy implementation in health care organizations.

    PubMed

    Bisbe, Josep; Barrubés, Joan

    2012-10-01

    Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations. Full English text available from:www.revespcardiol.org. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  4. Taking the easy way out? Increasing implementation effort reduces probability maximizing under cognitive load.

    PubMed

    Schulze, Christin; Newell, Ben R

    2016-07-01

    Cognitive load has previously been found to have a positive effect on strategy selection in repeated risky choice. Specifically, whereas inferior probability matching often prevails under single-task conditions, optimal probability maximizing sometimes dominates when a concurrent task competes for cognitive resources. We examined the extent to which this seemingly beneficial effect of increased task demands hinges on the effort required to implement each of the choice strategies. Probability maximizing typically involves a simple repeated response to a single option, whereas probability matching requires choice proportions to be tracked carefully throughout a sequential choice task. Here, we flipped this pattern by introducing a manipulation that made the implementation of maximizing more taxing and, at the same time, allowed decision makers to probability match via a simple repeated response to a single option. The results from two experiments showed that increasing the implementation effort of probability maximizing resulted in decreased adoption rates of this strategy. This was the case both when decision makers simultaneously learned about the outcome probabilities and responded to a dual task (Exp. 1) and when these two aspects were procedurally separated in two distinct stages (Exp. 2). We conclude that the effort involved in implementing a choice strategy is a key factor in shaping repeated choice under uncertainty. Moreover, highlighting the importance of implementation effort casts new light on the sometimes surprising and inconsistent effects of cognitive load that have previously been reported in the literature.

  5. The successful implementation of STEM initiatives in lower income schools

    NASA Astrophysics Data System (ADS)

    Bakshi, Leena

    The purpose of this study was to examine the leadership strategies utilized by superintendents, district administrators and school principals and the impact of these identified strategies on implementing STEM initiatives specifically for lower-income students. This study set out to determine (a) What role does district leadership play in the implementation of STEM initiatives in lower income secondary schools; (b) What internal systems of accountability exist in successful lower income secondary schools' STEM programs; (c) What leadership strategies are used to implement STEM curriculum initiatives; (d) How do school and district leadership support staff in order to achieve student engagement in STEM Initiative curriculum. This study used a mixed-methods approach to determine the impact of leadership strategies utilized by superintendents, district administrators and school principals on implementing STEM initiatives. Quantitative data analyzed survey questionnaires to determine the degree of correlation between the school districts that have demonstrated the successful implementation of STEM initiatives at the school and district levels. Qualitative data was collected using highly structured participant interviews and purposeful sampling of four district superintendents, one district-level administrator and five school leaders to capture the key strategies in implementing STEM initiatives in lower income secondary schools. Through the process of triangulation, the results of the study revealed that superintendents and principals should consider the characteristics of effective STEM initiatives that have shown a considerable degree of correlation with positive outcomes for lower income students. These included the leadership strategies of personnel's making decisions about the district's and school's instructional direction and an emphasis on the conceptual development of scientific principles using the Next Generation Science Standards coupled with the Common Core State Standards across the grade levels. It also emphasized the importance of establishing community partnerships as a primary resource. This study highlighted the criteria district and school leadership should include in implementing STEM initiatives and designing professional development models that result in meaningful instructional practices of STEM curriculum for secondary lower income students. Overall, this study provides insight for superintendents, district leaders and school administrators that can play an integral role in implementing STEM initiatives with access for socioeconomically disadvantaged students.

  6. Teaching the science of learning.

    PubMed

    Weinstein, Yana; Madan, Christopher R; Sumeracki, Megan A

    2018-01-01

    The science of learning has made a considerable contribution to our understanding of effective teaching and learning strategies. However, few instructors outside of the field are privy to this research. In this tutorial review, we focus on six specific cognitive strategies that have received robust support from decades of research: spaced practice, interleaving, retrieval practice, elaboration, concrete examples, and dual coding. We describe the basic research behind each strategy and relevant applied research, present examples of existing and suggested implementation, and make recommendations for further research that would broaden the reach of these strategies.

  7. Development and implementation of outreach strategies for breast and cervical cancer prevention among African American women. FoCaS Project. Forsyth County Cancer Screening.

    PubMed

    Tatum, C; Wilson, A; Dignan, M; Paskett, E D; Velez, R

    1997-01-01

    The purpose of the FoCaS (Forsyth County Cancer Screening) Project was to develop and implement strategies that would improve the beliefs, attitudes, and preventive health habits of populations typically considered hard to reach. Conventional health education methods have not produced substantial results; thus, innovative and unusual strategies are needed. The FoCaS project implemented specific methods to reach the targeted population of African American women aged 40 and older that resides in public housing communities. Five outreach strategies were used: 1) educational classes (group setting and one-on-one sessions) on various topics that relate not to breast and cervical cancer but to women's issues in general; 2) media campaigns strategically scheduled throughout the year; 3) the inclusion of religion in educational classes and community outreach; 4) the use of information centers to distribute materials; and 5) a community-wide cancer-awareness event. These strategies reached women in nonthreatening environments that permitted heavy involvement and easy understanding of the importance of breast and cervical cancer screening. The effects of these strategies on promoting screening will be evaluated using data from the follow-up survey conducted during the spring of 1996.

  8. Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015

    PubMed Central

    Dvorak, Jiri; Baume, Norbert; Botré, Francesco; Broséus, Julian; Budgett, Richard; Frey, Walter O; Geyer, Hans; Harcourt, Peter Rex; Ho, Dave; Howman, David; Isola, Victor; Lundby, Carsten; Marclay, François; Peytavin, Annie; Pipe, Andrew; Pitsiladis, Yannis P; Reichel, Christian; Robinson, Neil; Rodchenkov, Grigory; Saugy, Martial; Sayegh, Souheil; Segura, Jordi; Thevis, Mario; Vernec, Alan; Viret, Marjolaine; Vouillamoz, Marc; Zorzoli, Mario

    2014-01-01

    A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward. PMID:24764550

  9. Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015.

    PubMed

    Dvorak, Jiri; Baume, Norbert; Botré, Francesco; Broséus, Julian; Budgett, Richard; Frey, Walter O; Geyer, Hans; Harcourt, Peter Rex; Ho, Dave; Howman, David; Isola, Victor; Lundby, Carsten; Marclay, François; Peytavin, Annie; Pipe, Andrew; Pitsiladis, Yannis P; Reichel, Christian; Robinson, Neil; Rodchenkov, Grigory; Saugy, Martial; Sayegh, Souheil; Segura, Jordi; Thevis, Mario; Vernec, Alan; Viret, Marjolaine; Vouillamoz, Marc; Zorzoli, Mario

    2014-05-01

    A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward.

  10. TQM and lean strategy deployment in Italian hospitals.

    PubMed

    Chiarini, Andrea; Baccarani, Claudio

    2016-10-03

    Purpose This paper aims to contribute to the debate concerning total quality management (TQM)-Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls. Design/methodology/approach Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment. At the same time, they have also implemented many TQM-Lean tools. The case studies are based on interviews held with four managers in each of these three public hospitals. Findings Results from the interviews show that there is a specific deployment path for TQM-Lean implementation. The hospitals have also achieved benefits linked to patient satisfaction and improved organizational performances. Problems related to organizational and cultural issues, such as senior managers' commitment, staff management, manufacturing culture and tools adaptation, could affect the benefits. Research limitations/implications The research has been carried out in just three Italian public hospitals. Hence, similar investigations could be managed in other countries. Researchers could also use a larger sample and investigate these issues by means of quantitative inquiry. Practical implications Practitioners could try to apply the deployment path revealed by these case studies in other public and private hospitals. Originality/value The results of this research show that there is a specific, new deployment path for implementing TQM-Lean strategy in some public hospitals.

  11. Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis

    PubMed Central

    Pérez-Lago, Laura; Martínez-Lirola, Miguel; García, Sergio; Herranz, Marta; Mokrousov, Igor; Comas, Iñaki; Martínez-Priego, Llúcia; Bouza, Emilio

    2016-01-01

    Current migratory movements require new strategies for rapidly tracking the transmission of high-risk imported Mycobacterium tuberculosis strains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR Beijing M. tuberculosis strains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis. PMID:27682128

  12. Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis.

    PubMed

    Pérez-Lago, Laura; Martínez-Lirola, Miguel; García, Sergio; Herranz, Marta; Mokrousov, Igor; Comas, Iñaki; Martínez-Priego, Llúcia; Bouza, Emilio; García-de-Viedma, Darío

    2016-12-01

    Current migratory movements require new strategies for rapidly tracking the transmission of high-risk imported Mycobacterium tuberculosis strains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR Beijing M. tuberculosis strains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  13. Assessment of public involvement

    DOT National Transportation Integrated Search

    2011-01-31

    The Texas Department of Transportation (TxDOT) employs a range of methods and strategies to incorporate Texans in the many aspects of planning, project implementation and partnerships. This public involvement process is supported by TxDOT specific, s...

  14. Agent based models for testing city evacuation strategies under a flood event as strategy to reduce flood risk

    NASA Astrophysics Data System (ADS)

    Medina, Neiler; Sanchez, Arlex; Nokolic, Igor; Vojinovic, Zoran

    2016-04-01

    This research explores the uses of Agent Based Models (ABM) and its potential to test large scale evacuation strategies in coastal cities at risk from flood events due to extreme hydro-meteorological events with the final purpose of disaster risk reduction by decreasing human's exposure to the hazard. The first part of the paper corresponds to the theory used to build the models such as: Complex adaptive systems (CAS) and the principles and uses of ABM in this field. The first section outlines the pros and cons of using AMB to test city evacuation strategies at medium and large scale. The second part of the paper focuses on the central theory used to build the ABM, specifically the psychological and behavioral model as well as the framework used in this research, specifically the PECS reference model is cover in this section. The last part of this section covers the main attributes or characteristics of human beings used to described the agents. The third part of the paper shows the methodology used to build and implement the ABM model using Repast-Symphony as an open source agent-based modelling and simulation platform. The preliminary results for the first implementation in a region of the island of Sint-Maarten a Dutch Caribbean island are presented and discussed in the fourth section of paper. The results obtained so far, are promising for a further development of the model and its implementation and testing in a full scale city

  15. Computational strategies for three-dimensional flow simulations on distributed computer systems

    NASA Technical Reports Server (NTRS)

    Sankar, Lakshmi N.; Weed, Richard A.

    1995-01-01

    This research effort is directed towards an examination of issues involved in porting large computational fluid dynamics codes in use within the industry to a distributed computing environment. This effort addresses strategies for implementing the distributed computing in a device independent fashion and load balancing. A flow solver called TEAM presently in use at Lockheed Aeronautical Systems Company was acquired to start this effort. The following tasks were completed: (1) The TEAM code was ported to a number of distributed computing platforms including a cluster of HP workstations located in the School of Aerospace Engineering at Georgia Tech; a cluster of DEC Alpha Workstations in the Graphics visualization lab located at Georgia Tech; a cluster of SGI workstations located at NASA Ames Research Center; and an IBM SP-2 system located at NASA ARC. (2) A number of communication strategies were implemented. Specifically, the manager-worker strategy and the worker-worker strategy were tested. (3) A variety of load balancing strategies were investigated. Specifically, the static load balancing, task queue balancing and the Crutchfield algorithm were coded and evaluated. (4) The classical explicit Runge-Kutta scheme in the TEAM solver was replaced with an LU implicit scheme. And (5) the implicit TEAM-PVM solver was extensively validated through studies of unsteady transonic flow over an F-5 wing, undergoing combined bending and torsional motion. These investigations are documented in extensive detail in the dissertation, 'Computational Strategies for Three-Dimensional Flow Simulations on Distributed Computing Systems', enclosed as an appendix.

  16. Computational strategies for three-dimensional flow simulations on distributed computer systems

    NASA Astrophysics Data System (ADS)

    Sankar, Lakshmi N.; Weed, Richard A.

    1995-08-01

    This research effort is directed towards an examination of issues involved in porting large computational fluid dynamics codes in use within the industry to a distributed computing environment. This effort addresses strategies for implementing the distributed computing in a device independent fashion and load balancing. A flow solver called TEAM presently in use at Lockheed Aeronautical Systems Company was acquired to start this effort. The following tasks were completed: (1) The TEAM code was ported to a number of distributed computing platforms including a cluster of HP workstations located in the School of Aerospace Engineering at Georgia Tech; a cluster of DEC Alpha Workstations in the Graphics visualization lab located at Georgia Tech; a cluster of SGI workstations located at NASA Ames Research Center; and an IBM SP-2 system located at NASA ARC. (2) A number of communication strategies were implemented. Specifically, the manager-worker strategy and the worker-worker strategy were tested. (3) A variety of load balancing strategies were investigated. Specifically, the static load balancing, task queue balancing and the Crutchfield algorithm were coded and evaluated. (4) The classical explicit Runge-Kutta scheme in the TEAM solver was replaced with an LU implicit scheme. And (5) the implicit TEAM-PVM solver was extensively validated through studies of unsteady transonic flow over an F-5 wing, undergoing combined bending and torsional motion. These investigations are documented in extensive detail in the dissertation, 'Computational Strategies for Three-Dimensional Flow Simulations on Distributed Computing Systems', enclosed as an appendix.

  17. Parent-implemented picture exchange communication system (PECS) training: an analysis of YouTube videos.

    PubMed

    Jurgens, Anneke; Anderson, Angelika; Moore, Dennis W

    2012-01-01

    To investigate the integrity with which parents and carers implement PECS in naturalistic settings, utilizing a sample of videos obtained from YouTube. Twenty-one YouTube videos meeting selection criteria were identified. The videos were reviewed for instances of seven implementer errors and, where appropriate, presence of a physical prompter. Forty-three per cent of videos and 61% of PECS exchanges contained errors in parent implementation of specific teaching strategies of the PECS training protocol. Vocal prompts, incorrect error correction and the absence of timely reinforcement occurred most frequently, while gestural prompts, insistence on speech, incorrect use of the open hand prompt and not waiting for the learner to initiate occurred less frequently. Results suggest that parents engage in vocal prompting and incorrect use of the 4-step error correction strategy when using PECS with their children, errors likely to result in prompt dependence.

  18. Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach.

    PubMed

    Zimmermann, Katja; Holzinger, Iris Bachmann; Ganassi, Lorena; Esslinger, Peter; Pilgrim, Sina; Allen, Meredith; Burmester, Margarita; Stocker, Martin

    2015-10-29

    Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. The programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.

  19. Suicide: An Indian perspective

    PubMed Central

    Radhakrishnan, Rajiv; Andrade, Chittaranjan

    2012-01-01

    Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. There has been an increase in the rates of suicide in India over the years, although trends of both increases and decline in suicide rates have been present. Distinct from global demographic risk factors, In India, marital status is not necessarily protective and the female: male ratio in the rate of suicide is higher. The motives and modes of suicide are also distinct from western countries. Preventive strategies implemented at a community level and identifying vulnerable individuals maybe more effective than global strategies. PMID:23372232

  20. Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

    PubMed

    Schneider, Helen; Nxumalo, Nonhlanhla

    2017-09-15

    National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.

  1. Value-based integrated (renal) care: setting a development agenda for research and implementation strategies.

    PubMed

    Valentijn, Pim P; Biermann, Claus; Bruijnzeels, Marc A

    2016-08-02

    Integrated care services are considered a vital strategy for improving the Triple Aim values for people with chronic kidney disease. However, a solid scholarly explanation of how to develop, implement and evaluate such value-based integrated renal care services is limited. The aim of this study was to develop a framework to identify the strategies and outcomes for the implementation of value-based integrated renal care. First, the theoretical foundations of the Rainbow Model of Integrated Care and the Triple Aim were united into one overarching framework through an iterative process of key-informant consultations. Second, a rapid review approach was conducted to identify the published research on integrated renal care, and the Cochrane Library, Medline, Scopus, and Business Source Premier databases were searched for pertinent articles published between 2000 and 2015. Based on the framework, a coding schema was developed to synthesis the included articles. The overarching framework distinguishes the integrated care domains: 1) type of integration, 2) enablers of integration and the interrelated outcome domains, 3) experience of care, 4) population health and 5) costs. The literature synthesis indicated that integrated renal care implementation strategies have particularly focused on micro clinical processes and physical outcomes, while little emphasis has been placed on meso organisational as well as macro system integration processes. In addition, evidence regarding patients' perceived outcomes and economic outcomes has been weak. These results underscore that the future challenge for researchers is to explore which integrated care implementation strategies achieve better health and improved experience of care at a lower cost within a specific context. For this purpose, this study's framework and evidence synthesis have set a developmental agenda for both integrated renal care practice and research. Accordingly, we plan further work to develop an implementation model for value-based integrated renal services.

  2. Identifying optimal agricultural countermeasure strategies for a hypothetical contamination scenario using the strategy model.

    PubMed

    Cox, G; Beresford, N A; Alvarez-Farizo, B; Oughton, D; Kis, Z; Eged, K; Thørring, H; Hunt, J; Wright, S; Barnett, C L; Gil, J M; Howard, B J; Crout, N M J

    2005-01-01

    A spatially implemented model designed to assist the identification of optimal countermeasure strategies for radioactively contaminated regions is described. Collective and individual ingestion doses for people within the affected area are estimated together with collective exported ingestion dose. A range of countermeasures are incorporated within the model, and environmental restrictions have been included as appropriate. The model evaluates the effectiveness of a given combination of countermeasures through a cost function which balances the benefit obtained through the reduction in dose with the cost of implementation. The optimal countermeasure strategy is the combination of individual countermeasures (and when and where they are implemented) which gives the lowest value of the cost function. The model outputs should not be considered as definitive solutions, rather as interactive inputs to the decision making process. As a demonstration the model has been applied to a hypothetical scenario in Cumbria (UK). This scenario considered a published nuclear power plant accident scenario with a total deposition of 1.7x10(14), 1.2x10(13), 2.8x10(10) and 5.3x10(9)Bq for Cs-137, Sr-90, Pu-239/240 and Am-241, respectively. The model predicts that if no remediation measures were implemented the resulting collective dose would be approximately 36 000 person-Sv (predominantly from 137Cs) over a 10-year period post-deposition. The optimal countermeasure strategy is predicted to avert approximately 33 000 person-Sv at a cost of approximately 160 million pounds. The optimal strategy comprises a mixture of ploughing, AFCF (ammonium-ferric hexacyano-ferrate) administration, potassium fertiliser application, clean feeding of livestock and food restrictions. The model recommends specific areas within the contaminated area and time periods where these measures should be implemented.

  3. Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.

    PubMed

    Joosen, Margot C W; van Beurden, Karlijn M; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P M; van der Klink, Jac J L

    2015-04-24

    Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01). The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

  4. [Evidence-based clinical oral healthcare guidelines 4. Adherence requires an implementation strategy].

    PubMed

    Braspenning, J C C; Mettes, T G P H; van der Sanden, W J M; Wensing, M J P

    2015-03-01

    Adherence to clinical guidelines requires support in practice. However, systematic implementation of evidence-based guidelines is not common practice in oral healthcare. The Knowledge Institute Oral Care (KiMo) offers the opportunity to take into account potential barriers and facilitators during the development of evidence-based clinical practice guidelines. These factors which are relevant to the guideline and the oral healthcare practice provide the ingredients for a tailor-made programme of implementation that has a scientific basis. Elements of any implementation programme are the quality indicators derived from the oral healthcare guidelines. These indicators should fit, on the one hand, the specific goals of the guidelines (patient safety, effectiveness, efficiency, patient-centred, timeliness, accessibility) and, onthe other hand, the various perspectives of the different stakeholders, such as patients, caregivers, health insurers and inspectorate. These quality indicators provide information on adherence to the guidelines, the results of a certain treatment and the success of the implementation strategy, all with the aim to improve the quality of oral healthcare.

  5. Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review.

    PubMed

    Savic, Michael; Best, David; Manning, Victoria; Lubman, Dan I

    2017-04-07

    There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care. We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised. We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians' primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning. Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable.

  6. Development and implementation of a Hope Intervention Program.

    PubMed

    Herth, K A

    2001-07-01

    To describe the development and evaluation of the Hope Intervention Program (HIP), designed to enhance hope, based on the Hope Process Framework. Descriptive and evaluative. Outpatient oncology clinics of two large hospitals. Convenience sample--38 adults with first recurrence of cancer. Questionnaire completed at end of last HIP session, three months, six months, and nine months. Helpfulness of the HIP components in maintaining hope. Participants used intervention strategies that represented all four attributes of hope, with specific strategy use varying across time and individuals. Data suggested that HIP positively affected the participants' rebuilding and maintenance of hope. HIP has the potential to positively influence hope, and it supports the strategic vital role that nurses play in implementing research-based strategies designed to engender hope in their patients and prevent hopelessness.

  7. The Implementation of Action Research for the Improvement of Biology Teaching and Learning in Senior Secondary Schools in Nigeria

    ERIC Educational Resources Information Center

    Udeani, U. N.; Atagana, H. I.; Esiobu, G. O.

    2016-01-01

    The main objective of the study was to implement an action research strategy to improve the teaching and learning of biology in senior secondary schools in Nigeria. Specifically the following research questions were raised: (1) What are the levels of intellectual challenge included in the activities used for classroom and laboratory instructions?…

  8. Developing an active implementation model for a chronic disease management program.

    PubMed

    Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

    2013-04-01

    Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council's model for complex interventions and the Chronic Care Model. We used the Medical Research Council's five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council's model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council's model added transparency to the design phase which further facilitated the process of implementing the program. http://www.clinicaltrials.gov/(NCT01228708).

  9. MicroRNAfold: pre-microRNA secondary structure prediction based on modified NCM model with thermodynamics-based scoring strategy.

    PubMed

    Han, Dianwei; Zhang, Jun; Tang, Guiliang

    2012-01-01

    An accurate prediction of the pre-microRNA secondary structure is important in miRNA informatics. Based on a recently proposed model, nucleotide cyclic motifs (NCM), to predict RNA secondary structure, we propose and implement a Modified NCM (MNCM) model with a physics-based scoring strategy to tackle the problem of pre-microRNA folding. Our microRNAfold is implemented using a global optimal algorithm based on the bottom-up local optimal solutions. Our experimental results show that microRNAfold outperforms the current leading prediction tools in terms of True Negative rate, False Negative rate, Specificity, and Matthews coefficient ratio.

  10. Universal immunogenicity validation and assessment during early biotherapeutic development to support a green laboratory.

    PubMed

    Bautista, Ami C; Zhou, Lei; Jawa, Vibha

    2013-10-01

    Immunogenicity support during nonclinical biotherapeutic development can be resource intensive if supported by conventional methodologies. A universal indirect species-specific immunoassay can eliminate the need for biotherapeutic-specific anti-drug antibody immunoassays without compromising quality. By implementing the R's of sustainability (reduce, reuse, rethink), conservation of resources and greener laboratory practices were achieved in this study. Statistical analysis across four biotherapeutics supported identification of consistent product performance standards (cut points, sensitivity and reference limits) and a streamlined universal anti-drug antibody immunoassay method implementation strategy. We propose an efficient, fit-for-purpose, scientifically and statistically supported nonclinical immunogenicity assessment strategy. Utilization of a universal method and streamlined validation, while retaining comparability to conventional immunoassays and meeting the industry recommended standards, provides environmental credits in the scientific laboratory. Collectively, individual reductions in critical material consumption, energy usage, waste and non-environment friendly consumables, such as plastic and paper, support a greener laboratory environment.

  11. Strategies and Problems Encountered by Teachers in Implementing Mother Tongue-Based Instruction in a Multilingual Classroom

    ERIC Educational Resources Information Center

    Lartec, Jane K.; Belisario, Anastacia M.; Bendanillo, Jamaica P.; Binas-o, Hanni K.; Bucang, Novefirst O.; Cammagay, Jan Lorie W.

    2014-01-01

    The use of mother tongue in teaching in a multilingual setting affects the way pupils learn. A melting pot and the educational center of the North, Baguio City, Philippines demands teaching strategies that not only adapt to the interplay of the different cultures and languages but give importance to them, too. Specifically, this paper analyzed the…

  12. Design, implementation and reporting strategies to reduce the instance and impact of missing patient-reported outcome (PRO) data: a systematic review

    PubMed Central

    Mercieca-Bebber, Rebecca; Palmer, Michael J; Brundage, Michael; Stockler, Martin R; King, Madeleine T

    2016-01-01

    Objectives Patient-reported outcomes (PROs) provide important information about the impact of treatment from the patients' perspective. However, missing PRO data may compromise the interpretability and value of the findings. We aimed to report: (1) a non-technical summary of problems caused by missing PRO data; and (2) a systematic review by collating strategies to: (A) minimise rates of missing PRO data, and (B) facilitate transparent interpretation and reporting of missing PRO data in clinical research. Our systematic review does not address statistical handling of missing PRO data. Data sources MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (inception to 31 March 2015), and citing articles and reference lists from relevant sources. Eligibility criteria English articles providing recommendations for reducing missing PRO data rates, or strategies to facilitate transparent interpretation and reporting of missing PRO data were included. Methods 2 reviewers independently screened articles against eligibility criteria. Discrepancies were resolved with the research team. Recommendations were extracted and coded according to framework synthesis. Results 117 sources (55% discussion papers, 26% original research) met the eligibility criteria. Design and methodological strategies for reducing rates of missing PRO data included: incorporating PRO-specific information into the protocol; carefully designing PRO assessment schedules and defining termination rules; minimising patient burden; appointing a PRO coordinator; PRO-specific training for staff; ensuring PRO studies are adequately resourced; and continuous quality assurance. Strategies for transparent interpretation and reporting of missing PRO data include utilising auxiliary data to inform analysis; transparently reporting baseline PRO scores, rates and reasons for missing data; and methods for handling missing PRO data. Conclusions The instance of missing PRO data and its potential to bias clinical research can be minimised by implementing thoughtful design, rigorous methodology and transparent reporting strategies. All members of the research team have a responsibility in implementing such strategies. PMID:27311907

  13. Teachers' implementation of gender-inclusive instructional strategies in single-sex and mixed-sex science classrooms

    NASA Astrophysics Data System (ADS)

    Parker, Lesley H.; Rennie, Léonie J.

    2002-09-01

    Debate continues over the benefits, or otherwise, of single-sex classes in science and mathematics, particularly for the performance of girls. Previous research and analyses of the circumstances surrounding the implementation of single-sex classes warn that the success of the strategy requires due consideration of the nature of the instructional environment for both boys and girls, together with appropriate support for the teachers involved. This article reports the circumstances under which teachers were able to implement gender-inclusive strategies in single-sex science classes in coeducational high schools and documents some of the difficulties faced. The study was part of the Single-Sex Education Pilot Project (SSEPP) in ten high schools in rural and urban Western Australia. Qualitative and quantitative data were gathered during the project from teachers, students and classroom observations. Overall, it was apparent that single-sex grouping created environments in which teachers could implement gender-inclusive science instructional strategies more readily and effectively than in mixed-sex settings. Teachers were able to address some of the apparent shortcomings of the students' previous education (specifically, the poor written and oral communication of boys and the limited experience of girls with 'hands-on' activities and open-ended problem solving). Further, in same-sex classrooms, sexual harassment which inhibited girls' learning was eliminated. The extent to which teachers were successful in implementing gender-inclusive instructional strategies, however, depended upon their prior commitment to the SSEPP as a whole, and upon the support or obstacles encountered from a variety of sources, including parents, the community, students, and non-SSEPP teachers.

  14. The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy.

    PubMed

    Harvey, Gill; Fitzgerald, Louise; Fielden, Sandra; McBride, Anne; Waterman, Heather; Bamford, David; Kislov, Roman; Boaden, Ruth

    2011-08-23

    In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.

  15. The Learning Environment Counts: Longitudinal Qualitative Analysis of Study Strategies Adopted by First-Year Medical Students in a Competency-Based Educational Program.

    PubMed

    Bierer, S Beth; Dannefer, Elaine F

    2016-11-01

    The move toward competency-based education will require medical schools and postgraduate training programs to restructure learning environments to motivate trainees to take personal ownership for learning. This qualitative study explores how medical students select and implement study strategies while enrolled in a unique, nontraditional program that emphasizes reflection on performance and competence rather than relying on high-stakes examinations or grades to motivate students to learn and excel. Fourteen first-year medical students volunteered to participate in three, 45-minute interviews (42 overall) scheduled three months apart during 2013-2014. Two medical educators used structured interview guides to solicit students' previous assessment experiences, preferred learning strategies, and performance monitoring processes. Interviews were digitally recorded and transcribed verbatim. Participants confirmed accuracy of transcripts. Researchers independently read transcripts and met regularly to discuss transcripts and judge when themes achieved saturation. Medical students can adopt an assessment for learning mind-set with faculty guidance and implement appropriate study strategies for mastery-learning demands. Though students developed new strategies at different rates during the year, they all eventually identified study and performance monitoring strategies to meet learning needs. Students who had diverse learning experiences in college embraced mastery-based study strategies sooner than peers after recognizing that the learning environment did not reward performance-based strategies. Medical students can take ownership for their learning and implement specific strategies to regulate behavior when learning environments contain building blocks emphasized in self-determination theory. Findings should generalize to educational programs seeking strategies to design learning environments that promote self-regulated learning.

  16. Update of Implementation of Recommendations from the NRT Following the Exxon Valdez Oil Spill

    EPA Pesticide Factsheets

    As this report indicates, many of the specific recommendations have been addressed and the nation’s oil spill prevention, preparedness, and response strategies have been vastly improved. However, additional action is necessary.

  17. Pressure ulcers: implementation of evidence-based nursing practice.

    PubMed

    Clarke, Heather F; Bradley, Chris; Whytock, Sandra; Handfield, Shannon; van der Wal, Rena; Gundry, Sharon

    2005-03-01

    A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers.

  18. Finnish NGOs promoting health equity in the context of welfare economy.

    PubMed

    Rouvinen-Wilenius, Päivi; Ahokas, Jussi; Kiukas, Vertti; Aalto-Kallio, Mervi

    2018-04-05

    Health inequality is a national challenge in Finland. The WHO global strategy of Health for All implies that all people should have an equal opportunity to develop and maintain their health through fair and just access to health resources. This article examines the role of Finnish Non-Governmental Organizations (NGO) in strengthening the health equity. The article presents the strategy and specific criteria constructed by the NGOs to promote health equity in society. The health equity criteria and welfare economy strategy are combined to a framework which NGOs can utilize in their work to promote health equity. The welfare economy strategy describes the important issues that NGOs have to address when working towards a specific societal goal, in this case equity. The health equity criteria in turn are an instrument for the practical implementation of the preconditions of equity.

  19. A Study on the Model of Detecting the Variation of Geomagnetic Intensity Based on an Adapted Motion Strategy.

    PubMed

    Li, Hong; Liu, Mingyong; Liu, Kun; Zhang, Feihu

    2017-12-25

    By simulating the geomagnetic fields and analyzing thevariation of intensities, this paper presents a model for calculating the objective function ofan Autonomous Underwater Vehicle (AUV)geomagnetic navigation task. By investigating the biologically inspired strategies, the AUV successfullyreachesthe destination duringgeomagnetic navigation without using the priori geomagnetic map. Similar to the pattern of a flatworm, the proposed algorithm relies on a motion pattern to trigger a local searching strategy by detecting the real-time geomagnetic intensity. An adapted strategy is then implemented, which is biased on the specific target. The results show thereliabilityandeffectivenessofthe proposed algorithm.

  20. ONRASIA Scientific Information Bulletin. Volume 17, Number 4, October-December 1992

    DTIC Science & Technology

    1992-12-01

    Corporate Software Planning Oki’s Software Improvement Environment and Engineering Div. Strategy - Effective Management - Improvement of Informa- Mr...a CCITT-supported implementation phase. -- David K fore we have effectively implemented ISO Standard high-level language Kahaner, ONRASIA them...power with a system fo- putation) Result cused on their specific needs. Result Effective speed should be (Readers can write to me or to 150 times VP-400

  1. Strategies for the Legal Implementation of the International Code of Marketing of Breast-Milk Substitutes: Report on a WHO Meeting (Copenhagen, Denmark, November 10-12, 1982).

    ERIC Educational Resources Information Center

    World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

    For various reasons, several countries have had difficulty implementing the International Code of Marketing of Breast-milk Substitutes. To address those problems, a meeting was convened under the auspices of the World Health Organization. Specific purposes of the meeting were to inform member states about the Code and to develop national…

  2. Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital.

    PubMed

    Khan, Junaid H; Green, Emily A; Chang, Jimmin; Ayala, Alexandria M; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D

    2017-12-01

    Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management. Retrospective analysis of blood product usage pre-implementation, post-CPB changes and post-Hemostasis Management System (HMS) implementation was done to determine the effectiveness of the blood conservation strategies. Statistically significant decrease in packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelet usage over the stepped implementation of both technologies was observed. New oxygenator and centrifugal pump technologies reduced active circuitry volume and caused less damage to blood cells. Individualizing heparin and protamine dosing to a patient using the HMS led to transfusion reductions as well. Overall trends toward reductions in hospital length of stay and intensive care unit stay, and as a result, blood product cost and total hospitalization cost are positive over the period of implementation of both CPB circuit changes and HMS implementation. Although they are multifactorial in nature, these trends provide positive enforcement to the changes implemented.

  3. Issues regarding the usage of MPPT techniques in micro grid systems

    NASA Astrophysics Data System (ADS)

    Szeidert, I.; Filip, I.; Dragan, F.; Gal, A.

    2018-01-01

    The main objective of the control strategies applied at hybrid micro grid systems (wind/hydro/solar), that function based on maximum power point tracking (MPPT) techniques is to improve the conversion system’s efficiency and to preserve the quality of the generated electrical energy (voltage and power factor). One of the main goals of maximum power point tracking strategy is to achieve the harvesting of the maximal possible energy within a certain time period. In order to implement the control strategies for micro grid, there are typically required specific transducers (sensor for wind speed, optical rotational transducers, etc.). In the technical literature, several variants of the MPPT techniques are presented and particularized at some applications (wind energy conversion systems, solar systems, hydro plants, micro grid hybrid systems). The maximum power point tracking implementations are mainly based on two-level architecture. The lower level controls the main variable and the superior level represents the MPPT control structure. The paper presents micro grid structures developed at Politehnica University Timisoara (PUT) within the frame of a research grant. The paper is focused on the application of MPPT strategies on hybrid micro grid systems. There are presented several structures and control strategies and are highlighted their advantages and disadvantages, together with practical implementation guidelines.

  4. World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation.

    PubMed

    Brailo, Vlaho; Firriolo, Francis John; Tanaka, Takako Imai; Varoni, Elena; Sykes, Rosemary; McCullough, Michael; Hua, Hong; Sklavounou, Alexandra; Jensen, Siri Beier; Lockhart, Peter B; Mattsson, Ulf; Jontell, Mats

    2015-08-01

    To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Implementing health care reform in Israel: organizational response to perceived incentives.

    PubMed

    Gross, Revital

    2003-08-01

    Devising new incentives was a main element of health care reform in Israel, which created a regulated market that embodies many principles of managed competition. This study examined sick fund directors' perceptions of the new incentives and their strategic responses to these incentives, enabling the testing of how managed competition works in practice. The methodology used was a multiple case study of Israel's four sick funds. Data were gathered through in-depth interviews with 160 senior officials, analysis of national health insurance legislation, and analysis of published and unpublished archival documents, newspaper articles, public statements of senior managers, and other published data on the sick funds' behavior. The study revealed discrepancies between planned and perceived incentives and highlighted the effect of the latter on strategy formulation. Analysis of sick fund strategies showed that their responses to managed competition incentives deviated from theoretical expectations, compromising some of the objectives of the reform. The study also shows that contextual features account for the specific model of managed competition that was implemented and for the specific strategies employed by the sick funds. The study concludes by highlighting the need to build a process that will enable policy makers to consider local contextual factors when planning and implementing reform, involving health care providers in designing incentives, continuously monitoring processes and outcomes in the reformed system, and allowing for flexibility in policy making.

  6. Critical challenges in ERP implementation: A qualitative case study in the Canadian oil and gas industry

    NASA Astrophysics Data System (ADS)

    Menon, Sreekumar A.

    This exploratory qualitative single-case study examines critical challenges encountered during ERP implementation based on individual perspectives in four project roles: senior leaders, project managers, project team members, and business users, all specifically in Canadian oil and gas industry. Data was collected by interviewing participants belonging to these categories, and by analyzing project documentation about ERP implementation. The organization for the case study was a leading multinational oil and gas company having a substantial presence in the energy sector in Canada. The study results were aligned with the six management questions regarding critical challenges in ERP: (a) circumstances to implement ERP, (b) benefits and process improvements achieved, (c) best practices implemented, (d) critical challenges encountered, (e) strategies and mitigating actions used, and (f) recommendations to improve future ERP implementations. The study results highlight six key findings. First, the study provided valid circumstances for implementing ERP systems. Second, the study underscored the importance of benefits and process improvements in ERP implementation. Third, the study highlighted that adoption of best practices is crucial for ERP Implementation. Fourth, the study found that critical challenges are encountered in ERP Implementation and are significant during ERP implementation. Fifth, the study found that strategies and mitigating actions can overcome challenges in ERP implementation. Finally, the study provided ten major recommendations on how to improve future ERP implementations.

  7. Using the interactive systems framework to support a quality improvement approach to dissemination of evidence-based strategies to promote early detection of breast cancer: planning a comprehensive dynamic trial.

    PubMed

    Rapkin, Bruce D; Weiss, Elisa S; Lounsbury, David W; Thompson, Hayley S; Goodman, Robert M; Schechter, Clyde B; Merzel, Cheryl; Shelton, Rachel C; Blank, Arthur E; Erb-Downward, Jennifer; Williams, Abigail; Valera, Pamela; Padgett, Deborah K

    2012-12-01

    Dissemination efforts must optimize interventions for new settings and populations. As such, dissemination research should incorporate principles of quality improvement. Comprehensive Dynamic Trial (CDT) designs examine how information gained during dissemination may be used to modify interventions and improve performance. Although CDT may offer distinct advantages over static designs, organizing the many necessary roles and activities is a significant challenge. In this article, we discuss use of the Interactive Systems Framework for Dissemination and Implementation to systematically implement a CDT. Specifically, we describe "Bronx ACCESS", a program designed to disseminate evidence-based strategies to promote adherence to mammography guidelines. In Bronx ACCESS, the Intervention Delivery System will elicit information needed to adapt strategies to specific settings and circumstances. The Intervention Synthesis and Translation System will use this information to test changes to strategies through "embedded experiments". The Intervention Support System will build local capacities found to be necessary for intervention institutionalization. Simulation modeling will be used to integrate findings across systems. Results will inform on-going policy debate about interventions needed to promote population-level screening. More generally, this project is intended to advance understanding of research paradigms necessary to study dissemination.

  8. Ensuring treatment fidelity in a multi-site behavioral intervention study: implementing NIH Behavior Change Consortium recommendations in the SMART trial.

    PubMed

    Robb, Sheri L; Burns, Debra S; Docherty, Sharron L; Haase, Joan E

    2011-11-01

    The Stories and Music for Adolescent/Young Adult Resilience during Transplant (SMART) study (R01NR008583; U10CA098543; U10CA095861) is an ongoing multi-site Children's Oncology Group randomized clinical trial testing the efficacy of a therapeutic music video intervention for adolescents/young adults (11-24 years of age) with cancer undergoing stem cell transplant. Treatment fidelity strategies from our trial are consistent with the National Institutes of Health (NIH) Behavior Change Consortium Treatment Fidelity Workgroup (BCC) recommendations and provide a successful working model for treatment fidelity implementation in a large, multi-site behavioral intervention study. In this paper, we summarize 20 specific treatment fidelity strategies used in the SMART trial and how these strategies correspond with NIH BCC recommendations in five specific areas: (1) study design, (2) training providers, (3) delivery of treatment, (4) receipt of treatment, and (5) enactment of treatment skills. Increased use and reporting of treatment fidelity procedures is essential in advancing the reliability and validity of behavioral intervention research. The SMART trial provides a strong model for the application of fidelity strategies to improve scientific findings and addresses the absence of published literature, illustrating the application of BCC recommendations in behavioral intervention studies. Copyright © 2010 John Wiley & Sons, Ltd.

  9. Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities.

    PubMed

    Cailhol, Johann; Craveiro, Isabel; Madede, Tavares; Makoa, Elsie; Mathole, Thubelihle; Parsons, Ann Neo; Van Leemput, Luc; Biesma, Regien; Brugha, Ruairi; Chilundo, Baltazar; Lehmann, Uta; Dussault, Gilles; Van Damme, Wim; Sanders, David

    2013-10-25

    Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries' responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.

  10. Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

    PubMed Central

    2013-01-01

    Background Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. Methods A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. Results In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Conclusion Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries. PMID:24160182

  11. Structured models of infectious disease: inference with discrete data

    PubMed Central

    Metcalf, C.J.E.; Lessler, J.; Klepac, P.; Morice, A.; Grenfell, B.T.; Bjørnstad, O.N.

    2014-01-01

    The usage of structured population models can make substantial contributions to public health, particularly for infections where clinical outcomes vary over age. There are three theoretical challenges in implementing such analyses: i) developing an appropriate framework that models both demographic and epidemiological transitions; ii) parameterizing the framework, where parameters may be based on data ranging from the biological course of infection, basic patterns of human demography, specific characteristics of population growth, and details of vaccination regimes implemented; and iii) evaluating public health strategies in the face of changing human demography. We illustrate the general approach by developing a model of rubella in Costa Rica. The demographic profile of this infection is a crucial aspect of its public health impact, and we use a transient perturbation analysis to explore the impact of changing human demography on immunization strategies implemented. PMID:22178687

  12. [Regionalization of perinatal health care in the province of Santa Fe, Argentina].

    PubMed

    Simioni, Alberto Tomás; Llanos, Oraldo; Romero, Mariana; Ramos, Silvina; Brizuela, Vanessa; Abalos, Edgardo

    2017-05-25

    Improve the performance of the regionalization policy in the province of Santa Fe, Argentina, as a strategy to improve perinatal health care by analyzing implementation processes and building consensus among decision makers and stakeholders around an action plan. Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy. Actors were studied to identify the barriers and facilitators of implementation. Training was provided on the development of consensus- and evidence-based policies, through workshops in which policy briefs were prepared and through a deliberative dialogue. There were improvements in the number of births in appropriate hospitals and in the number of births in maternity hospitals with Essential Obstetric and Neonatal Care (CONE). Barriers were identified in the referral systems and in communication on policy, which resulted in an initial agreement on the need for guidelines and specific technical training on the transfer of babies and mothers. The participation of health workers in identifying barriers and strategies to overcome them, and the use of tools to report this to management, permit the adoption of consensus- and evidence-based strategies to improve policy implementation.

  13. Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings.

    PubMed

    Brinkley-Rubinstein, Lauren; Cloud, David H; Davis, Chelsea; Zaller, Nickolas; Delany-Brumsey, Ayesha; Pope, Leah; Martino, Sarah; Bouvier, Benjamin; Rich, Josiah

    2017-03-13

    Purpose The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.

  14. Examining teacher self-efficacy about best practices in science during a professional development series

    NASA Astrophysics Data System (ADS)

    Menez, Jessica L.

    Using extant data that were collected as part of a larger project, the current study examined teacher self-efficacy and the teachers' intentions to implement workshop content throughout the course of a six-week professional development workshop focused on enhancing science motivation for students through the adoption of specific instructional strategies. There were a total of 20 middle and high school teacher participants. Results indicated teacher self-efficacy changed significantly from pre to post. Teachers showed higher teacher self-efficacy after the professional development, in particular for influencing student engagement. In addition, we found a moderate correlation between the level of confidence after the implementation of a strategy and teachers intention of trying the strategy again. Finally, new direction for future research topics made possible by this study are presented.

  15. Corporate incentives for promoting safety belt use : rationale, guidelines, and examples

    DOT National Transportation Integrated Search

    1982-10-01

    This manual was designed to teach the corporate executive successful strategies for implementing and evaluating a successful industry-based program to motivate employee safety belt use. A rationale is given for the general approach; and specific guid...

  16. Site-Specific Protein Labeling via Sortase-Mediated Transpeptidation

    PubMed Central

    Antos, John M.; Ingram, Jessica; Fang, Tao; Pishesha, Novalia; Truttmann, Matthias C.; Ploegh, Hidde L.

    2017-01-01

    Strategies for site-specific protein modification are highly desirable for the construction of conjugates containing non-genetically encoded functional groups. Ideally, these strategies should proceed under mild conditions, and be compatible with a wide range of protein targets and non-natural moieties. The transpeptidation reaction catalyzed by bacterial sortases is a prominent strategy for protein derivatization that possesses these features. Naturally occurring or engineered variants of sortase A from Staphylococcus aureus catalyze a ligation reaction between a five amino acid substrate motif (LPXTG) and oligoglycine nucleophiles. By pairing proteins and synthetic peptides that possess these ligation handles, it is possible to install modifications onto the protein N- or C-terminus in site-specific fashion. As described in this unit, the successful implementation of sortase-mediated labeling involves straightforward solid-phase synthesis and molecular biology techniques, and this method is compatible with proteins in solution or on the surface of live cells. PMID:19365788

  17. Oversight Hearing on the Equal Employment Opportunity Commission's Implementation of the Americans with Disabilities Act (Title I on Employment and Title V Covering Miscellaneous Provisions). Hearing before the Subcommittee on Employment Opportunities of the Committee on Education and Labor, House of Representatives, One Hundred Second Congress, First Session (October 30, 1991).

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Committee on Education and Labor.

    This hearing transcript presents testimony, a prepared statement, and supplemental materials provided by Evan J. Kemp, Jr., Chairman of the Equal Employment Opportunities Commission (EEOC), specifically related to implementation of the Americans with Disabilities Act (ADA). The hearing deals with EEOC enforcement strategies for implementing Title…

  18. Gainsharing Strategies, Physician Champions, Getting Physician Buy In.

    PubMed

    Anoushiravani, Afshin A; Nunley, Ryan M

    2017-06-01

    As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

  19. 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

  20. What We Do and Do Not Know about Teaching Medical Image Interpretation.

    PubMed

    Kok, Ellen M; van Geel, Koos; van Merriënboer, Jeroen J G; Robben, Simon G F

    2017-01-01

    Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.

  1. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease.

    PubMed

    Wolfenden, Luke; Nathan, Nicole K; Sutherland, Rachel; Yoong, Sze Lin; Hodder, Rebecca K; Wyse, Rebecca J; Delaney, Tessa; Grady, Alice; Fielding, Alison; Tzelepis, Flora; Clinton-McHarg, Tara; Parmenter, Benjamin; Butler, Peter; Wiggers, John; Bauman, Adrian; Milat, Andrew; Booth, Debbie; Williams, Christopher M

    2017-11-29

    A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

  2. Implementing evidence-based medicine in general practice: a focus group based study

    PubMed Central

    Hannes, Karin; Leys, Marcus; Vermeire, Etienne; Aertgeerts, Bert; Buntinx, Frank; Depoorter, Anne-Marie

    2005-01-01

    Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed. PMID:16153300

  3. Age-related differences in emotion regulation strategies: Examining the role of contextual factors.

    PubMed

    Schirda, Brittney; Valentine, Thomas R; Aldao, Amelia; Prakash, Ruchika Shaurya

    2016-09-01

    Increasing age is characterized by greater positive affective states. However, there is mixed evidence on the implementation of emotion regulation strategies across the life span. To clarify the discrepancies in the literature, we examined the modulating influence of contextual factors in understanding emotion regulation strategy use in older and young adults. Forty-eight older adults and forty-nine young adults completed a retrospective survey inquiring about the use of emotion regulation strategies in emotion-eliciting situations experienced over the preceding 2 weeks. We used factor analysis to establish clusters of emotion regulation strategies, resulting in cognitive strategies, acceptance, and maladaptive strategies. Overall, we found context-dependent age-related differences in emotion regulation strategy use. Specifically, older adults reported greater use of acceptance than young adults in situations of moderate intensity and in situations that evoke anxiety and sadness. In addition, older adults reported using maladaptive strategies to a lesser extent in high- and moderate-intensity situations and in situations that elicit anxiety and sadness when compared with young adults. There were no age-related differences in the use of cognitive strategies across contexts. Older adults, compared to young adults, reported less use of maladaptive strategies and greater use of acceptance than young adults, which suggests that the enhanced emotional functioning observed later in life may be due to a shift in strategy implementation. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  4. Persuasive Dialogue Based on a Narrative Theory: An ECA Implementation

    NASA Astrophysics Data System (ADS)

    Cavazza, Marc; Smith, Cameron; Charlton, Daniel; Crook, Nigel; Boye, Johan; Pulman, Stephen; Moilanen, Karo; Pizzi, David; de La Camara, Raul Santos; Turunen, Markku

    Embodied Conversational Agents (ECA) are poised to constitute a specific category within persuasive systems, in particular through their ability to support affective dialogue. One possible approach consists in using ECA as virtual coaches or personal assistants and to make persuasion part of a dialogue game implementing specific argumentation or negotiation features. In this paper, we explore an alternative framework, which emerges from the long-term development of ECA as "Companions" supporting free conversation with the user, rather than task-oriented dialogue. Our system aims at influencing user attitudes as part of free conversation, albeit on a limited set of topics. We describe the implementation of a Companion ECA to which the user reports on his working day, and which can assess the user's emotional attitude towards daily events in the office, trying to influence such attitude using affective strategies derived from a narrative model. This discussion is illustrated through examples from a first fully-implemented prototype.

  5. Normative legal regulating of vehicles with a high degree of automation of control: strategy and tactics for implementation in Russia

    NASA Astrophysics Data System (ADS)

    Kisulenko, B. V.; Bocharov, A. V.; Pugachev, V. V.

    2018-02-01

    The article discusses the risks specific to vehicles with a high level of automation of control, and conditions the limits on the operating conditions of such vehicles. The article determines existing legal barriers to the implementation of autonomous vehicles. The article contains an analysis of foreign practice of regulating in the European Union, Japan and the United States and information about the UNECE activities aimed at enabling operation of vehicles with a high degree of automation control. Basing on the results of the analysis, the authors made proposals for removal of legal barriers. The article also contains proposals for the development of specific requirements for autonomous vehicles associated with their specific features of design.

  6. Chapter 12: Survey Design and Implementation for Estimating Gross Savings Cross-Cutting Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

    Kurnik, Charles W; Baumgartner, Robert

    This chapter presents an overview of best practices for designing and executing survey research to estimate gross energy savings in energy efficiency evaluations. A detailed description of the specific techniques and strategies for designing questions, implementing a survey, and analyzing and reporting the survey procedures and results is beyond the scope of this chapter. So for each topic covered below, readers are encouraged to consult articles and books cited in References, as well as other sources that cover the specific topics in greater depth. This chapter focuses on the use of survey methods to collect data for estimating gross savingsmore » from energy efficiency programs.« less

  7. Assessing the flexibility of research-based instructional strategies: Implementing tutorials in introductory physics in the lecture environment

    NASA Astrophysics Data System (ADS)

    Kryjevskaia, Mila; Boudreaux, Andrew; Heins, Dustin

    2014-03-01

    Materials from Tutorials in Introductory Physics, originally designed and implemented by the Physics Education Group at the University of Washington, were used in modified form as interactive lectures under conditions significantly different from those suggested by the curriculum developers. Student learning was assessed using tasks drawn from the physics education research literature. Use of tutorials in the interactive lecture format yielded gains in student understanding comparable to those obtained through the canonical tutorial implementation at the University of Washington, suggesting that student engagement with the intellectual steps laid out in the tutorials, rather than the specific strategies used in facilitating such engagement, plays the central role in promoting student learning. We describe the implementation details and assessment of student learning for two different tutorials: one focused on mechanical waves, used at North Dakota State University, and one on Galilean relativity, used at Western Washington University. Also discussed are factors that may limit the generalizability of the results.

  8. Technical Packages in Injury and Violence Prevention to Move Evidence into Practice: Systematic Reviews and Beyond

    PubMed Central

    Haegerich, Tamara M.; David-Ferdon, Corinne; Noonan, Rita K.; Manns, Brian J.; Billie, Holly C.

    2016-01-01

    Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. “Technical packages,” developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence. PMID:27604301

  9. Everybody wants it done but nobody wants to do it: an exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer.

    PubMed

    Rankin, Nicole M; Butow, Phyllis N; Thein, Thida; Robinson, Tracy; Shaw, Joanne M; Price, Melanie A; Clover, Kerrie; Shaw, Tim; Grimison, Peter

    2015-01-22

    This study aimed to explore barriers to and enablers for future implementation of a draft clinical pathway for anxiety and depression in cancer patients in the Australian context. Health professionals reviewed a draft clinical pathway and participated in qualitative interviews about the delivery of psychosocial care in their setting, individual components of the draft pathway, and barriers and enablers for its future implementation. Five interrelated themes were identified: ownership; resources and responsibility; education and training; patient reluctance; and integration with health services beyond oncology. The five themes were perceived as both barriers and enablers and provide a basis for an implementation plan that includes strategies to overcome barriers. The next steps are to design and deliver the clinical pathway with specific implementation strategies that address team ownership, endorsement by leaders, education and training modules designed for health professionals and patients and identify ways to integrate the pathway into existing cancer services.

  10. Building evaluation capacity in Ontario's public health units: promising practices and strategies.

    PubMed

    Bourgeois, I; Simmons, L; Buetti, D

    2018-06-01

    This article presents the findings of a project focusing on building evaluation capacity in 10 Ontario public health units. The study sought to identify effective strategies that lead to increased evaluation capacity in the participating organizations. This study used a qualitative, multiple case research design. An action research methodology was used to design customized evaluation capacity building (ECB) strategies for each participating organization, based on its specific context and needs. This methodological approach also enabled monitoring and assessment of each strategy, based on a common set of reporting templates. A multiple case study was used to analyze the findings from the 10 participating organizations and derive higher level findings. The main findings of the study show that most of the strategies used to increase evaluation capacity in public health units are promising, especially those focusing on developing the knowledge, skills, and attitudes of health unit staff and managers. Facilitators to ECB strategies were the engagement of all staff members, the support of leadership, and the existence of organizational tools and infrastructure to support evaluation. It is also essential to recognize that ECB takes time and resources to be successful. The design and implementation of ECB strategies should be based on organizational needs. These can be assessed using a standardized instrument, as well as interviews and staff surveys. The implementation of a multicomponent approach (i.e. several strategies implemented simultaneously) is also linked to better ECB outcomes in organizations. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  11. College Students' Attitude towards Computer Technology

    ERIC Educational Resources Information Center

    Njagi, K. O.; Havice, W. L.

    2011-01-01

    Recent advances in the contemporary world, especially in the area of computer technology, have heralded the development and implementation of new and innovative teaching strategies and particularly with the Internet revolution. This study assessed students' attitude towards computer technology. Specifically, the study assessed differences in…

  12. Planning and Design: A Systems Approach.

    ERIC Educational Resources Information Center

    Bozeman, William C.; Clements, Mary A.

    1981-01-01

    Explains "purpose design," a planning and problem-solving strategy involving determination of planning purposes, generation and selection of solutions, specification of solution details, implementation, and evaluation. Describes the application of purpose design to the planning of an alumni association at Black Hawk College, a community…

  13. Fiscal year 1980-81 implementation plan in support of technical development and integration of sampling and aggregation procedures. [crop acreage estimation

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The specific objectives of the FY 1980-81 tasks are: (1) further refinements to the weighted aggregation procedure; (2) improved approaches for estimating within-stratum variance; (3) more intensive investigation of alternative sampling strategies such as full-frame sampling strategy, and (4) further developments in regard to a simulated approach for assessing the performance of the overall designed sampling and aggregation system.

  14. Developing an active implementation model for a chronic disease management program

    PubMed Central

    Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

    2013-01-01

    Background Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council’s model for complex interventions and the Chronic Care Model. Methods We used the Medical Research Council’s five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. Results The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council’s model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). Conclusion The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council’s model added transparency to the design phase which further facilitated the process of implementing the program. Trial registration: http://www.clinicaltrials.gov/(NCT01228708). PMID:23882169

  15. Advanced Mirror Technology Development (AMTD) for Very Large Space Telescopes

    NASA Technical Reports Server (NTRS)

    Stahl, H. Philip

    2013-01-01

    Accomplishments include: Assembled outstanding team from academia, industry and government with expertise in science and space telescope engineering. Derived engineering specifications for monolithic primary mirror from science measurement needs & implementation constraints. Pursuing long-term strategy to mature technologies necessary to enable future large aperture space telescopes. Successfully demonstrated capability to make 0.5 m deep mirror substrate and polish it to UVOIR traceable figure specification.

  16. What Counts is not Falling … but Landing: Strategic Analysis: An Adapted Model for Implementation Evaluation.

    PubMed

    Brousselle, Astrid

    2004-04-01

    Implementation evaluations, also called process evaluations, involve studying the development of programmes, and identifying and understanding their strengths and weaknesses. Undertaking an implementation evaluation offers insights into evaluation objectives, but does not help the researcher develop a research strategy. During the implementation analysis of the UNAIDS drug access initiative in Chile, the strategic analysis model developed by Crozier and Friedberg was used. However, a major incompatibility was noted between the procedure put forward by Crozier and Friedberg and the specific characteristics of the programme being evaluated. In this article, an adapted strategic analysis model for programme evaluation is proposed.

  17. Update on infection control challenges in special pediatric populations.

    PubMed

    Balkhy, Hanan H; Zingg, Walter

    2014-08-01

    Compared with adults, neonatal and pediatric populations are especially vulnerable patients who have specific diagnostic and therapeutic differences; therefore, the standard infection control practices designed for adults are sometimes not effective or need modifications to work. This review focuses on the recent literature addressing the challenges and successes in preventing healthcare-associated infections (HAIs) in children. Improving the implementation of pediatric versions of preventive bundles focusing on proper catheter insertion and maintenance, mainly as a part of a larger multimodal strategy, is effective in reducing the central-line-associated bloodstream infections in neonatal and pediatric populations including oncology patients. Appropriate feeding, antimicrobial stewardship, and infection control measures should be combined in reducing necrotizing enterocolitis in preterm neonates. Implementing a multimodal bundle strategy adapted for pediatric population is successful in preventing ventilator-associated pneumonia. Appropriate use of antimicrobial prophylaxis remains the cornerstone for preventing surgical-site infections irrespective of age, with few additional effective adjuvant preventive practices in specific pediatric patients. Several evidence-based practices are effective in reducing the incidence and the impact of HAIs in children; however, proper implementation remains a challenge. Additionally, several adult preventive practices are still unestablished in children and need further thorough examination.

  18. The integrated rangeland fire management strategy actionable science plan

    USGS Publications Warehouse

    Aldridge, Cameron L.; Berg, Ken; Boyd, Chad S.; Boyte, Stephen P.; Bradford, John B.; Brunson, Ed; Cissel, John H.; Conway, Courtney J.; Chalfoun, Anna D.; Chambers, Jeanne C.; Clark, Patrick; Coates, Peter S.; Crist, Michele R.; Davis, Dawn M.; DeCrappeo, Nicole; Deibert, Patricia A.; Doherty, Kevin E.; Evers, Louisa B.; Finch, Deborah M.; Finn, Sean P.; Germino, Matthew J.; Glenn, Nancy F.; Gucker, Corey; Hall, John A.; Hanser, Steven E.; Havlina, Douglas W.; Heinrichs, Julie; Heller, Matt; Homer, Collin G.; Hunter, Molly E.; Jacobs, Ruth W.; Karl, Jason W.; Kearney, Richard; Kemp, Susan K; Kilkenny, Francis F.; Knick, Steven T.; Launchbaugh, Karen; Manier, Daniel J.; Mayer, Kenneth E.; Meyer, Susan E.; Monroe, Adrian; MontBlanc, Eugénie; Newingham, Beth A.; Pellant, Michael L.; Phillips, Susan L.; Pilliod, David S.; Ricca, Mark A.; Richardson, Bryce A.; Rose, Jeffrey A.; Shaw, Nancy; Sheley, Roger L.; Shinneman, Douglas J.; Wiechman , Lief A.; Wylie, Bruce K.

    2016-01-01

    The Integrated Rangeland Fire Management Strategy (hereafter Strategy, DOI 2015) outlined the need for coordinated, science-based adaptive management to achieve long-term protection, conservation, and restoration of the sagebrush (Artemisia spp.) ecosystem. A key component of this management approach is the identification of knowledge gaps that limit implementation of effective strategies to meet current management challenges. The tasks and actions identified in the Strategy address several broad topics related to management of the sagebrush ecosystem. This science plan is organized around these topics and specifically focuses on fire, invasive plant species and their effects on altering fire regimes, restoration, sagebrush and greater sage-grouse (Centrocercus urophasianus), and climate and weather.

  19. A Novel Implementation Strategy in Residential Care Settings to Promote EBP: Direct Care Provider Perceptions and Development of a Conceptual Framework.

    PubMed

    Slaughter, Susan E; Bampton, Erin; Erin, Daniel F; Ickert, Carla; Jones, C Allyson; Estabrooks, Carole A

    2017-06-01

    Innovative approaches are required to facilitate the adoption and sustainability of evidence-based care practices. We propose a novel implementation strategy, a peer reminder role, which involves offering a brief formal reminder to peers during structured unit meetings. This study aims to (a) identify healthcare aide (HCA) perceptions of a peer reminder role for HCAs, and (b) develop a conceptual framework for the role based on these perceptions. In 2013, a qualitative focus group study was conducted in five purposively sampled residential care facilities in western Canada. A convenience sample of 24 HCAs agreed to participate in five focus groups. Concurrent with data collection, two researchers coded the transcripts and identified themes by consensus. They jointly determined when saturation was achieved and took steps to optimize the trustworthiness of the findings. Five HCAs from the original focus groups commented on the resulting conceptual framework. HCAs were cautious about accepting a role that might alienate them from their co-workers. They emphasized feeling comfortable with the peer reminder role and identified circumstances that would optimize their comfort including: effective implementation strategies, perceptions of the role, role credibility and a supportive context. These intersecting themes formed a peer reminder conceptual framework. We identified HCAs' perspectives of a new peer reminder role designed specifically for them. Based on their perceptions, a conceptual framework was developed to guide the implementation of a peer reminder role for HCAs. This role may be a strategic implementation strategy to optimize the sustainability of new practices in residential care settings, and the related framework could offer guidance on how to implement this role. © 2017 Sigma Theta Tau International.

  20. Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic streptococcus disease in the Netherlands.

    PubMed

    Kolkman, Diny G E; Rijnders, Marlies E B; Wouters, Maurice G A J; van den Akker-van Marle, M Elske; van der Ploeg, Cpb Kitty; de Groot, Christianne J M; Fleuren, Margot A H

    2013-07-30

    Early-onset Group B haemolytic streptococcus infection (EOGBS) is an important cause of neonatal morbidity and mortality in the first week of life. Primary prevention of EOGBS is possible with intra-partum antibiotic prophylaxis (IAP.) Different prevention strategies are used internationally based on identifying pregnant women at risk, either by screening for GBS colonisation and/or by identifying risk factors for EOGBS in pregnancy or labour. A theoretical cost-effectiveness study has shown that a strategy with IAP based on five risk factors (risk-based strategy) or based on a positive screening test in combination with one or more risk factors (combination strategy) was the most cost-effective approach in the Netherlands. IAP for all pregnant women with a positive culture in pregnancy (screening strategy) and treatment in line with the current Dutch guideline (IAP after establishing a positive culture in case of pre-labour rupture of membranes or preterm birth and immediate IAP in case of intra-partum fever, previous sibling with EOGBS or GBS bacteriuria), were not cost-effective. Cost-effectiveness was based on the assumption of 100% adherence to each strategy. However, adherence in daily practice will be lower and therefore have an effect on cost-effectiveness. The aims are to: a.) implement the current Dutch guideline, the risk-based strategy and the combination strategy in three pilot regions and b.) study the effects of these strategies in daily practice. Regions where all the care providers in maternity care implement the allocated strategy will be randomised. Before the introduction of the strategy, there will be a pre-test (use of the current guideline) involving 105 pregnant women per region. This will be followed by a post-test (use of the allocated strategy) involving 315 women per region. The outcome measures are: 1.) adherence to the specific prevention strategy and the determinants of adherence among care providers and pregnant women, 2.) outcomes in pregnant women and their babies and 3.) the costs of each strategy in relation to the effects. This study will provide recommendations for the implementation of the most cost-effective prevention strategy for EOGBS in the Netherlands on the basis of feasibility in daily practice. Dutch Trial Register, NTR3965.

  1. Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory.

    PubMed

    Roberts, Alison S; Hopp, Trine; Sørensen, Ellen Westh; Benrimoj, Shalom I; Chen, Timothy F; Herborg, Hanne; Williams, Kylie; Aslani, Parisa

    2003-10-01

    The past decade has seen a notable shift in the practice of pharmacy, with a strong focus on the provision of cognitive pharmaceutical services (CPS) by community pharmacists. The benefits of these services have been well documented, yet their uptake appears to be slow. Various strategies have been developed to overcome barriers to the implementation of CPS, with varying degrees of success, and little is known about the sustainability of the practice changes they produce. Furthermore, the strategies developed are often specific to individual programs or services, and their applicability to other CPS has not been explored. There seems to be a need for a flexible change management model for the implementation and dissemination of a range of CPS, but before it can be developed, a better understanding of the change process is required. This paper describes the development of a qualitative research instrument that may be utilised to investigate practice change in community pharmacy. Specific objectives included gaining knowledge about the circumstances surrounding attempts to implement CPS, and understanding relationships that are important to the change process. Organisational theory provided the conceptual framework for development of the qualitative research instrument, within which two theories were used to give insight into the change process: Borum's theory of organisational change, which categorizes change strategies as rational, natural, political or open; and Social Network Theory, which helps identify and explain the relationships between key people involved in the change process. A semi-structured affecting practice change found in the literature that warranted further investigation with the theoretical perspectives of organisational change and social networks. To address the research objectives, the instrument covered four broad themes: roles, experiences, strategies and networks. The qualitative research instrument developed in this study provides a starting point for future research to lead to a description and understanding of practice change in community pharmacy, and subsequent development of models for the sustainable implementation of CPS.

  2. Reducing hospital-acquired pressure ulcers using bundle methodology in pediatric and neonatal patients receiving extracorporeal membrane oxygenation therapy: An integrative review and call to action.

    PubMed

    Courtwright, Suzanne E; Mastro, Kari A; Preuster, Christa; Dardashti, Navid; McGill, Sandra; Madelon, Myrlene; Johnson, Donna

    2017-10-01

    This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population. An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of the scientific literature was performed. Studies included were published between January 2011 and February 2016. A total of seven articles met inclusion criteria. Data were extracted from each published article and analyzed to identify common themes, specifically bundle methodology and barriers to implementing HAPU bundles, in this population. There is limited research on effectiveness of care bundle methodology in reducing HAPUs in children, and no research specific to its effectiveness in pediatric or neonatal ECMO patients. No research was identified studying barriers to implementation of HAPU care bundles in this population. Nurses are well poised to test innovative strategies to prevent HAPUs. Nurses should consider implementing and testing bundle methodology to reduce HAPU in this at-risk population, and conduct research to identify any barriers to implementing this strategy. There is literature to support the use of nurses as unit-based skin care champions to facilitate teamwork and reliable use of the bundle, both critical components to the success of bundle methodology. © 2017 Wiley Periodicals, Inc.

  3. Planning the diffusion of a neck-injury prevention programme among community rugby union coaches.

    PubMed

    Donaldson, Alex; Poulos, Roslyn G

    2014-01-01

    This paper describes the development of a theory-informed and evidence-informed, context-specific diffusion plan for the Mayday Safety Procedure (MSP) among community rugby coaches in regional New South Wales, Australia. Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation. Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory. This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher-practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.

  4. Storage strategies of eddy-current FE-BI model for GPU implementation

    NASA Astrophysics Data System (ADS)

    Bardel, Charles; Lei, Naiguang; Udpa, Lalita

    2013-01-01

    In the past few years graphical processing units (GPUs) have shown tremendous improvements in computational throughput over standard CPU architecture. However, this comes at the cost of restructuring the algorithms to meet the strengths and drawbacks of this GPU architecture. A major drawback is the state of limited memory, and hence storage of FE stiffness matrices on the GPU is important. In contrast to storage on CPU the GPU storage format has significant influence on the overall performance. This paper presents an investigation of a storage strategy in the implementation of a two-dimensional finite element-boundary integral (FE-BI) model for Eddy current NDE applications, on GPU architecture. Specifically, the high dimensional matrices are manipulated by examining the matrix structure and optimally splitting into structurally independent component matrices for efficient storage and retrieval of each component. Results obtained using the proposed approach are compared to those of conventional CPU implementation for validating the method.

  5. Optimal policy for value-based decision-making.

    PubMed

    Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre

    2016-08-18

    For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down.

  6. Optimal policy for value-based decision-making

    PubMed Central

    Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre

    2016-01-01

    For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down. PMID:27535638

  7. Strategies for implementation of an effective pharmacogenomics program in pharmacy education.

    PubMed

    Rao, U Subrahmanyeswara; Mayhew, Susan L; Rao, Prema S

    2015-07-01

    Sequencing of the human genome and the evidence correlating specific genetic variations to diseases have opened up the potential of genomics to more effective and less harmful interventions of human diseases. A wealth of pharmacogenomics knowledge is in place for the practice of precision medicine. However, this knowledge is not fully realized in clinical practice. One reason for this impasse is the lack of in-depth understanding of the potential of pharmacogenomics among the healthcare professionals. Pharmacists are the point-of-care providers and are expected to advise clinicians on matters relating to the implementation of pharmacogenomics in patient care. However, current pharmacogenomics instruction in pharmacy schools fails to produce pharmacists with the required knowledge or practical training in this discipline. In this perspective, we provide several strategies to overcome limitations faced by pharmacy schools. Once implemented, pharmacy schools will produce precision medicine-ready pharmacists.

  8. Stakeholder management for conservation projects: a case study of Ream National Park, Cambodia.

    PubMed

    De Lopez, T T

    2001-07-01

    The paper gives an account of the development and implementation of a stakeholder management framework at Ream National Park, Cambodia. Firstly, the concept of stakeholder is reviewed in management and in conservation literatures. Secondly, the context in which the stakeholder framework was implemented is described. Thirdly, a five-step methodological framework is suggested: (1) stakeholder analysis, (2) stakeholder mapping, (3) development of generic strategies and workplan, (4) presentation of the workplan to stakeholders, and (5) implementation of the workplan. This framework classifies stakeholders according to their level of influence on the project and their potential for the conservation of natural resources. In a situation characterized by conflicting claims on natural resources, park authorities were able to successfully develop specific strategies for the management of stakeholders. The conclusion discusses the implications of the Ream experience and the generalization of the framework to other protected areas.

  9. Optimization of Antibiotic Use in Hospitals – Antimicrobial Stewardship and the EU Project ABS International

    PubMed Central

    Allerberger, Franz; Lechner, Arno; Wechsler-Fördös, Agnes; Gareis, Roland

    2008-01-01

    Background The problem of antimicrobial resistance requires common strategies at the European level. Methods We report on an EU initiative fostering antibiotic (AB) stewardship (ABS) in hospitals. Results The project ‘ABS International: implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the EU’ started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (AB list, guidelines for AB treatment and surgical prophylaxis, and AB-related organization) and valid process measures as well as quality indicators for AB use were developed. Specific ABS tools are being implemented in up to five health care facilities per country. Conclusion ABS International is the first EU-funded initiative focusing on the implementation of structural measures in hospitals to promote the prudent use of ABs. PMID:18667815

  10. Separate neural mechanisms underlie choices and strategic preferences in risky decision making.

    PubMed

    Venkatraman, Vinod; Payne, John W; Bettman, James R; Luce, Mary Frances; Huettel, Scott A

    2009-05-28

    Adaptive decision making in real-world contexts often relies on strategic simplifications of decision problems. Yet, the neural mechanisms that shape these strategies and their implementation remain largely unknown. Using an economic decision-making task, we dissociate brain regions that predict specific choices from those predicting an individual's preferred strategy. Choices that maximized gains or minimized losses were predicted by functional magnetic resonance imaging activation in ventromedial prefrontal cortex or anterior insula, respectively. However, choices that followed a simplifying strategy (i.e., attending to overall probability of winning) were associated with activation in parietal and lateral prefrontal cortices. Dorsomedial prefrontal cortex, through differential functional connectivity with parietal and insular cortex, predicted individual variability in strategic preferences. Finally, we demonstrate that robust decision strategies follow from neural sensitivity to rewards. We conclude that decision making reflects more than compensatory interaction of choice-related regions; in addition, specific brain systems potentiate choices depending on strategies, traits, and context.

  11. Separate neural mechanisms underlie choices and strategic preferences in risky decision making

    PubMed Central

    Venkatraman, Vinod; Payne, John W.; Bettman, James R.; Luce, Mary Frances; Huettel, Scott A.

    2011-01-01

    Adaptive decision making in real-world contexts often relies on strategic simplifications of decision problems. Yet, the neural mechanisms that shape these strategies and their implementation remain largely unknown. Using a novel economic decision-making task, we dissociate brain regions that predict specific choices from those predicting an individual’s preferred strategy. Choices that maximized gains or minimized losses were predicted by fMRI activation in ventromedial prefrontal cortex or anterior insula, respectively. However, choices that followed a simplifying strategy (i.e., attending to overall probability of winning) were associated with activation in parietal and lateral prefrontal cortices. Dorsomedial prefrontal cortex, through differential functional connectivity with parietal and insular cortex, predicted individual variability in strategic preferences. Finally, we demonstrate that robust decision strategies follow from neural sensitivity to rewards. We conclude that decision making reflects more than compensatory interaction of choice-related regions; in addition, specific brain systems potentiate choices depending upon strategies, traits, and context. PMID:19477159

  12. Investigating and Learning Lessons from Early Experiences of Implementing ePrescribing Systems into NHS Hospitals: A Questionnaire Study

    PubMed Central

    Cresswell, Kathrin; Coleman, Jamie; Slee, Ann; Williams, Robin; Sheikh, Aziz

    2013-01-01

    Background ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned. Methods A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated. Results We obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity. Conclusions Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activities. PMID:23335961

  13. Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers.

    PubMed

    Reifels, Lennart; Nicholas, Angela; Fletcher, Justine; Bassilios, Bridget; King, Kylie; Ewen, Shaun; Pirkis, Jane

    2018-01-01

    Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers. We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively. Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy). This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

  14. Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective.

    PubMed

    Munce, Sarah; Kastner, Monika; Cramm, Heidi; Lal, Shalini; Deschêne, Sarah-Maude; Auais, Mohammad; Stacey, Dawn; Brouwers, Melissa

    2013-09-01

    Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.

  15. Using Live Dual Modeling to Help Preservice Teachers Develop TPACK

    ERIC Educational Resources Information Center

    Lu, Liangyue; Lei, Jing

    2012-01-01

    To help preservice teachers learn about teaching with technology--specifically, technological pedagogical content knowledge (TPACK)--the researchers designed and implemented a Live Dual Modeling strategy involving both live behavior modeling and cognitive modeling in this study. Using qualitative research methods, the researchers investigated…

  16. Interpretation and Nonformal Environmental Education in Natural Resources Management.

    ERIC Educational Resources Information Center

    Olson, E. C.; And Others

    1984-01-01

    A visitor education strategy was developed, implemented, and tested for its effectiveness in raising levels of knowledge and attitudes toward state nature preserve management. Visitor sociodemographic and site-specific data were also collected and analyzed. Methodology, results, conclusions, and implications are reported. (Author/JN)

  17. Investigating TPACK: Knowledge Growth in Teaching with Technology

    ERIC Educational Resources Information Center

    Niess, Margaret L.

    2011-01-01

    Technological pedagogical and content knowledge (TPACK) presents a dynamic framework for describing teachers' knowledge required for designing, implementing, and evaluating curriculum and instruction with technology. TPACK strategic thinking includes knowing when, where, and how to use domain-specific knowledge and strategies for guiding students'…

  18. More than Solutions: Empowering Students to Think Strategically and Tactically

    ERIC Educational Resources Information Center

    Del Gandio, Jason

    2017-01-01

    Courses: Communication Activism; Public Advocacy; Social Movements; Public Speaking; Persuasion; Argumentation; Public Sphere. Objectives: This semester-long activity helps students implement a solutions--strategies--tactics framework into their advocacy work. More specifically, students learn to (1) designate, research, and assess the causes of…

  19. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials.

    PubMed

    Brookman-Frazee, Lauren; Stahmer, Aubyn C

    2018-05-09

    The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.

  20. How Should I Study for the Exam? Self-Regulated Learning Strategies and Achievement in Introductory Biology.

    PubMed

    Sebesta, Amanda J; Bray Speth, Elena

    2017-01-01

    In college introductory science courses, students are challenged with mastering large amounts of disciplinary content while developing as autonomous and effective learners. Self-regulated learning (SRL) is the process of setting learning goals, monitoring progress toward them, and applying appropriate study strategies. SRL characterizes successful, "expert" learners, and develops with time and practice. In a large, undergraduate introductory biology course, we investigated: 1) what SRL strategies students reported using the most when studying for exams, 2) which strategies were associated with higher achievement and with grade improvement on exams, and 3) what study approaches students proposed to use for future exams. Higher-achieving students, and students whose exam grades improved in the first half of the semester, reported using specific cognitive and metacognitive strategies significantly more frequently than their lower-achieving peers. Lower-achieving students more frequently reported that they did not implement their planned strategies or, if they did, still did not improve their outcomes. These results suggest that many students entering introductory biology have limited knowledge of SRL strategies and/or limited ability to implement them, which can impact their achievement. Course-specific interventions that promote SRL development should be considered as integral pedagogical tools, aimed at fostering development of students' lifelong learning skills. © 2017 A. J. Sebesta and E. Bray Speth. CBE—Life Sciences Education © 2017 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  1. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

    PubMed Central

    2013-01-01

    Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations. PMID:23742217

  2. Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

    PubMed

    Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

    2013-06-06

    Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

  3. Design-for-Six-Sigma To Develop a Bioprocess Knowledge Management Framework.

    PubMed

    Junker, Beth; Maheshwari, Gargi; Ranheim, Todd; Altaras, Nedim; Stankevicz, Michael; Harmon, Lori; Rios, Sandra; D'anjou, Marc

    2011-01-01

    Owing to the high costs associated with biopharmaceutical development, considerable pressure has developed for the biopharmaceutical industry to increase productivity by becoming more lean and flexible. The ability to reuse knowledge was identified as one key advantage to streamline productivity, efficiently use resources, and ultimately perform better than the competition. A knowledge management (KM) strategy was assembled for bioprocess-related information using the technique of Design-for-Six-Sigma (DFSS). This strategy supported quality-by-design and process validation efforts for pipeline as well as licensed products. The DFSS technique was selected because it was both streamlined and efficient. These characteristics permitted development of a KM strategy with minimized team leader and team member resources. DFSS also placed a high emphasis on the voice of the customer, information considered crucial to the selection of solutions most appropriate for the current knowledge-based challenges of the organization. The KM strategy developed was comprised of nine workstreams, constructed from related solution buckets which in turn were assembled from the individual solution tasks that were identified. Each workstream's detailed design was evaluated against published and established best practices, as well as the KM strategy project charter and design inputs. Gaps and risks were identified and mitigated as necessary to improve the robustness of the proposed strategy. Aggregated resources (specifically expense/capital funds and staff) and timing were estimated to obtain vital management sponsorship for implementation. Where possible, existing governance and divisional/corporate information technology efforts were leveraged to minimize the additional bioprocess resources required for implementation. Finally, leading and lagging indicator metrics were selected to track the success of pilots and eventual implementation. A knowledge management framework was assembled for bioprocess-related information using a streamlined and efficient technique that minimized team leader and member resources. The technique also highly emphasized input from the staff, who generated and used the knowledge, information considered crucial to selection of solutions most appropriate for the current knowledge-based challenges in the organization. The framework developed was comprised of nine workstreams, constructed from related solution buckets which were assembled from individual solution tasks that were identified. Each workstream's detailed design was evaluated against published and established best practices, as well as the project charter and design inputs. Gaps and risks were identified and mitigated to improve robustness of the proposed framework. Aggregated resources (specifically expense/capital funds and staff) and timing were estimated to obtain vital management sponsorship for implementation. Where possible, existing governance and information technology efforts were leveraged to minimize additional bioprocess resources required for implementation. Finally, metrics were selected to track the success of pilots and eventual implementation.

  4. Design, implementation and reporting strategies to reduce the instance and impact of missing patient-reported outcome (PRO) data: a systematic review.

    PubMed

    Mercieca-Bebber, Rebecca; Palmer, Michael J; Brundage, Michael; Calvert, Melanie; Stockler, Martin R; King, Madeleine T

    2016-06-15

    Patient-reported outcomes (PROs) provide important information about the impact of treatment from the patients' perspective. However, missing PRO data may compromise the interpretability and value of the findings. We aimed to report: (1) a non-technical summary of problems caused by missing PRO data; and (2) a systematic review by collating strategies to: (A) minimise rates of missing PRO data, and (B) facilitate transparent interpretation and reporting of missing PRO data in clinical research. Our systematic review does not address statistical handling of missing PRO data. MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (inception to 31 March 2015), and citing articles and reference lists from relevant sources. English articles providing recommendations for reducing missing PRO data rates, or strategies to facilitate transparent interpretation and reporting of missing PRO data were included. 2 reviewers independently screened articles against eligibility criteria. Discrepancies were resolved with the research team. Recommendations were extracted and coded according to framework synthesis. 117 sources (55% discussion papers, 26% original research) met the eligibility criteria. Design and methodological strategies for reducing rates of missing PRO data included: incorporating PRO-specific information into the protocol; carefully designing PRO assessment schedules and defining termination rules; minimising patient burden; appointing a PRO coordinator; PRO-specific training for staff; ensuring PRO studies are adequately resourced; and continuous quality assurance. Strategies for transparent interpretation and reporting of missing PRO data include utilising auxiliary data to inform analysis; transparently reporting baseline PRO scores, rates and reasons for missing data; and methods for handling missing PRO data. The instance of missing PRO data and its potential to bias clinical research can be minimised by implementing thoughtful design, rigorous methodology and transparent reporting strategies. All members of the research team have a responsibility in implementing such strategies. 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/

  5. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

    PubMed

    Wolfenden, Luke; Jones, Jannah; Williams, Christopher M; Finch, Meghan; Wyse, Rebecca J; Kingsland, Melanie; Tzelepis, Flora; Wiggers, John; Williams, Amanda J; Seward, Kirsty; Small, Tameka; Welch, Vivian; Booth, Debbie; Yoong, Sze Lin

    2016-10-04

    Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.

  6. Using the Theory of Planned Behavior to predict implementation of harm reduction strategies among MDMA/ecstasy users.

    PubMed

    Davis, Alan K; Rosenberg, Harold

    2016-06-01

    This prospective study was designed to test whether the variables proposed by the Theory of Planned Behavior (TPB) were associated with baseline intention to implement and subsequent use of 2 MDMA/ecstasy-specific harm reduction interventions: preloading/postloading and pill testing/pill checking. Using targeted Facebook advertisements, an international sample of 391 recreational ecstasy users were recruited to complete questionnaires assessing their ecstasy consumption history, and their attitudes, subjective norms, perceived behavioral control, habit strength (past strategy use), and intention to use these two strategies. Attitudes, subjective norms, and perceived behavioral control were significantly associated with baseline intention to preload/postload and pill test/pill check. Out of the 391 baseline participants, 100 completed the two-month follow-up assessment. Baseline habit strength and frequency of ecstasy consumption during the three months prior to baseline were the only significant predictors of how often participants used the preloading/postloading strategy during the follow-up. Baseline intention to pill test/pill check was the only significant predictor of how often participants used this strategy during the follow-up. These findings provide partial support for TPB variables as both correlates of baseline intention to implement and predictors of subsequent use of these two strategies. Future investigations could assess whether factors related to ecstasy consumption (e.g., subjective level of intoxication, craving, negative consequences following consumption), and environmental factors (e.g., accessibility and availability of harm reduction resources) improve the prediction of how often ecstasy users employ these and other harm reduction strategies. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  7. [Experience with games in operative groups as part of health education for diabetics].

    PubMed

    Torres, Heloisa de Carvalho; Hortale, Virginia Alonso; Schall, Virginia

    2003-01-01

    This paper presents and discusses an educational strategy implemented in a specialized hospital clinic. The goal was to stimulate individuals to reflect on their everyday lifestyles as related to their disease, specifically diabetes mellitus. The strategy can be characterized as an educational tool from the perspective of health promotion and disease prevention and control. The experience was implemented on an interactive basis (health professionals and individual patients) with educational games in operative groups. Pedagogical techniques were used: orientation concerning diabetes mellitus, individual consultation, the operative group, and educational games (communications and learning). The techniques enabled participants to improve knowledge and exchange experiences. In addition, the health professionals gained a better understanding of the participants' experience with their illness.

  8. The BESCT Lung Cancer Program (Biology, Education, Screening, Chemoprevention, and Treatment)

    DTIC Science & Technology

    2009-03-01

    array CGH experiments to determine if other genomic changes have occurred. Specific Aim 3.8 To perform LOH studies at specific loci (if warranted from...strategies for lung cancer • To implement experimental molecular therapeutic approaches for lung cancer treatment Difficulties resulting from the...cancer has had an uncertain course ; however, inhibition of IGFR by either a monoclonal antibody or tyrosine kinase inhibitors (TKIs) is undergoing

  9. What Counts is not Falling … but Landing1

    PubMed Central

    BROUSSELLE, ASTRID

    2012-01-01

    Implementation evaluations, also called process evaluations, involve studying the development of programmes, and identifying and understanding their strengths and weaknesses. Undertaking an implementation evaluation offers insights into evaluation objectives, but does not help the researcher develop a research strategy. During the implementation analysis of the UNAIDS drug access initiative in Chile, the strategic analysis model developed by Crozier and Friedberg was used. However, a major incompatibility was noted between the procedure put forward by Crozier and Friedberg and the specific characteristics of the programme being evaluated. In this article, an adapted strategic analysis model for programme evaluation is proposed. PMID:23526306

  10. Exploring information technology adoption by family physicians: survey instrument valuation.

    PubMed Central

    Dixon, D. R.; Stewart, M.

    2000-01-01

    As the information needs of family physicians become more complex, there will be a greater need to successfully implement the technologies needed to manage that information. The ability to stratify primary care physicians can enable the implementation process to be more efficient. This research tested a new instrument on 101 family physicians, and was able to stratify physicians into high, intermediate, and low information technology (IT) usage groups. It is expected that this stratification would allow managers of IT implementation to target specific adoption strategies for each group. The instrument is available from ddixon@julian.uwo.ca. PMID:11079870

  11. CERES: An ab initio code dedicated to the calculation of the electronic structure and magnetic properties of lanthanide complexes.

    PubMed

    Calvello, Simone; Piccardo, Matteo; Rao, Shashank Vittal; Soncini, Alessandro

    2018-03-05

    We have developed and implemented a new ab initio code, Ceres (Computational Emulator of Rare Earth Systems), completely written in C++11, which is dedicated to the efficient calculation of the electronic structure and magnetic properties of the crystal field states arising from the splitting of the ground state spin-orbit multiplet in lanthanide complexes. The new code gains efficiency via an optimized implementation of a direct configurational averaged Hartree-Fock (CAHF) algorithm for the determination of 4f quasi-atomic active orbitals common to all multi-electron spin manifolds contributing to the ground spin-orbit multiplet of the lanthanide ion. The new CAHF implementation is based on quasi-Newton convergence acceleration techniques coupled to an efficient library for the direct evaluation of molecular integrals, and problem-specific density matrix guess strategies. After describing the main features of the new code, we compare its efficiency with the current state-of-the-art ab initio strategy to determine crystal field levels and properties, and show that our methodology, as implemented in Ceres, represents a more time-efficient computational strategy for the evaluation of the magnetic properties of lanthanide complexes, also allowing a full representation of non-perturbative spin-orbit coupling effects. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Engineering and agronomy aspects of a long-term precision agriculture field experiment

    USDA-ARS?s Scientific Manuscript database

    Much research has been conducted on specific precision agriculture tools and implementation strategies, but little has been reported on long-term evaluation of integrated precision agriculture field experiments. In 2004 our research team developed and initiated a multi-faceted “precision agriculture...

  13. The Learning Leader: Reflecting, Modeling, and Sharing

    ERIC Educational Resources Information Center

    Jacobs, Jacqueline E.; O'Gorman, Kevin L.

    2012-01-01

    With this book, principals, principals-in-training, and other school leaders get practical, easy-to-implement strategies for professional growth, strengthening relationships with faculty and staff, and making the necessary changes to improve K-12 learning environments. Grounded in specific, real-world examples and personal experiences, "The…

  14. What are the Effects of Implementing Learning-Focused Strategies in Biology and Physical Science Classrooms?

    NASA Astrophysics Data System (ADS)

    Simmons, Robin

    The objective of this study was to determine if Learning-Focused Strategies (LFS) implemented in high school science courses would affect student achievement and the pass rate of biology and physical science Common District Assessments (CDAs). The LFS, specific teaching strategies contained in the Learning-Focused Strategies Model (LFSM) Program were researched in this study. The LFSM Program provided a framework for comprehensive school improvement to those schools that implemented the program. The LFSM Program provided schools with consistent training in the utilization of exemplary practices and instruction. A high school located in the suburbs of Atlanta, Georgia was the focus of this investigation. Twelve high school science classrooms participated in the study: six biology and six physical science classes. Up-to-date research discovered that the strategies contained in the LFSM Program were research-based and highly effective for elementary and middle school instruction. Research on its effectiveness in high school instruction was the main focus of this study. This investigation utilized a mixed methods approach, in which data were examined qualitatively and quantitatively. Common District Assessment (CDA) quantitative data were collected and compared between those science classrooms that utilized LFS and those using traditional instructional strategies. Qualitative data were generated through classroom observations, student surveys, and teacher interviews. Individual data points were triangulated to determine trends of information reflecting the effects of implementing LFS. Based on the data collected in the research study, classrooms utilizing LFS were more successful academically than the classrooms using traditional instructional methods. Derived from the quantitative data, students in LFS classrooms were more proficient on both the biology and physical science Unit 1 CDAs, illustrating the effectiveness of LFS in the science classroom. Key terms: Cognitive teaching strategies, College readiness, Common District Assessments (CDAs), Concept maps, Constructivism, Curriculum, Differentiated Instruction, Instruction, Formative assessments, Learning-Focused Strategies (LFS), Learning-Focused Strategies Model (LFSM), No Child Left Behind (NCLB), Post-secondary institution, Remediation courses, School improvement grant, School reform, Secondary institution, Traditional instructional strategies.

  15. Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS): a cluster randomized trial targeting system-wide improvement in substance use services.

    PubMed

    Knight, Danica K; Belenko, Steven; Wiley, Tisha; Robertson, Angela A; Arrigona, Nancy; Dennis, Michael; Bartkowski, John P; McReynolds, Larkin S; Becan, Jennifer E; Knudsen, Hannah K; Wasserman, Gail A; Rose, Eve; DiClemente, Ralph; Leukefeld, Carl

    2016-04-29

    The purpose of this paper is to describe the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. This paper describes (a) the study background and rationale, including the juvenile justice context and best practices for substance use disorders, (b) the selection and use of an implementation science framework to guide study design and inform selection of implementation components, and (c) the specific study design elements, including research questions, implementation interventions, measurement, and analytic plan. The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in seven states. A Core strategy for promoting change is compared to an Enhanced strategy that incorporates all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment. Contributions to implementation science are discussed as well as challenges associated with designing and deploying a complex, collaborative project. NCT02672150 .

  16. A Collision Avoidance Strategy for a Potential Natural Satellite around the Asteroid Bennu for the OSIRIS-REx Mission

    NASA Technical Reports Server (NTRS)

    Mashiku, Alinda K.; Carpenter, J. Russell

    2016-01-01

    The cadence of proximity operations for the OSIRIS-REx mission may have an extra induced challenge given the potential of the detection of a natural satellite orbiting the asteroid Bennu. Current ground radar observations for object detection orbiting Bennu show no found objects within bounds of specific size and rotation rates. If a natural satellite is detected during approach, a different proximity operation cadence will need to be implemented as well as a collision avoidance strategy for mission success. A collision avoidance strategy will be analyzed using the Wald Sequential Probability Ratio Test.

  17. A Collision Avoidance Strategy for a Potential Natural Satellite Around the Asteroid Bennu for the OSIRIS-REx Mission

    NASA Technical Reports Server (NTRS)

    Mashiku, Alinda; Carpenter, Russell

    2016-01-01

    The cadence of proximity operations for the OSIRIS-REx mission may have an extra induced challenge given the potential of the detection of a natural satellite orbiting the asteroid Bennu. Current ground radar observations for object detection orbiting Bennu show no found objects within bounds of specific size and rotation rates. If a natural satellite is detected during approach, a different proximity operation cadence will need to be implemented as well as a collision avoidance strategy for mission success. A collision avoidance strategy will be analyzed using the Wald Sequential Probability Ratio Test.

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

    PubMed

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

    2014-02-01

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

  19. Providing culturally competent services for American Indian and Alaska Native veterans to reduce health care disparities.

    PubMed

    Noe, Timothy D; Kaufman, Carol E; Kaufmann, L Jeanne; Brooks, Elizabeth; Shore, Jay H

    2014-09-01

    We conducted an exploratory study to determine what organizational characteristics predict the provision of culturally competent services for American Indian and Alaska Native (AI/AN) veterans in Department of Veterans Affairs (VA) health facilities. In 2011 to 2012, we adapted the Organizational Readiness to Change Assessment (ORCA) for a survey of 27 VA facilities in the Western Region to assess organizational readiness and capacity to adopt and implement native-specific services and to profile the availability of AI/AN veteran programs and interest in and resources for such programs. Several ORCA subscales (Program Needs, Leader's Practices, and Communication) statistically significantly predicted whether VA staff perceived that their facilities were meeting the needs of AI/AN veterans. However, none predicted greater implementation of native-specific services. Our findings may aid in developing strategies for adopting and implementing promising native-specific programs and services for AI/AN veterans, and may be generalizable for other veteran groups.

  20. Providing Culturally Competent Services for American Indian and Alaska Native Veterans to Reduce Health Care Disparities

    PubMed Central

    Kaufman, Carol E.; Kaufmann, L. Jeanne; Brooks, Elizabeth; Shore, Jay H.

    2014-01-01

    Objectives. We conducted an exploratory study to determine what organizational characteristics predict the provision of culturally competent services for American Indian and Alaska Native (AI/AN) veterans in Department of Veterans Affairs (VA) health facilities. Methods. In 2011 to 2012, we adapted the Organizational Readiness to Change Assessment (ORCA) for a survey of 27 VA facilities in the Western Region to assess organizational readiness and capacity to adopt and implement native-specific services and to profile the availability of AI/AN veteran programs and interest in and resources for such programs. Results. Several ORCA subscales (Program Needs, Leader’s Practices, and Communication) statistically significantly predicted whether VA staff perceived that their facilities were meeting the needs of AI/AN veterans. However, none predicted greater implementation of native-specific services. Conclusions. Our findings may aid in developing strategies for adopting and implementing promising native-specific programs and services for AI/AN veterans, and may be generalizable for other veteran groups. PMID:25100420

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

    PubMed

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

    2014-02-21

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

  2. Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation

    PubMed Central

    Gutiérrez-Colina, Ana; Toder, Katherine; Esposito, Gregory; Barg, Frances; Castro, Frank; Beck, Aaron T.; Crits-Christoph, Paul

    2012-01-01

    Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings. PMID:22426739

  3. From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science.

    PubMed

    Lewis, Cara C; Klasnja, Predrag; Powell, Byron J; Lyon, Aaron R; Tuzzio, Leah; Jones, Salene; Walsh-Bailey, Callie; Weiner, Bryan

    2018-01-01

    The science of implementation has offered little toward understanding how different implementation strategies work. To improve outcomes of implementation efforts, the field needs precise, testable theories that describe the causal pathways through which implementation strategies function. In this perspective piece, we describe a four-step approach to developing causal pathway models for implementation strategies. First, it is important to ensure that implementation strategies are appropriately specified. Some strategies in published compilations are well defined but may not be specified in terms of its core component that can have a reliable and measureable impact. Second, linkages between strategies and mechanisms need to be generated. Existing compilations do not offer mechanisms by which strategies act, or the processes or events through which an implementation strategy operates to affect desired implementation outcomes. Third, it is critical to identify proximal and distal outcomes the strategy is theorized to impact, with the former being direct, measurable products of the strategy and the latter being one of eight implementation outcomes (1). Finally, articulating effect modifiers, like preconditions and moderators, allow for an understanding of where, when, and why strategies have an effect on outcomes of interest. We argue for greater precision in use of terms for factors implicated in implementation processes; development of guidelines for selecting research design and study plans that account for practical constructs and allow for the study of mechanisms; psychometrically strong and pragmatic measures of mechanisms; and more robust curation of evidence for knowledge transfer and use.

  4. Implementation Measurement for Evidence-Based Violence Prevention Programs in Communities.

    PubMed

    Massetti, Greta M; Holland, Kristin M; Gorman-Smith, Deborah

    2016-08-01

    Increasing attention to the evaluation, dissemination, and implementation of evidence-based programs (EBPs) has led to significant advancements in the science of community-based violence prevention. One of the prevailing challenges in moving from science to community involves implementing EBPs and strategies with quality. The CDC-funded National Centers of Excellence in Youth Violence Prevention (YVPCs) partner with communities to implement a comprehensive community-based strategy to prevent violence and to evaluate that strategy for impact on community-wide rates of violence. As part of their implementation approach, YVPCs document implementation of and fidelity to the components of the comprehensive youth violence prevention strategy. We describe the strategies and methods used by the six YVPCs to assess implementation and to use implementation data to inform program improvement efforts. The information presented describes the approach and measurement strategies employed by each center and for each program implemented in the partner communities. YVPCs employ both established and innovative strategies for measurement and tracking of implementation across a broad range of programs, practices, and strategies. The work of the YVPCs highlights the need to use data to understand the relationship between implementation of EBPs and youth violence outcomes.

  5. APPLYING LESSONS LEARNED FROM THE UNITED STATES SPECIAL OPERATIONS COMMAND’S HUMAN PERFORMANCE PROGRAM TO THE UNITED STATES AIR FORCES COMPREHENSIVE AIRMAN FITNESS

    DTIC Science & Technology

    2016-04-01

    implementation, focusing physical training on the mission specific requirements of the individual similar to an athletic sports model, increasing access to...initiative as a mechanism to help maintain the resiliency, health, and welfare of its force.1 As Air Force Instruction (AFI) 90-506 states, the strategy ...implementation of Tactical Athlete Programs, which provide tailored workout plans and nutrition education that prepare service members to meet the physical

  6. Northeast Artificial Intelligence Consortium (NAIC). Volume 15. Strategies for Coupling Symbolic and Numerical Computation in Knowledge Base Systems

    DTIC Science & Technology

    1990-12-01

    Implementation of Coupled System 18 15.4. CASE STUDIES & IMPLEMENTATION EXAMPLES 24 15.4.1. The Case Studies of Coupled System 24 15.4.2. Example: Coupled System...occurs during specific phases of the problem-solving process. By decomposing the coupling process into its component layers we effectively study the nature...by the qualitative model, appropriate mathematical model is invoked. 5) The results are verified. If successful, stop. Else go to (2) and use an

  7. A Coherent Approach to High School Improvement: A District and School Self-Assessment Tool

    ERIC Educational Resources Information Center

    Fryer, Lindsay; Johnson, Amy

    2012-01-01

    High school improvement initiatives often focus on specific intervention strategies, programs, or priority topics (e.g., dropout intervention, dual enrollment, freshman academies). However, research shows that systemic and sustainable improvement can be achieved only when initiatives are implemented with consideration for the broader education…

  8. TQE, Technology, and Teaching.

    ERIC Educational Resources Information Center

    Hertzke, Eugene R.; Olson, Warren E.

    This book provides a total "how-to" approach for the use of technology, including information on the types of systems, hardware, and software available. It offers guidelines for determining how to match specific systems and needs, as well as strategies for implementing technology and Total Quality Education (TQE) to improve teaching. It…

  9. Clinical Office Safety: Strategies to Enhance the Safety of Staff and Clients

    ERIC Educational Resources Information Center

    Wilson, Richard M.

    2012-01-01

    Mental health practitioners' exposure to threats and acts of nonfatal violence are among the highest of all professions. Implementing a comprehensive workplace violence prevention program specific to the clinical setting is paramount to decreasing these risks. However, generic security recommendations at times come in conflict with the…

  10. Implementing Integrated Multicultural Instructional Design in Management Education

    ERIC Educational Resources Information Center

    Schultz, Jennifer L.; Higbee, Jeanne L.

    2011-01-01

    This purpose of this paper is to summarize the principles of integrated multicultural instructional design (IMID; Higbee, Goff, & Schultz, in press; Higbee, Schultz, & Goff, 2010) and present specific strategies for incorporating IMID in management education. The primary goal of IMID is to promote the integration of multicultural content…

  11. Rap and Resistance: A Social Movement of the Wu-Tang Clan.

    ERIC Educational Resources Information Center

    Chasteen, Amy L.; Shriver, Thomas

    1998-01-01

    Examines specific collective identity and political expression of the rap group the Wu-Tang Clan. Reveals a multi-layered political strategy that has been conscientiously designed and implemented to instigate a social movement. Prioritizes the voices of marginalized Black peoples and provides raw narratives about oppression. (MMU)

  12. Helping Students Overcome Depression and Anxiety: A Practical Guide. Second Edition

    ERIC Educational Resources Information Center

    Merrell, Kenneth W.

    2008-01-01

    This guide provides expert information and clear-cut strategies for assessing and treating internalizing problems in school settings. More than 40 specific psychoeducational and psychosocial intervention techniques are detailed, with a focus on approaches that are evidence based, broadly applicable, and easy to implement. Including 26…

  13. Teachers' Perceived Values on the Effect of Literacy Strategy Professional Development

    ERIC Educational Resources Information Center

    Mundy, Marie-Anne; Howe, Mary E.; Kupczynski, Lori

    2015-01-01

    This study examined 299 Louisiana teachers from three school districts regarding their perceptions of the value provided by specific types of professional development (PD) including professional learning communities (PLC), demonstration lessons, and in-service as well as graduate hours in reading/literacy on implementation (frequency of use),…

  14. The Distance Education Evolution: Issues and Case Studies

    ERIC Educational Resources Information Center

    Monolescu, Dominique; Schifter, Catherine; Greenwood, Linda

    2004-01-01

    "The Distance Education Evolution: Case Studies" addresses issues regarding the development and design of online courses, and the implementation and evaluation of an online learning program. Several chapters include design strategies for online courses that range from the specific to the universal. Many authors address pedagogical issues from both…

  15. Metrics for measuring net-centric data strategy implementation

    NASA Astrophysics Data System (ADS)

    Kroculick, Joseph B.

    2010-04-01

    An enterprise data strategy outlines an organization's vision and objectives for improved collection and use of data. We propose generic metrics and quantifiable measures for each of the DoD Net-Centric Data Strategy (NCDS) data goals. Data strategy metrics can be adapted to the business processes of an enterprise and the needs of stakeholders in leveraging the organization's data assets to provide for more effective decision making. Generic metrics are applied to a specific application where logistics supply and transportation data is integrated across multiple functional groups. A dashboard presents a multidimensional view of the current progress to a state where logistics data shared in a timely and seamless manner among users, applications, and systems.

  16. International migration, "middle classness" and the state.

    PubMed

    Grant, G S

    1995-01-01

    "This paper examines the issues of who is likely to migrate and why, and what happens when people migrate, by viewing the migratory process as a strategy formulated and implemented by networks of kin for culturally surviving the redefinitions of contemporary political systems within the context of the capitalist world economy. Specifically the argument presented is that people move across the juridical boundaries of contemporary nation-states as part of household strategies designed to maintain membership in a specific social stratum. For a substantial number this social stratum is a middle class. Self-identification with a social stratum, in other words, takes precedence over self-identification with, and commitments to, nation, region or ethnic group." excerpt

  17. Wearing the White Hat: The Effect of American Strategic Culture on Implementing National Strategy

    DTIC Science & Technology

    2000-06-01

    governing behavior are transmitted physiologically—an infant’s desire for food , for example, is triggered by internal stimuli. An adult’s specific desire...victorious states swore never again to cut off food or water from besieged fellow Greeks (a practice that was to occur centuries later in the...strategy aimed at destroying the enemy’s food supply, thus using famine as a means to eradicate the Indian population.”48 The war between the Indians and

  18. Marketing strategies for the cosmetic practice.

    PubMed

    Austin, C J

    1994-01-01

    Appropriate marketing business systems need to be in place to attract and sustain a cosmetic dentistry patient base. Marketing for this sector is most effective when consistently patterned after businesses with high-end consumer services and products. Motivating patients of record and potential new patients to choose cosmetic dental services involves implementing both basic marketing and a series of cosmetic-specific marketing strategies. Consultants are valuable for the process of developing a strategic plan and making recommendations for developing new marketing business systems.

  19. The regulation of emotions in adolescents: Age differences and emotion-specific patterns

    PubMed Central

    Theurel, Anne

    2018-01-01

    Two experiments addressed the issue of age-related differences and emotion-specific patterns in emotion regulation during adolescence. Experiment 1 examined emotion-specific patterns in the effectiveness of reappraisal and distraction strategies in 14-year-old adolescents (N = 50). Adolescents were instructed to answer spontaneously or to downregulate their responses by using either distraction or cognitive reappraisal strategies before viewing negative pictures and were asked to rate their emotional state after picture presentation. Results showed that reappraisal effectiveness was modulated by emotional content but distraction was not. Reappraisal was more effective than distraction at regulating fear or anxiety (threat-related pictures) but was similar to distraction regarding other emotions. Using the same paradigm, Experiment 2 examined in 12-year-old (N = 56), 13-year-old (N = 49) and 15-year-old adolescents (N = 54) the age-related differences a) in the effectiveness of reappraisal and distraction when implemented and b) in the everyday use of regulation strategies using the Cognitive Emotion Regulation Questionnaire. Results revealed that regulation effectiveness was equivalent for both strategies in 12-year-olds, whereas a large improvement in reappraisal effectiveness was observed in 13- and 15-year-olds. No age differences were observed in the reported use of reappraisal, but older adolescents less frequently reported using distraction and more frequently reported using the rumination strategy. Taken together, these experiments provide new findings regarding the use and the effectiveness of cognitive regulation strategies during adolescence in terms of age differences and emotion specificity. PMID:29879165

  20. Implementation of the American Society of Anesthesiology's guidelines to reduce prolonged fasting times in pediatric preoperative patients: a best practice implementation project.

    PubMed

    Costello, Carol M

    2016-10-01

    The American Society of Anesthesiology (ASA) guidelines for pediatric preoperative fasting have been a standard for well over a decade. However, use of protocols involving an excessive fasting duration exposes patients to the physiological impacts of fluid volume loss. The current project aimed to improve fluid supplementation during presurgical fasting in pediatric patients at an academic medical center. Specific objectives were to increase clinical staff knowledge regarding ASA fasting standards and implement them in specific pediatric patient populations. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice tools were used. A baseline audit assessed compliance with best practice criteria regarding staff education, patient/family instruction and preoperative fasting times. Intervention outcomes were evaluated in a post implementation criteria audit. Although compliance with fasting less than 12 hours more than doubled, only half of these patients/parents adhered to the guidelines. No excessive fasting events were attributed to a language barrier. There were no insufficient fasting events. Moderate success with fasting compliance was demonstrated when patients/parents were taught the multi-step ASA non per os (nothing by mouth) instructions. This complexity may have contributed to non-compliance and pointed to the need for enhanced teaching strategies. No operative start delays related to insufficient fasting indicated surgical scheduling flexibility was not at risk, and anesthesia providers had adopted the guidelines. Interdisciplinary engagement in this project was significantly impacted by director level communication which will be a key strategy for future implementations.

  1. Train-the-trainer: implementation of cognitive behavioural guided self-help for recurrent binge eating in a naturalistic setting.

    PubMed

    Zandberg, Laurie J; Wilson, G Terence

    2013-05-01

    The present study evaluated the feasibility and acceptability of cognitive behavioural guided self-help (CBTgsh) for recurrent binge eating using the train-the-trainer implementation strategy. After receiving expert-led training in CBTgsh, a master's-level graduate student in clinical psychology subsequently trained and supervised less experienced graduate students to implement the treatment in an open clinical trial. Participants were 38 treatment-seeking students at a university counselling centre with recurrent binge eating, featuring cases of bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified. Intent-to-treat (ITT) analyses revealed 42.1% abstinence from binge eating at post-treatment and 47.4% at one-month follow-up. Participants reported significant pretreatment to post-treatment reductions on measures of specific eating disorder psychopathology, general psychopathology, and functional impairment and high levels of treatment acceptability. These results provide 'proof-of-concept' for the train-the-trainer implementation strategy and add to the evidence supporting the feasibility and effectiveness of CBTgsh in routine clinical care. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

  2. Towards a resilience management framework for complex enterprise systems upgrade implementation

    NASA Astrophysics Data System (ADS)

    Teoh, Say Yen; Yeoh, William; Zadeh, Hossein Seif

    2017-05-01

    The lack of knowledge of how resilience management supports enterprise system (ES) projects accounts for the failure of firms to leverage their investments in costly ES implementations. Using a structured-pragmatic-situational (SPS) case study research approach, this paper reports on an investigation into the resilience management of a large utility company as it implemented an ES upgrade. Drawing on the literature and on the case study findings, we developed a process-based resilience management framework that involves three strategies (developing situation awareness, demystifying threats, and executing restoration plans) and four organisational capabilities that transform resilience management concepts into practices. We identified the crucial phases of ES upgrade implementation and developed indicators for how different strategies and capabilities of resilience management can assist managers at different stages of an ES upgrade. This research advances the state of existing knowledge by providing specific and verifiable propositions for attaining a state of resilience, the knowledge being grounded in the empirical reality of a case study. Moreover, the framework offers ES practitioners a roadmap to better identify appropriate responses and levels of preparedness.

  3. Technical Packages in Injury and Violence Prevention to Move Evidence Into Practice: Systematic Reviews and Beyond.

    PubMed

    Haegerich, Tamara M; David-Ferdon, Corinne; Noonan, Rita K; Manns, Brian J; Billie, Holly C

    2016-09-07

    Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. "Technical packages," developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence. © The Author(s) 2016.

  4. Reliable nanomaterial classification of powders using the volume-specific surface area method

    NASA Astrophysics Data System (ADS)

    Wohlleben, Wendel; Mielke, Johannes; Bianchin, Alvise; Ghanem, Antoine; Freiberger, Harald; Rauscher, Hubert; Gemeinert, Marion; Hodoroaba, Vasile-Dan

    2017-02-01

    The volume-specific surface area (VSSA) of a particulate material is one of two apparently very different metrics recommended by the European Commission for a definition of "nanomaterial" for regulatory purposes: specifically, the VSSA metric may classify nanomaterials and non-nanomaterials differently than the median size in number metrics, depending on the chemical composition, size, polydispersity, shape, porosity, and aggregation of the particles in the powder. Here we evaluate the extent of agreement between classification by electron microscopy (EM) and classification by VSSA on a large set of diverse particulate substances that represent all the anticipated challenges except mixtures of different substances. EM and VSSA are determined in multiple labs to assess also the level of reproducibility. Based on the results obtained on highly characterized benchmark materials from the NanoDefine EU FP7 project, we derive a tiered screening strategy for the purpose of implementing the definition of nanomaterials. We finally apply the screening strategy to further industrial materials, which were classified correctly and left only borderline cases for EM. On platelet-shaped nanomaterials, VSSA is essential to prevent false-negative classification by EM. On porous materials, approaches involving extended adsorption isotherms prevent false positive classification by VSSA. We find no false negatives by VSSA, neither in Tier 1 nor in Tier 2, despite real-world industrial polydispersity and diverse composition, shape, and coatings. The VSSA screening strategy is recommended for inclusion in a technical guidance for the implementation of the definition.

  5. The landscape of knowledge translation interventions in cancer control: What do we know and where to next? A review of systematic reviews

    PubMed Central

    2011-01-01

    Background Effective implementation strategies are needed to optimize advancements in the fields of cancer diagnosis, treatment, survivorship, and end-of-life care. We conducted a review of systematic reviews to better understand the evidentiary base of implementation strategies in cancer control. Methods Using three databases, we conducted a search and identified English-language systematic reviews published between 2005 and 2010 that targeted consumer, professional, organizational, regulatory, or financial interventions, tested exclusively or partially in a cancer context (primary focus); generic or non-cancer-specific reviews were also considered. Data were extracted, appraised, and analyzed by members of the research team, and research ideas to advance the field were proposed. Results Thirty-four systematic reviews providing 41 summaries of evidence on 19 unique interventions comprised the evidence base. AMSTAR quality ratings ranged between 2 and 10. Team members rated most of the interventions as promising and in need of further research, and 64 research ideas were identified. Conclusions While many interventions show promise of effectiveness in the cancer-control context, few reviews were able to conclude definitively in favor of or against a specific intervention. We discuss the complexity of implementation research and offer suggestions to advance the science in this area. PMID:22185329

  6. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study.

    PubMed

    Waltz, Thomas J; Powell, Byron J; Matthieu, Monica M; Damschroder, Laura J; Chinman, Matthew J; Smith, Jeffrey L; Proctor, Enola K; Kirchner, JoAnn E

    2015-08-07

    Poor terminological consistency for core concepts in implementation science has been widely noted as an obstacle to effective meta-analyses. This inconsistency is also a barrier for those seeking guidance from the research literature when developing and planning implementation initiatives. The Expert Recommendations for Implementing Change (ERIC) study aims to address one area of terminological inconsistency: discrete implementation strategies involving one process or action used to support a practice change. The present report is on the second stage of the ERIC project that focuses on providing initial validation of the compilation of 73 implementation strategies that were identified in the first phase. Purposive sampling was used to recruit a panel of experts in implementation science and clinical practice (N = 35). These key stakeholders used concept mapping sorting and rating activities to place the 73 implementation strategies into similar groups and to rate each strategy's relative importance and feasibility. Multidimensional scaling analysis provided a quantitative representation of the relationships among the strategies, all but one of which were found to be conceptually distinct from the others. Hierarchical cluster analysis supported organizing the 73 strategies into 9 categories. The ratings data reflect those strategies identified as the most important and feasible. This study provides initial validation of the implementation strategies within the ERIC compilation as being conceptually distinct. The categorization and strategy ratings of importance and feasibility may facilitate the search for, and selection of, strategies that are best suited for implementation efforts in a particular setting.

  7. Organizational strategies for promoting patient and provider uptake of personal health records

    PubMed Central

    Wells, Susan; Rozenblum, Ronen; Park, Andrea; Dunn, Marie; Bates, David W

    2015-01-01

    Objective To investigate organizational strategies to promote personal health records (PHRs) adoption with a focus on patients with chronic disease. Methods Using semi-structured interviews and a web-based survey, we sampled US health delivery organizations which had implemented PHRs for at least 12 months, were recognized as PHR innovators, and had scored highly in national patient satisfaction surveys. Respondents had lead positions for clinical information systems or high-risk population management. Using grounded theory approach, thematic categories were derived from interviews and coupled with data from the survey. Results Interviews were conducted with 30 informants from 16 identified organizations. Organizational strategies were directed towards raising patient awareness via multimedia communications, and provider acceptance and uptake. Strategies for providers were grouped into six main themes: organizational vision, governance and policies, work process redesign, staff training, information technology (IT) support, and monitoring and incentives. Successful organizations actively communicated their vision, engaged leaders at all levels, had clear governance, planning, and protocols, set targets, and celebrated achievement. The most effective strategy for patient uptake was through health professional encouragement. No specific outreach efforts targeted patients with chronic disease. Registration and PHR activity was routinely measured but without reference to a denominator population or high risk subpopulations. Discussion and conclusion Successful PHR implementation represents a social change and operational project catalyzed by a technical solution. The key to clinician acceptance is making their work easier. However, organizations will likely not achieve the value they want from PHRs unless they target specific populations and monitor their uptake. PMID:25326601

  8. The Examination of the Effects of Writing Strategy-Based Procedural Facilitative Environments on Students' English Foreign Language Writing Anxiety Levels

    PubMed Central

    Tsiriotakis, Ioanna K.; Vassilaki, Eleni; Spantidakis, Ioannis; Stavrou, Nektarios A. M.

    2017-01-01

    Empirical studies have shown that anxiety and negative emotion can hinder language acquisition. The present study implemented a writing instructional model so as to investigate its effects on the writing anxiety levels of English Foreign Language learners. The study was conducted with 177 participants, who were administered the Second Language Writing Anxiety Inventory (SLWAI; Cheng, 2004) that assesses somatic, cognitive and behavioral anxiety, both at baseline and following the implementation of a writing instructional model. The hypothesis stated that the participant's writing anxiety levels would lessen following the provision of a writing strategy-based procedural facilitative environment that fosters cognitive apprenticeship. The initial hypothesis was supported by the findings. Specifically, in the final measurement statistical significant differences appeared where participants in the experimental group showed notable lower mean values of the three factors of anxiety, a factor that largely can be attributed to the content of the intervention program applied to this specific group. The findings validate that Foreign Language writing anxiety negatively effects Foreign Language learning and performance. The findings also support the effectiveness of strategy-based procedural facilitative writing environments that foster cognitive apprenticeship, so as to enhance language skill development and reduce feelings of Foreign Language writing anxiety. PMID:28119658

  9. [Situational profile and intervention strategy in the Mesoamerican region in maternal, neonatal and reproductive health area].

    PubMed

    Hernández-Prado, Bernardo; Kestler, Edgar; Díaz, Juan; Walker, Dilys; Langer, Ana; Lewis, Sarah; De la Vara-Salazar, Elvia; Melo-Zurita, María del Carmen; Iriarte, Emma; Danel, Isabella; Donnay, France; Alemán, Denis; Serrano, Roselyn; Morales, Evelyn; Largaespada, Natalia; González, José Douglas Jarquín; Hernández, Ma Del Carmen; Mejía, Claudia E Quiroz; González, Geneva; Carrera, Yadira; Valverde, Clelia; Luna, Rufino; Valencia-Mendoza, Atanacio; Sosa-Rubí, Sandra G; Hernández-Prado, Bernardo; Kestler, Edgar; Díaz, Juan; Walker, Dilys; Langer, Ana; Lewis, Sarah; De la Vara-Salazar, Elvia; Melo-Zurita, María Del Carmen

    2011-01-01

    To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.

  10. The Examination of the Effects of Writing Strategy-Based Procedural Facilitative Environments on Students' English Foreign Language Writing Anxiety Levels.

    PubMed

    Tsiriotakis, Ioanna K; Vassilaki, Eleni; Spantidakis, Ioannis; Stavrou, Nektarios A M

    2016-01-01

    Empirical studies have shown that anxiety and negative emotion can hinder language acquisition. The present study implemented a writing instructional model so as to investigate its effects on the writing anxiety levels of English Foreign Language learners. The study was conducted with 177 participants, who were administered the Second Language Writing Anxiety Inventory (SLWAI; Cheng, 2004) that assesses somatic, cognitive and behavioral anxiety, both at baseline and following the implementation of a writing instructional model. The hypothesis stated that the participant's writing anxiety levels would lessen following the provision of a writing strategy-based procedural facilitative environment that fosters cognitive apprenticeship. The initial hypothesis was supported by the findings. Specifically, in the final measurement statistical significant differences appeared where participants in the experimental group showed notable lower mean values of the three factors of anxiety, a factor that largely can be attributed to the content of the intervention program applied to this specific group. The findings validate that Foreign Language writing anxiety negatively effects Foreign Language learning and performance. The findings also support the effectiveness of strategy-based procedural facilitative writing environments that foster cognitive apprenticeship, so as to enhance language skill development and reduce feelings of Foreign Language writing anxiety.

  11. The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015.

    PubMed

    Manser, Tanja; Frings, Janina; Heuser, Gregory; Mc Dermott, Fiona

    2016-01-01

    Despite the growing recognition of the need to implement systematic approaches for managing the risks associated with healthcare, few studies have investigated the level of implementation for clinical risk management (CRM) at a national level. Therefore, this study aimed to assess the current level of CRM implementation in German hospitals and to explore differences across hospital types. From March to June 2015, persons responsible for CRM in 2,617 hospitals and rehabilitation clinics in Germany were invited to participate in a voluntary online survey assessing the level of implementation for various aspects of CRM: CRM strategy, structures and processes; risk assessment (risk identification, risk analysis, risk evaluation) with a focus on incident reporting systems; risk mitigation measures; and risk monitoring and reporting. 572 hospitals participated in the survey (response rate 22 %). Most of these hospitals had a formalised, binding CRM strategy (72 %). 66 % had a centralised and 34 % a decentralised CRM structure. We also found that, despite a broad range of risk assessment methods being applied, there was a lack of integration of risk information from different data sources. Hospitals also reported a high level of implementation of critical incident reporting systems with a strong preference for local (74 %) over transorganisational systems. This study provides relevant data to inform targeted interventions concerning CRM implementation at a national level and to consider the specific context of different types of hospitals more carefully in this process. The approach to CRM assessment illustrated in this article could be the basis of a system for monitoring CRM over time and, thus, for evaluating the impact of strategy decisions at the policy level on CRM development. Copyright © 2016. Published by Elsevier GmbH.

  12. The promise and challenge of practice-research collaborations: Guiding principles and strategies for initiating, designing, and implementing program evaluation research.

    PubMed

    Secret, Mary; Abell, Melissa L; Berlin, Trey

    2011-01-01

    The authors present a set of guiding principles and strategies to facilitate the collaborative efforts of social work researchers and practitioners as they initiate, design, and implement outcome evaluations of human service interventions and programs. Beginning with an exploration of the interpersonal barriers to practice-research collaborations, and building on their experiences in successfully completing a community-based research evaluation, the authors identify specific relationship-focused principles and strategies and illustrate how these approaches can guide practice-research teams through the various sequential activities of the evaluation research process. In particular, it is suggested that practice-research collaborations can be formed, strengthened, and sustained by emphasis on a spirit of discovery and shared leadership at the start of the relationship, use of a comprehensive evaluation model to clarify and frame the evaluation and program goals, beginning where the client is when selecting research methodology and measurement tools, commitment to keeping the program first and recording everything during the implementation and data-collection stages, discussion of emerging findings and presentation of findings in graphic format at the data-analysis stage, and a total team approach at the dissemination stage.

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

    PubMed

    Moyo, Laurane; Wehn, Uta

    2017-02-01

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

  14. Evaluation of control strategies using an oxidation ditch benchmark.

    PubMed

    Abusam, A; Keesman, K J; Spanjers, H; van, Straten G; Meinema, K

    2002-01-01

    This paper presents validation and implementation results of a benchmark developed for a specific full-scale oxidation ditch wastewater treatment plant. A benchmark is a standard simulation procedure that can be used as a tool in evaluating various control strategies proposed for wastewater treatment plants. It is based on model and performance criteria development. Testing of this benchmark, by comparing benchmark predictions to real measurements of the electrical energy consumptions and amounts of disposed sludge for a specific oxidation ditch WWTP, has shown that it can (reasonably) be used for evaluating the performance of this WWTP. Subsequently, the validated benchmark was then used in evaluating some basic and advanced control strategies. Some of the interesting results obtained are the following: (i) influent flow splitting ratio, between the first and the fourth aerated compartments of the ditch, has no significant effect on the TN concentrations in the effluent, and (ii) for evaluation of long-term control strategies, future benchmarks need to be able to assess settlers' performance.

  15. Knowledge translation strategies for enhancing nurses' evidence-informed decision making: a scoping review.

    PubMed

    Yost, Jennifer; Thompson, David; Ganann, Rebecca; Aloweni, Fazila; Newman, Kristine; McKibbon, Ann; Dobbins, Maureen; Ciliska, Donna

    2014-06-01

    Nurses are increasingly expected to engage in evidence-informed decision making (EIDM); the use of research evidence with information about patient preferences, clinical context and resources, and their clinical expertise in decision making. Strategies for enhancing EIDM have been synthesized in high-quality systematic reviews, yet most relate to physicians or mixed disciplines. Existing reviews, specific to nursing, have not captured a broad range of strategies for promoting the knowledge and skills for EIDM, patient outcomes as a result of EIDM, or contextual information for why these strategies "work." To conduct a scoping review to identify and map the literature related to strategies implemented among nurses in tertiary care for promoting EIDM knowledge, skills, and behaviours, as well as patient outcomes and contextual implementation details. A search strategy was developed and executed to identify relevant research evidence. Participants included registered nurses, clinical nurse specialists, nurse practitioners, and advanced practice nurses. Strategies were those enhancing nurses' EIDM knowledge, skills, or behaviours, as well as patient outcomes. Relevant studies included systematic reviews, randomized controlled trials, cluster randomized controlled trials, non-randomized trials (including controlled before and after studies), cluster non-randomized trials, interrupted time series designs, prospective cohort studies, mixed-method studies, and qualitative studies. Two reviewers performed study selection and data extraction using standardized forms. Disagreements were resolved through discussion or third party adjudication. Using a narrative synthesis, the body of research was mapped by design, clinical areas, strategies, and provider and patient outcomes to determine areas appropriate for a systematic review. There are a sufficiently high number of studies to conduct a more focused systematic review by care settings, study design, implementation strategies, or outcomes. A focused review could assist in determining which strategies can be recommended for enhancing EIDM knowledge, skills, and behaviours among nurses in tertiary care. © 2014 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International.

  16. Developing geogebra-assisted reciprocal teaching strategy to improve junior high school students’ abstraction ability, lateral thinking and mathematical persistence

    NASA Astrophysics Data System (ADS)

    Priatna, N.; Martadiputra, B. A. P.; Wibisono, Y.

    2018-05-01

    The development of science and technology requires reform in the utilization of various resources for mathematics teaching and learning process. One of the efforts that can be made is the implementation of GeoGebra-assisted Reciprocal Teaching strategy in mathematics instruction as an effective strategy in improving students’ cognitive, affective, and psychomotor abilities. This research is intended to implement GeoGebra-assisted Reciprocal Teaching strategy in improving abstraction ability, lateral thinking, and mathematical persistence of junior high school students. It employed quasi-experimental method with non-random pre-test and post-test control design. More specifically, it used the 2x3 factorial design, namely the learning factors that included GeoGebra-assisted Reciprocal Teaching and conventional teaching learning, and levels of early mathematical ability (high, middle, and low). The subjects in this research were the eighth grade students of junior high school, taken with purposive sampling. The results of this research show: Abstraction and lateral abilities of students who were taught with GeoGebra-assisted Reciprocal Teaching strategy were significantly higher than those of students who received conventional learning. Mathematical persistence of students taught with GeoGebra-assisted Reciprocal Teaching strategy was also significantly higher than of those taught with conventional learning.

  17. Automated storm water sampling on small watersheds

    USGS Publications Warehouse

    Harmel, R.D.; King, K.W.; Slade, R.M.

    2003-01-01

    Few guidelines are currently available to assist in designing appropriate automated storm water sampling strategies for small watersheds. Therefore, guidance is needed to develop strategies that achieve an appropriate balance between accurate characterization of storm water quality and loads and limitations of budget, equipment, and personnel. In this article, we explore the important sampling strategy components (minimum flow threshold, sampling interval, and discrete versus composite sampling) and project-specific considerations (sampling goal, sampling and analysis resources, and watershed characteristics) based on personal experiences and pertinent field and analytical studies. These components and considerations are important in achieving the balance between sampling goals and limitations because they determine how and when samples are taken and the potential sampling error. Several general recommendations are made, including: setting low minimum flow thresholds, using flow-interval or variable time-interval sampling, and using composite sampling to limit the number of samples collected. Guidelines are presented to aid in selection of an appropriate sampling strategy based on user's project-specific considerations. Our experiences suggest these recommendations should allow implementation of a successful sampling strategy for most small watershed sampling projects with common sampling goals.

  18. Developing a Palliative Care Competency Framework for Health Professionals and Volunteers: The Nova Scotian Experience.

    PubMed

    McCallum, Meg; Carver, Janet; Dupere, David; Ganong, Sharon; Henderson, J David; McKim, Ann; McNeil-Campbell, Lisa; Richardson, Holly; Simpson, Judy; Tschupruk, Cheryl; Jewers, Heather

    2018-05-15

    In 2014, Nova Scotia released a provincial palliative care strategy and implementation working groups were established. The Capacity Building and Practice Change Working Group, comprised of health professionals, public advisors, academics, educators, and a volunteer supervisor, was asked to select palliative care education programs for health professionals and volunteers. The first step in achieving this mandate was to establish competencies for health professionals and volunteers caring for patients with life-limiting illness and their families and those specializing in palliative care. In 2015, a literature search for palliative care competencies and an environmental scan of related education programs were conducted. The Irish Palliative Care Competence Framework serves as the foundation of the Nova Scotia Palliative Care Competency Framework. Additional disciplines and competencies were added and any competencies not specific to palliative care were removed. To highlight interprofessional practice, the framework illustrates shared and discipline-specific competencies. Stakeholders were asked to validate the framework and map the competencies to educational programs. Numerous rounds of review refined the framework. The framework includes competencies for 22 disciplines, 9 nursing specialties, and 4 physician specialties. The framework, released in 2017, and the selection and implementation of education programs were a significant undertaking. The framework will support the implementation of the Nova Scotia Integrated Palliative Care Strategy, enhance the interprofessional nature of palliative care, and guide the further implementation of education programs. Other jurisdictions have expressed considerable interest in the framework.

  19. An empirical analysis of strategy implementation process and performance of construction companies

    NASA Astrophysics Data System (ADS)

    Zaidi, F. I.; Zawawi, E. M. A.; Nordin, R. M.; Ahnuar, E. M.

    2018-02-01

    Strategy implementation is known as action stage where it is to be considered as the most difficult stage in strategic planning. Strategy implementation can influence the whole texture of a company including its performance. The aim of this research is to provide the empirical relationship between strategy implementation process and performance of construction companies. This research establishes the strategy implementation process and how it influences the performance of construction companies. This research used quantitative method approached via questionnaire survey. Respondents were G7 construction companies in Klang Valley, Selangor. Pearson correlation analysis indicate a strong positive relationship between strategy implementation process and construction companies’ performance. The most importance part of strategy implementation process is to provide sufficient training for employees which directly influence the construction companies’ profit growth and employees’ growth. This research results will benefit top management in the construction companies to conduct strategy implementation in their companies. This research may not reflect the whole construction industry in Malaysia. Future research may be resumed to small and medium grades contractors and perhaps in other areas in Malaysia.

  20. Implementation of Strategies in Continuing Education

    ERIC Educational Resources Information Center

    Kettunen, Juha

    2005-01-01

    Purpose--The purpose of this paper is to provide higher education institutions with strategies of continuing education and methods to communicate and implement these strategies. Design/methodology/approach--The balanced scorecard approach is used to implement the strategy. It translates the strategy into tangible objectives, measures and targets…

  1. The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.

    PubMed

    Howard, N; Mounier-Jack, S; Gallagher, K E; Kabakama, S; Griffiths, U K; Feletto, M; LaMontagne, D S; Burchett, H E D; Watson-Jones, D

    2016-09-01

    Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion.

  2. Investigating the complementary value of discrete choice experiments for the evaluation of barriers and facilitators in implementation research: a questionnaire survey

    PubMed Central

    van Helvoort-Postulart, Debby; van der Weijden, Trudy; Dellaert, Benedict GC; de Kok, Mascha; von Meyenfeldt, Maarten F; Dirksen, Carmen D

    2009-01-01

    Background The potential barriers and facilitators to change should guide the choice of implementation strategy. Implementation researchers believe that existing methods for the evaluation of potential barriers and facilitators are not satisfactory. Discrete choice experiments (DCE) are relatively new in the health care sector to investigate preferences, and may be of value in the field of implementation research. The objective of our study was to investigate the complementary value of DCE for the evaluation of barriers and facilitators in implementation research. Methods Clinical subject was the implementation of the guideline for breast cancer surgery in day care. We identified 17 potential barriers and facilitators to the implementation of this guideline. We used a traditional questionnaire that was made up of statements about the potential barriers and facilitators. Respondents answered 17 statements on a five-point scale ranging from one (fully disagree) to five (fully agree). The potential barriers and facilitators were included in the DCE as decision attributes. Data were gathered among anaesthesiologists, surgical oncologists, and breast care nurses by means of a paper-and-pencil questionnaire. Results The overall response was 10%. The most striking finding was that the responses to the traditional questionnaire hardly differentiated between barriers. Forty-seven percent of the respondents thought that DCE is an inappropriate method. These respondents considered DCE too difficult and too time-consuming. Unlike the traditional questionnaire, the results of a DCE provide implementation researchers and clinicians with a relative attribute importance ranking that can be used to prioritize potential barriers and facilitators to change, and hence to better fine-tune the implementation strategies to the specific problems and challenges of a particular implementation process. Conclusion The results of our DCE and traditional questionnaire would probably lead to different implementation strategies. Although there is no 'gold standard' for prioritising potential barriers and facilitators to the implementation of change, theoretically, DCE would be the method of choice. However, the feasibility of using DCE was less favourable. Further empirical applications should investigate whether DCE can really make a valuable contribution to the implementation science. PMID:19250555

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

    PubMed Central

    2013-01-01

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

  4. Feedback about Teaching in Higher Ed: Neglected Opportunities to Promote Change

    PubMed Central

    Evans, Mara; Brickman, Peggy

    2014-01-01

    Despite ongoing dissemination of evidence-based teaching strategies, science teaching at the university level is less than reformed. Most college biology instructors could benefit from more sustained support in implementing these strategies. One-time workshops raise awareness of evidence-based practices, but faculty members are more likely to make significant changes in their teaching practices when supported by coaching and feedback. Currently, most instructional feedback occurs via student evaluations, which typically lack specific feedback for improvement and focus on teacher-centered practices, or via drop-in classroom observations and peer evaluation by other instructors, which raise issues for promotion, tenure, and evaluation. The goals of this essay are to summarize the best practices for providing instructional feedback, recommend specific strategies for providing feedback, and suggest areas for further research. Missed opportunities for feedback in teaching are highlighted, and the sharing of instructional expertise is encouraged. PMID:26086652

  5. Intentional research design in implementation science: implications for the use of nomothetic and idiographic assessment.

    PubMed

    Lyon, Aaron R; Connors, Elizabeth; Jensen-Doss, Amanda; Landes, Sara J; Lewis, Cara C; McLeod, Bryce D; Rutt, Christopher; Stanick, Cameo; Weiner, Bryan J

    2017-09-01

    The advancement of implementation science is dependent on identifying assessment strategies that can address implementation and clinical outcome variables in ways that are valid, relevant to stakeholders, and scalable. This paper presents a measurement agenda for implementation science that integrates the previously disparate assessment traditions of idiographic and nomothetic approaches. Although idiographic and nomothetic approaches are both used in implementation science, a review of the literature on this topic suggests that their selection can be indiscriminate, driven by convenience, and not explicitly tied to research study design. As a result, they are not typically combined deliberately or effectively. Thoughtful integration may simultaneously enhance both the rigor and relevance of assessments across multiple levels within health service systems. Background on nomothetic and idiographic assessment is provided as well as their potential to support research in implementation science. Drawing from an existing framework, seven structures (of various sequencing and weighting options) and five functions (Convergence, Complementarity, Expansion, Development, Sampling) for integrating conceptually distinct research methods are articulated as they apply to the deliberate, design-driven integration of nomothetic and idiographic assessment approaches. Specific examples and practical guidance are provided to inform research consistent with this framework. Selection and integration of idiographic and nomothetic assessments for implementation science research designs can be improved. The current paper argues for the deliberate application of a clear framework to improve the rigor and relevance of contemporary assessment strategies.

  6. A survey of managed care strategies for pregnant smokers.

    PubMed

    Barker, D C; Robinson, L A; Rosenthal, A C

    2000-01-01

    The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey. This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy. 147 MCOs identifying a pregnancy specific smoking cessation strategy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. Pregnancy specific smoking cessation strategies varied. 40% of respondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included self help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient databases for outreach. Only 42% offered a postpartum relapse prevention element. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implementing strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional workshops, newsletters, on-site assistance, and national conferences. The survey provides the first profile of prenatal tobacco treatment strategies in managed care. While design limitations prevent generalisation of these results to all MCOs, such information can help guide technical assistance to plans interested in reducing smoking among pregnant women.

  7. Biomedical research in a Digital Health Framework

    PubMed Central

    2014-01-01

    This article describes a Digital Health Framework (DHF), benefitting from the lessons learnt during the three-year life span of the FP7 Synergy-COPD project. The DHF aims to embrace the emerging requirements - data and tools - of applying systems medicine into healthcare with a three-tier strategy articulating formal healthcare, informal care and biomedical research. Accordingly, it has been constructed based on three key building blocks, namely, novel integrated care services with the support of information and communication technologies, a personal health folder (PHF) and a biomedical research environment (DHF-research). Details on the functional requirements and necessary components of the DHF-research are extensively presented. Finally, the specifics of the building blocks strategy for deployment of the DHF, as well as the steps toward adoption are analyzed. The proposed architectural solutions and implementation steps constitute a pivotal strategy to foster and enable 4P medicine (Predictive, Preventive, Personalized and Participatory) in practice and should provide a head start to any community and institution currently considering to implement a biomedical research platform. PMID:25472554

  8. Palm Beach Community College Strategic Plan, 1999-2004.

    ERIC Educational Resources Information Center

    Samuels, Seymour

    This report addresses strategies and action plans for Palm Beach Community College (PBCC) (Florida) between 1999-2004. As part of a commitment to achieve specific, measurable end results, the college has set various objectives, including: (1) develop, implement and institutionalize a mission driven strategic budget for the 1999-2000 fiscal year;…

  9. Guide to Operating and Maintaining EnergySmart Schools

    ERIC Educational Resources Information Center

    US Department of Energy, 2010

    2010-01-01

    The guide allows users to adapt and implement suggested O&M (operating and maintaining) strategies to address specific energy efficiency goals. It recognizes and expands on existing tools and resources that are widely used throughout the high-performance school industry. The guide is organized into the following sections: (1) Chapter 1:…

  10. Bringing Evidence-Based Sexual Health Programs to Adolescents in Black Churches: Applying Knowledge from Systematic Adaptation Frameworks

    ERIC Educational Resources Information Center

    Weeks, Fiona H.; Powell, Terrinieka W.; Illangasekare, Samantha; Rice, Eric; Wilson, James; Hickman, Debra; Blum, Robert W.

    2016-01-01

    Previous studies have documented Black churches' receptivity to implementing adolescent sexual health programs within their congregations. Some authors have argued for new sexual health programs to be designed specifically for churches, similar to the development of school- and community-based interventions. However, strategies and curricula used…

  11. Transformation of Online Teaching Practices through Implementation of Appreciative Inquiry

    ERIC Educational Resources Information Center

    Johnson, Bruce A.

    2014-01-01

    The purpose of this case study was to explore the application and outcome of appreciative inquiry as an online instructional strategy for the development of three specific factors: adult learner motivation, engagement, and performance. Appreciative andragogy was an original phrase developed for this study and is an adaptation of appreciative…

  12. Diagnosing Causes of Teacher Retention, Mobility and Turnover: Guidelines for TIF Grantees

    ERIC Educational Resources Information Center

    Finster, Matthew

    2015-01-01

    To effectively address teacher turnover, Teacher Incentive Fund (TIF) grantees need to follow an approach that entails aligning the tracking, diagnosing, and intervening processes. Unfortunately, too often retention strategies are implemented without regard to the various types of teacher turnover and specific data about the causes of turnover.…

  13. 5. What Can Schools Do to Motivate Students?

    ERIC Educational Resources Information Center

    Usher, Alexandra

    2012-01-01

    This is the fifth in a series of six papers from the Center on Education Policy exploring issues related to students' motivation to learn. While past papers in this series have examined broad strategies to improve academic motivation that could be implemented across a school, district, or state, this paper focuses specifically on changes within…

  14. A Coherent Approach to High School Improvement: A School and District Needs Assessment Tool

    ERIC Educational Resources Information Center

    National High School Center, 2010

    2010-01-01

    High school improvement initiatives often focus on specific intervention strategies, programs, or priority topics (e.g., dropout intervention). However, research shows that systemic and sustainable improvement can only be achieved when initiatives are implemented with consideration for the broader education contexts in which they operate. The…

  15. Meeting the Challenge of Limited Literacy Resources for Adolescents and Adults with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Morgan, Michelle F.; Moni, Karen B.

    2008-01-01

    For adolescents and adults with mild to moderate intellectual disabilities (or, in the UK, learning disabilities or learning difficulties), the achievement of successful engagement with, and construction of meaning from, texts necessitates the implementation and use of specifically designed and adapted teaching strategies and resources. The…

  16. Capacity Levels of Academic Staff in a Malaysian Public University: Students' Perspective

    ERIC Educational Resources Information Center

    Tajuddin, Muhammad Jawad; Ghani, Muhammad Faizal A.; Siraj, Saedah; Saifuldin, Mohd Helmi Firdaus; Kenayatulla, Husaina Banu; Elham, Faisol

    2013-01-01

    This research aims to develop a competency model for staff of higher education institutions in Malaysia. The model involves the listing of the main features and implementation strategy for the development of academic competence. Specifically, this research aims to achieve the following research objectives: a) to identify if there is any…

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

    PubMed

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

    2018-12-01

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

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

    PubMed Central

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

    2018-01-01

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

  19. Partnered Evaluation of a Community Engagement Intervention: Use of a “Kickoff” Conference in a Randomized Trial for Depression Care Improvement in Underserved Communities

    PubMed Central

    Mendel, Peter; Ngo, Victoria K.; Dixon, Elizabeth; Stockdale, Susan; Jones, Felica; Chung, Bowen; Jones, Andrea; Masongsong, Zoe; Khodyakov, Dmitry

    2013-01-01

    Community partnered research and engagement strategies are gaining recognition as innovative approaches to improving healthcare systems and reducing health disparities in underserved communities. These strategies may have particular relevance for mental health interventions in low income, minority communities in which there often is great stigma and silence surrounding conditions such as depression and difficulty in implementing improved access and quality of care. At the same time, there is a relative dearth of evidence on the effectiveness of specific community engagement interventions and on the design, process, and context of these interventions necessary for understanding their implementation and generalizability. This paper evaluates one of a number of community engagement strategies employed in the Community Partners in Care (CPIC) study, the first randomized controlled trial of the role of community engagement in adapting and implementing evidence-based depression care. We specifically describe the unique goals and features of a community engagement “kickoff” conference as used in CPIC and provide evidence on the effectiveness of this type of intervention by analyzing its impact on: 1) stimulating a dialogue, sense of collective efficacy, and opportunities for learning and networking to address depression and depression care in the community, 2) activating interest and participation in CPIC’s randomized trial of two different ways to implement evidence-based quality improvement (QI) programs for depression across diverse community agencies, and 3) introducing evidence-based toolkits and collaborative care models to potential participants in both intervention conditions and other community members. We evaluated the effectiveness of the conference through a community-partnered process in which both community and academic project members were involved in study design, data collection and analysis. Data sources include participant conference evaluation forms (n=187 over two conferences; response rate 59%) and qualitative observation field notes of each conference session. Mixed methods for the analysis consist of descriptive statistics of conference evaluation form ratings, as well as thematic analysis of evaluation form write-in comments and qualitative observation notes. Results indicate the effectiveness of this type of event for each of the three main goals, and provide insights into intervention implementation and use of similar community engagement strategies for other studies. PMID:22352084

  20. The municipalities of the Northwest region of the Czech Republic adapt to climate change: overview of barriers and challenges

    NASA Astrophysics Data System (ADS)

    Emmer, Adam; Krkoška Lorencová, Eliška; Vačkář, David

    2017-04-01

    The municipalities of the Czech Republic have been facing negative impacts of changing climate in the past decades - especially floods (1997, 2002, 2010, 2013), droughts and heat waves (2013, 2015), claiming lives, material damages and economic losses up to several % of GDP. Reflecting these events, climate change adaptation should represent major issue in strategical planning on all administrative levels, which is actually not fully met nowadays. Sectoral National Adaptation Strategy (NAS) was approved by the Government of the Czech Republic in autumn 2015 and the implementation action plan is currently being approved. Adaptation strategies on lower administrative level (adaptation strategies of individual municipalities) are, however, still quite rare. In this contribution, we analyse barriers and challenges for: (i) the development of climate change adaptation strategies on administrative level of individual municipalities in the Northwest region, Czech Republic; and (ii) implementation of adaptation measures into the decision-making processes. Based on participatory seminars with key stakeholders organised in pilot municipalities, it was shown that municipalities are (at least partly) able to cope with existing risks such as floods, but are not well-prepared for expected regionally "new" risks such as long lasting heat waves, insufficient water retention and flash floods. Linking the goals of adaptation strategy with urban planning seems to be challenging task but also potentially powerfull tool to implement specific adaptation measures. It emerged, that complicated ownership relations often cause obstacles for implementation of adaptation measures, highlighting the potential of stimulation and motivation tools from the side of the municipality. On the other hand, it was also shown that despite experiencing its negative impacts, climate change is often neglected or percepted as a marginal issue by some municipalities and developing adaptation strategy is considered needless, referring to another burning issues such as socioeconomic situation. The role of information campaigns and education of stakeholders as well as public regarding climate change and possible future climate change impacts is, therefore, considered highly important task.

  1. Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.

    PubMed

    Gold, Rachel; Hollombe, Celine; Bunce, Arwen; Nelson, Christine; Davis, James V; Cowburn, Stuart; Perrin, Nancy; DeVoe, Jennifer; Mossman, Ned; Boles, Bruce; Horberg, Michael; Dearing, James W; Jaworski, Victoria; Cohen, Deborah; Smith, David

    2015-10-16

    Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. ClinicalTrials.gov, NCT02325531.

  2. Post-Occupancy Evaluation of a Mental Healthcare Facility Based on Staff Perceptions of Design Innovations.

    PubMed

    Kalantari, Saleh; Snell, Robin

    2017-07-01

    This study was a post-occupancy evaluation (POE) to examine the effectiveness of three specific design innovations in a mental healthcare facility. In addition to collecting data about the impact of these specific designs, the study provides a model for the broader implementation of POE approaches in the mental healthcare context. POEs in general healthcare settings have been shown to lead to better work environments and better outcomes for patients. Despite growing evidence of the value provided by POE studies, the industry has been somewhat slow to adopt their regular use, in part due to unfamiliarity with the POE process. This is particularly true in mental healthcare contexts, where POE studies remain virtually nonexistent. In-depth interviews and a widely distributed, anonymous survey were used to collect hospital staff perceptions and feedback regarding the impact of specific design features. The hospital staff were quite enthusiastic about two of the design innovations studied here (a new wayfinding strategy and the use of vibrant colors in specific areas of the facility). The third innovation, open-style communication centers, elicited more mixed evaluations. The results include extensive hypothesis testing about the effects of each innovation as well as narrative discussions of their pros and cons. The study generated new knowledge about three specific mental healthcare design innovations and provides a model for the practical implementation of a POE approach in mental healthcare contexts. The results are particularly relevant for designers who are considering innovative strategies in future mental healthcare facilities.

  3. A multimedia campaign to improve back beliefs in patients with non-specific low back pain: a process evaluation.

    PubMed

    Suman, Arnela; Schaafsma, Frederieke G; Bamarni, Jiman; van Tulder, Maurits W; Anema, Johannes R

    2017-05-18

    Low back pain (LBP) is one of the most prevalent and costly disorders worldwide. To reduce its burden in the Netherlands, implementation of a multidisciplinary guideline for LBP was supported by a multifaceted eHealth campaign for patients with LBP. The current study aims 1) to evaluate whether the implementation strategy was performed as planned; 2) to assess the feasibility, barriers and facilitators of the patient based eHealth campaign; 3) to gain insight into the satisfaction and experiences of patients with various ethnic backgrounds with the implementation strategy and to make a comparison between them; and 4) to explore the association between exposure to and satisfaction with the implementation strategy. This process evaluation was performed using the Linnan and Steckler framework, and used a mixed methods approach for data collection and analysis. The relationship between satisfaction of patients and exposure to the strategy was statistically examined. Semi-structured interviews were analysed using qualitative data analysis methods. Two hundred and fourteen patients participated in the quantitative, and 44 in the qualitative analysis. Most were female and had a high level of education. Many patients did not use the campaign at all or only once, and those that did rated it as reasonable. Patient satisfaction with the campaign increased significantly with an increase in its use. Qualitative analysis showed that four main themes played a role in campaign rating and use: satisfaction with intervention components, perceived benefits of the intervention, usage of the intervention, and satisfaction with the medium used. This process evaluation showed that the eHealth campaign was used only by a small proportion of patients with non-specific LBP. It seemed that the campaign was offered to the patients too late, that the lay-out of the campaign did not meet patient needs, and that healthcare providers rarely discussed the campaign with their patients, while involvement of those providers seemed to improve trustworthiness of the campaign and increase its usage. It is important to invest effort into healthcare providers to motivate patients to use eHealth intervention and to tailor strategies better to the needs of users. Netherlands Trial Register (NTR): NTR4329 . Registered December 20th, 2013.

  4. Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

    PubMed

    Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W

    2017-08-01

    The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

  5. Blood management issues using blood management strategies.

    PubMed

    Stulberg, Bernard N; Zadzilka, Jayson D

    2007-06-01

    Blood management strategies is a term used to address a coordinated approach to the management of blood loss in the perioperative period for total joint arthroplasty. The premise of any blood management strategy is that each patient, surgeon, and operative intervention experiences different risks of requiring transfusion, that those risks can be identified, and that a plan can be implemented to address them. A surgeon's decision to transfuse should be based on physiologic assessment of the patient's response to anemia and not on an arbitrary number ("transfusion trigger"). Intervention strategies can be applied preoperatively, intraoperatively, and postoperatively. Patient-specific planning allows for the appropriate use of patient, hospital, and system resources, ensuring that the consequences of anemia are minimized and that the patient's recovery process is optimized.

  6. The FIFA Women’s World Cup in Germany 2011 – A practical example for tailoring an event-specific enhanced infectious disease surveillance system

    PubMed Central

    2012-01-01

    Background Mass gatherings require a decision from public health authorities on how to monitor infectious diseases during the event. The appropriate level of enhanced surveillance depends on parameters like the scale of the event (duration, spatial distribution, season), participants’ origin, amount of public attention, and baseline disease activity in the host country. For the FIFA Men’s World Cup 2006, Germany implemented enhanced surveillance. As the scale of the FIFA Women’s World Cup (June 26 – July 17, 2011) was estimated to be substantially smaller in size, visitors and duration, it was not feasible to simply adopt the previously implemented measures. Our aim was therefore to develop a strategy to tailor an event-specific enhanced surveillance for this smaller-scale mass gathering. Methods Based on the enhanced surveillance measures during the Men’s Cup, we conducted a needs assessment with the district health authorities in the 9 host cities in March 2011. Specific measures with a majority consent were implemented. After the event, we surveyed the 9 district and their corresponding 7 state health authorities to evaluate the implemented measures. Results All 9 district health authorities participated in the pre-event needs assessment. The majority of sites consented to moving from weekly to daily (Monday-Friday) notification reporting of routine infectious diseases, receiving regular feedback on those notification reports and summaries of national/international World Cup-relevant epidemiological incidents, e.g. outbreaks in countries of participating teams. In addition, we decided to implement twice-weekly reports of “unusual events” at district and state level. This enhanced system would commence on the first day and continue to one day following the tournament. No World Cup-related infectious disease outbreaks were reported during this time period. Eight of 9 district and 6 of 8 state health authorities participated in the final evaluation. The majority perceived the implemented measures as adequate. Conclusions Our approach to tailor an event-specific enhanced surveillance concept worked well. Involvement of the participating stakeholders early-on in the planning phase secured ownership of and guaranteed support for the chosen strategy. The enhanced surveillance for this event resulted as a low-level surveillance. However, we included mechanisms for rapid upscaling if the situation would require adaptations. PMID:22849632

  7. The FIFA Women's World Cup in Germany 2011--a practical example for tailoring an event-specific enhanced infectious disease surveillance system.

    PubMed

    Takla, Anja; Velasco, Edward; Benzler, Justus

    2012-07-31

    Mass gatherings require a decision from public health authorities on how to monitor infectious diseases during the event. The appropriate level of enhanced surveillance depends on parameters like the scale of the event (duration, spatial distribution, season), participants' origin, amount of public attention, and baseline disease activity in the host country. For the FIFA Men's World Cup 2006, Germany implemented enhanced surveillance. As the scale of the FIFA Women's World Cup (June 26 - July 17, 2011) was estimated to be substantially smaller in size, visitors and duration, it was not feasible to simply adopt the previously implemented measures. Our aim was therefore to develop a strategy to tailor an event-specific enhanced surveillance for this smaller-scale mass gathering. Based on the enhanced surveillance measures during the Men's Cup, we conducted a needs assessment with the district health authorities in the 9 host cities in March 2011. Specific measures with a majority consent were implemented. After the event, we surveyed the 9 district and their corresponding 7 state health authorities to evaluate the implemented measures. All 9 district health authorities participated in the pre-event needs assessment. The majority of sites consented to moving from weekly to daily (Monday-Friday) notification reporting of routine infectious diseases, receiving regular feedback on those notification reports and summaries of national/international World Cup-relevant epidemiological incidents, e.g. outbreaks in countries of participating teams. In addition, we decided to implement twice-weekly reports of "unusual events" at district and state level. This enhanced system would commence on the first day and continue to one day following the tournament. No World Cup-related infectious disease outbreaks were reported during this time period. Eight of 9 district and 6 of 8 state health authorities participated in the final evaluation. The majority perceived the implemented measures as adequate. Our approach to tailor an event-specific enhanced surveillance concept worked well. Involvement of the participating stakeholders early-on in the planning phase secured ownership of and guaranteed support for the chosen strategy. The enhanced surveillance for this event resulted as a low-level surveillance. However, we included mechanisms for rapid upscaling if the situation would require adaptations.

  8. Self-regulation Interventions for the Reduction of Sugar-Sweetened Beverages in Adolescents

    PubMed Central

    Ames, Susan L.; Wurpts, Ingrid C.; Pike, James; MacKinnon, David P.; Reynolds, Kim R.; Stacy, Alan W.

    2017-01-01

    This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption. PMID:27374899

  9. New strategies to improve the efficacy of colorectal cancer vaccines: from bench to bedside.

    PubMed

    Mocellin, Simone

    2006-12-01

    By exploiting a naturally occurring defense system, anticancer vaccination embodies an ideal non-toxic treatment capable of evoking tumor-specific immune responses that can ultimately recognize and kill colorectal cancer (CRC) cells. Despite the enormous theoretical potential of active specific immunotherapy, no vaccination regimen has achieved sufficient therapeutic efficacy necessary for clinical implementation. Nevertheless, several immunological advances have opened new avenues of research to decipher the biological code governing tumor immune responsiveness, and this is leading to the design of potentially more effective immunotherapeutic protocols. This review briefly summarizes the principles behind anti-CRC vaccination and describes the most promising immunological strategies that have been developed, which are expected to renew interest in this molecularly targeted anticancer approach.

  10. Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making.

    PubMed Central

    Behets, F. M.; Miller, W. C.; Cohen, M. S.

    2001-01-01

    The syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by WHO and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment. The present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances. Among them are the general aspects of decision-making and caveats concerning the rational decision-making approach. The positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values. Other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints. There is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders. PMID:11731816

  11. Energizing the nursing lecture: Application of the Theory of Multiple Intelligence Learning.

    PubMed

    Amerson, Roxanne

    2006-01-01

    Nurse educators struggle to find ways to create learning opportunities that are interactive and appeal to the needs of various students. The key to energizing the nursing lecture is to create an environment that encourages students to be active participants. It is essential to use creativity to design cognitive strategies that appeal to students' learning preferences. This article discusses the methods one educator has used to implement the Theory of Multiple Intelligence Learning in the classroom. Specific cognitive strategies that address the learning preferences of each intelligence are discussed.

  12. Reducing depressive symptoms through behavioral activation in churches: A Hybrid-2 randomized effectiveness-implementation design.

    PubMed

    Haynes, Tiffany; Turner, Jerome; Smith, Johnny; Curran, Geoffrey; Bryant-Moore, Keneshia; Ounpraseuth, Songthip T; Kramer, Teresa; Harris, Kimberly; Hutchins, Ellen; Yeary, Karen Hye-Cheon Kim

    2018-01-01

    Rural African Americans are disproportionately exposed to numerous stressors such as poverty that place them at risk for experiencing elevated levels of depressive symptoms. Effective treatments for decreasing depressive symptoms exist, but rural African Americans often fail to receive adequate and timely care. Churches have been used to address physical health outcomes in rural African American communities, but few have focused primarily on addressing mental health outcomes. Our partnership, consisting of faith community leaders and academic researchers, adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8-session intervention was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g. bible studies) This manuscript describes a Hybrid-II implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention (Renewed and Empowered for the Journey to Overcome in Christ: REJOICE) and gather preliminary data on the strategies necessary to support the successful implementation of this intervention in 24 rural African American churches. This study employs a randomized one-way crossover cluster design to assess effectiveness in reducing depressive symptoms and gather preliminary data regarding implementation outcomes, specifically fidelity, associated with 2 implementation strategies: training only and training+coaching calls. This project has the potential to generate knowledge that will lead to improvements in the provision of mental health interventions within the rural African American community. Further, the use of the Hybrid-II design has the potential to advance our understanding of strategies that will support the implementation of and sustainability of mental health interventions within rural African American faith communities. NCT02860741. Registered August 5, 2016. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Measuring the impact of outreach and enrollment strategies for public health insurance in California.

    PubMed

    Cousineau, Michael R; Stevens, Gregory D; Farias, Albert

    2011-02-01

    OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative. Administrative enrollment databases. The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children. Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter. Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies. National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments. © Health Research and Educational Trust.

  14. Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice

    PubMed Central

    2015-01-01

    A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health. PMID:26474761

  15. Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis.

    PubMed

    Miao, Melissa; Power, Emma; O'Halloran, Robyn

    2015-01-01

    Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

  16. Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions.

    PubMed

    Meyer, Jaimie P; Muthulingam, Dharushana; El-Bassel, Nabila; Altice, Frederick L

    2017-12-01

    The criminal justice (CJ) system can be leveraged to access women for HIV prevention and treatment programs. Research is lacking on effective implementation strategies tailored to the specific needs of CJ-involved women. We conducted a scoping review of published studies in English from the United States that described HIV interventions, involved women or girls, and used the CJ system as an access point for sampling or intervention delivery. We identified 350 studies and synthesized data from 42 unique interventions, based in closed (n = 26), community (n = 7), or multiple/other CJ settings (n = 9). A minority of reviewed programs incorporated women-specific content or conducted gender-stratified analyses. CJ systems are comprised of diverse access points, each with unique strengths and challenges for implementing HIV treatment and prevention programs for women. Further study is warranted to develop women-specific and trauma-informed content and evaluate program effectiveness.

  17. Evaluating a policing strategy intended to disrupt an illicit street-level drug market.

    PubMed

    Corsaro, Nicholas; Brunson, Rod K; McGarrell, Edmund F

    2010-12-01

    The authors examined a strategic policing initiative that was implemented in a high crime Nashville, Tennessee neighborhood by utilizing a mixed-methodological evaluation approach in order to provide (a) a descriptive process assessment of program fidelity; (b) an interrupted time-series analysis relying upon generalized linear models; (c) in-depth resident interviews. Results revealed that the initiative corresponded with a statistically significant reduction in drug and narcotics incidents as well as perceived changes in neighborhood disorder within the target community. There was less-clear evidence, however, of a significant impact on other outcomes examined. The implications that an intensive crime prevention strategy corresponded with a reduction in specific forms of neighborhood crime illustrates the complex considerations that law enforcement officials face when deciding to implement this type of crime prevention initiative.

  18. Efficacy of a strategy for implementing a guideline for the control of cardiovascular risk in a primary healthcare setting: the SIRVA2 study a controlled, blinded community intervention trial randomised by clusters

    PubMed Central

    2011-01-01

    This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid. Background The results on clinical practice of introducing CPGs have been little studied in Spain. The strategy used to implement a CPG is known to influence its final use. Strategies based on the involvement of opinion leaders and that are easily executed appear to be among the most successful. Aim The main aim of the present work was to compare the effectiveness of two strategies for implementing a CPG designed to reduce cardiovascular risk in the primary healthcare setting, measured in terms of improvements in the recording of calculated cardiovascular risk or specific risk factors in patients' medical records, the control of cardiovascular risk factors, and the incidence of cardiovascular events. Methods This study involved a controlled, blinded community intervention in which the 21 health centres of the Number 2 Health Area of Madrid were randomly assigned by clusters to be involved in either a proposed CPG implementation strategy to reduce cardiovascular risk, or the normal dissemination strategy. The study subjects were patients ≥ 45 years of age whose health cards showed them to belong to the studied health area. The main variable examined was the proportion of patients whose medical histories included the calculation of their cardiovascular risk or that explicitly mentioned the presence of variables necessary for its calculation. The sample size was calculated for a comparison of proportions with alpha = 0.05 and beta = 0.20, and assuming that the intervention would lead to a 15% increase in the measured variables. Corrections were made for the design effect, assigning a sample size to each cluster proportional to the size of the population served by the corresponding health centre, and assuming losses of 20%. This demanded a final sample size of 620 patients. Data were analysed using summary measures for each cluster, both in making estimates and for hypothesis testing. Analysis of the variables was made on an intention-to-treat basis. Trial Registration ClinicalTrials.gov: NCT01270022 PMID:21504570

  19. Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community-driven health programmes in an Indigenous community in Canada.

    PubMed

    Willows, Noreen; Dyck Fehderau, David; Raine, Kim D

    2016-09-01

    Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes. © 2015 John Wiley & Sons Ltd.

  20. Organizational strategies for promoting patient and provider uptake of personal health records.

    PubMed

    Wells, Susan; Rozenblum, Ronen; Park, Andrea; Dunn, Marie; Bates, David W

    2015-01-01

    To investigate organizational strategies to promote personal health records (PHRs) adoption with a focus on patients with chronic disease. Using semi-structured interviews and a web-based survey, we sampled US health delivery organizations which had implemented PHRs for at least 12 months, were recognized as PHR innovators, and had scored highly in national patient satisfaction surveys. Respondents had lead positions for clinical information systems or high-risk population management. Using grounded theory approach, thematic categories were derived from interviews and coupled with data from the survey. Interviews were conducted with 30 informants from 16 identified organizations. Organizational strategies were directed towards raising patient awareness via multimedia communications, and provider acceptance and uptake. Strategies for providers were grouped into six main themes: organizational vision, governance and policies, work process redesign, staff training, information technology (IT) support, and monitoring and incentives. Successful organizations actively communicated their vision, engaged leaders at all levels, had clear governance, planning, and protocols, set targets, and celebrated achievement. The most effective strategy for patient uptake was through health professional encouragement. No specific outreach efforts targeted patients with chronic disease. Registration and PHR activity was routinely measured but without reference to a denominator population or high risk subpopulations. Successful PHR implementation represents a social change and operational project catalyzed by a technical solution. The key to clinician acceptance is making their work easier. However, organizations will likely not achieve the value they want from PHRs unless they target specific populations and monitor their uptake. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.comFor numbered affiliations see end of article.

  1. Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

    PubMed

    Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

    2011-02-01

    Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

  2. A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation.

    PubMed

    Rieckmann, Traci; Abraham, Amanda; Zwick, Janet; Rasplica, Caitlin; McCarty, Dennis

    2015-08-01

    To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT). Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009. The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs. Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged. Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act. © Health Research and Educational Trust.

  3. Nuclear Weapons Council: Enhancing Interagency Collaboration Could Help with Implementation of Expanded Responsibilities

    DTIC Science & Technology

    2015-05-01

    provide a cross section of the types of programs and activities the Council oversees. Specifically, we selected the B61 -12 life-extension program; the... B61 -12 life-extension program; the W76-1 life-extension program; the plutonium strategy; and budget- related activities,7 such as the Council’s

  4. Strengthening the Connection between School & Home. Second Edition. Essentials for Principals [TM

    ERIC Educational Resources Information Center

    LeBlanc-Esparza, Ricardo; LeBlanc-Esparza, Kym

    2012-01-01

    Examine the pivotal role family engagement plays in student achievement, and explore in depth the process of creating and implementing a family-engagement plan. This research-based guide includes many specific strategies, handouts, and reproducibles leaders can use to make their schools family friendly and connect with those families who may be…

  5. Distance Video-Teleconferencing in Early Intervention: Pilot Study of a Naturalistic Parent-Implemented Language Intervention

    ERIC Educational Resources Information Center

    McDuffie, Andrea; Machalicek, Wendy; Oakes, Ashley; Haebig, Eileen; Weismer, Susan Ellis; Abbeduto, Leonard

    2013-01-01

    Maternal verbal responsiveness in naturally occurring interactions is known to facilitate language development for children with neurodevelopmental disorders. The present study used a series of A-B replications to examine proximal effects of a naturalistic language intervention on the use of specific language support strategies by mothers of eight…

  6. Engaging Hispanic Students in Agricultural Education and the FFA: A 3-Year Case Study

    ERIC Educational Resources Information Center

    Roberts, T. Grady; Hall, Johnathan L.; Briers, Gary E.; Gill, Ernie; Shinn, Glen C.; Larke, Alvin, Jr.; Jaure, Paul

    2009-01-01

    This article describes the outcomes of field-based efforts to increase diversity in agricultural education programs and the FFA. This study focused on three schools in San Antonio, Texas. Guided by Rogers' (2003) theories of diffusion of innovations, a series of six intervention strategies was implemented: (a) provide specific FFA or agricultural…

  7. Analyzing the Correlation between Data Usage and Student Performance on the Missouri Assessment Program

    ERIC Educational Resources Information Center

    Cooper, Melissa A.

    2012-01-01

    School districts are charged with the task of improving standardized test scores and closing the gaps between specific groups of students. Numerous programs, school improvement strategies, changes in instruction and leadership have been implemented to close the gap. Data are becoming more abundant at the state, district, and school levels. Many…

  8. Using WebQuests to Teach Content: Comparing Instructional Strategies

    ERIC Educational Resources Information Center

    Strickland, Janet

    2005-01-01

    The purpose of this study was to compare the use of WebQuests with traditional instruction. Specifically, the study examined the end-of-unit exam scores for students who completed a WebQuest on the Texas Revolution and those students completing a poster activity. Both of the instructional activities were implemented as additional enhancement to…

  9. Proposals for Standardizing and Improving the Policy of Adding Points on the Entrance Exam

    ERIC Educational Resources Information Center

    Yuhong, Deng

    2013-01-01

    This article reviews policies for adding points on the College Entrance Examination. It analyzes the rationales and specific implementation strategies of various policies for adding points on the entrance exam, as well as their advantages and pitfalls. Based on these observations and analysis, the author also offers policy recommendations on the…

  10. The Effects of an Innovative Activity-Centered Biology Program on Attitude toward Elementary Teachers.

    ERIC Educational Resources Information Center

    Hall, Donald A.

    One of the primary goals in many teacher education programs is to design and to implement specific courses, strategies, and methods that promote positive attitude toward science and science teaching among elementary education majors. This paper describes the effects of a biology content course, patterned after innovative elementary school science…

  11. An Ethic of Care in High School Instrumental Music

    ERIC Educational Resources Information Center

    Edgar, Scott N.

    2014-01-01

    The purpose of this paper is to apply Noddings' ethic of care to a qualitative inquiry of select instrumental music educators. In the first section I describe and define an ethic of care, considering specifically who is involved in a caring relationship, how an ethic of care can be taught, and strategies for educational implementation and…

  12. Proceedings: 1990 EPRI gas turbine procurement seminar

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

    McDonald, B.L.; Miller, M.N.

    1991-06-01

    This seminar presents information that enables utilities to implement more cost-effective procurements for gas turbine and combined-cycle power generation equipment. A systematic approach to specification and permitting procedures can lower unit life-cycle cost. APPROACH. Thirty-two staff members from 25 utilities met in Danvers, Massachusetts, October 9--11, 1990. Speakers representing utilities, vendors, and EPRI contractors presented material on recent procurement and startup experiences, permitting considerations, specification strategy, bid evaluation techniques, and a vendor's perspective of utility procurements. KEY POINTS. The seminar focused on specification features, procurement procedures, and bid evaluation techniques designed to implement life-cycle cost-effective procurement consistent with the plantmore » mission. Speakers highlighted the following issues: Experiential case histories of recent procurements and startups, emphasizing how to design procurement procedures that improve plant operating economics; Current trends in permitting for NO{sub x} compliance and recent permitting experience; Quantifiable evaluations of vendors' bids for RAM-related characteristics; The means to obtain specifically desired but nonstandard equipment features.« less

  13. Glossary for the implementation of Health in All Policies (HiAP).

    PubMed

    Freiler, Alix; Muntaner, Carles; Shankardass, Ketan; Mah, Catherine L; Molnar, Agnes; Renahy, Emilie; O'Campo, Patricia

    2013-12-01

    Health in All Policies (HiAP) is becoming increasingly popular as a governmental strategy to improve population health by coordinating action across health and non-health sectors. A variety of intersectoral initiatives may be used in HiAP that frame health determinants as the bridge between policies and health outcomes. The purpose of this glossary is to present concepts and terms useful in understanding the implementation of HiAP as a cross-sectoral policy. The concepts presented here were applied and elaborated over the course of case studies of HiAP in multiple jurisdictions, which used key informant interviews and the systematic review of literature to study the implementation of specific HiAP initiatives.

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

    PubMed

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

    2017-09-01

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

  15. Refining a taxonomy for guideline implementation: results of an exercise in abstract classification

    PubMed Central

    2013-01-01

    Background To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. Methods A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. Results The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). Conclusions Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support. PMID:23497520

  16. Refining a taxonomy for guideline implementation: results of an exercise in abstract classification.

    PubMed

    Mazza, Danielle; Bairstow, Phillip; Buchan, Heather; Chakraborty, Samantha Paubrey; Van Hecke, Oliver; Grech, Cathy; Kunnamo, Ilkka

    2013-03-15

    To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support.

  17. What are the implications of implementation science for medical education?

    PubMed Central

    Price, David W.; Wagner, Dianne P.; Krane, N. Kevin; Rougas, Steven C.; Lowitt, Nancy R.; Offodile, Regina S.; Easdown, L. Jane; Andrews, Mark A. W.; Kodner, Charles M.; Lypson, Monica; Barnes, Barbara E.

    2015-01-01

    Background Derived from multiple disciplines and established in industries outside of medicine, Implementation Science (IS) seeks to move evidence-based approaches into widespread use to enable improved outcomes to be realized as quickly as possible by as many as possible. Methods This review highlights selected IS theories and models, chosen based on the experience of the authors, that could be used to plan and deliver medical education activities to help learners better implement and sustain new knowledge and skills in their work settings. Results IS models, theories and approaches can help medical educators promote and determine their success in achieving desired learner outcomes. We discuss the importance of incorporating IS into the training of individuals, teams, and organizations, and employing IS across the medical education continuum. Challenges and specific strategies for the application of IS in educational settings are also discussed. Conclusions Utilizing IS in medical education can help us better achieve changes in competence, performance, and patient outcomes. IS should be incorporated into curricula across disciplines and across the continuum of medical education to facilitate implementation of learning. Educators should start by selecting, applying, and evaluating the teaching and patient care impact one or two IS strategies in their work. PMID:25911282

  18. What are the implications of implementation science for medical education?

    PubMed

    Price, David W; Wagner, Dianne P; Krane, N Kevin; Rougas, Steven C; Lowitt, Nancy R; Offodile, Regina S; Easdown, L Jane; Andrews, Mark A W; Kodner, Charles M; Lypson, Monica; Barnes, Barbara E

    2015-01-01

    Derived from multiple disciplines and established in industries outside of medicine, Implementation Science (IS) seeks to move evidence-based approaches into widespread use to enable improved outcomes to be realized as quickly as possible by as many as possible. This review highlights selected IS theories and models, chosen based on the experience of the authors, that could be used to plan and deliver medical education activities to help learners better implement and sustain new knowledge and skills in their work settings. IS models, theories and approaches can help medical educators promote and determine their success in achieving desired learner outcomes. We discuss the importance of incorporating IS into the training of individuals, teams, and organizations, and employing IS across the medical education continuum. Challenges and specific strategies for the application of IS in educational settings are also discussed. Utilizing IS in medical education can help us better achieve changes in competence, performance, and patient outcomes. IS should be incorporated into curricula across disciplines and across the continuum of medical education to facilitate implementation of learning. Educators should start by selecting, applying, and evaluating the teaching and patient care impact one or two IS strategies in their work.

  19. Technical approach to groundwater restoration. Final report

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

    Not Available

    1993-11-01

    The Technical Approach to Groundwater Restoration (TAGR) provides general technical guidance to implement the groundwater restoration phase of the Uranium Mill Tailings Remedial Action (UMTRA) Project. The TAGR includes a brief overview of the surface remediation and groundwater restoration phases of the UMTRA Project and describes the regulatory requirements, the National Environmental Policy Act (NEPA) process, and regulatory compliance. A section on program strategy discusses program optimization, the role of risk assessment, the observational approach, strategies for meeting groundwater cleanup standards, and remedial action decision-making. A section on data requirements for groundwater restoration evaluates the data quality objectives (DQO) andmore » minimum data required to implement the options and comply with the standards. A section on sits implementation explores the development of a conceptual site model, approaches to site characterization, development of remedial action alternatives, selection of the groundwater restoration method, and remedial design and implementation in the context of site-specific documentation in the site observational work plan (SOWP) and the remedial action plan (RAP). Finally, the TAGR elaborates on groundwater monitoring necessary to evaluate compliance with the groundwater cleanup standards and protection of human health and the environment, and outlines licensing procedures.« less

  20. Dairy farmers' perceptions toward the implementation of on-farm Johne's disease prevention and control strategies.

    PubMed

    Ritter, C; Jansen, J; Roth, K; Kastelic, J P; Adams, C L; Barkema, H W

    2016-11-01

    Implementation of specific management strategies on dairy farms is currently the most effective way to reduce the prevalence of Johne's disease (JD), an infectious chronic enteritis of ruminants caused by Mycobacterium avium subspecies paratuberculosis (MAP). However, dairy farmers often fail to implement recommended strategies. The objective of this study was to assess perceptions of farmers participating in a JD prevention and control program toward recommended practices, and explore factors that influence whether or not a farmer adopts risk-reducing measures for MAP transmission. Semi-structured interviews were conducted with 25 dairy farmers enrolled in a voluntary JD control program in Alberta, Canada. Principles of classical grounded theory were used for participant selection, interviewing, and data analysis. Additionally, demographic data and MAP infection status were collected and analyzed using quantitative questionnaires and the JD control program database. Farmers' perceptions were distinguished according to 2 main categories: first, their belief in the importance of JD, and second, their belief in recommended JD prevention and control strategies. Based on these categories, farmers were classified into 4 groups: proactivists, disillusionists, deniers, and unconcerned. The first 2 groups believed in the importance of JD, and proactivists and unconcerned believed in proposed JD prevention and control measures. Groups that regarded JD as important had better knowledge about best strategies to reduce MAP transmission and had more JD risk assessments conducted on their farm. Although not quantified, it also appeared that these groups had more JD prevention and control practices in place. However, often JD was not perceived as a problem in the herd and generally farmers did not regard JD control as a "hot topic" in communications with their herd veterinarian and other farmers. Recommendations regarding how to communicate with farmers and motivate various groups of farmers according to their specific perceptions were provided to optimize adoption of JD prevention and control measures and thereby increase success of voluntary JD control programs. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  1. Helping learners level up with cognitive supports.

    PubMed

    Malenczak, Derek; Nemec, Patricia B

    2017-03-01

    This column describes strategies for helping educators and trainers address common problems with executive functioning and memory for their audiences, to better facilitate learning. The purpose of the article is to suggest strategies for maximizing learning and goal achievement for students in academic settings, as well as for building employee knowledge and skills in the psychiatric rehabilitation workforce through worksite-based training. The content in this column is drawn from the professional experience of the authors as well as available literature. Educators and trainers encounter many challenges when assisting people to achieve desired learning objectives. Attending to the cognitive needs of all learners, by supporting their planning, attention, memory, and reasoning skills, can minimize some of these challenges. Educators and trainers may implement the strategies described to better engage with their audiences, whether in an academic or clinical practice environment. Implementation of specific strategies to offset limitations will positively affect all learners, who benefit both from maximized knowledge and skill acquisition as well as improved job performance. Improved learning will likely translate to better practitioner skill over time, which should lead to improved outcomes for service users in the field of psychiatric rehabilitation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  2. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.

    PubMed

    Palinkas, Lawrence A; Horwitz, Sarah M; Green, Carla A; Wisdom, Jennifer P; Duan, Naihua; Hoagwood, Kimberly

    2015-09-01

    Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.

  3. Influence of occupation and education level on breast cancer stage at diagnosis, and treatment options in China: A nationwide, multicenter 10-year epidemiological study.

    PubMed

    Liu, Yang; Zhang, Jian; Huang, Rong; Feng, Wei-Liang; Kong, Ya-Nan; Xu, Feng; Zhao, Lin; Song, Qing-Kun; Li, Jing; Zhang, Bao-Ning; Fan, Jin-Hu; Qiao, You-Lin; Xie, Xiao-Ming; Zheng, Shan; He, Jian-Jun; Wang, Ke

    2017-04-01

    The objective of this study was to evaluate the impact of occupation and education level of Chinese female breast cancer patients on their cancer staging at diagnosis, clinical and pathological features, rate of implementation, and selection of treatment.The medical charts of 4211 confirmed female breast cancer cases diagnosed between 1999 and 2008, from 7 breast cancer centers spread across the whole of China, were reviewed. Data including information on the patient's sociodemographic status, clinical and pathological characteristics, implementation of clinical examination and treatment modalities were analyzed. In parallel, the associations between different occupations and level of educational attainment were analyzed in relation to tumor stage through TNM staging, clinical and pathological characteristics, implementation of clinical examination, and treatment patterns. Multivariate logistic regression was used to identify whether the occupation and education level of patients are independent factors of TNM staging at diagnosis.There were significant differences among different occupation groups and the education level of patients in regards to pathological characteristics and treatment choice. Both the occupation and education level of patients were independent factors of TNM staging at diagnosis. For patients within the lower-income occupation or lower educational attainment group, the tumor stage was later, the rates of implementation of relevant investigations were lower, as were the rates of radiotherapy, chemotherapy, and endocrine therapy.This study suggests that strategies should work toward developing more accurate and effective breast cancer prevention and treatment strategies aimed specifically at patients with lower educational attainment levels and at specific occupation groups.

  4. Influence of occupation and education level on breast cancer stage at diagnosis, and treatment options in China

    PubMed Central

    Liu, Yang; Zhang, Jian; Huang, Rong; Feng, Wei-Liang; Kong, Ya-Nan; Xu, Feng; Zhao, Lin; Song, Qing-Kun; Li, Jing; Zhang, Bao-Ning; Fan, Jin-Hu; Qiao, You-Lin; Xie, Xiao-Ming; Zheng, Shan; He, Jian-Jun; Wang, Ke

    2017-01-01

    Abstract The objective of this study was to evaluate the impact of occupation and education level of Chinese female breast cancer patients on their cancer staging at diagnosis, clinical and pathological features, rate of implementation, and selection of treatment. The medical charts of 4211 confirmed female breast cancer cases diagnosed between 1999 and 2008, from 7 breast cancer centers spread across the whole of China, were reviewed. Data including information on the patient's sociodemographic status, clinical and pathological characteristics, implementation of clinical examination and treatment modalities were analyzed. In parallel, the associations between different occupations and level of educational attainment were analyzed in relation to tumor stage through TNM staging, clinical and pathological characteristics, implementation of clinical examination, and treatment patterns. Multivariate logistic regression was used to identify whether the occupation and education level of patients are independent factors of TNM staging at diagnosis. There were significant differences among different occupation groups and the education level of patients in regards to pathological characteristics and treatment choice. Both the occupation and education level of patients were independent factors of TNM staging at diagnosis. For patients within the lower-income occupation or lower educational attainment group, the tumor stage was later, the rates of implementation of relevant investigations were lower, as were the rates of radiotherapy, chemotherapy, and endocrine therapy. This study suggests that strategies should work toward developing more accurate and effective breast cancer prevention and treatment strategies aimed specifically at patients with lower educational attainment levels and at specific occupation groups. PMID:28403116

  5. Putting women at the center: a review of Indian policy to address person-centered care in maternal and newborn health, family planning and abortion.

    PubMed

    Srivastava, Aradhana; Singh, Devaki; Montagu, Dominic; Bhattacharyya, Sanghita

    2017-07-14

    Person-centered care is a critical component of quality care, essential to enable treatment adherence, and maximize health outcomes. Improving the quality of health services is a key strategy to achieve the new global target of zero preventable maternal deaths by 2030. Recognizing this, the Government of India has in the last decade initiated a number of strategies to address quality of care in health and family welfare services. We conducted a policy review of quality improvement strategies in India from 2005 to 15, covering three critical areas- maternal and newborn health, family planning, and abortion (MNHFP + A). Based on Walt and Gilson's policy triangle framework, we analyzed the extent to which policies incorporated person-centered care, while identifying unaddressed issues. Data was sourced from Government of India websites, scientific and grey literature databases. Twenty-two national policy documents, comprising two policy statements and 20 implementation guidelines of specific schemes were included in the review. Quality improvement strategies span infrastructure, commodities, human resources, competencies, and accountability that are driving quality assurance in MNHFP + A services. However, several implementation challenges have affected compliance with person-centered care, thereby affecting utilization and outcomes. Focus on person-centered care in Indian MNHFP + A policy has increased in recent years. Nevertheless, some aspects must still be strengthened, such as positive interpersonal behavior, information sharing and promptness of care. Implementation can be improved through better provider training, patient feedback and monitoring mechanisms. Moreover, unless persisting structural challenges are addressed implementation of person-centered care in facilities will not be effective.

  6. Nutritional recommendations for water polo.

    PubMed

    Cox, Gregory R; Mujika, Iñigo; van den Hoogenband, Cees Rein

    2014-08-01

    Water polo is an aquatic team sport that requires endurance, strength, power, swimming speed, agility, tactical awareness, and specific technical skills, including ball control. Unlike other team sports, few researchers have examined the nutritional habits of water polo athletes or potential dietary strategies that improve performance in water polo match play. Water polo players are typically well muscled, taller athletes; female players display higher levels of adiposity compared with their male counterparts. Positional differences exist: Center players are heavier and have higher body fat levels compared with perimeter players. Knowledge of the physical differences that exist among water polo players offers the advantage of player identification as well as individualizing nutrition strategies to optimize desired physique goals. Individual dietary counseling is warranted to ensure dietary adequacy, and in cases of physique manipulation. Performance in games and during quality workouts is likely to improve by adopting strategies that promote high carbohydrate availability, although research specific to water polo is lacking. A planned approach incorporating strategies to facilitate muscle glycogen refueling and muscle protein synthesis should be implemented following intensified training sessions and matches, particularly when short recovery times are scheduled. Although sweat losses of water polo players are less than what is reported for land-based athletes, specific knowledge allows for appropriate planning of carbohydrate intake strategies for match play and training. Postgame strategies to manage alcohol intake should be developed with input from the senior player group to minimize the negative consequences on recovery and player welfare.

  7. Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina.

    PubMed

    Carter-Edwards, Lori; Lowe-Wilson, Abby; Mouw, Mary Sherwyn; Jeon, Janet Yewon; Baber, Ceola Ross; Vu, Maihan B; Bethell, Monique

    2015-08-13

    The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state's most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing. In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity-related issues. Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts. Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies.

  8. Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina

    PubMed Central

    Lowe-Wilson, Abby; Mouw, Mary Sherwyn; Jeon, Janet Yewon; Baber, Ceola Ross; Vu, Maihan B.; Bethell, Monique

    2015-01-01

    Introduction The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state’s most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing. Methods In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity–related issues. Results Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts. Conclusions Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies. PMID:26270741

  9. Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.

    PubMed

    DeSisto, Carla L; Estrich, Cameron; Kroelinger, Charlan D; Goodman, David A; Pliska, Ellen; Mackie, Christine N; Waddell, Lisa F; Rankin, Kristin M

    2017-11-21

    Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015-2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct educational meetings, facilitation, promote network weaving, provide ongoing consultation, and distribute educational materials. Convening a multi-state learning collaborative is a promising approach for facilitating the implementation of new reimbursement policies for evidence-based practices complicated by systems challenges. By integrating several implementation strategies, the Learning Community serves as a meta-strategy for supporting implementation.

  10. Competency of new graduate nurses: a review of their weaknesses and strategies for success.

    PubMed

    Theisen, Janelle L; Sandau, Kristin E

    2013-09-01

    Because of the ongoing nursing shortage and the increasing acuity of patients, new graduate nurses must master both psychomotor and critical thinking skills rapidly. Inadequate orientation leads to high turnover rates for new graduates. Health care leaders must examine the competencies needed for new graduate nurses to succeed in this environment. A critical review of studies (n = 26) was conducted to identify crucial competencies that are needed for new graduate nurses to be successful. Six areas were identified in which new graduates lacked competence: communication, leadership, organization, critical thinking, specific situations, and stress management. Strategies were identified to improve the transition of new graduates. Hospitals should consider implementing nurse residency programs that include strategies for clear communication and conflict management, prioritization skills, and leadership development. Schools of nursing should add communication strategies to their current focus on critical thinking, clinical reasoning, and simulation scenarios and include situation-specific skills such as end-of-life scenarios. Further research should focus on stress management, leadership, clinical reasoning, and evaluation of measurement tools for new graduates. Copyright 2013, SLACK Incorporated.

  11. A simulation model to quantify the value of implementing whole-herd Bovine viral diarrhea virus testing strategies in beef cow-calf herds.

    PubMed

    Nickell, Jason S; White, Brad J; Larson, Robert L; Renter, David G; Sanderson, Mike W

    2011-03-01

    Although numerous diagnostic tests are available to identify cattle persistently infected (PI) with Bovine viral diarrhea virus (BVDV) in cow-calf herds, data are sparse when evaluating the economic viability of individual tests or diagnostic strategies. Multiple factors influence BVDV testing in determining if testing should be performed and which strategy to use. A stochastic model was constructed to estimate the value of implementing various whole-herd BVDV cow-calf testing protocols. Three common BVDV tests (immunohistochemistry, antigen-capture enzyme-linked immunosorbent assay, and polymerase chain reaction) performed on skin tissue were evaluated as single- or two-test strategies. The estimated testing value was calculated for each strategy at 3 herd sizes that reflect typical farm sizes in the United States (50, 100, and 500 cows) and 3 probabilities of BVDV-positive herd status (0.077, 0.19, 0.47) based upon the literature. The economic value of testing was the difference in estimated gross revenue between simulated cow-calf herds that either did or did not apply the specific testing strategy. Beneficial economic outcomes were more frequently observed when the probability of a herd being BVDV positive was 0.47. Although the relative value ranking of many testing strategies varied by each scenario, the two-test strategy composed of immunohistochemistry had the highest estimated value in all but one herd size-herd prevalence permutation. These data indicate that the estimated value of applying BVDV whole-herd testing strategies is influenced by the selected strategy, herd size, and the probability of herd BVDV-positive status; therefore, these factors should be considered when designing optimum testing strategies for cow-calf herds.

  12. The Causality Study of External Environment Analysis (EEA), Internal Environment Analysis (IEA), Strategy Implementation on Study Program Performance at Vocational High School (VHS) in Nias Archipelago, Indonesia

    ERIC Educational Resources Information Center

    Waruwu, Binahati; Sitompul, Harun; Manullang, Belferik

    2016-01-01

    The purposes of this study are to find out the significant effect of: (1) EEA on strategy implementation, (2) IEA on strategy implementation, (3) EEA on study program performance, (4) IEA on study program performance, and (5) strategy implementation on study program performance of Vocational High School (VHS) in Nias Archipelago. The population of…

  13. An Action Research to Optimize the Well-Being of Older People in Nursing Homes: Challenges and Strategies for Implementing a Complex Intervention.

    PubMed

    Bourbonnais, Anne; Ducharme, Francine; Landreville, Philippe; Michaud, Cécile; Gauthier, Marie-Andrée; Lavallée, Marie-Hélène

    2018-03-01

    Few studies have been conducted on strategies to promote the implementation of complex interventions in nursing homes (NHs). This article presents a pilot study intended to assess the strategies that would enable the optimal implementation of a complex intervention approach in NHs based on the meanings of screams of older people living with Alzheimer's disease. An action research approach was used with 19 formal and family caregivers from five NHs. Focus groups and individual interviews were held to assess different implementation strategies. A number of challenges were identified, as were strategies to overcome them. These latter included interactive training, intervention design, and external support. This study shows the feasibility of implementing a complex intervention to optimize older people's well-being. The article shares strategies that may promote the implementation of these types of interventions in NHs.

  14. Controlling the Seedbeds of Tuberculosis: Diagnosis and Treatment of Tuberculosis Infection

    PubMed Central

    Rangaka, Molebogeng X.; Cavalcante, Solange C.; Marais, Ben J.; Thim, Sok; Martinson, Neil A.; Swaminathan, Soumya; Chaisson, Richard E.

    2015-01-01

    The billions of people with latent tuberculosis infection serve as the seedbeds for future cases of active tuberculosis. Virtually all episodes of tuberculosis disease are preceded by a period of asymptomatic Mycobacterium tuberculosis infection; therefore, identifying infected individuals most likely to progress to disease and treating such subclinical infections to prevent future disease provides a critical opportunity to interrupt tuberculosis transmission and reduce the global burden of tuberculosis disease. Programs focusing on single strategies rather than comprehensive programs that deliver an integrated arsenal for tuberculosis control may continue to struggle. Tuberculosis preventive therapy is a poorly utilized tool that is essential for controlling the reservoirs of disease that drive the current epidemic. Comprehensive control strategies that combine preventive therapy for the most high-risk populations and communities with improved case-finding and treatment, control of transmission and health systems strengthening could ultimately lead to worldwide tuberculosis elimination. This paper outlines challenges to implementation of preventive therapy and provides pragmatic suggestions for overcoming them. It further advocates for tuberculosis preventive therapy as the core of a renewed global focus to implement a comprehensive epidemic control strategy that would reduce new tuberculosis cases to elimination targets. This strategy would be underpinned by accelerated research to further understand the biology of subclinical tuberculosis infections, develop novel diagnostics, and drug regimens specifically for subclinical tuberculosis infection, strengthen health systems, community engagement, and enhance sustainable large scale implementation of preventive therapy programs. PMID:26515679

  15. Community Readiness Within Systems of Care: The Validity and Reliability of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS).

    PubMed

    Rosas, Scott R; Behar, Lenore B; Hydaker, William M

    2016-01-01

    Establishing a system of care requires communities to identify ways to successfully implement strategies and support positive outcomes for children and their families. Such community transformation is complex and communities vary in terms of their readiness for implementing sustainable community interventions. Assessing community readiness and guiding implementation, specifically for the funded communities implementing a system of care, requires a well-designed tool with sound psychometric properties. This scale development study used the results of a previously published concept mapping study to create, administer, and assess the psychometric characteristics of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS). The results indicate the SOC-RIMS possesses excellent internal consistency characteristics, measures clearly discernible dimensions of community readiness, and demonstrates the target constructs exist within a broad network of content. The SOC-RIMS can be a useful part of a comprehensive assessment in communities where system of care practices, principles, and philosophies are implemented and evaluated.

  16. How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy.

    PubMed

    Egeland, Karina Myhren; Ruud, Torleif; Ogden, Terje; Färdig, Rickard; Lindstrøm, Jonas Christoffer; Heiervang, Kristin Sverdvik

    2017-01-01

    The purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway. A total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes. Although the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life. The implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice. Trial registration ClinicalTrials.gov NCT02077829. Registered 25 February 2014.

  17. Self-regulation interventions to reduce consumption of sugar-sweetened beverages in adolescents.

    PubMed

    Ames, Susan L; Wurpts, Ingrid C; Pike, James R; MacKinnon, David P; Reynolds, Kim R; Stacy, Alan W

    2016-10-01

    This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption. Copyright © 2016. Published by Elsevier Ltd.

  18. What drives successful implementation of pollution prevention and cleaner technology strategy? The role of innovative capability.

    PubMed

    Bhupendra, Kumar Verma; Sangle, Shirish

    2015-05-15

    Firms that are dynamic and prepared to implement environmental strategies have a potential competitive advantage over their industry counterparts. Therefore, it is important to understand, what capabilities are required to implement proactive environmental strategies. The paper discusses the attributes of innovative capability required by firms in order to adopt pollution prevention and cleaner technology strategies. Empirical results show that process and behavioral innovativeness are required by firms to implement a pollution prevention strategy. In addition to process and behavioral innovativeness, firms need a top management with high risk-taking ability as well as market, product, and strategic innovativeness to implement a cleaner technology strategy. The paper proposes some important managerial implications on the basis of the above research findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial.

    PubMed

    Waiswa, Peter; O'Connell, Thomas; Bagenda, Danstan; Mullachery, Pricila; Mpanga, Flavia; Henriksson, Dorcus Kiwanuka; Katahoire, Anne Ruhweza; Ssegujja, Eric; Mbonye, Anthony K; Peterson, Stefan Swartling

    2016-03-11

    Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably. The CODES strategy combines management, diagnostic, and evaluation tools to identify and analyze the causes of bottlenecks to implementation, build capacity of district management teams to implement context-specific solutions, and to foster community monitoring and social accountability to increase demand for services. CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. Implementation and all data collection will be by the districts teams or local Community-based Organizations who will be supported by two local implementing partners. The study will be evaluated as a cluster randomized trial with eight intervention and eight comparison districts over a period of 3 years. Evaluation will focus on differences in uptake of child survival interventions and will follow an intention-to-treat analysis. We will also document and analyze experiences in implementation including changes in management practices. By increasing the District Health Management Teams' capacity to prioritize and implement context-specific solutions, and empowering communities to become active partners in service delivery, coverage of child survival interventions will increase. Lessons learned on strengthening district-level managerial capacities and mechanisms for community monitoring may have implications, not only in Uganda but also in other similar settings, especially with regard to accelerating effective coverage of key child survival interventions using locally available resources. ISRCTN15705788 , Date of registration; 24 July 2015.

  20. A sample implementation for parallelizing Divide-and-Conquer algorithms on the GPU.

    PubMed

    Mei, Gang; Zhang, Jiayin; Xu, Nengxiong; Zhao, Kunyang

    2018-01-01

    The strategy of Divide-and-Conquer (D&C) is one of the frequently used programming patterns to design efficient algorithms in computer science, which has been parallelized on shared memory systems and distributed memory systems. Tzeng and Owens specifically developed a generic paradigm for parallelizing D&C algorithms on modern Graphics Processing Units (GPUs). In this paper, by following the generic paradigm proposed by Tzeng and Owens, we provide a new and publicly available GPU implementation of the famous D&C algorithm, QuickHull, to give a sample and guide for parallelizing D&C algorithms on the GPU. The experimental results demonstrate the practicality of our sample GPU implementation. Our research objective in this paper is to present a sample GPU implementation of a classical D&C algorithm to help interested readers to develop their own efficient GPU implementations with fewer efforts.

  1. Dissemination and implementation of evidence-based practices for child and adolescent mental health: a systematic review.

    PubMed

    Novins, Douglas K; Green, Amy E; Legha, Rupinder K; Aarons, Gregory A

    2013-10-01

    Although there has been a dramatic increase in the number of evidence-based practices (EBPs) to improve child and adolescent mental health, the poor uptake of these EBPs has led to investigations of factors related to their successful dissemination and implementation. The purpose of this systematic review was to identify key findings from empirical studies examining the dissemination and implementation of EBPs for child and adolescent mental health. Of 14,247 citations initially identified, 73 articles drawn from 44 studies met inclusion criteria. The articles were classified by implementation phase (exploration, preparation, implementation, and sustainment) and specific implementation factors examined. These factors were divided into outer (i.e., system level) and inner (i.e., organizational level) contexts. Few studies used true experimental designs; most were observational. Of the many inner context factors that were examined in these studies (e.g., provider characteristics, organizational resources, leadership), fidelity monitoring and supervision had the strongest empirical evidence. Albeit the focus of fewer studies, implementation interventions focused on improving organizational climate and culture were associated with better intervention sustainment as well as child and adolescent outcomes. Outer contextual factors such as training and use of specific technologies to support intervention use were also important in facilitating the implementation process. The further development and testing of dissemination and implementation strategies is needed to more efficiently move EBPs into usual care. Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Essential Resources for Implementation and Sustainability of Evidence-Based Health Promotion Programs: A Mixed Methods Multi-Site Case Study.

    PubMed

    Dattalo, M; Wise, M; Ford Ii, J H; Abramson, B; Mahoney, J

    2017-04-01

    As of October 2016, use of federal Older Americans Act funds for health promotion and disease prevention will be restricted to the Administration on Aging's criteria for high-level evidence-based health promotion programs. Dissemination of these programs to rural communities remains limited. Therefore a strong need exists to identify strategies that facilitate program implementation and sustainability. The objective of this study was to compare organizational readiness and implementation strategies used by rural communities that achieved varying levels of success in sustaining evidence-based health promotion programs for older adults. We utilized a qualitative multi-site case study design to analyze the longitudinal experiences of eight rural sites working to implement evidence-based health promotion program over 3 years (8/2012-7/2015). Multiple sources of data (interviews, documents, reports, surveys) from each site informed the analysis. We used conventional content analysis to conduct a cross-case comparison to identify common features of rural counties that successfully implemented and sustained their target evidence-based health promotion program. Readiness to implement evidence-based programs as low at baseline as all site leaders described needing to secure additional resources for program implementation. Sites that successfully utilized six essential resources implemented and sustained greater numbers of workshops: (1) External Partnerships, (2) Agency Leadership Commitment, (3) Ongoing Source of Workshop Leaders, (4) Health Promotion Coordination Tasks Assigned to Specific Staff, (5) Organizational Stability, and (6) Change Team Engagement. The six essential resources described in this study can help rural communities assess their readiness to implement health promotion programs and work secure the resources necessary for successful implementation.

  3. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research

    PubMed Central

    Palinkas, Lawrence A.; Horwitz, Sarah M.; Green, Carla A.; Wisdom, Jennifer P.; Duan, Naihua; Hoagwood, Kimberly

    2013-01-01

    Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research. PMID:24193818

  4. Implementation of an Integrated Approach to the National HIV/AIDS Strategy for Improving Human Immunodeficiency Virus Care for Youths.

    PubMed

    Fortenberry, J Dennis; Koenig, Linda J; Kapogiannis, Bill G; Jeffries, Carrie L; Ellen, Jonathan M; Wilson, Craig M

    2017-07-01

    Youths aged 13 to 24 years old living with human immunodeficiency virus (HIV) are less likely than adults to receive the health and prevention benefits of HIV treatments, with only a small proportion having achieved sustained viral suppression. These age-related disparities in HIV continuum of care are owing in part to the unique developmental issues of adolescents and young adults as well as the complexity and fragmentation of HIV care and related services. This article summarizes a national, multiagency, and multilevel approach to HIV care for newly diagnosed youths designed to bridge some of these fragmentations by addressing National HIV/AIDS Strategy goals for people living with HIV. Three federal agencies developed memoranda of understanding to sequentially implement 3 protocols addressing key National HIV/AIDS Strategy goals. The goals were addressed in the Adolescent Trials Network, with protocols implemented in 12 to 15 sites across the United States. Outcome data were collected from recently diagnosed youth referred to the program. Cross-agency collaboration, youth-friendly linkage to care services, community mobilization to address structural barriers to care, cooperation among services, proportion of all men who have sex with men who tested, and rates of linkage to prevention services. The program addressed National HIV/AIDS Strategy goals 2 through 4 including steps within each goal. A total of 3986 HIV-positive youths were referred for care, with more than 75% linked to care within 6 weeks of referral, with almost 90% of those youths engaged in subsequent HIV care. Community mobilization efforts implemented and completed structural change objectives to address local barriers to care. Age and racial/ethnic group disparities were addressed through targeted training for culturally competent, youth-friendly care, and intensive motivational interviewing training. A national program to address the National HIV/AIDS Strategy specifically for youths can improve coordination of federal resources as well as implement best-practice models that are adapted to decrease service fragmentation and systemic barriers at local jurisdictions.

  5. Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial.

    PubMed

    Suman, Arnela; Schaafsma, Frederieke G; Elders, Petra J M; van Tulder, Maurits W; Anema, Johannes R

    2015-05-31

    Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session. The timing these clusters receive the training is the unit of randomisation. LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aimed at improving beliefs, cognitions, and self-management. The primary outcome measure of this study is patient back beliefs. Secondary outcome measures on patient level include pain, functional status, quality of life, health care utility, and productivity losses. Outcome measures on professional level include knowledge and attitude towards the guideline, and guideline adherence. A process evaluation for the implementation strategy will be performed among the health care providers and the patients. Furthermore, a qualitative subgroup analysis among patients with various ethnic backgrounds will be performed. This study will give insight into the (cost-) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non-specific back pain to improve outcomes on patient and professional level. The valuable information gained with this study may prove useful for policy-makers, health care providers, and researchers who are in the process of reducing the burden of back pain on individuals and society. Netherlands Trial Register (NTR): NTR4329. Registered December 20th, 2013.

  6. Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment.

    PubMed

    Anderson, Andrew C; O'Rourke, Erin; Chin, Marshall H; Ponce, Ninez A; Bernheim, Susannah M; Burstin, Helen

    2018-03-01

    Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.

  7. Development and demonstration of marketing techniques for establishment of ridesharing corporations in New York State: Final report

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

    Peters, E.W.; Matthews, N.P.

    1987-10-01

    The intent of this project was to develop, demonstrate and evaluate marketing techniques for the establishment of ridesharing corporations in New York State. The objectives of the first phase of the project were to: (1) develop a ''how-to'' guide for establishing a ridesharing corporation; and (2) conduct a market assessment to identify specific methods for capturing potential users of the service. The objectives of the second phase of the project were to: (1) prepare and implement a marketing strategy to address the various major users and evaluate the viability of new marketing techniques developed in Phase 1 and marketing techniquesmore » developed during the first year of operations; and (2) develop and disseminate a ''how-to'' guide regarding the development, implementation and evaluation of marketing strategies for ridesharing in New York State.« less

  8. Tips for using mobile audience response systems in medical education

    PubMed Central

    Gousseau, Michael; Sommerfeld, Connor; Gooi, Adrian

    2016-01-01

    Background With growing evidence on the benefits of active learning, audience response systems (ARSs) have been increasingly used in conferences, business, and education. With the introduction of mobile ARS as an alternative to physical clickers, there are increasing opportunities to use this tool to improve interactivity in medical education. Aim The aim of this study is to provide strategies on using mobile ARS in medical education by discussing steps for implementation and pitfalls to avoid. Method The tips presented reflect our commentary of the literature and our experiences using mobile ARS in medical education. Results This article offers specific strategies for the preparation, implementation, and assessment of medical education teaching sessions using mobile ARS. Conclusion We hope these tips will help instructors use mobile ARS as a tool to improve student interaction, teaching effectiveness, and participant enjoyment in medical education. PMID:27942242

  9. BCG and New Preventive Tuberculosis Vaccines: Implications for Healthcare Workers

    PubMed Central

    Hatherill, Mark; Scriba, Thomas J.; Udwadia, Zarir F.; Mullerpattan, Jai B.; Hawkridge, Anthony; Mahomed, Hassan; Dye, Christopher

    2016-01-01

    Healthcare workers (HCWs) are at high risk of Mycobacterium tuberculosis (Mtb) infection and tuberculosis disease, but also play a crucial role in implementing healthcare. Preexposure tuberculosis vaccination, including revaccination with BCG, might benefit Mtb-uninfected HCWs, but most HCWs in tuberculosis-endemic countries are already sensitized to mycobacteria. A new postexposure tuberculosis vaccine offers greatest potential for protection, in the setting of repeated occupational Mtb exposure. Novel strategies for induction of mycobacteria-specific resident memory T cells in the lung by aerosol administration, or induction of T cells with inherent propensity for residing in mucosal sites, such as CD1-restricted T cells and mucosa-associated innate T cells, should be explored. The need for improved protection of HCWs against tuberculosis disease is clear. However, health systems in tuberculosis-endemic countries would need significantly improved occupational health structures to implement a screening and vaccination strategy for HCWs. PMID:27118856

  10. Flipped classroom model for learning evidence-based medicine.

    PubMed

    Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf

    2017-01-01

    Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice.

  11. Flipped classroom model for learning evidence-based medicine

    PubMed Central

    Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf

    2017-01-01

    Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice. PMID:28919831

  12. The Strategy and Implementation of the Rosetta Communication Campaign

    NASA Astrophysics Data System (ADS)

    Bauer, M.; McCaughrean, M.; Landeau-Constantin, J.

    2016-03-01

    The communication campaign for Rosetta has been the biggest success in the history of European Space Agency outreach, resulting in global awareness for the agency. The mission itself is an extraordinary operational and scientific success, but communicating only the operational and scientific firsts would likely not have brought the Rosetta orbiter and Philae lander to the attention of so many people, and would not have made the mission part of people's lives across the globe. The additional impact brought to the mission through the communication campaign was based on a strategic approach focusing on: real-time release of information with maximum transparency; direct real-time access for media and social media; adding a human dimension to the story; and communicating the risks openly in order to manage expectations. In this article we describe our overall strategy, illustrate its implementation, and provide the framework for subsequent articles in this journal highlighting specific aspects of the campaign in more detail.

  13. Writing usable qualitative health research findings.

    PubMed

    Sandelowski, Margarete; Leeman, Jennifer

    2012-10-01

    Scholars in diverse health-related disciplines and specialty fields of practice routinely promote qualitative research as an essential component of intervention and implementation programs of research and of a comprehensive evidence base for practice. Remarkably little attention, however, has been paid to the most important element of qualitative studies--the findings in reports of those studies--and specifically to enhancing the accessibility and utilization value of these findings for diverse audiences of users. The findings in reports of qualitative health research are too often difficult to understand and even to find owing to the way they are presented. A basic strategy for enhancing the presentation of these findings is to translate them into thematic statements, which can then in turn be translated into the language of intervention and implementation. Writers of qualitative health research reports might consider these strategies better to showcase the significance and actionability of findings to a wider audience.

  14. Development and Pilot of the Caregiver Strategies Inventory.

    PubMed

    Kirby, Anne V; Little, Lauren M; Schultz, Beth; Watson, Linda R; Zhang, Wanqing; Baranek, Grace T

    2016-01-01

    Children with autism spectrum disorder often demonstrate unusual behavioral responses to sensory stimuli (i.e., sensory features). To manage everyday activities, caregivers may implement strategies to address these features during family routines. However, investigation of specific strategies used by caregivers is limited by the lack of empirically developed measures. In this study, we describe the development and pilot results of the Caregiver Strategies Inventory (CSI), a supplement to the Sensory Experiences Questionnaire Version 3.0 (SEQ 3.0; Baranek, 2009) that measures caregivers' strategies in response to their children's sensory features. Three conceptually derived and empirically grounded strategy types were tested: cognitive-behavioral, sensory-perceptual, and avoidance. Results indicated that the CSI demonstrated good internal consistency and that strategy use was related to child age and cognition. Moreover, parent feedback after completing the CSI supported its utility and social validity. The CSI may be used alongside the SEQ 3.0 to facilitate a family-centered approach to assessment and intervention planning. Copyright © 2016 by the American Occupational Therapy Association, Inc.

  15. The effectiveness of a learning strategies program for university students.

    PubMed

    Roces Montero, Cristina; Sierra Y Arizmendiarrieta, Beatriz

    2017-11-01

    University lecturers often complain about their students’ lack of learning strategies, but not many universities in Spain offer specific courses in this area. Studies on their effectiveness are also rare. This study presents the results of a Learning Strategies Course implemented at the School of Teacher Training and Education, University of Oviedo, Spain. A quasi-experimental design was used with an experi-mental (n = 60) and a control group (n = 57) of students on the Educational Psychology course. A Spanish adaptation of the Motivated Strategies for Learning Questionnaire (MSLQ): the CEAMR2 was used as a pre and post-test measure. Group A (EG) received training in learning strategies, while group B (CG) received no training. Post-test measures showed significant differences in five out of the ten learning strategies assessed: elaboration, organization, repetition, self-questioning and study space, and also an improvement in one out of the six motivational scales: control of learning beliefs. The results suggest that learning strategies courses with proven effectiveness should be offered to university students.

  16. Legal framework for food fortification: examples from Vietnam and Indonesia.

    PubMed

    Dijkhuizen, Marjoleine Amma; Wieringa, Frank Tammo; Soekarjo, Damayanti; Van, Khan Tran; Laillou, Arnaud

    2013-06-01

    Food fortification is a cost-effective, powerful, and sustainable strategy to combat micronutrient deficiency, with the potential to reach large sections of the population with minimal cost and effort. However, the implementation of food fortification on a systematic and large scale, for instance in national programs, has often been challenging. This paper takes a closer look at food fortification efforts and legislation mechanisms in Vietnam and Indonesia in order to determine specific factors and components in the legal framework that are crucial to the success of fortification programs. Fortification efforts in Indonesia and Vietnam are evaluated using published data as well as unpublished data from detailed evaluation reports, and compared with respect to the specific circumstances, constraints, objectives and results in each country. The legal framework is a crucial factor for the success of food fortification programs, as it shapes to a large extent the implementation of food fortification. The legal framework is instrumental to ensure the quality, safety, availability, cost-effectiveness, and sustainability of food fortification. In the first place, the legal framework should specify the fortificants and fortification levels, as well as the food vehicles and the fortification procedures. In addition, it should ensure the commitment of policy makers and producers to fortification, regulate the costing, describe and ensure information and communication such as product labeling integrate social marketing into the implementation, and provide the means to monitor and enforce fortification. A clear public health objective, together with careful consideration of the choices and restrictions dictated by the specific national environments, will help to develop legal frameworks that optimize the potential success of food fortification strategies. The lessons from these experiences show that a mandatory approach to fortification, with costing, monitoring and enforcement, and social marketing clearly defined and well embedded in the legal framework and in the implementation structures, is the best foundation for an effective, sustainable, and feasible food fortification program.

  17. The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample.

    PubMed

    Rogal, Shari S; Yakovchenko, Vera; Waltz, Thomas J; Powell, Byron J; Kirchner, JoAnn E; Proctor, Enola K; Gonzalez, Rachel; Park, Angela; Ross, David; Morgan, Timothy R; Chartier, Maggie; Chinman, Matthew J

    2017-05-11

    Hepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally. A 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed. A total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment. These results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems.

  18. Interplay and characterization of Dark Matter searches at colliders and in direct detection experiments

    DOE PAGES

    Malik, Sarah A.; McCabe, Christopher; Araujo, Henrique; ...

    2015-05-18

    In our White Paper we present and discuss a concrete proposal for the consistent interpretation of Dark Matter searches at colliders and in direct detection experiments. Furthermore, based on a specific implementation of simplified models of vector and axial-vector mediator exchanges, this proposal demonstrates how the two search strategies can be compared on an equal footing.

  19. Success and Failure in Dynamic Decision Environments: Understanding Treatment Strategies for Patients with a Chronic Disease

    ERIC Educational Resources Information Center

    Ramsey, Gregory W.

    2010-01-01

    This dissertation proposes and tests a theory explaining how people make decisions to achieve a goal in a specific task environment. The theory is represented as a computational model and implemented as a computer program. The task studied was primary care physicians treating patients with type 2 diabetes. Some physicians succeed in achieving…

  20. [The non-pharmacological management of chronic pain].

    PubMed

    Berlemont, Christine

    2017-05-01

    Pain management is not limited to the putting in place of pharmacological, surgical, physiotherapy or psychological strategies. Non-pharmacological therapies can also be proposed, notably in relation to chronic pain. Appreciated by patients and developed by caregivers, they require appropriate regulatory guidelines and specific training in order for them to be implemented safely. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Teachers' Beliefs and Practices for Nurturing Creativity in Students: Perspectives from Teachers of Gifted Students in Hong Kong

    ERIC Educational Resources Information Center

    Chan, Serene; Yuen, Mantak

    2015-01-01

    The long-term aim of fostering creativity in all students is specifically included in Hong Kong's curriculum guidelines. However, implementation of teaching strategies to achieve this aim has presented difficulties for many teachers. It is likely that teachers with experience in gifted education are in the best position in this respect, because…

  2. Assessing Students' Understanding of Human Behavior: A Multidisciplinary Outcomes Based Approach for the Design and Assessment of an Academic Program Goal.

    ERIC Educational Resources Information Center

    Keith, Bruce; Meese, Michael J.; Efflandt, Scott; Malinowski, Jon C.; LeBoeuf, Joseph; Gallagher, Martha; Hurley, John; Green, Charles

    2002-01-01

    Presents a strategy for the curricular design and assessment of one multidisciplinary program goal: understanding human behavior. Discusses how to assess a desired outcome based on four specific areas: (1) organizational context; (2) articulation of a learning model; (3) program design and implementation; and (4) outcomes assessment. (Author/KDR)

  3. Campsite impact management: A survey of National Park Service backcountry managers

    USGS Publications Warehouse

    Marion, J.L.; Stubbs, C.J.; Vander Stoep, Gail A.

    1993-01-01

    Though a central purpose for the creation and management of parks, visitation inevitably affects the natural resources of parks. This is particularly true at campsites, where visitation and its effects are concentrated. This paper presents partial results from a survey of National Park Service managers regarding general strategies and specific actions implemented by park managers to address campsite impact problems.

  4. Teaching statics of fluids in bioengineering: a multidisciplinary proposal based on competences

    NASA Astrophysics Data System (ADS)

    Alborch, A.; Puzzella, A.; Lopez, N.; Cabrera, L.; Zabala, A.; Demartini, H.

    2007-11-01

    The aim of this work is to share the findings of an educational experience undertaken by first-year university students of bioengineering, oriented towards the model of Competence-based Education. Different aspects on integrative education pursued in the subject goals are explicitly focused here by designing a strategy within a contextualized and multidisciplinary approach that combines knowledge from Physics, Chemistry and Biology. The topic chosen for the work is Static of Fluids, because it allows relating pressure to its biological effects on human beings. After evaluating a pre-test, new interrelated strategies are implemented. Due to the motivation audiovisuals generate in adolescents, we start showing an argumentative film entitled 'The Big Blue', and continue with different individual and/or group activities, finishing with a post-test to assess the development of the competences proposed. Results are encouraging as regards the level of specific competences acquired and, complementarily, basic and professional competences in general. Besides, the experience met expectations as regards student motivation, interest and commitment to learning, which ensured the path taken by the academicians by means of implementing innovative strategies.

  5. Implementing climate change mitigation in health services: the importance of context.

    PubMed

    Desmond, Sharon

    2016-10-01

    Academic interest in strategies to reduce the impact of health services on climate change is quickening. Research has largely focused on local innovations with little consideration of the contextual and systemic elements that influence sustainable development across health systems. A realistic framework specifically to guide decision-making by health care providers is still needed. To address this deficit, the literature is explored in relation to health services and climate change mitigation strategies, and the contextual factors that influence efforts to mitigate climate effects in health service delivery environments are highlighted. A conceptual framework is proposed that offers a model for the pursuit of sustainable development practice in health services. A set of propositions is advanced to provide a systems approach to assist decision-making by decoding the challenges faced in implementing sustainable health services. This has important implications for health care providers, funders and legislators since the financial, policy and regulatory environment of health care, along with its leadership and models of care generally conflict with carbon literacy and climate change mitigation strategies. © The Author(s) 2016.

  6. Integration of land-sharing and land-sparing conservation strategies through regional networking: the Mesoamerican Biological Corridor as a lifeline for carnivores in El Salvador.

    PubMed

    Crespin, Silvio J; García-Villalta, Jorge E

    2014-10-01

    Nations with little remaining natural habitat and small extent are challenged when trying to achieve biodiversity targets. We show that the Central American nation of El Salvador cannot viably sustain populations of 87 % of its extant carnivores, especially in the case of large-bodied species with low population densities. Current land-sparing strategies will not suffice; therefore we propose that land-sharing strategies be implemented in tandem with protected areas to expand current conservation efforts via new regional networks. In Central America such a network can be established by linking international protected area systems in a way that implements the existing vision for the Mesoamerican Biological Corridor. Specifically, we propose a re-envisioning of the Mesoamerican Biological Corridor in which land-sharing practices are adopted throughout the agricultural matrix while ensuring formal protection of the remaining natural habitat. Such an integration of land-sparing and land-sharing could result in the creation of an effective network of protected areas, thereby increasing the probability of safeguarding species with populations that overlap national borders.

  7. Suicide burden and prevention in Nepal: The need for a national strategy.

    PubMed

    Marahatta, Kedar; Samuel, Reuben; Sharma, Pawan; Dixit, Lonim; Shrestha, Bhola Ram

    2017-04-01

    Suicide is a major cause of deaths worldwide and is a key public health concern in Nepal. Although routine national data are not collected in Nepal, the available evidence suggests that suicide rates are relatively high, notably for women. In addition, civil conflict and the 2015 earthquake have had significant contributory effects. A range of factors both facilitate suicide attempts and hinder those affected from seeking help, such as the ready availability of toxic pesticides and the widespread, although erroneous, belief that suicide is illegal. Various interventions have been undertaken at different levels in prevention and rehabilitation but a specific long-term national strategy for suicide prevention is lacking. Hence, to address this significant public health problem, a multisectoral platform of stakeholders needs to be established under government leadership, to design and implement innovative and country-contextualized policies and programmes. A bottom-up approach, with active and participatory community engagement from the start of the policy- and strategy-formulation stage, through to the design and implementation of interventions, could potentially build grass-roots public ownership, reduce stigma and ensure a scaleable and sustainable response.

  8. Improving the quality of learning in science through optimization of lesson study for learning community

    NASA Astrophysics Data System (ADS)

    Setyaningsih, S.

    2018-03-01

    Lesson Study for Learning Community is one of lecturer profession building system through collaborative and continuous learning study based on the principles of openness, collegiality, and mutual learning to build learning community in order to form professional learning community. To achieve the above, we need a strategy and learning method with specific subscription technique. This paper provides a description of how the quality of learning in the field of science can be improved by implementing strategies and methods accordingly, namely by applying lesson study for learning community optimally. Initially this research was focused on the study of instructional techniques. Learning method used is learning model Contextual teaching and Learning (CTL) and model of Problem Based Learning (PBL). The results showed that there was a significant increase in competence, attitudes, and psychomotor in the four study programs that were modelled. Therefore, it can be concluded that the implementation of learning strategies in Lesson study for Learning Community is needed to be used to improve the competence, attitude and psychomotor of science students.

  9. Challenges at Petascale for Pseudo-Spectral Methods on Spheres (A Last Hurrah?)

    NASA Technical Reports Server (NTRS)

    Clune, Thomas

    2011-01-01

    Conclusions: a) Proper software abstractions should enable rapid-exploration of platform-specific optimizations/ tradeoffs. b) Pseudo-spectra! methods are marginally viable for at least some classes of petascaie problems. i.e., GPU based machine with good bisection would be best. c) Scalability at exascale is possible, but the necessary resolution will make algorithm prohibitively expensive. Efficient implementations of realistic global transposes are mtricate and tedious in MPI. PS at petascaie requires exploration of a variety of strategies for spreading local and remote communic3tions. PGAS allows far simpler implementation and thus rapid exploration of variants.

  10. Process and outcomes evaluation of retention strategies within a nursing workforce diversity project.

    PubMed

    Escallier, Lori A; Fullerton, Judith T

    2009-09-01

    A commitment to enhancing the diversity of the nursing workforce is reflected in the recruitment and retention strategies designed by Stony Brook University with support of a grant received from the Department of Health and Human Services, Health Resources and Services Administration. Three specific student retention strategies are evaluated in terms of their influence on student inclusion and promotion of student success. A review of the cultural competence of teaching and learning strategies and the promotion of cultural self-awareness underpinned these strategies. A mentorship program designed to provide individual support for students, particularly for those engaged in distance learning, proved to be challenging to implement and underused by students. Students found other means of support in their workplace and through individual connections with the faculty. Instructional programs that enhanced individual skills in the use of computer hardware and software were particularly effective in promoting student success.

  11. Implementation strategies for collaborative primary care-mental health models.

    PubMed

    Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

    2013-09-01

    Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

  12. Achieving change in primary care—effectiveness of strategies for improving implementation of complex interventions: systematic review of reviews

    PubMed Central

    Lau, Rosa; Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Treweek, Shaun; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Qureshi, Nadeem; Rogers, Anne; Peacock, Richard; Murray, Elizabeth

    2015-01-01

    Objective To identify, summarise and synthesise available literature on the effectiveness of implementation strategies for optimising implementation of complex interventions in primary care. Design Systematic review of reviews. Data sources MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychINFO were searched, from first publication until December 2013; the bibliographies of relevant articles were screened for additional reports. Eligibility criteria for selecting studies Eligible reviews had to (1) examine effectiveness of single or multifaceted implementation strategies, (2) measure health professional practice or process outcomes and (3) include studies from predominantly primary care in developed countries. Two reviewers independently screened titles/abstracts and full-text articles of potentially eligible reviews for inclusion. Data synthesis Extracted data were synthesised using a narrative approach. Results 91 reviews were included. The most commonly evaluated strategies were those targeted at the level of individual professionals, rather than those targeting organisations or context. These strategies (eg, audit and feedback, educational meetings, educational outreach, reminders) on their own demonstrated a small to modest improvement (2–9%) in professional practice or behaviour with considerable variability in the observed effects. The effects of multifaceted strategies targeted at professionals were mixed and not necessarily more effective than single strategies alone. There was relatively little review evidence on implementation strategies at the levels of organisation and wider context. Evidence on cost-effectiveness was limited and data on costs of different strategies were scarce and/or of low quality. Conclusions There is a substantial literature on implementation strategies aimed at changing professional practices or behaviour. It remains unclear which implementation strategies are more likely to be effective than others and under what conditions. Future research should focus on identifying and assessing the effectiveness of strategies targeted at the wider context and organisational levels and examining the costs and cost-effectiveness of implementation strategies. PROSPERO registration number CRD42014009410. PMID:26700290

  13. The place of physical activity in the WHO Global Strategy on Diet and Physical Activity.

    PubMed

    Bauman, Adrian; Craig, Cora L

    2005-08-24

    In an effort to reduce the global burden of non-communicable disease, the World Health Organization released a Global Strategy for Diet and Physical Activity in May 2004. This commentary reports on the development of the strategy and its importance specifically for physical activity-related work of NGOs and researchers interested in increasing global physical activity participation. Sparked by its work on global efforts to target non-communicable disease prevention in 2000, the World Health Organization commissioned a global strategy on diet and physical activity. The physical activity interest followed efforts that had led to the initial global "Move for Health Day" in 2002. WHO assembled a reference group for the global strategy, and a regional consultation process with countries was undertaken. Underpinning the responses was the need for more physical activity advocacy; partnerships outside of health including urban planning; development of national activity guidelines; and monitoring of the implementation of the strategy. The consultation process was an important mechanism to confirm the importance and elevate the profile of physical activity within the global strategy. It is suggested that separate implementation strategies for diet and physical activity may be needed to work with partner agencies in disparate sectors (e.g. urban planning for physical activity, agriculture for diet). International professional societies are well situated to make an important contribution to global public health by advocating for the importance of physical activity among risk factors; developing international measures of physical activity and global impacts of inactivity; and developing a global research and intervention agenda.

  14. Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.

    PubMed

    Jabbour, Mona; Curran, Janet; Scott, Shannon D; Guttman, Astrid; Rotter, Thomas; Ducharme, Francine M; Lougheed, M Diane; McNaughton-Filion, M Louise; Newton, Amanda; Shafir, Mark; Paprica, Alison; Klassen, Terry; Taljaard, Monica; Grimshaw, Jeremy; Johnson, David W

    2013-05-22

    The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. ClinicalTrials.gov: NCT01815710.

  15. Implementation Strategies for Educational Intranet Resources.

    ERIC Educational Resources Information Center

    Herson, Katie; Sosabowski, Michael; Lloyd, Andrew; Flowers, Stephen; Paine, Cameron; Newton, Becci

    2000-01-01

    Describes two alternative strategies for intranet implementation based on experiences at the University of Brighton (United Kingdom). Highlights include differing degrees of staff and student utilization; barriers to success; a unified strategy for effective intranet implementation; and how to manage organizational resistance to change.…

  16. How Static is the Statics Classroom? An investigation into how innovations, specifically Research-Based Instructional Strategies, are adopted into the Statics Classroom

    NASA Astrophysics Data System (ADS)

    Cutler, Stephanie Leigh

    The purpose of this dissertation is to investigate how educational research, specifically Research-Based Instructional Strategies (RBIS), is adopted by education practice, specifically within the engineering Statics classroom. Using a systematic approach, changes in classroom teaching practices were investigated from the instructors' perspective. Both researchers and practitioners are included in the process, combining efforts to improve student learning, which is a critical goal for engineering education. The study is divided into 3 stages and each is discussed in an individual manuscript. Manuscript 1 provides an assessment of current teaching practices; Manuscript 2 explores RBIS use by Statics instructors and perceived barriers of adoption; and Manuscript 3 evaluates adoption using Fidelity of Implementation. A common set of concurrent mixed methods was used for each stage of this study. A quantitative national survey of Statics instructors (n =166) and 18 qualitative interviews were conducted to examine activities used in the Statics classroom and familiarity with nine RBIS. The results of this study show that lecturing is the most common activity throughout Statics classrooms, but is not the only activity. Other common activities included working examples and students working on problems individually and in groups. As discussed by the interview participants, each of Rogers' characteristics influenced adoption for different reasons. For example, Complexity (level of difficulty with implementation of an RBIS) was most commonly identified as a barrier. His study also evaluated the Fidelity of Implementation for each RBIS and found it to be higher for RBIS that were less complex (in terms of the number of critical components). Many of the critical components (i.e. activities required for implementation, as described in the literature) were found to statistically distinguish RBIS users and non-users. This dissertation offers four contributions: (1) an understanding of current practices in Statics; (2) the instructor perspective of the barriers to using RBIS in the classroom; (3) the use of Fidelity of Implementation as a unique evaluation of RBIS adoption, which can be used by future engineering education researchers; and (4) a systematic approach of exploring change in the classroom, which offers new perspectives and approaches to accelerate the adoption process.

  17. Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol.

    PubMed

    Willging, Cathleen E; Green, Amy E; Ramos, Mary M

    2016-10-22

    Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science. ClinicalTrials.gov, NCT02875535.

  18. Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

    PubMed

    Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

    2016-01-27

    Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.

  19. An Implementation Strategy to Improve the Guideline Adherence of Insurance Physicians: A Process Evaluation Alongside an Experiment in a Controlled Setting

    ERIC Educational Resources Information Center

    Zwerver, Feico; Bonefaas-Groenewoud, Karin; Schellart, Antonius J. M.; Anema, Johannes R.; van der Beek, Allard J.

    2013-01-01

    Background: We developed an implementation strategy for the insurance medicine guidelines for depression, which we implemented via a post-graduate course for insurance physicians (IPs). In this study we evaluate the physicians' experiences of the implementation strategy by measuring the following aspects: recruitment and reach, dose delivered and…

  20. Integrating cognitive rehabilitation: A preliminary program description and theoretical review of an interdisciplinary cognitive rehabilitation program.

    PubMed

    Fleeman, Jennifer A; Stavisky, Christopher; Carson, Simon; Dukelow, Nancy; Maier, Sheryl; Coles, Heather; Wager, John; Rice, Jordyn; Essaff, David; Scherer, Marcia

    2015-01-01

    Interdisciplinary cognitive rehabilitation is emerging as the expected standard of care for individuals with mild to moderate degrees of cognitive impairment for a variety of etiologies. There is a growing body of evidence in cognitive rehabilitation literature supporting the involvement of multiple disciplines, with the use of cognitive support technologies (CSTs), in delivering cognitive therapy to individuals who require cognitive rehabilitative therapies. This article provides an overview of the guiding theories related to traditional approaches of cognitive rehabilitation and the positive impact of current theoretical models of an interdisciplinary approach in clinical service delivery of this rehabilitation. A theoretical model of the Integrative Cognitive Rehabilitation Program (ICRP) will be described in detail along with the practical substrates of delivering specific interventions to individuals and caregivers who are living with mild to moderate cognitive impairment. The ultimate goal of this article is to provide a clinically useful resource for direct service providers. It will serve to further clinical knowledge and understanding of the evolution from traditional silo based treatment paradigms to the current implementation of multiple perspectives and disciplines in the pursuit of patient centered care. The article will discuss the theories that contributed to the development of the interdisciplinary team and the ICRP model, implemented with individuals with mild to moderate cognitive deficits, regardless of etiology. The development and implementation of specific assessment and intervention strategies in this cognitive rehabilitation program will also be discussed. The assessment and intervention strategies utilized as part of ICRP are applicable to multiple clinical settings in which individuals with cognitive impairment are served. This article has specific implications for rehabilitation which include: (a) An Interdisciplinary Approach is an effective method for cognitive rehabilitation; and (b) Recent theories offer beneficial evaluation and intervention techniques for cognitive rehabilitation.

  1. Implementing trauma-focused CBT with fidelity and flexibility: a family case study.

    PubMed

    Kerig, Patricia K; Sink, Holli E; Cuellar, Raven E; Vanderzee, Karin L; Elfstrom, Jennifer L

    2010-01-01

    Effective approaches for the treatment of childhood posttraumatic stress disorder and traumatic grief are needed given the prevalence of trauma and its impact on children's lives. To effectively treat posttraumatic stress disorder in children, evidence-based practices should be implemented with flexibility and responsiveness to culture, developmental level, and the specific needs of the family. This case study illustrates flexibility with fidelity in the use of a manualized treatment, describing the implementation of Trauma Focused-Cognitive Behavior Therapy with three traumatized family members-a caregiver and two children. Particular attention is paid to the use of creative strategies to tailor interventions to the individual clients while maintaining fidelity to the principles and components of this evidence-based treatment.

  2. Examining the feasibility of implementing behavioural economics strategies that encourage home dinner vegetable intake among low-income children.

    PubMed

    Leak, Tashara M; Swenson, Alison; Rendahl, Aaron; Vickers, Zata; Mykerezi, Elton; Redden, Joseph P; Mann, Traci; Reicks, Marla

    2017-06-01

    To examine the feasibility of implementing nine behavioural economics-informed strategies, or 'nudges', that aimed to encourage home dinner vegetable intake among low-income children. Caregivers were assigned six of nine strategies and implemented one new strategy per week (i.e. 6 weeks) during three dinner meals. Caregivers recorded child dinner vegetable intake on the nights of strategy implementation and rated the level of difficulty for assigned strategies. Baseline data on home vegetable availability and child vegetable liking were collected to assess overall strategy feasibility. Participants' homes in a large Midwestern metropolitan area, USA. Low-income caregiver/child (aged 9-12 years) dyads (n 39). Pairwise comparisons showed that child dinner vegetable intake for the strategy 'Serve at least two vegetables with dinner meals' was greater than intake for each of two other strategies: 'Pair vegetables with other foods the child likes' and 'Eat dinner together with an adult(s) modelling vegetable consumption'. Overall, caregivers' mean rating of difficulty for implementing strategies was 2·6 (1='not difficult', 10='very difficult'). Households had a mean of ten different types of vegetables available. Children reported a rating ≥5 for seventeen types of vegetable on a labelled hedonic scale (1='hate it', 5-6='it's okay', 10='like it a lot'). Behavioural economics-informed strategies are feasible to implement during dinner meals, with some strategies differing by how much they influence vegetable intake among low-income children in the home.

  3. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health.

    PubMed

    Dorsey, Shannon; Kerns, Suzanne E U; Lucid, Leah; Pullmann, Michael D; Harrison, Julie P; Berliner, Lucy; Thompson, Kelly; Deblinger, Esther

    2018-01-24

    Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials. Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health organizations (in 23 offices) were objectively coded for presence and intensity coverage of 29 supervision strategies (16 content and 13 technique items), duration, and temporal focus. Random effects mixed models estimated proportion of variance in content and techniques attributable to the supervisor and clinician levels. Interrater reliability among coders was excellent. EBT cases averaged 12.4 min of supervision per session. Intensity of coverage for EBT content varied, with some discussed frequently at medium or high intensity (exposure) and others infrequently discussed or discussed only at low intensity (behavior management; assigning/reviewing client homework). Other than fidelity assessment, supervision techniques common in treatment trials (e.g., reviewing actual practice, behavioral rehearsal) were used rarely or primarily at low intensity. In general, EBT content clustered more at the clinician level; different techniques clustered at either the clinician or supervisor level. Workplace-based clinical supervision may be a feasible implementation strategy for supporting EBT implementation, yet it differs from supervision in treatment trials. Time allotted per case is limited, compressing time for EBT coverage. Techniques that involve observation of clinician skills are rarely used. Workplace-based supervision content appears to be tailored to individual clinicians and driven to some degree by the individual supervisor. Our findings point to areas for intervention to enhance the potential of workplace-based supervision for implementation effectiveness. NCT01800266 , Clinical Trials, Retrospectively Registered (for this descriptive study; registration prior to any intervention [part of phase II RCT, this manuscript is only phase I descriptive results]).

  4. Implementation of effective alcohol control strategies is needed at large sports and entertainment events.

    PubMed

    Lyne, Mark; Galloway, Andrew

    2012-02-01

    To assess the implementation and effectiveness of strategies and actions to eliminate and/or reduce alcohol-related problems at large sports and entertainment events in New Zealand. We conducted site visits and monitoring observations at venues before, during and after a variety of large events between March 2009 and November 2010. Thirteen events were attended at nine different venues. Events included rugby, rugby league and cricket matches, motor racing, rowing, horse racing, an outdoor music festival, and food and wine festivals. Most large events appeared to pass with few or no alcohol-related problems. The exceptions were one of the horse-race meetings, a rugby league match and one food and wine festival. Common contexts at events where alcohol-related problems were seen included: inadequate alcohol control and management by security staff; the ability to purchase four alcoholic drinks (rather than two) at a time; inexperienced bar staff untrained in responsible alcohol service; no or little promotion of low and non-alcoholic drinks; and a lack of monitoring and enforcement of the law on intoxication. An important approach to prevent and reduce alcohol-related problems at large spots and entertainment events is the use of specific alcohol-control strategies. The management of alcohol consumption is a major part of event management that must be planned with harm-minimisation strategies well in advance of the event itself. If strategies and actions are not properly implemented to manage the sale and supply of alcohol at large events, there is significant risk of alcohol-related problems and harm resulting from them. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  5. Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study.

    PubMed

    Watson, Dennis P; Young, Jeani; Ahonen, Emily; Xu, Huiping; Henderson, Macey; Shuman, Valery; Tolliver, Randi

    2014-10-17

    There is currently a lack of scientifically designed and tested implementation strategies. Such strategies are particularly important for highly complex interventions that require coordination between multiple parts to be successful. This paper presents a protocol for the development and testing of an implementation strategy for a complex intervention known as the Housing First model (HFM). Housing First is an evidence-based practice for chronically homeless individuals demonstrated to significantly improve a number of outcomes. Drawing on practices demonstrated to be useful in implementation and e-learning theory, our team is currently adapting a face-to-face implementation strategy so that it can be delivered over a distance. Research activities will be divided between Chicago and Central Indiana, two areas with significantly different barriers to HFM implementation. Ten housing providers (five from Chicago and five from Indiana) will be recruited to conduct an alpha test of each of four e-learning modules as they are developed. Providers will be requested to keep a detailed log of their experience completing the modules and participate in one of two focus groups. After refining the modules based on alpha test results, we will test the strategy among a sample of four housing organizations (two from Chicago and two from Indiana). We will collect and analyze both qualitative and quantitative data from administration and staff. Measures of interest include causal factors affecting implementation, training outcomes, and implementation outcomes. This project is an important first step in the development of an evidence-based implementation strategy to increase scalability and impact of the HFM. The project also has strong potential to increase limited scientific knowledge regarding implementation strategies in general.

  6. 40 CFR 51.112 - Demonstration of adequacy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... REQUIREMENTS FOR PREPARATION, ADOPTION, AND SUBMITTAL OF IMPLEMENTATION PLANS Control Strategy § 51.112... of the control strategy. (2) A presentation of emission levels expected to result from implementation... result from implementation of the overall control strategy presented either in tabular form or as an...

  7. Improving cost-effectiveness and mitigating risks of renewable energy requirements

    NASA Astrophysics Data System (ADS)

    Griffin, James P.

    Policy makers at the federal and state levels of government are debating actions to reduce U.S. greenhouse gas emissions and dependence on oil as an energy source. Several concerns drive this debate: sharp rises in energy prices, increasing unease about the risks of climate change, energy security, and interest in expanding the domestic renewable energy industry. Renewable energy requirements are frequently proposed to address these concerns, and are currently in place, in various forms, at the federal and state levels of government. These policies specify that a certain portion of the energy supply come from renewable energy sources. This dissertation focuses on a specific proposal, known as 25 X 25, which requires 25% of electricity and motor vehicle transportation fuels supplied to U.S. consumers to come from renewable energy sources, such as wind power and ethanol, by 2025. This dissertation builds on prior energy policy analysis, and more specifically analyses of renewable energy requirements, by assessing the social welfare implications of a 25 x 25 policy and applying new methods of uncertainty analysis to multiple policy options decision makers can use to implement the policy. These methods identify policy options that can improve the cost-effectiveness and reduce the risks of renewable energy requirements. While the dissertation focuses on a specific policy, the research methods and findings are applicable to other renewable energy requirement policies. In the dissertation, I analyze six strategies for implementing a 25 x 25 policy across several hundred scenarios that represent plausible futures for uncertainties in energy markets, such as renewable energy costs, energy demand, and fossil fuel prices. The strategies vary in the availability of resources that qualify towards the policy requirement and the use of a "safety valve" that allows refiners and utilities to pay a constant fee after renewable energy costs reach a predetermined threshold. I test each strategy across the set of scenarios and conclude that an "all-combined" strategy---one that allows greater corn ethanol production and energy efficiency to qualify towards the requirement and includes a safety valve---is the most robust strategy to address future uncertainties in energy markets.

  8. Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review.

    PubMed

    Watkins, Kim; Wood, Helen; Schneider, Carl R; Clifford, Rhonda

    2015-10-29

    The clinical role of community pharmacists is expanding, as is the use of clinical guidelines in this setting. However, it is unclear which strategies are successful in implementing clinical guidelines and what outcomes can be achieved. The aim of this systematic review is to synthesise the literature on the implementation of clinical guidelines to community pharmacy. The objectives are to describe the implementation strategies used, describe the resulting outcomes and to assess the effectiveness of the strategies. A systematic search was performed in six electronic databases (Medline, EMBASE, CINAHL, Web of Science, Informit, Cochrane Library) for relevant articles. Studies were included if they reported on clinical guidelines implementation strategies in the community pharmacy setting. Two researchers completed the full-search strategy, data abstraction and quality assessments, independently. A third researcher acted as a moderator. Quality assessments were completed with three validated tools. A narrative synthesis was performed to analyse results. A total of 1937 articles were retrieved and the titles and abstracts were screened. Full-text screening was completed for 36 articles resulting in 19 articles (reporting on 22 studies) included for review. Implementation strategies were categorised according to a modified version of the EPOC taxonomy. Educational interventions were the most commonly utilised strategy (n = 20), and computerised decision support systems demonstrated the greatest effect (n = 4). Most studies were multifaceted and used more than one implementation strategy (n = 18). Overall outcomes were moderately positive (n = 17) but focused on process (n = 22) rather than patient (n = 3) or economic outcomes (n = 3). Most studies (n = 20) were rated as being of low methodological quality and having low or very low quality of evidence for outcomes. Studies in this review did not generally have a well thought-out rationale for the choice of implementation strategy. Most utilised educational strategies, but the greatest effect on outcomes was demonstrated using computerised clinical decision support systems. Poor methodology, in the majority of the research, provided insufficient evidence to be conclusive about the best implementation strategies or the benefit of clinical guidelines in this setting. However, the generally positive outcomes across studies and strategies indicate that implementing clinical guidelines to community pharmacy might be beneficial. Improved methodological rigour in future research is required to strengthen the evidence for this hypothesis. PROSPERO 2012: CRD42012003019 .

  9. NASA's strategic plan for education. A strategy for change, 1993-1998

    NASA Technical Reports Server (NTRS)

    1992-01-01

    NASA's education vision is to promote excellence in America's education system through enhancing and expanding scientific and technological competence. In doing so, NASA strives to be recognized by the education community as the premier mission agency in support of the National Education Goals and in the development and implementation of education standards. To realize this vision, NASA has clearly defined and developed three specific goals to promote excellence in education. Specific objectives and milestones are defined for each goal in the body of this strategic plan.

  10. Patient-oriented randomisation: A new trial design applied in the Neuroleptic Strategy Study.

    PubMed

    Schulz, Constanze; Timm, Jürgen; Cordes, Joachim; Gründer, Gerhard; Mühlbauer, Bernd; Rüther, Eckart; Heinze, Martin

    2016-06-01

    The 'gold standard' for clinical studies is a randomised controlled trial usually comparing specific treatments. If the scientific study expands to strategy comparison with each strategy including various treatments, the research problems are increasingly complicated. The strategy debate in the psychiatric community is the starting point for the development of our new design. It is widely accepted that second-generation antipsychotics are the therapy of choice in the treatment of schizophrenia. However, their general superiority over first-generation antipsychotics could not be demonstrated in recent randomised controlled trials. Furthermore, we are becoming increasingly aware that the experimental conditions of randomised controlled trials, as in the European First Episode Schizophrenia Trial and Clinical Antipsychotic Trials of Intervention Effectiveness Phase 1 studies, may be inappropriate for psychiatric treatments. The high heterogeneity in the patient population produces discrepancies between daily clinical perception and randomised controlled trials results. The patient-oriented approach in the Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study reflects everyday clinical practice. The results, however, are highly dependent on the physicians' preferences. The goal of the design described here is to take an intermediate path between randomised controlled trials and clinical studies such as Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study, combining the advantages of both study types. The idea is to randomise two treatment pairs each consisting of one first-generation antipsychotic and one second-generation antipsychotic in a first step and subsequently, to involve the investigators in deciding for a pair most appropriate to the patients' needs and then to randomise the allocation to one drug (first-generation antipsychotic or second-generation antipsychotic) of that chosen pair. This idea was first implemented in the clinical trial, the Neuroleptic Strategy Study, with a randomised design comparing efficacy and safety of two different strategies: either to use first-generation antipsychotics (haloperidol and flupentixol) or second-generation antipsychotics (olanzapine, aripiprazole and quetiapine) in patients suffering from schizophrenia. In the course of the Neuroleptic Strategy Study, feasibility of this design was demonstrated. All aspects of the new design were implemented: randomisation process, documentation of responses from investigators as well as patients and drug logistic experience. In implementing the design, furthermore, we could investigate its theoretical properties. The physicians' preferences for specific drugs used for the respective patients were analysed. The idea of patient-oriented randomisation can be generalised. In light of the heterogeneity and complexity of patient-drug interaction, this design should prove particularly useful. © The Author(s) 2016.

  11. A simple model-based control for Pichia pastoris allows a more efficient heterologous protein production bioprocess.

    PubMed

    Cos, Oriol; Ramon, Ramon; Montesinos, José Luis; Valero, Francisco

    2006-09-05

    A predictive control algorithm coupled with a PI feedback controller has been satisfactorily implemented in the heterologous Rhizopus oryzae lipase production by Pichia pastoris methanol utilization slow (Mut(s)) phenotype. This control algorithm has allowed the study of the effect of methanol concentration, ranging from 0.5 to 1.75 g/L, on heterologous protein production. The maximal lipolytic activity (490 UA/mL), specific yield (11,236 UA/g(biomass)), productivity (4,901 UA/L . h), and specific productivity (112 UA/g(biomass)h were reached for a methanol concentration of 1 g/L. These parameters are almost double than those obtained with a manual control at a similar methanol set-point. The study of the specific growth, consumption, and production rates showed different patterns for these rates depending on the methanol concentration set-point. Results obtained have shown the need of implementing a robust control scheme when reproducible quality and productivity are sought. It has been demonstrated that the model-based control proposed here is a very efficient, robust, and easy-to-implement strategy from an industrial application point of view. (c) 2006 Wiley Periodicals, Inc.

  12. Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation

    PubMed Central

    Camm, A. John; Pinto, Fausto J.; Hankey, Graeme J.; Andreotti, Felicita; Hobbs, F.D. Richard

    2015-01-01

    Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers. PMID:26116685

  13. Testing Strategies for Model-Based Development

    NASA Technical Reports Server (NTRS)

    Heimdahl, Mats P. E.; Whalen, Mike; Rajan, Ajitha; Miller, Steven P.

    2006-01-01

    This report presents an approach for testing artifacts generated in a model-based development process. This approach divides the traditional testing process into two parts: requirements-based testing (validation testing) which determines whether the model implements the high-level requirements and model-based testing (conformance testing) which determines whether the code generated from a model is behaviorally equivalent to the model. The goals of the two processes differ significantly and this report explores suitable testing metrics and automation strategies for each. To support requirements-based testing, we define novel objective requirements coverage metrics similar to existing specification and code coverage metrics. For model-based testing, we briefly describe automation strategies and examine the fault-finding capability of different structural coverage metrics using tests automatically generated from the model.

  14. 40 CFR 93.120 - Consequences of control strategy implementation plan failures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Consequences of control strategy implementation plan failures. 93.120 Section 93.120 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Consequences of control strategy implementation plan failures. (a) Disapprovals. (1) If EPA disapproves any...

  15. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

    PubMed

    Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

    2017-05-22

    Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

  16. Optimal combinations of control strategies and cost-effective analysis for visceral leishmaniasis disease transmission.

    PubMed

    Biswas, Santanu; Subramanian, Abhishek; ELMojtaba, Ibrahim M; Chattopadhyay, Joydev; Sarkar, Ram Rup

    2017-01-01

    Visceral leishmaniasis (VL) is a deadly neglected tropical disease that poses a serious problem in various countries all over the world. Implementation of various intervention strategies fail in controlling the spread of this disease due to issues of parasite drug resistance and resistance of sandfly vectors to insecticide sprays. Due to this, policy makers need to develop novel strategies or resort to a combination of multiple intervention strategies to control the spread of the disease. To address this issue, we propose an extensive SIR-type model for anthroponotic visceral leishmaniasis transmission with seasonal fluctuations modeled in the form of periodic sandfly biting rate. Fitting the model for real data reported in South Sudan, we estimate the model parameters and compare the model predictions with known VL cases. Using optimal control theory, we study the effects of popular control strategies namely, drug-based treatment of symptomatic and PKDL-infected individuals, insecticide treated bednets and spray of insecticides on the dynamics of infected human and vector populations. We propose that the strategies remain ineffective in curbing the disease individually, as opposed to the use of optimal combinations of the mentioned strategies. Testing the model for different optimal combinations while considering periodic seasonal fluctuations, we find that the optimal combination of treatment of individuals and insecticide sprays perform well in controlling the disease for the time period of intervention introduced. Performing a cost-effective analysis we identify that the same strategy also proves to be efficacious and cost-effective. Finally, we suggest that our model would be helpful for policy makers to predict the best intervention strategies for specific time periods and their appropriate implementation for elimination of visceral leishmaniasis.

  17. A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

    PubMed Central

    Powell, Byron J.; Proctor, Enola K.; Glass, Joseph E.

    2013-01-01

    Objective This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Methods A literature search was conducted using electronic databases and a manual search. Results Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. Conclusions There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area. PMID:24791131

  18. 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.

  19. The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care.

    PubMed

    Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M

    2010-12-01

    The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.

  20. Job satisfaction among a multigenerational nursing workforce.

    PubMed

    Wilson, Barbara; Squires, Mae; Widger, Kimberley; Cranley, Lisa; Tourangeau, Ann

    2008-09-01

    To explore generational differences in job satisfaction. Effective retention strategies are required to mitigate the international nursing shortage. Job satisfaction, a strong and consistent predictor of retention, may differ across generations. Understanding job satisfaction generational differences may lead to increasing clarity about generation-specific retention approaches. The Ontario Nurse Survey collected data from 6541 Registered Nurses. Participants were categorized as Baby Boomer, Generation X or Generation Y based on birth year. Multivariate analysis of variance explored generational differences for overall and specific satisfaction components. In overall job satisfaction and five specific satisfaction components, Baby Boomers were significantly more satisfied than Generations X and Y. It is imperative to improve job satisfaction for younger generations of nurses. Strategies to improve job satisfaction for younger generations of nurses may include creating a shared governance framework where nurses are empowered to make decisions. Implementing shared governance, through nurse-led unit-based councils, may lead to greater job satisfaction, particularly for younger nurses. Opportunities to self schedule or job share may be other potential approaches to increase job satisfaction, especially for younger generations of nurses. Another potential strategy would be to aggressively provide and support education and career-development opportunities.

  1. Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems.

    PubMed

    Palinkas, Lawrence A; Holloway, Ian W; Rice, Eric; Brown, C Hendricks; Valente, Thomas W; Chamberlain, Patricia

    2013-11-14

    Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice. Semi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions. Of those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network. Although the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies. NCT00880126.

  2. Methods to Improve the Selection and Tailoring of Implementation Strategies

    PubMed Central

    Powell, Byron J.; Beidas, Rinad S.; Lewis, Cara C.; Aarons, Gregory A.; McMillen, J. Curtis; Proctor, Enola K.; Khinduka, Shanti K.; Mandell, David S.

    2015-01-01

    Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research. PMID:26289563

  3. Evaluating the implementation of "managing the risk of suicide: a suicide prevention strategy for the ACT 2009-2014".

    PubMed

    Sheehan, Johann; Griffiths, Kathleen; Rickwood, Debra; Carron-Arthur, Bradley

    2015-01-01

    Over the past two decades, governments have invested significantly in policies and strategies to prevent the tragic loss of life to suicide. However, there has been little focus on evaluating the implementation of such policies. This paper reports on the evaluation of the implementation of "Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009-2014," the Australian Capital Territory's (ACT) suicide prevention strategy. We sought to answer two questions: (1) Could agencies provide data reporting on their progress in implementing the activities for which they were responsible?; and (2) Could a judgment about implementation progress be made and, if so, to what extent was the activity implemented? Individually tailored electronic surveys were sent to 18 ACT agencies annually over 4 years to measure their progress in implementing activities for which they had responsibility. By year four, full data were provided for 64% of activities, maximal partial data for 9%, and minimal partial data for 27%. Forty-two per cent of activities were fully implemented, 20% were partially implemented, and 38% were not implemented or could not be measured. It is possible to measure implementation of suicide prevention strategies, but appropriate processes and dedicated resources must be in place at the outset.

  4. [Strategy for implementing and assessing a health care risk management unit in a primary care area].

    PubMed

    Mena Mateo, José María; de la Fuente, Angel Sanz-Vírseda; Cañada Dorado, Asunción; Villamor Borrego, Manuela

    2009-06-01

    To describe the setting up of a clinical risk management unit (CRMU) within primary care management, as well as the aims of the project, its implementation phases and the assessment of the results after one year of experience. A safety plan was prepared, based on the European Excellence Model (EFQM), to establish a strategic working framework. The plan included 38 proposed actions, associated with criteria elements and 26 indicators to evaluate the selected criteria. A total of 82% of the anticipated actions were implemented in 2007, which included, actions related to teaching and training (15 activities with 237 trainees), spreading of information associated with patient safety, incident analysis (14) and the introduction of specific safe practices (12). Four of those were considered as "generalisable" safe practices and were spread to the rest of the CRMUs in the Autonomous Region of Madrid. The CRMUs have introduced and monitored three processes related to patient safety, participated in a formal programme on the polymedicated elderly, with good results in cover and quality of the indicators. A primary care team (PCT) from the area took part in the first study carried out in Spain on adverse effects in primary care (APEAS Study). The CRMU can give impetus to strategic lines of safety. The preparation of a strategy defining specific aims has helped in the introduction of patient safety activities and along with the proposed indicators enables the impact of the intervention to be assessed.

  5. Evaluation of an effective multifaceted implementation strategy for elective single-embryo transfer after in vitro fertilization.

    PubMed

    Kreuwel, I A M; van Peperstraten, A M; Hulscher, M E J L; Kremer, J A M; Grol, R P T M; Nelen, W L D M; Hermens, R P M G

    2013-02-01

    What is the relationship between the rate of elective single-embryo transfer (eSET) and couples' exposure to different elements of a multifaceted implementation strategy? Additional elements in a multifaceted implementation strategy do not result in an increased eSET rate. A multifaceted eSET implementation strategy with four different elements is effective in increasing the eSET rate by 11%. It is unclear whether every strategy element contributes equally to the strategy's effectiveness. An observational study was performed among 222 subfertile couples included in a previously performed randomized controlled trial. Of the 222 subfertile couples included, 109 couples received the implementation strategy and 113 couples received standard IVF care. A multivariate regression analysis assessed the effectiveness of four different strategy elements on the decision about the number embryos to be transferred. Questionnaires evaluated the experiences of couples with the different elements. Of the couples who received the implementation strategy, almost 50% (52/109) were exposed to all the four elements of the strategy. The remaining 57 couples who received two or three elements of the strategy could be divided into two further classes of exposure. Our analysis demonstrated that additional elements do not result in an increased eSET rate. In addition to the physician's advice, couples rated a decision aid and a counselling session as more important for their decision to transfer one or two embryos, compared with a phone call and a reimbursement offer (P < 0.001). The differences in eSET rate between exposure groups failed to reach significance, probably because of the small numbers of couples in each exposure group. Adding more elements to an implementation strategy does not always result in an increased effectiveness, which is in concordance with recent literature. This in-depth evaluation of a multifaceted intervention strategy could therefore help to modify strategies, by making them more effective and less expensive.

  6. Precision medicine in oncology: New practice models and roles for oncology pharmacists.

    PubMed

    Walko, Christine; Kiel, Patrick J; Kolesar, Jill

    2016-12-01

    Three different precision medicine practice models developed by oncology pharmacists are described, including strategies for implementation and recommendations for educating the next generation of oncology pharmacy practitioners. Oncology is unique in that somatic mutations can both drive the development of a tumor and serve as a therapeutic target for treating the cancer. Precision medicine practice models are a forum through which interprofessional teams, including pharmacists, discuss tumor somatic mutations to guide patient-specific treatment. The University of Wisconsin, Indiana University, and Moffit Cancer Center have implemented precision medicine practice models developed and led by oncology pharmacists. Different practice models, including a clinic, a clinical consultation service, and a molecular tumor board (MTB), were adopted to enhance integration into health systems and payment structures. Although the practice models vary, commonalities of three models include leadership by the clinical pharmacist, specific therapeutic recommendations, procurement of medications for off-label use, and a research component. These three practice models function as interprofessional training sites for pharmacy and medical students and residents, providing an important training resource at these institutions. Key implementation strategies include interprofessional involvement, institutional support, integration into clinical workflow, and selection of model by payer mix. MTBs are a pathway for clinical implementation of genomic medicine in oncology and are an emerging practice model for oncology pharmacists. Because pharmacists must be prepared to participate fully in contemporary practice, oncology pharmacy residents must be trained in genomic oncology, schools of pharmacy should expand precision medicine and genomics education, and opportunities for continuing education in precision medicine should be made available to practicing pharmacists. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Targeted intervention strategies to optimise diversion of BMW in the Dublin, Ireland region

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

    Purcell, M., E-mail: mary.purcell@cit.ie; Centre for Water Resources Research, School of Architecture, Landscape and Civil Engineering, University College Dublin, Newstead, Belfield, Dublin 4; Magette, W.L.

    Highlights: > Previous research indicates that targeted strategies designed for specific areas should lead to improved diversion. > Survey responses and GIS model predictions from previous research were the basis for goal setting. > Then logic modelling and behavioural research were employed to develop site-specific management intervention strategies. > Waste management initiatives can be tailored to specific needs of areas rather than one size fits all means currently used. - Abstract: Urgent transformation is required in Ireland to divert biodegradable municipal waste (BMW) from landfill and prevent increases in overall waste generation. When BMW is optimally managed, it becomes amore » resource with value instead of an unwanted by-product requiring disposal. An analysis of survey responses from commercial and residential sectors for the Dublin region in previous research by the authors proved that attitudes towards and behaviour regarding municipal solid waste is spatially variable. This finding indicates that targeted intervention strategies designed for specific geographic areas should lead to improved diversion rates of BMW from landfill, a requirement of the Landfill Directive 1999/31/EC. In the research described in this paper, survey responses and GIS model predictions from previous research were the basis for goal setting, after which logic modelling and behavioural research were employed to develop site-specific waste management intervention strategies. The main strategies devised include (a) roll out of the Brown Bin (Organics) Collection and Community Workshops in Dun Laoghaire Rathdown, (b) initiation of a Community Composting Project in Dublin City (c) implementation of a Waste Promotion and Motivation Scheme in South Dublin (d) development and distribution of a Waste Booklet to promote waste reduction activities in Fingal (e) region wide distribution of a Waste Booklet to the commercial sector and (f) Greening Irish Pubs Initiative. Each of these strategies was devised after interviews with both the residential and commercial sectors to help make optimal waste management the norm for both sectors. Strategy (b), (e) and (f) are detailed in this paper. By integrating a human element into accepted waste management approaches, these strategies will make optimal waste behaviour easier to achieve. Ultimately this will help divert waste from landfill and improve waste management practice as a whole for the region. This method of devising targeted intervention strategies can be adapted for many other regions.« less

  8. Accelerating Research Impact in a Learning Health Care System

    PubMed Central

    Elwy, A. Rani; Sales, Anne E.; Atkins, David

    2017-01-01

    Background: Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. Objectives: With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA’s transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act. Design: QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations. Results: QUERI’s national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law’s further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks. Conclusions: Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health. PMID:27997456

  9. A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health.

    PubMed

    Kellom, Katherine S; Matone, Meredith; Adejare, Aderinola; Barg, Frances K; Rubin, David M; Cronholm, Peter F

    2018-06-01

    Objectives The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts. Methods As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for Implementation Research (CFIR) to describe the key elements mitigating implementation of multiple home visiting models. Results A primary advantage of co-location described by participants was the ability to increase the agency's base of eligible clients through the implementation of a model with different program eligibility (e.g. income, child age) than the existing agency offering. Model differences related to curriculum (e.g. content or intensity/meeting frequency) enabled programs to more selectively match clients to models. To recruit eligible clients, new models were able to build upon the existing service networks of the initial program. Co-location provided organizational opportunities for shared trainings, enabling administrative efficiencies and collaborative staff learning. Programs implemented strategies to build synergies with complementary model features, for instance using the additional program option to serve waitlisted clients and to transition services after one model is completed. Conclusions for Practice Considerable benefits are experienced when home visiting models co-locate. This research builds on literature encouraging collaboration among community agencies and provides insight on a specific facilitative approach. This implementation strategy informs policy across the social services spectrum and competitive funding contexts.

  10. Implementation Guide: Leading School Change

    ERIC Educational Resources Information Center

    Whitaker, Todd

    2010-01-01

    This two-part "Implementation Guide" will help to deepen your understanding and sharpen your ability to implement each of the strategies discussed in "Leading School Change: Nine Strategies to Bring Everybody on Board" (ED509821). Part One offers discussion questions and activities which focus on each of the nine strategies. They can be completed…

  11. 75 FR 43528 - Seeking Public Comment on Draft National Health Security Strategy Biennial Implementation Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-26

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Seeking Public Comment on Draft National Health Security Strategy Biennial Implementation Plan AGENCY: Department of Health and Human... Interim Implementation Guide for the National Health Security Strategy of the United States of America...

  12. Do parents of obese children use ineffective parenting strategies?

    PubMed

    Morawska, Alina; West, Felicity

    2013-12-01

    Research has shown mixed findings about the relationship between parenting style and child lifestyle outcomes. This paper describes a cross-sectional study that aimed to clarify the relationship between ineffective parenting and childhood obesity by using multiple measures of child and family functioning. Sixty-two families with an obese child (aged four to 11 years) were matched with 62 families with a healthy weight child on key sociodemographic variables. Significant differences were found on several measures, including general parenting style, domain-specific parenting practices, and parenting self-efficacy (d = .53 to 1.96). Parents of obese children were more likely to use permissive and coercive discipline techniques, and to lack confidence in managing children's lifestyle behaviour. In contrast, parents of healthy weight children were more likely to implement specific strategies for promoting a healthy lifestyle.

  13. AHA Scientific Statement Population Approaches to Improve Diet, Physical Activity, and Smoking Habits A Scientific Statement From the American Heart Association

    PubMed Central

    Mozaffarian, Dariush; Afshin, Ashkan; Benowitz, Neal L.; Bittner, Vera; Daniels, Stephen R.; Franch, Harold A.; Jacobs, David R.; Kraus, William E.; Kris-Etherton, Penny M.; Krummel, Debra A.; Popkin, Barry M.; Whitsel, Laurie P.; Zakai, Neil A.

    2013-01-01

    Background Poor lifestyle, including suboptimal diet, physical inactivity, and tobacco use are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. Methods and Results For this American Heart Association Scientific Statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) media and education campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. Conclusions This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action. PMID:22907934

  14. What roles do middle managers play in implementation of innovative practices?

    PubMed Central

    Engle, Ryann L.; Lopez, Emily R.; Gormley, Katelyn E.; Chan, Jeffrey A.; Charns, Martin P.; Lukas, Carol VanDeusen

    2017-01-01

    Background: Middle managers play key roles in hospitals as the bridge between senior leaders and frontline staff. Yet relatively little research has focused on their role in implementing new practices. Purpose: The aim of this study was to expand the understanding of middle managers’ influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks. Methodology/Approach: We analyzed qualitative data from 17 Veterans Affairs Medical Centers with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior leaders to frontline staff to identify themes within an a priori framework reflecting middle manager activities. Findings: Analyses yielded 14 emergent themes that allowed us to classify specific expressions of middle manager commitment to implementation of innovative practices (e.g., facilitate improvement innovation, garner staff buy-in). In comparing middle manager behaviors in high and low change potential sites, we found that most emergent themes were present in both groups. However, the activities and interactions described differed between the groups. Practice Implications: Middle managers can use the promising strategies identified by our analyses to guide and improve their effectiveness in implementing new practices. These strategies can also inform senior leaders striving to guide middle managers in those efforts. PMID:26488239

  15. Implementation of E-Government in Mexico: The Case of Infonavit

    NASA Astrophysics Data System (ADS)

    Herrera, Lizbeth; Gil-Garcia, J. Ramon

    The implementation of information and communication technologies (ICTs) in the public sector is a strategy for administrative reform that has grown in ­importance in recent years. The use of ICT in government can help to improve the ­efficiency, quality, and transparency of public services and reduce the operating costs of bureaucracy. ICTs have also opened a new communication channel for government to provide public services to citizens without intermediaries. However, the ­implementation of an ICT initiative is not a simple process. Organizations ­frequently invest a great amount of resources into ICT initiatives, but the results they obtain often do not meet expectations. This observation is particularly true in some developing countries. Based on a case study of a Mexican federal agency, this ­chapter analyzes a successful strategy involving three ICT projects, taking into consideration institutional, organizational, and managerial aspects. Overall, the results of this study show that having a strategic plan that aligns the ICT project objectives with the overarching organizational goals leads to successful implementation because the technical, organizational, and institutional resources are ­managed in an integrated fashion. The chapter also reports on specific factors that had an impact on the characteristics and success of the three ICT projects.

  16. Implementing the End TB Strategy in the Western Pacific Region: Translating vision into reality.

    PubMed

    Rahevar, Kalpeshsinh; Fujiwara, Paula I; Ahmadova, Shalala; Morishita, Fukushi; Reichman, Lee B

    2018-04-12

    The End TB Strategy aims to end the global tuberculosis (TB) epidemic by 2035 in line with the sustainable development goals targets and has been implemented in the World Health Organization (WHO) Western Pacific Region since 2015. Significant progress has been made in implementing this strategy. However, several challenges still remain. In 2016, an estimated 1.8 million people developed TB in the region, and of these about 20% were missed by national TB programmes. The gap in diagnosis and enrolment as well as treatment completion is greater with drug-resistant TB. Many TB-affected families face catastrophic costs due to the disease. Sustaining financing for TB care is a long-term challenge in many countries. This article emphasizes targeted interventions in high-risk populations, including systematic screening and patient-centred TB care. Several other approaches including improving TB diagnostic tools and algorithm, and engaging all care providers are suggested to find missing TB patients. Drug-resistant TB requires additional resourcing for laboratories, enrolment and patient support. Specific measures are required at different levels to mitigate financial burden due to TB including linking TB to overall social protection schemes. The Moscow Ministerial conference in 2017 and upcoming United Nations (UN) 2018 high-level meeting provide an opportunity to raise TB higher on the global agenda, forge partnerships and move towards universal health coverage. © 2018 Asian Pacific Society of Respirology.

  17. Photochemical grid model implementation and application of ...

    EPA Pesticide Factsheets

    For the purposes of developing optimal emissions control strategies, efficient approaches are needed to identify the major sources or groups of sources that contribute to elevated ozone (O3) concentrations. Source-based apportionment techniques implemented in photochemical grid models track sources through the physical and chemical processes important to the formation and transport of air pollutants. Photochemical model source apportionment has been used to track source impacts of specific sources, groups of sources (sectors), sources in specific geographic areas, and stratospheric and lateral boundary inflow on O3. The implementation and application of a source apportionment technique for O3 and its precursors, nitrogen oxides (NOx) and volatile organic compounds (VOCs), for the Community Multiscale Air Quality (CMAQ) model are described here. The Integrated Source Apportionment Method (ISAM) O3 approach is a hybrid of source apportionment and source sensitivity in that O3 production is attributed to precursor sources based on O3 formation regime (e.g., for a NOx-sensitive regime, O3 is apportioned to participating NOx emissions). This implementation is illustrated by tracking multiple emissions source sectors and lateral boundary inflow. NOx, VOC, and O3 attribution to tracked sectors in the application are consistent with spatial and temporal patterns of precursor emissions. The O3 ISAM implementation is further evaluated through comparisons of apportioned am

  18. Promising New Teacher Support Strategies and Their Costs.

    ERIC Educational Resources Information Center

    Dianda, Marcella R.; Quartz, Karen Hunter

    1995-01-01

    Describes several promising new teacher support strategies implemented by California universities and their district partners as part of the California New Teacher Project, noting resources expended to implement each strategy. The strategies are framed according to their programmatic and economic dimensions. Strategies that make the most sense…

  19. Averting HIV Infections in New York City: A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies

    PubMed Central

    Kessler, Jason; Myers, Julie E.; Nucifora, Kimberly A.; Mensah, Nana; Kowalski, Alexis; Sweeney, Monica; Toohey, Christopher; Khademi, Amin; Shepard, Colin; Cutler, Blayne; Braithwaite, R. Scott

    2013-01-01

    Background New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically. Methods A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC. Results Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average). Conclusions Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs. PMID:24058465

  20. Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years.

    PubMed

    Nekitsing, Chandani; Blundell-Birtill, Pam; Cockroft, Jennie E; Hetherington, Marion M

    2018-04-25

    Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important. To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years. The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included. 30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984). Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  1. Projected Impact of a Sodium Consumption Reduction Initiative in Argentina: An Analysis from the CVD Policy Model – Argentina

    PubMed Central

    Konfino, Jonatan; Mekonnen, Tekeshe A.; Coxson, Pamela G.; Ferrante, Daniel; Bibbins-Domingo, Kirsten

    2013-01-01

    Background Cardiovascular disease (CVD) is the leading cause of death in adults in Argentina. Sodium reduction policies targeting processed foods were implemented in 2011 in Argentina, but the impact has not been evaluated. The aims of this study are to use Argentina-specific data on sodium excretion and project the impact of Argentina’s sodium reduction policies under two scenarios - the 2-year intervention currently being undertaken or a more persistent 10 year sodium reduction strategy. Methods We used Argentina-specific data on sodium excretion by sex and projected the impact of the current strategy on sodium consumption and blood pressure decrease. We assessed the projected impact of sodium reduction policies on CVD using the Cardiovascular Disease (CVD) Policy Model, adapted to Argentina, modeling two alternative policy scenarios over the next decade. Results Our study finds that the initiative to reduce sodium consumption currently in place in Argentina will have substantial impact on CVD over the next 10 years. Under the current proposed policy of 2-year sodium reduction, the mean sodium consumption is projected to decrease by 319–387 mg/day. This decrease is expected to translate into an absolute reduction of systolic blood pressure from 0.93 mmHg to 1.81 mmHg. This would avert about 19,000 all-cause mortality, 13,000 total myocardial infarctions, and 10,000 total strokes over the next decade. A more persistent sodium reduction strategy would yield even greater CVD benefits. Conclusion The impact of the Argentinean initiative would be effective in substantially reducing mortality and morbidity from CVD. This paper provides evidence-based support to continue implementing strategies to reduce sodium consumption at a population level. PMID:24040085

  2. Professors' Perceptions of Distance Education in Virtual Environments: The Case of the Education Faculty of University of Al-Yarmouk (Jordan)

    ERIC Educational Resources Information Center

    Oassim-Al-shboul, Oassim Mahmoud; Sabiote, Clemente Rodriguez; Álvarez-Rodríguez, José

    2015-01-01

    The goal of this study is to determine the perceptions that the teaching staff of the Faculty of Education at University of Al-Yarmouk (Jordan) have of the implementation of distance learning in virtual environments, more specifically, the professors' opinion of the potential and limitations of this educational strategy. To fulfil this goal, we…

  3. Perceptions of the Teacher-Student Relationship among Full-Day Kindergarten Teachers in Relation to the Achievement of Students of Poverty: A Phenomenological Qualitative Study

    ERIC Educational Resources Information Center

    Nolan, Lisa A.

    2016-01-01

    When considering closing the achievement gap, full-day kindergarten (FDK) is a viable contender. The implementation of specific teacher strategies enhances the FDK experience and elicits gains among the students. The literature clearly articulates a strong correlation between poverty and poor achievement and supports the notion that the…

  4. Noncommunicable Disease Prevention and Control in Mongolia: A Policy Analysis.

    PubMed

    Chimeddamba, Oyun; Peeters, Anna; Walls, Helen L; Joyce, Catherine

    2015-07-14

    Noncommunicable diseases (NCDs) are the major global cause of morbidity and mortality. In Mongolia, a number of health policies have been developed targeting the prevention and control of noncommunicable diseases. This paper aimed to evaluate the extent to which NCD-related policies introduced in Mongolia align with the World Health Organization (WHO) 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs. We conducted a review of policy documents introduced by the Government of Mongolia from 2000 to 2013. A literature review, internet-based search, and expert consultation identified the policy documents. Information was extracted from the documents using a matrix, mapping each document against the six objectives of the WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs and five dimensions: data source, aim and objectives of document, coverage of conditions, coverage of risk factors and implementation plan. 45 NCD-related policies were identified. Prevention and control of the common NCDs and their major risk factors as described by WHO were widely addressed, and policies aligned well with the objectives of the WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs. Many documents included explicit implementation or monitoring frameworks. It appears that each objective of the WHO 2008-2013 NCD Action Plan was well addressed. Specific areas less well and/or not addressed were chronic respiratory disease, physical activity guidelines and dietary standards. The Mongolian Government response to the emerging burden of NCDs is a population-based public health approach that includes a national multisectoral framework and integration of NCD prevention and control policies into national health policies. Our findings suggest gaps in addressing chronic respiratory disease, physical activity guidelines, specific food policy actions restricting sales advertising of food products, and a lack of funding specifically supporting NCD research. The neglect of these areas may hamper addressing the NCD burden, and needs immediate action. Future research should explore the effectiveness of national NCD policies and the extent to which the policies are implemented in practice.

  5. A mixed methods protocol for developing and testing implementation strategies for evidence-based obesity prevention in childcare: a cluster randomized hybrid type III trial.

    PubMed

    Swindle, Taren; Johnson, Susan L; Whiteside-Mansell, Leanne; Curran, Geoffrey M

    2017-07-18

    Despite the potential to reach at-risk children in childcare, there is a significant gap between current practices and evidence-based obesity prevention in this setting. There are few investigations of the impact of implementation strategies on the uptake of evidence-based practices (EBPs) for obesity prevention and nutrition promotion. This study protocol describes a three-phase approach to developing and testing implementation strategies to support uptake of EBPs for obesity prevention practices in childcare (i.e., key components of the WISE intervention). Informed by the i-PARIHS framework, we will use a stakeholder-driven evidence-based quality improvement (EBQI) process to apply information gathered in qualitative interviews on barriers and facilitators to practice to inform the design of implementation strategies. Then, a Hybrid Type III cluster randomized trial will compare a basic implementation strategy (i.e., intervention as usual) with an enhanced implementation strategy informed by stakeholders. All Head Start centers (N = 12) within one agency in an urban area in a southern state in the USA will be randomized to receive the basic or enhanced implementation with approximately 20 classrooms per group (40 educators, 400 children per group). The educators involved in the study, the data collectors, and the biostastician will be blinded to the study condition. The basic and enhanced implementation strategies will be compared on outcomes specified by the RE-AIM model (e.g., Reach to families, Effectiveness of impact on child diet and health indicators, Adoption commitment of agency, Implementation fidelity and acceptability, and Maintenance after 6 months). Principles of formative evaluation will be used throughout the hybrid trial. This study will test a stakeholder-driven approach to improve implementation, fidelity, and maintenance of EBPs for obesity prevention in childcare. Further, this study provides an example of a systematic process to develop and test a tailored, enhanced implementation strategy. ClinicalTrials.gov, NCT03075085.

  6. Evaluation of the Healthy Lifestyles Initiative for Improving Community Capacity for Childhood Obesity Prevention.

    PubMed

    Berman, Marcie; Bozsik, Frances; Shook, Robin P; Meissen-Sebelius, Emily; Markenson, Deborah; Summar, Shelly; DeWit, Emily; Carlson, Jordan A

    2018-02-22

    Policy, systems, and environmental approaches are recommended for preventing childhood obesity. The objective of our study was to evaluate the Healthy Lifestyles Initiative, which aimed to strengthen community capacity for policy, systems, and environmental approaches to healthy eating and active living among children and families. The Healthy Lifestyles Initiative was developed through a collaborative process and facilitated by community organizers at a local children's hospital. The initiative supported 218 partners from 170 community organizations through training, action planning, coalition support, one-on-one support, and the dissemination of materials and sharing of resources. Eighty initiative partners completed a brief online survey on implementation strategies engaged in, materials used, and policy, systems, and environmental activities implemented. In accordance with frameworks for implementation science, we assessed associations among the constructs by using linear regression to identify whether and which of the implementation strategies were associated with materials used and implementation of policy, systems, and environmental activities targeted by the initiative. Each implementation strategy was engaged in by 30% to 35% of the 80 survey respondents. The most frequently used materials were educational handouts (76.3%) and posters (66.3%). The most frequently implemented activities were developing or continuing partnerships (57.5%) and reviewing organizational wellness policies (46.3%). Completing an action plan and the number of implementation strategies engaged in were positively associated with implementation of targeted activities (action plan, effect size = 0.82; number of strategies, effect size = 0.51) and materials use (action plan, effect size = 0.59; number of strategies, effect size = 0.52). Materials use was positively associated with implementation of targeted activities (effect size = 0.35). Community-capacity-building efforts can be effective in supporting community organizations to engage in policy, systems, and environmental activities for healthy eating and active living. Multiple implementation strategies are likely needed, particularly strategies that involve a high level of engagement, such as training community organizations and working with them on structured action plans.

  7. A comprehensive custom panel design for routine hereditary cancer testing: preserving control, improving diagnostics and revealing a complex variation landscape.

    PubMed

    Castellanos, Elisabeth; Gel, Bernat; Rosas, Inma; Tornero, Eva; Santín, Sheila; Pluvinet, Raquel; Velasco, Juan; Sumoy, Lauro; Del Valle, Jesús; Perucho, Manuel; Blanco, Ignacio; Navarro, Matilde; Brunet, Joan; Pineda, Marta; Feliubadaló, Lidia; Capellá, Gabi; Lázaro, Conxi; Serra, Eduard

    2017-01-04

    We wanted to implement an NGS strategy to globally analyze hereditary cancer with diagnostic quality while retaining the same degree of understanding and control we had in pre-NGS strategies. To do this, we developed the I2HCP panel, a custom bait library covering 122 hereditary cancer genes. We improved bait design, tested different NGS platforms and created a clinically driven custom data analysis pipeline. The I2HCP panel was developed using a training set of hereditary colorectal cancer, hereditary breast and ovarian cancer and neurofibromatosis patients and reached an accuracy, analytical sensitivity and specificity greater than 99%, which was maintained in a validation set. I2HCP changed our diagnostic approach, involving clinicians and a genetic diagnostics team from panel design to reporting. The new strategy improved diagnostic sensitivity, solved uncertain clinical diagnoses and identified mutations in new genes. We assessed the genetic variation in the complete set of hereditary cancer genes, revealing a complex variation landscape that coexists with the disease-causing mutation. We developed, validated and implemented a custom NGS-based strategy for hereditary cancer diagnostics that improved our previous workflows. Additionally, the existence of a rich genetic variation in hereditary cancer genes favors the use of this panel to investigate their role in cancer risk.

  8. Validation and implementation of model based control strategies at an industrial wastewater treatment plant.

    PubMed

    Demey, D; Vanderhaegen, B; Vanhooren, H; Liessens, J; Van Eyck, L; Hopkins, L; Vanrolleghem, P A

    2001-01-01

    In this paper, the practical implementation and validation of advanced control strategies, designed using model based techniques, at an industrial wastewater treatment plant is demonstrated. The plant under study is treating the wastewater of a large pharmaceutical production facility. The process characteristics of the wastewater treatment were quantified by means of tracer tests, intensive measurement campaigns and the use of on-line sensors. In parallel, a dynamical model of the complete wastewater plant was developed according to the specific kinetic characteristics of the sludge and the highly varying composition of the industrial wastewater. Based on real-time data and dynamic models, control strategies for the equalisation system, the polymer dosing and phosphorus addition were established. The control strategies are being integrated in the existing SCADA system combining traditional PLC technology with robust PC based control calculations. The use of intelligent control in wastewater treatment offers a wide spectrum of possibilities to upgrade existing plants, to increase the capacity of the plant and to eliminate peaks. This can result in a more stable and secure overall performance and, finally, in cost savings. The use of on-line sensors has a potential not only for monitoring concentrations, but also for manipulating flows and concentrations. This way the performance of the plant can be secured.

  9. 75 FR 74517 - Approval and Promulgation of Implementation Plans; State of California; 2008 San Joaquin Valley...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ...EPA is proposing to approve in part and disapprove in part state implementation plan (SIP) revisions submitted by California to provide for attainment of the 1997 annual and 24-hour fine particulate matter (PM2.5) national ambient air quality standards (NAAQS) in the San Joaquin Valley (SJV) nonattainment area. The SIP revisions are the SJV 2008 PM2.5 Plan (revised 2010) and portions of the 2007 State Strategy (revised 2009). Specifically, EPA is proposing to approve the emissions inventories as meeting the requirements of the Clean Air Act and EPA's fine particle implementing rule and to approve commitments to implement specific measures and meet specific aggregate emissions reductions by the San Joaquin Valley Air Pollution Control District and the California Air Resource Board. In addition, we are proposing to find that volatile organic compounds are a PM2.5 attainment plan precursor in the SJV for which controls should be evaluated. EPA is proposing to disapprove the attainment demonstration. EPA is also proposing to disapprove the reasonably available control measures/reasonably available control technology demonstration, the air quality modeling, the reasonable further progress (RFP) demonstration, the contingency measures, and the attainment and RFP conformity motor vehicle emissions budgets. EPA is also proposing to not grant California's request to extend to April 5, 2015 the deadline for the SJV nonattainment area to attain the 1997 PM2.5 NAAQS.

  10. Sustaining quality improvement and patient safety training in graduate medical education: lessons from social theory.

    PubMed

    Wong, Brian M; Kuper, Ayelet; Hollenberg, Elisa; Etchells, Edward E; Levinson, Wendy; Shojania, Kaveh G

    2013-08-01

    Despite an official mandate to incorporate formal quality improvement (QI) and patient safety (PS) training into graduate medical education, many QI/PS curricular efforts face implementation challenges and are not sustained. Educators are increasingly turning to sociocultural theories to address issues such as curricular uptake in medical education. The authors conducted a case study using Bourdieu's concepts of "field" and "habitus" to identify theoretically derived strategies that can promote sustained implementation of QI/PS curricula. From October 2010 through May 2011, the authors conducted semistructured interviews with principal authors of studies included in a systematic review of QI/PS curricula and with key informants (identified by study participants) who did not publish on their QI/PS curricular efforts. The authors purposively sampled to theoretical saturation and analyzed data concurrently with iterative data gathering within Bourdieu's theoretical framework. The study included 16 participants representing six specialties in the United States and Canada. Data analysis revealed that academic physicians belong to, and compete for legitimate forms of capital within, two separate but related fields associated with QI/PScurricular implementation: the "academic field" and the "health care delivery field." Respondents used specific strategies toexploit and/or redefine the prevailingforms of legitimate capital in each field to encourage changes inacademic physicians' habitus that would legitimizeQI/PS. Situating study findings in a sociocultural theory enables articulation of concrete strategies that can legitimize QI/PS in the academic and health care delivery fields. These strategies can promote sustained QI/PS curricula in graduate medical education.

  11. Tailoring implementation strategies for evidence-based recommendations using computerised clinical decision support systems: protocol for the development of the GUIDES tools.

    PubMed

    Van de Velde, Stijn; Roshanov, Pavel; Kortteisto, Tiina; Kunnamo, Ilkka; Aertgeerts, Bert; Vandvik, Per Olav; Flottorp, Signe

    2016-03-05

    A computerised clinical decision support system (CCDSS) is a technology that uses patient-specific data to provide relevant medical knowledge at the point of care. It is considered to be an important quality improvement intervention, and the implementation of CCDSS is growing substantially. However, the significant investments do not consistently result in value for money due to content, context, system and implementation issues. The Guideline Implementation with Decision Support (GUIDES) project aims to improve the impact of CCDSS through optimised implementation based on high-quality evidence-based recommendations. To achieve this, we will develop tools that address the factors that determine successful CCDSS implementation. We will develop the GUIDES tools in four steps, using the methods and results of the Tailored Implementation for Chronic Diseases (TICD) project as a starting point: (1) a review of research evidence and frameworks on the determinants of implementing recommendations using CCDSS; (2) a synthesis of a comprehensive framework for the identified determinants; (3) the development of tools for use of the framework and (4) pilot testing the utility of the tools through the development of a tailored CCDSS intervention in Norway, Belgium and Finland. We selected the conservative management of knee osteoarthritis as a prototype condition for the pilot. During the process, the authors will collaborate with an international expert group to provide input and feedback on the tools. This project will provide guidance and tools on methods of identifying implementation determinants and selecting strategies to implement evidence-based recommendations through CCDSS. We will make the GUIDES tools available to CCDSS developers, implementers, researchers, funders, clinicians, managers, educators, and policymakers internationally. The tools and recommendations will be generic, which makes them scalable to a large spectrum of conditions. Ultimately, the better implementation of CCDSS may lead to better-informed decisions and improved care and patient outcomes for a wide range of conditions. PROSPERO, CRD42016033738.

  12. 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.

  13. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

    PubMed

    Francke, Anneke L; Smit, Marieke C; de Veer, Anke J E; Mistiaen, Patriek

    2008-09-12

    Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals - e.g., awareness of the existence of the guideline and familiarity with its content - likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines are followed. Finally, environmental characteristics may influence guideline implementation. For example, a lack of support from peers or superiors, as well as insufficient staff and time, appear to be the main impediments. Existing reviews describe various factors that influence whether guidelines are actually used. However, the evidence base is still thin, and future sound research - for instance comparing combinations of implementation strategies versus single strategies - is needed.

  14. 2005 AG20/20 Annual Review

    NASA Technical Reports Server (NTRS)

    Ross, Kenton W.; McKellip, Rodney D.

    2005-01-01

    Topics covered include: Implementation and Validation of Sensor-Based Site-Specific Crop Management; Enhanced Management of Agricultural Perennial Systems (EMAPS) Using GIS and Remote Sensing; Validation and Application of Geospatial Information for Early Identification of Stress in Wheat; Adapting and Validating Precision Technologies for Cotton Production in the Mid-Southern United States - 2004 Progress Report; Development of a System to Automatically Geo-Rectify Images; Economics of Precision Agriculture Technologies in Cotton Production-AG 2020 Prescription Farming Automation Algorithms; Field Testing a Sensor-Based Applicator for Nitrogen and Phosphorus Application; Early Detection of Citrus Diseases Using Machine Vision and DGPS; Remote Sensing of Citrus Tree Stress Levels and Factors; Spectral-based Nitrogen Sensing for Citrus; Characterization of Tree Canopies; In-field Sensing of Shallow Water Tables and Hydromorphic Soils with an Electromagnetic Induction Profiler; Maintaining the Competitiveness of Tree Fruit Production Through Precision Agriculture; Modeling and Visualizing Terrain and Remote Sensing Data for Research and Education in Precision Agriculture; Thematic Soil Mapping and Crop-Based Strategies for Site-Specific Management; and Crop-Based Strategies for Site-Specific Management.

  15. Organizational Strategies to Implement Hospital Pressure Ulcer Prevention Programs: Findings from a National Survey

    PubMed Central

    SOBAN, LYNN M.; KIM, LINDA; YUAN, ANITA H.; MILTNER, REBECCA S.

    2017-01-01

    Aim To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system. Background Comprehensive pressure ulcer programs include nursing interventions such as use of a risk assessment tool and organizational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programs. Methods Data were collected by an email survey to all Chief Nursing Officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarize survey responses and evaluate relationships between some variables. Results Organizational strategies that support pressure ulcer prevention program implementation (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalized within individual hospitals. Conclusion Organizational strategies to support implementation of pressure ulcer preventive programs are often not optimally operationalized to achieve consistent, sustainable performance. Implications for Nursing Management The results of this study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. PMID:27487972

  16. Personalized gene silencing therapeutics for Huntington disease.

    PubMed

    Kay, C; Skotte, N H; Southwell, A L; Hayden, M R

    2014-07-01

    Gene silencing offers a novel therapeutic strategy for dominant genetic disorders. In specific diseases, selective silencing of only one copy of a gene may be advantageous over non-selective silencing of both copies. Huntington disease (HD) is an autosomal dominant disorder caused by an expanded CAG trinucleotide repeat in the Huntingtin gene (HTT). Silencing both expanded and normal copies of HTT may be therapeutically beneficial, but preservation of normal HTT expression is preferred. Allele-specific methods can selectively silence the mutant HTT transcript by targeting either the expanded CAG repeat or single nucleotide polymorphisms (SNPs) in linkage disequilibrium with the expansion. Both approaches require personalized treatment strategies based on patient genotypes. We compare the prospect of safe treatment of HD by CAG- and SNP-specific silencing approaches and review HD population genetics used to guide target identification in the patient population. Clinical implementation of allele-specific HTT silencing faces challenges common to personalized genetic medicine, requiring novel solutions from clinical scientists and regulatory authorities. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. An evaluation of the impact and costs of three strategies used to recruit acutely unwell young children to a randomised controlled trial in primary care.

    PubMed

    Redmond, Niamh M; Hollinghurst, Sandra; Costelloe, Céire; Montgomery, Alan A; Fletcher, Margaret; Peters, Tim J; Hay, Alastair D

    2013-08-01

    Recruitment to primary care trials, particularly those involving young children, is known to be difficult. There are limited data available to inform researchers about the effectiveness of different trial recruitment strategies and their associated costs. To describe, evaluate, and investigate the costs of three strategies for recruiting febrile children to a community-based randomised trial of antipyretics. The three recruitment strategies used in the trial were termed as follows: (1) 'local', where paediatric research nurses stationed in primary care sites invited parents of children to participate; (2) 'remote', where clinicians at primary care sites faxed details of potentially eligible children to the trial office; and (3) 'community', where parents, responding to trial publicity, directly contacted the trial office when their child was unwell. Recruitment rates increased in response to the sequential introduction of three recruitment strategies, which were supplemented by additional recruiting staff, flexible staff work patterns, and improved clinician reimbursement schemes. The three strategies yielded different randomisation rates. They also appeared to be interdependent and highly effective together. Strategy-specific costs varied from £297 to £857 per randomised participant and represented approximately 10% of the total trial budget. Because the recruitment strategies were implemented sequentially, it was difficult to measure their independent effects. The cost analysis was performed retrospectively. Trial recruiter expertise and deployment of several interdependent, illness-specific strategies were key factors in achieving rapid recruitment of young children to a community-based randomised controlled trial (RCT). The 'remote' recruitment strategy was shown to be more cost-effective compared to 'community' and 'local' strategies in the context of this trial. Future trialists should report recruitment costs to facilitate a transparent evaluation of recruitment strategy cost-effectiveness.

  18. Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

    PubMed Central

    2013-01-01

    Background The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. Design/methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. Discussion This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. Trial registration ClinicalTrials.gov: NCT01815710 PMID:23692634

  19. Organisational change stressors and nursing job satisfaction: the mediating effect of coping strategies.

    PubMed

    Teo, Stephen T T; Pick, David; Newton, Cameron J; Yeung, Melissa E; Chang, Esther

    2013-09-01

    To examine the mediating effect of coping strategies on the consequences of nursing and non-nursing (administrative) stressors on the job satisfaction of nurses during change management. Organisational change can result in an increase in nursing and non-nursing-related stressors, which can have a negative impact on the job satisfaction of nurses employed in health-care organisations. Matched data were collected in 2009 via an online survey at two time-points (six months apart). Partial least squares path analysis revealed a significant causal relationship between Time 1 administrative and role stressors and an increase in nursing-specific stressors in Time 2. A significant relationship was also identified between job-specific nursing stressors and the adoption of effective coping strategies to deal with increased levels of change-induced stress and strain and the likelihood of reporting higher levels of job satisfaction in Time 2. The effectiveness of coping strategies is critical in helping nurses to deal with the negative consequences of organisational change. This study shows that there is a causal relationship between change, non-nursing stressors and job satisfaction. Senior management should implement strategies aimed at reducing nursing and non-nursing stress during change in order to enhance the job satisfaction of nurses. © 2013 John Wiley & Sons Ltd.

  20. Human Resource Development Issues in the Implementation of the Western China Development Strategy

    ERIC Educational Resources Information Center

    Xiao, Mingzheng

    2007-01-01

    This paper systematically illustrates the value and role of human resource development in the implementation of the Western China development strategy. It analyzes in details some current human resource issues constraining the implementation of the Western China development strategy and those on the sustainable development process of economic…

  1. Implementation of Peer Tutoring Strategies in Teaching Students with ADHD: Teachers' Attitudes in Saudi Education

    ERIC Educational Resources Information Center

    Abaoud, Abdulrahman A.

    2016-01-01

    This study aimed to measured teachers' attitudes toward implementation of peer tutoring strategies in teaching students with ADHD in Saudi Arabia. The study moreover examined the relationship between teachers' attitudes of implementation of peer tutoring strategies and variables of demographic characteristics. Five hundred thirty eight teachers…

  2. 36 CFR Exhibit B to Part 906 - Guidelines for Establishing Strategy To Implement Affirmative Action Personnel Plan

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Strategy To Implement Affirmative Action Personnel Plan B Exhibit B to Part 906 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION AFFIRMATIVE ACTION POLICY AND PROCEDURE Pt. 906, Exh. B Exhibit B to Part 906—Guidelines for Establishing Strategy To Implement Affirmative Action...

  3. Early Childhood Educators' Meta-Cognitive Knowledge of Problem-Solving Strategies and Quality of Childcare Curriculum Implementation

    ERIC Educational Resources Information Center

    Kim, Yeon Ha

    2016-01-01

    This study aims to explore the impact of early childhood educators' meta-cognitive knowledge on the quality of their childcare curriculum implementation, and to gain insights regarding successful problem-solving strategies associated with early education and care. Early childhood educators' implementation of general problem-solving strategies in…

  4. An evaluation of the total quality management implementation strategy for the advanced solid rocket motor project at NASA's Marshall Space Flight Center. M.S. Thesis - Tennessee Univ.

    NASA Technical Reports Server (NTRS)

    Schramm, Harry F.; Sullivan, Kenneth W.

    1991-01-01

    An evaluation of the NASA's Marshall Space Flight Center (MSFC) strategy to implement Total Quality Management (TQM) in the Advanced Solid Rocket Motor (ASRM) Project is presented. The evaluation of the implementation strategy reflected the Civil Service personnel perspective at the project level. The external and internal environments at MSFC were analyzed for their effects on the ASRM TQM strategy. Organizational forms, cultures, management systems, problem solving techniques, and training were assessed for their influence on the implementation strategy. The influence of ASRM's effort was assessed relative to its impact on mature projects as well as future projects at MSFC.

  5. Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

    PubMed Central

    2012-01-01

    Introduction In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor. PMID:22429615

  6. Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing.

    PubMed

    Jin, Xiaoning; Weiss, Brian A; Siegel, David; Lee, Jay

    2016-01-01

    The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy.

  7. Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing

    PubMed Central

    Jin, Xiaoning; Weiss, Brian A.; Siegel, David; Lee, Jay

    2016-01-01

    The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy. PMID:28058173

  8. A cost-effectiveness analysis evaluating endoscopic surveillance for gastric cancer for populations with low to intermediate risk.

    PubMed

    Zhou, Hui Jun; Dan, Yock Young; Naidoo, Nasheen; Li, Shu Chuen; Yeoh, Khay Guan

    2013-01-01

    Gastric cancer (GC) surveillance based on oesophagogastroduodenoscopy (OGD) appears to be a promising strategy for GC prevention. By evaluating the cost-effectiveness of endoscopic surveillance in Singaporean Chinese, this study aimed to inform the implementation of such a program in a population with a low to intermediate GC risk. USING A REFERENCE STRATEGY OF NO OGD INTERVENTION, WE EVALUATED FOUR STRATEGIES: 2-yearly OGD surveillance, annual OGD surveillance, 2-yearly OGD screening and 2-yearly screening plus annual surveillance in Singaporean Chinese aged 50-69 years. From a perspective of the healthcare system, Markov models were built to simulate the life experience of the target population. The models projected discounted lifetime costs ($), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) indicating the cost-effectiveness of each strategy against a Singapore willingness-to-pay of $46,200/QALY. Deterministic and probabilistic sensitivity analyses were used to identify the influential variables and their associated thresholds, and to quantify the influence of parameter uncertainties respectively. With an ICER of $44,098/QALY, the annual OGD surveillance was the optimal strategy while the 2-yearly surveillance was the most cost-effective strategy (ICER = $25,949/QALY). The screening-based strategies were either extendedly dominated or cost-ineffective. The cost-effectiveness heterogeneity of the four strategies was observed across age-gender subgroups. Eight influential parameters were identified each with their specific thresholds to define the choice of optimal strategy. Accounting for the model uncertainties, the probability that the annual surveillance is the optimal strategy in Singapore was 44.5%. Endoscopic surveillance is potentially cost-effective in the prevention of GC for populations at low to intermediate risk. Regarding program implementation, a detailed analysis of influential factors and their associated thresholds is necessary. Multiple strategies should be considered in order to recommend the right strategy for the right population.

  9. Health system factors affecting implementation of integrated management of childhood illness (IMCI): qualitative insights from a South African province.

    PubMed

    Pandya, Himani; Slemming, Wiedaad; Saloojee, Haroon

    2018-03-01

    The Integrated Management of Childhood Illness (IMCI) strategy has been adopted by 102 countries including South Africa, as the preferred primary health care (PHC) delivery strategy for sick children under 5 years. Despite substantial investment to support IMCI in South Africa, its delivery remains sub-optimal, with varied implementation in different settings. There is scarce research globally, and in the local context, examining the effects of health system characteristics on IMCI implementation. This study explored key determinants of IMCI delivery in a South African province, with a specific focus on health system building blocks using a health system dynamics framework. In-depth interviews were conducted with 38 districts, provincial and national respondents involved with IMCI co-ordination and delivery, exploring their involvement in, and perceptions of, IMCI strategy implementation. Identified barriers included poor definition of elements of a service package for children and how IMCI aligned with this, incompetence of trained nurses exacerbated by inappropriate rotation practices, use of inappropriate indicators to track progress, multiple cadres coordinating similar activities with poor role delineation, and fragmented, vertical governance of programmes included within IMCI, such as immunization. Enabling practices in one district included the use of standardized child health records incorporating IMCI activities and stringent practice monitoring through record audits. Using IMCI as a case study, our work highlights critical health system deficiencies affecting service delivery for young children which need to be resolved to reposition IMCI within the broader child 'survive, thrive and transform' agenda. Recommendations for appropriate health system strengthening include the need for redefining IMCI within a broader PHC service package for children, prioritizing post-training supervision and mentoring of practitioners through appropriate duty allocation and rotation policies, strengthening IMCI monitoring with a specific focus on quality of care and building stronger clinical governance through workforce allocation, role delineation and improved accountability. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Implementation strategies for guidelines at ICUs: a systematic review.

    PubMed

    Jordan, Portia; Mpasa, Ferestas; Ten Ham-Baloyi, Wilma; Bowers, Candice

    2017-05-08

    Purpose The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs). Design/methodology/approach A systematic review with a narrative synthesis adapted from Popay et al.'s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August). After reading the abstracts, titles and full-text articles, 11 ( n=11) research studies met the inclusion criteria. Findings After critical appraisal, using the Joanna Briggs Critical Appraisal Tools, eight randomized controlled trials conducted in adult and neonatal ICUs using implementation strategies remained. Popay et al.'s method for narrative synthesis was adapted and used to analyze and synthesize the data and formulate concluding statements. Included studies found that multi-faceted strategies appear to be more effective than single strategies. Strategies mostly used were printed educational materials, information/ sessions, audit, feedback, use of champion leaders, educational outreach visits, and computer or internet usage. Practical training, monitoring visits and grand rounds were less used. Practical implications Findings can be used by clinicians to implement the best combination of multi-faceted implementation strategies in the ICUs in order to enhance the optimal use of CPGs. Originality/value No systematic review was previously done on the implementation strategies that should be used best for optimal CPG implementation in the ICU.

  11. IEC planning: eight state-of-the-art principles.

    PubMed

    Middleton, J

    1983-12-01

    Considerable experience and research has been accumulated in the last 20 years on the ways in which information/education/communication (IEC) programs can be effectively designed, implemented, and evaluated. Possibly more effort has focused on population and family planning IEC than on any other sectoral program of development communication. Several principles have emerged which, taken together, define the state of the art in the field. These principles provide a framework of experience which can guide the development of comprehensive IEC programs. They include: policy and resource assessment; audience analysis; strategy design; message research and pretesting; participation and feedback; management; evaluation; and collaboration. The nature of the national policy base for population and family planning programs will determine the goals and approaches of the IEC program. Strong policies of limitation on popultion growth lead to equally strong and pervasive IEC efforts designed to directly affect contraceptive behavior. Assessment of existing policy is an essential aspect of the design of an effective IEC program. Policies establish the rationale and boundaries for action. Population and family planning programs are concerned with some of the most intimate human behavior. Consequently, structured and sensitive audience analysis has become an integral part of the design of IEC programs. The design of communication strategy requires clearly stated objectives. Principles of human learning are used to structure information appropriately. Message research and pretesting have become integral components of the strategy design process. Small scale research on specific objectives is necessary to establish the basis for message design. Audience participation and feedback in remaining phases of program development and implementation are important. The management of an IEC program requires a specific combination of planning, flexibility, and creativity. Evaluation of program effects--identification of the degree of change toward stated objectives -- is critical to long term assessment of the underlying strategy and the identification both of needed corrections and new directions for the future. Collaboration with and involvement of stakeholders in the design and implementation of a national IEC program significantly raises the probability that support will be forthcoming. Taken together these 8 principles can become the basic building blocks of an effective population/family planning IEC program.

  12. Increasing In-Service Teacher Implementation of Classroom Management Practices through Consultation, Implementation Planning, and Participant Modeling

    ERIC Educational Resources Information Center

    Hagermoser Sanetti, Lisa M.; Williamson, Kathleen M.; Long, Anna C. J.; Kratochwill, Thomas R.

    2018-01-01

    Numerous evidence-based classroom management strategies to prevent and respond to problem behavior have been identified, but research consistently indicates teachers rarely implement them with sufficient implementation fidelity. The purpose of this study was to evaluate the effectiveness of implementation planning, a strategy involving logistical…

  13. Review of implementation strategies to change healthcare provider behaviour in the emergency department.

    PubMed

    de Wit, Kerstin; Curran, Janet; Thoma, Brent; Dowling, Shawn; Lang, Eddy; Kuljic, Nebojsa; Perry, Jeffrey J; Morrison, Laurie

    2018-05-01

    Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies. We produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research. We present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

  14. A 7-Step Strategy for the Implementation of Worksite Lifestyle Interventions: Helpful or Not?

    PubMed

    Wierenga, Debbie; Engbers, Luuk H; Van Empelen, Pepjin; van Mechelen, Willem

    2016-05-01

    The aim of this study was to evaluate the use of and adherence to a 7-step strategy for the development, implementation, and continuation of a comprehensive, multicomponent lifestyle program. Strategy use and adherence was assessed with 12 performance indicators. Data were collected by combining onsite monitoring with semi-structured interviews at baseline and follow-up (6, 12, and 18 months). Not all performance indicators were met so partial strategy adherence was obtained. The strategy could be improved on the following aspects: support among management, project structure, adaptation to needs of employees, planning, and maintenance. The results of this evaluation indicate that strategy adherence facilitated structured development and implementation. On the basis of the qualitative data, this study suggests that when improvements will be made on both the content and performance, the 7-step strategy could be an effective tool to successfully implement a multicomponent WHPP.

  15. Implementing a Strategy Awareness Raising Programme: Strategy Changes and Feedback

    ERIC Educational Resources Information Center

    Blanco, Maria; Pino, Margarita; Rodriguez, Beatriz

    2010-01-01

    This article reports on a collaborative action research study carried out on three groups of Spanish beginners during the implementation of a strategy awareness raising programme (SAR). The objective was to analyse the impact of the SAR programme on the students' learning process in three main areas: strategy awareness, strategy use in learning…

  16. Antibiotic stewardship through the EU project "ABS International".

    PubMed

    Allerberger, Franz; Frank, Annegret; Gareis, Roland

    2008-01-01

    The increasing problem of antimicrobial resistance requires implementation of antibiotic stewardship (ABS) programs. The project "ABS International--implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union" was started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (antibiotic list, guides for antibiotic treatment and surgical prophylaxis, antibiotic-related organization) and valid process measures, as well as quality indicators for antibiotic use were developed. Specific ABS tools are being implemented in up to five healthcare facilities in each country. Although ABS International clearly focuses on healthcare institutions, future antimicrobial stewardship programs must also cover public education and antibiotic prescribing in primary care.

  17. Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis.

    PubMed

    Keurhorst, Myrna; van de Glind, Irene; Bitarello do Amaral-Sabadini, Michaela; Anderson, Peter; Kaner, Eileen; Newbury-Birch, Dorothy; Braspenning, Jozé; Wensing, Michel; Heinen, Maud; Laurant, Miranda

    2015-12-01

    Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)=-0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians. © 2015 Society for the Study of Addiction.

  18. Using focus groups and social marketing to strengthen promotion of group prenatal care.

    PubMed

    Vonderheid, Susan C; Carrie, S Klima; Norr, Kathleen F; Grady, Mary Alice; Westdahl, Claire M

    2013-01-01

    Centering Pregnancy, an innovative group model of prenatal care, shows promise to reduce persistent adverse maternal-infant outcomes and contain costs. Because this innovation requires systemwide change, clinics reported needing support enrolling women into groups and obtaining organizational buy-in. This study used the 3-step social marketing communication strategy to help clinic staff identify key customers and customer-specific barriers to adopting or supporting Centering Pregnancy. They developed targeted information to reduce barriers and built skills in communicating with different customers through role-playing. Findings provide practical information for others to use this communication strategy to improve implementation of Centering Pregnancy.

  19. Design of Firmware Update Strategy in Tower Mounted Amplifier

    NASA Astrophysics Data System (ADS)

    Lv, Yi; Han, Shuqin

    With rapid development of radio communication, Tower mounted amplifier (TMA) that conform to AISG protocol will be increasingly applied. Remote firmware update function is essential for TMA. In this paper, a method about remote firmware update that conforms to AISG2.0 is proposed. In this paper, defect of traditional firmware storage is given, and the implementation procedure of firmware storing that based on internal flash of STR755 was introduced. According to corresponding specification in aisg2.0, the process of firmware download and activation are provided in detail. The key point of bootloader was given. Application result shows that the strategy is reliable and highly secure.

  20. Severe disability: do primary health care nurses have a role to play?

    PubMed

    Bornman, J; Alant, E; Lloyd, L L

    2004-05-01

    This article focuses on the importance of primary health care nurses' involvement in the identification of children with severe disabilities, early and appropriate intervention that includes referral, as well as the provision of support to the children's caregivers. The use of multiskilling as a strategy to train nurses to fulfil this role is described. The traditional roles of community nurses are explored within the disability paradigm, with specific reference to multi-skilling. Finally, research results following the implementation of the Beginning Communication Intervention Protocol (BCIP), which uses multi-skilling as a training strategy, are described. Recommendations for further research are then provided.

Some links on this page may take you to non-federal websites. Their policies may differ from this site.
Top