WorldWideScience

Sample records for facilitating practice improvement

  1. Primary care quality improvement from a practice facilitator's perspective.

    Science.gov (United States)

    Liddy, Clare E; Blazhko, Valeriya; Dingwall, Molly; Singh, Jatinderpreet; Hogg, William E

    2014-02-03

    Practice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change. We conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007-2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts. Common barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility. The consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions.

  2. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review.

    Science.gov (United States)

    Solomons, Nan M; Spross, Judith A

    2011-01-01

    The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI). EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators. Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework. Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers. The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  3. Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

    Science.gov (United States)

    Harvey, Gillian; Lynch, Elizabeth

    2017-01-01

    Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified. PMID:28275594

  4. Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams.

    Science.gov (United States)

    Bunniss, Suzanne; Gray, Francesca; Kelly, Diane

    2012-06-01

    Many patients, families, health care professionals and politicians desire for quality improvement within the UK National Health Service. One way to achieve this change is for health care teams to work and learn together more effectively. This research aimed to design and trial a facilitated learning programme with the aim of supporting general practice teams in fostering the characteristics of learning organizations. This is an action research study. Qualitative data were captured during and after the trial from 40 participants in two multi-professional general practice teams within different Scottish health boards. Data were gathered using observations, semi-structured interviews and written learning notes. Taking part in the LPP was a positive experience of learning together as a practice and enhanced communication within the team was a particular outcome. External facilitation helped provide focus and reduce inter-professional barriers. Teams found working in small, mixed role discussion groups particularly valuable in understanding each others' perspectives. The active learning style of the LPP could be daunting at times but teams valued the chance to identify their own quality improvement goals. Teams introduced a number of changes to improve the quality of care within their practice as a result of their participation. This trial of the learning practice programme shows that, with facilitation and the appropriate input of resources, general practice teams can successfully apply learning organization principles to produce quality improvement outcomes. The study also demonstrates the value of action research in researching iterative change over time. © 2011 Blackwell Publishing Ltd.

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

    Science.gov (United States)

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

    2014-01-01

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

  6. Positive experiences with a specialist as facilitator in general practice

    DEFF Research Database (Denmark)

    Kousgaard, Marius Brostrøm; Thorsen, Thorkil

    2012-01-01

    The use of facilitators for quality improvement in general practice has accelerated during the past decade. As general practitioners (GPs) or pharmacists have typically been used as facilitators, there is a lack of knowledge of how other professionals function as facilitators. This article explor...

  7. Best practice in clinical facilitation of undergraduate nursing students.

    Science.gov (United States)

    Needham, Judith; McMurray, Anne; Shaban, Ramon Z

    2016-09-01

    Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students. Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison. Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes; 'assessing', 'learning to facilitate' and 'facilitating effectively'. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students.

  8. Practical-theological facilitation as skilled helping

    Directory of Open Access Journals (Sweden)

    Elmo Pienaar

    2013-11-01

    Full Text Available The article discussed the idea of skilled helping in relation to what has been put forward as practical theological facilitation. It has been argued that various helping relationships, amongst which the author refers to coaching, facilitation, and therapy has more in common than what differentiates them if epistemology is viewed as a unifying concept. As such the scope of practical theology in terms of the contexts and themes in which it might be involved is said to widen. The public dimension of the organisational context, more so than the congregational context, has been put forward as an important habitus of practical-theological facilitation. The organisational involvement of the practical-theological facilitator in terms of professional-vocational skilled helping takes on an actual role through facilitation and other helping modalities.

  9. Facilitating practical knowledge by using ECT

    Directory of Open Access Journals (Sweden)

    Rita Jentoft

    2009-01-01

    Full Text Available Practical skills constitute essential knowledge in occupational therapy. The knowledge is situation- and experience-based, generated from within the situation. In a particular program for educating Palestinian Occupational Therapists in Gaza, facilitating such knowledge proved to be difficult. Due to travel restrictions and an unstable political situation, teachers and students were separated. Educational communication technology (ECT like videoconferences, internet and videos became new and necessary tools. This article is based on results from an action research project which followed the process of using flexible forms of learning and developing an internet based learning programme named Ergonet. The learning process of the students using it was examined with the aim of answering the following research question: How can flexible forms of learning be developed and used to facilitate practical knowledge in Occupational Therapy education? The development and implementation of Ergonet as a supporting device in students’ learning of practical skills is described through the experience of the teachers involved. The results indicate how rote-learning and lack of reflective and critical thinking, firmly established among Palestinian students, have been challenged and changed by the didactic use of Ergonet.

  10. An overview of practice facilitation programs in Canada: current perspectives and future directions.

    Science.gov (United States)

    Liddy, Clare; Laferriere, Dianne; Baskerville, Bruce; Dahrouge, Simone; Knox, Lyndee; Hogg, William

    2013-02-01

    Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field.

  11. Developing a facilitation model to promote organisational development in primary care practices.

    Science.gov (United States)

    Rhydderch, Melody; Edwards, Adrian; Marshall, Martin; Elwyn, Glyn; Grol, Richard

    2006-06-19

    The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted. A model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care. The facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning. This study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by practices increases.

  12. Developing a facilitation model to promote organisational development in primary care practices

    Directory of Open Access Journals (Sweden)

    Elwyn Glyn

    2006-06-01

    Full Text Available Abstract Background The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted. Method A model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care. Results The facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning. Conclusion This study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by

  13. Society for Academic Continuing Medical Education Intervention Guideline Series: Guideline 2, Practice Facilitation.

    Science.gov (United States)

    Van Hoof, Thomas J; Grant, Rachel E; Campbell, Craig; Colburn, Lois; Davis, David; Dorman, Todd; Fischer, Michael; Horsley, Tanya; Jacobs-Halsey, Virginia; Kane, Gabrielle; LeBlanc, Constance; Moore, Donald E; Morrow, Robert; Olson, Curtis A; Silver, Ivan; Thomas, David C; Turco, Mary; Kitto, Simon

    2015-01-01

    The Society for Academic Continuing Medical Education commissioned a study to clarify and, if possible, standardize the terminology for a set of important educational interventions. In the form of a guideline, this article describes one such intervention, practice facilitation, which is a common strategy in primary care to help practices develop capacity and infrastructure to support their ability to improve patient care. Based on a review of recent evidence and a facilitated discussion with US and Canadian experts, we describe practice facilitation, its terminology, and other important information about the intervention. We encourage leaders and researchers to consider and build on this guideline as they plan, implement, evaluate, and report practice facilitation efforts. Clear and consistent use of terminology is imperative, along with complete and accurate descriptions of interventions, to improve the use and study of practice facilitation.

  14. Facilitative Effects of Practice upon Nonverbal Creativity.

    Science.gov (United States)

    Roweton, William E.; Spencer, Herbert L., Jr.

    Numerous studies of verbal creativity indicate that idea originality increases progressively as more ideas are produced. The present study tested the effects of practice upon nonverbal creativity. Thirty-two fifth grade children were administered Form A and/or Form B of Torrance's picture completion task for 5 consecutive days. Figural originality…

  15. FACILITATING RADICAL FRONT-END INNOVATION THROUGH TARGETED HR PRACTICES

    DEFF Research Database (Denmark)

    Aagaard, Annabeth

    2017-01-01

    This study examines how radical front end innovation can be actively facilitated through selected and targeted HR practices and bundles of HR practices. The empirical field is an explorative case study of front end innovation and HR practices in the pharmaceutical industry, with an in-depth case ...

  16. The practical theologian as decentred but influential facilitator

    Directory of Open Access Journals (Sweden)

    H. Elmo Pienaar

    2012-12-01

    Full Text Available Since the 1970s along with the resurgence in practical philosophy new possibilities opened up in our understanding of the place for and purpose of practical theology. The repositioning of practical theology as a fully worthy discipline was important to find its voice amongst theological peer disciplines. Against this background, it was argued that the full measure of what the discipline can contribute, especially outside of the ministry context, has not yet been fully developed or practiced. Towards this end the presentation’s main contention was put forward, in that it is vital for the practical theologian to take up a role of an inscribed facilitator. It signifies a shift from practical theology to practical theologian and is exemplified by the practice of a facilitative approach in, and to practical theology.

  17. Facilitated subcutaneous immunoglobulin (fSCIg) therapy--practical considerations.

    Science.gov (United States)

    Ponsford, M; Carne, E; Kingdon, C; Joyce, C; Price, C; Williams, C; El-Shanawany, T; Williams, P; Jolles, S

    2015-12-01

    There is an increasing range of therapeutic options for primary antibody-deficient patients who require replacement immunoglobulin. These include intravenous immunoglobulin (IVIg), subcutaneous immunoglobulin (SCIg), rapid push SCIg and most recently recombinant human hyaluronidase-facilitated SCIg (fSCIg). Advantages of fSCIg include fewer needle punctures, longer infusion intervals and an improved adverse effect profile relative to IVIg. Limited real-life experience exists concerning the practical aspects of switching or starting patients on fSCIg. We describe the first 14 patients who have been treated with fSCIg at the Immunodeficiency Centre for Wales (ICW), representing more than 6 patient-years of experience. The regimen was well tolerated, with high levels of satisfaction and no increase in training requirement, including for a treatment-naive patient. Two patients discontinued fSCIg due to pain and swelling at the infusion site, and one paused therapy following post-infusion migraines. Ultrasound imaging of paired conventional and facilitated SCIg demonstrated clear differences in subcutaneous space distribution associated with a 10-fold increase in rate and volume delivery with fSCIg. Patient profiles for those choosing fSCIg fell into two main categories: those experiencing clinical problems with their current treatment and those seeking greater convenience and flexibility. When introducing fSCIg, consideration of the type and programming of infusion pump, needle gauge and length, infusion site, up-dosing schedule, home training and patient information are important, as these may differ from conventional SCIg. This paper provides guidance on practical aspects of the administration, training and outcomes to help inform decision-making for this new treatment modality.

  18. FACILITATING RADICAL FRONT-END INNOVATION THROUGH TARGETED HR PRACTICES

    DEFF Research Database (Denmark)

    Aagaard, Annabeth

    2016-01-01

    This study examines how radical front end innovation can be actively facilitated through selected and targeted HR practices and bundles of HR practices. The empirical field is an explorative case study of front end innovation and HR practices in the pharmaceutical industry, with an in-depth case...... study of the Danish pharmaceutical company, H. Lundbeck A/S, and explorative studies of seven European and American pharmaceutical and biotech companies. The study aims to show how companies can apply HR practices in ways that actively supports the development of radical front end innovation. The value...... added and the contribution of this article to the existing FEI and HR literature therefore lies in the exploration and mapping of how radical front end innovation is and can be facilitated through targeted HR practices; and in identifying the unique opportunities and challenges of innovation...

  19. Effective Developmental Math Instructional Practices That Facilitate Learning and Academic Success of Community College Students

    Science.gov (United States)

    Little, Pamela Hilson

    2017-01-01

    The purpose of the qualitative study was to discover instructional practices used by developmental math instructors that facilitate learning and academic success of students in developmental math courses at select community colleges in Alabama in order to generate improved instructional practices in the developmental education field. Emergent data…

  20. Mobile technology: streamlining practice and improving care

    OpenAIRE

    Blake, Holly

    2013-01-01

    The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.

  1. Using creative writing to explore facilitation skills in practice

    Directory of Open Access Journals (Sweden)

    Ann Price

    2016-05-01

    Full Text Available Background: Facilitation skills are key to the effective use of practice development strategies. Students on a masters degree in practice development and innovation undertake a module on facilitation skills that incorporates the use of a creative writing piece to explore facilitation. The aim of this article is to critically reflect on the use of creative writing within an assignment from the lecturer’s perspective. Critical reflection: The Rolfe et al. (2001 model of reflection will be used to structure the reflections, considering the questions ‘What?’, ‘So what?’ and ‘Now what?’. This will form the basis of a discussion of concerns about the assessment method, students’ thoughts, relationship to practice development and evidence of effectiveness of the strategy. Examples of creative writing from the students will be used to demonstrate the diversity of the approach. Ethics: All students have given permission for their work to be included. Discussion: Using creative writing can be freeing for students as they can use their voice to explore a topic. For the lecturer, courage is needed to facilitate this expression but it is rewarding as it links to the principles of practice development to embed new ways of working. Important within the process is the need to give students ‘permission’ to use a non-traditional style of writing; lecturers may benefit from practising the technique themselves to feel comfortable with the creative writing strategy. Conclusion: Creative writing offered an opportunity to explore facilitation in different ways and relate it to different aspects of real and imagined life. This paper shows that creative writing can be used successfully by students to engage in novel ways of thinking. However, future actions identify the importance of guidance regarding relevance to academia and ensuring the lecturer is familiar with the aim and techniques of the process when using it for masters-level assessment

  2. A theoretical and practical critique of Social Facilitation Theory

    Directory of Open Access Journals (Sweden)

    Loriente Zamora, Cristóbal

    2007-11-01

    Full Text Available Social facilitation theory is one of the most paradigmatic examples of social psychology, understood as an experimental science. However, in this paper we intend to demonstrate that the research that allegedly supports it suffers from a number of defects. It uses biased population samples, and the tasks it sets its experimental subjects are limited to the practical or productive, ignoring the broader range of everyday activities such as conversing or, indeed, urinating. Social facilitation theory, far from being objective, is a microcosm of American social psychology ideology insofar as it ignores basic human functions, and fails to include stigmatized communities such as stutterers and people with bladder problems.

  3. Through the eyes of the student: Best practices in clinical facilitation

    Directory of Open Access Journals (Sweden)

    Immaculate S. Muthathi

    2017-02-01

    Full Text Available Background: Clinical facilitation is an essential part of the undergraduate nursing curriculum. A number of studies address the issue of clinical facilitation in South Africa, but there remains a lack of knowledge and understanding regarding what students perceive as best practice in clinical facilitation of their learning.Objective: To determine what type of clinical facilitation undergraduate students believe should be offered by clinical facilitators (nurse educators, professional nurses and clinical preceptors in the clinical area in order to best facilitate their learning.Method: A qualitative, exploratory and descriptive study was conducted. Purposive sampling was performed to select nursing students from the second, third and fourth year of studies from a selected nursing education institution in Johannesburg. The sampling resulted in one focus group for each level of nursing, namely second, third and fourth year nursing students. Interviews were digitally recorded and transcribed verbatim, thematic data analysis was used and trustworthiness was ensured by applying credibility, dependability, confirmability and transferability.Main findings: The data revealed that participants differentiated between best practices in clinical facilitation in the clinical skills laboratory and clinical learning environment. In the clinical skills laboratory, pre-contact preparation, demonstration technique and optimising group learning were identified as best practices. In the clinical learning environment, a need for standardisation of procedures in simulation and practice, the allocation and support for students also emerged.Conclusion: There is a need for all nurses involved in undergraduate nursing education to reflect on how they approach clinical facilitation, in both clinical skills laboratory and clinical learning environment. There is also a need to improve consistency in clinical practices between the nursing education institution and the

  4. Through the eyes of the student: Best practices in clinical facilitation.

    Science.gov (United States)

    Muthathi, Immaculate S; Thurling, Catherine H; Armstrong, Susan J

    2017-08-28

    Clinical facilitation is an essential part of the undergraduate nursing curriculum. A number of studies address the issue of clinical facilitation in South Africa, but there remains a lack of knowledge and understanding regarding what students perceive as best practice in clinical facilitation of their learning. To determine what type of clinical facilitation undergraduate students believe should be offered by clinical facilitators (nurse educators, professional nurses and clinical preceptors) in the clinical area in order to best facilitate their learning. A qualitative, exploratory and descriptive study was conducted. Purposive sampling was performed to select nursing students from the second, third and fourth year of studies from a selected nursing education institution in Johannesburg. The sampling resulted in one focus group for each level of nursing, namely second, third and fourth year nursing students. Interviews were digitally recorded and transcribed verbatim, thematic data analysis was used and trustworthiness was ensured by applying credibility, dependability, confirmability and transferability. The data revealed that participants differentiated between best practices in clinical facilitation in the clinical skills laboratory and clinical learning environment. In the clinical skills laboratory, pre-contact preparation, demonstration technique and optimising group learning were identified as best practices. In the clinical learning environment, a need for standardisation of procedures in simulation and practice, the allocation and support for students also emerged. There is a need for all nurses involved in undergraduate nursing education to reflect on how they approach clinical facilitation, in both clinical skills laboratory and clinical learning environment. There is also a need to improve consistency in clinical practices between the nursing education institution and the clinical learning environment so as to support students' adaptation to clinical

  5. Improving Agile Software Practice

    DEFF Research Database (Denmark)

    Tjørnehøj, Gitte

    2006-01-01

    Software process improvement in small and agile organizations is often problematic, but achieving good SPI-assessments can still be necessary to stay in the marked or to meet demands of multinational owners. The traditional norm driven, centralized and control centered improvement approaches has...

  6. Improving Agile Software Practice

    DEFF Research Database (Denmark)

    Tjørnehøj, Gitte

    2006-01-01

    Software process improvement in small and agile organizations is often problematic, but achieving good SPI-assessments can still be necessary to stay in the marked or to meet demands of multinational owners. The traditional norm driven, centralized and control centered improvement approaches has...

  7. Sharing Research Models: Using Software Engineering Practices for Facilitation.

    Science.gov (United States)

    Bryant, Stephanie P; Solano, Eric; Cantor, Susanna; Cooley, Philip C; Wagener, Diane K

    2011-03-01

    Increasingly, researchers are turning to computational models to understand the interplay of important variables on systems' behaviors. Although researchers may develop models that meet the needs of their investigation, application limitations-such as nonintuitive user interface features and data input specifications-may limit the sharing of these tools with other research groups. By removing these barriers, other research groups that perform related work can leverage these work products to expedite their own investigations. The use of software engineering practices can enable managed application production and shared research artifacts among multiple research groups by promoting consistent models, reducing redundant effort, encouraging rigorous peer review, and facilitating research collaborations that are supported by a common toolset. This report discusses three established software engineering practices- the iterative software development process, object-oriented methodology, and Unified Modeling Language-and the applicability of these practices to computational model development. Our efforts to modify the MIDAS TranStat application to make it more user-friendly are presented as an example of how computational models that are based on research and developed using software engineering practices can benefit a broader audience of researchers.

  8. Facilitation: A Novel Way to Improve Students' Well-being

    DEFF Research Database (Denmark)

    Adriansen, Hanne Kirstine Olesen; Madsen, Lene Møller

    2013-01-01

    In this article we analyze a project that used facilitation techniques, which are known from training in industry, to improve the study environment at a public research university in Denmark. In 2009, the project was initiated in one graduate program; and it has subsequently been modified and ins...

  9. Facilitation: a novel way to improve students' well-being

    DEFF Research Database (Denmark)

    Adriansen, Hanne Kirstine; Madsen, Lene Møller

    2013-01-01

    In this article we analyze a project that used facilitation techniques, which are known from training in industry, to improve the study environment at a public research university in Denmark. In 2009, the project was initiated in one graduate program; and it has subsequently been modified and ins...

  10. Primary care quality improvement from a practice facilitator’s perspective

    OpenAIRE

    Liddy, Clare E; Blazhko, Valeriya; Dingwall, Molly; Singh, Jatinderpreet; Hogg, William E.

    2014-01-01

    Background Practice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards...

  11. Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations.

    Science.gov (United States)

    Smith, Kirsten V; Thew, Graham R

    2017-09-01

    The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice. We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations. We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles. We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings. Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested. © 2017 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

  12. Allowing time to consolidate knowledge gained through random practice facilitates later novel motor sequence acquisition.

    Science.gov (United States)

    Kim, Taewon; Rhee, Joohyun; Wright, David L

    2016-01-01

    Two experiments were conducted to examine the efficacy of random (RP) and blocked practice (BP) for enhancing later motor learning. Each experiment involved practicing three unique seven key serial reaction time (SRT) tasks in either a blocked or random format followed by practice of a novel SRT task either 2-min (Experiment 1) or 24-h (Experiment 2) later. While the expected benefit of RP for retention was present in both experiments, in Experiment 1 there was no advantage from prior RP for new learning. Experiment 2 explored the possibility that increasing the interval, from 2-min to 24-h, between BP or RP and practice of the novel motor task might allow consolidation of sequence knowledge acquired during BP or RP which in turn might facilitate new learning. As a result of the additional time between training bouts RP facilitated the rate at which the novel motor task was acquired. Interestingly, when this additional time was provided, both BP and RP supported (a) a performance saving for the first trial with the novel task, and (b) an offline improvement in performance across a 24-h interval not present when only the novel motor task was practiced. The latter benefits for new learning may have resulted from exposure to prior physical practice per se. or practice variability. These data are discussed with respect to (a) future learning benefits from prior experience training with greater CI, and (b) the importance of memory consolidation for motor learning. Published by Elsevier B.V.

  13. Training in practical ergonomics improvements.

    Science.gov (United States)

    Kogi, K

    1989-06-01

    Recent ILO experiences show that concrete ergonomics improvements can result from learning-by-doing training in real settings. Particularly important is to build on local practice focusing on good examples already available. Checklist exercise, demonstrating low-cost solutions and group work are effective training tools. Opportunities can be widely created by such enabling training.

  14. Improving Inquiry Teaching through Reflection on Practice

    Science.gov (United States)

    Lotter, Christine R.; Miller, Cory

    2016-08-01

    In this paper, we explore middle school science teachers' learning of inquiry-based instructional strategies through reflection on practice teaching sessions during a summer enrichment program with middle level students. The reflection sessions were part of a larger year-long inquiry professional development program in which teachers learned science content and inquiry pedagogy. The program included a 2-week summer institute in which teachers participated in science content sessions, practice teaching to middle level students, and small group-facilitated reflection sessions on their teaching. For this study, data collection focused on teachers' recorded dialogue during the facilitator - run reflection sessions, the teachers' daily written reflections, a final written reflection, and a written reflection on a videotaped teaching session. We investigated the teachers' reflection levels and the themes teachers focused on during their reflection sessions. Teachers were found to reflect at various reflection levels, from simple description to a more sophisticated focus on how to improve student learning. Recurrent themes point to the importance of providing situated learning environments, such as the practice teaching with immediate reflection for teachers to have time to practice new instructional strategies and gain insight from peers and science educators on how to handle student learning issues.

  15. Improving Inquiry Teaching through Reflection on Practice

    Science.gov (United States)

    Lotter, Christine R.; Miller, Cory

    2017-08-01

    In this paper, we explore middle school science teachers' learning of inquiry-based instructional strategies through reflection on practice teaching sessions during a summer enrichment program with middle level students. The reflection sessions were part of a larger year-long inquiry professional development program in which teachers learned science content and inquiry pedagogy. The program included a 2-week summer institute in which teachers participated in science content sessions, practice teaching to middle level students, and small group-facilitated reflection sessions on their teaching. For this study, data collection focused on teachers' recorded dialogue during the facilitator - run reflection sessions, the teachers' daily written reflections, a final written reflection, and a written reflection on a videotaped teaching session. We investigated the teachers' reflection levels and the themes teachers focused on during their reflection sessions. Teachers were found to reflect at various reflection levels, from simple description to a more sophisticated focus on how to improve student learning. Recurrent themes point to the importance of providing situated learning environments, such as the practice teaching with immediate reflection for teachers to have time to practice new instructional strategies and gain insight from peers and science educators on how to handle student learning issues.

  16. Practice education facilitator roles and their value to NHS organisations.

    Science.gov (United States)

    Scott, Betsy; Rapson, Terri; Allibone, Liz; Hamilton, Rozi; Mambanje, Constance S; Pisaneschi, Laura

    2017-02-23

    The role of the practice education facilitator (PEF) was introduced to support the management of large student nurse numbers in clinical areas and to monitor and enhance the quality of placements. While much has been written about the activities and roles undertaken by PEFs, less is known about the value of this type of role to the NHS organisations that employ them. This article explores some of the views of PEFs working in a variety of trusts and organisations in London and surrounding counties. There is no consistent job definition and often insufficient support, leading to some PEFs feeling overwhelmed by the work and isolated within the role. Since its introduction, the role has required post holders to work more strategically within their trusts' education remits. However, it was felt by most post holders that the role remains undervalued and the perception is that these posts are vulnerable to budget cuts. The article considers what effect this could have on pre-registration nurse education. The profile of the role needs to be strengthened through consistent job descriptions and streamlining the number of job titles attached to the role.

  17. "Refreshed…reinforced…reflective": A qualitative exploration of interprofessional education facilitators' own interprofessional learning and collaborative practice.

    Science.gov (United States)

    Evans, Sherryn; Shaw, Nicole; Ward, Catherine; Hayley, Alexa

    2016-11-01

    While there is extensive research examining the outcomes of interprofessional education (IPE) for students, minimal research has investigated how facilitating student learning influences the facilitators themselves. This exploratory case study aimed to explore whether and how facilitating IPE influences facilitators' own collaborative practice attitudes, knowledge, and workplace behaviours. Sixteen facilitators of an online pre-licensure IPE unit for an Australian university participated in semi-structured telephone interviews. Inductive thematic analysis revealed three emergent themes and associated subthemes characterising participants' reflexivity as IPE facilitators: interprofessional learning; professional behaviour change; and collaborative practice expertise. Participants experienced interprofessional learning in their role as facilitators, improving their understanding of other professionals' roles, theoretical and empirical knowledge underlying collaborative practice, and the use and value of online communication. Participants also reported having changed several professional behaviours, including improved interprofessional collaboration with colleagues, a change in care plan focus, a less didactic approach to supervising students and staff, and greater enthusiasm impressing the value of collaborative practice on placement students. Participants reported having acquired their prior interprofessional collaboration expertise via professional experience rather than formal learning opportunities and believed access to formal IPE as learners would aid their continuing professional development. Overall, the outcomes of the IPE experience extended past the intended audience of the student learners and positively impacted on the facilitators as well.

  18. Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice.

    Science.gov (United States)

    Sharma, Sangeeta; Pandit, Ajay; Tabassum, Fauzia

    2017-04-18

    Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality

  19. How Workflow Systems Facilitate Business Process Reengineering and Improvement

    Directory of Open Access Journals (Sweden)

    Mohamed El Khadiri

    2012-03-01

    Full Text Available This paper investigates the relationship between workflow systems and business process reengineering and improvement. The study is based on a real case study at the “Centre Rgional dInvestissement” (CRI of Marrakech, Morocco. The CRI is entrusted to coordinate various investment projects at the regional level. Our previous work has shown that workflow system can be a basis for business process reengineering. However, for continuous process improvement, the system has shown to be insufficient as it fails to deal with exceptions and problem resolutions that informal communications provide. However, when this system is augmented with an expanded corporate memory system that includes social tools, to capture informal communication and data, we are closer to a more complete system that facilitates business process reengineering and improvement.

  20. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

    Science.gov (United States)

    Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

    2013-01-01

    Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

  1. A model for facilitation of critical reflective practice

    Directory of Open Access Journals (Sweden)

    TR Mavundla

    2001-09-01

    Full Text Available The impressive growth in the extent and range of psychiatric services provided by general hospitals in South Africa creates stress among nurses employed in these settings who are not psychiatric trained. This manifests itself in negative attitudes displayed towards mentally ill people. The aim of this paper is to discuss the process followed in the development of the model of facilitative communication. A theory generative design was used. The research methods were dealt with in four steps of theory generation as set out below. . Step 1 entailed concept analysis. This step was dealt with in two phases, namely concept identification and concept definition. During concept identification, a qualitative research strategy that is explorative, descriptive and contextual was used. This was achieved through field research conducted in an urban general hospital. A sample of twelve professional nurses was selected from a population of 800 professional nurses employed in a general hospital using the purposive sampling technique. This sample size was determined by saturation of data in themes. Both semi-structured individual phenomenological interviews and observations were used as methods of data collection. Giorgi’s method of descriptive data analysis (1985 was used. Four themes emerged from the results of the study. The main concepts of the model were identified and classified using a survey list of Dickoff et al. (1968. Step 2 dealt with the creation of interrelationship statements between concepts identified in Step 1, while Step 3 dealt with the description of the model using strategies proposed by Chinn and Kramer (1991. In Step 4, the description of guidelines for operationalising in practice was ensured. To ensure valid results, a model for trustworthiness proposed by Guba (Lincoln & Guba, 1985 was used. The following criteria for trustworthiness were applied in all the steps of theory generation: truth value, applicability, consistency and

  2. Facilitating participatory steps for planning and implementing low-cost improvements in small workplaces.

    Science.gov (United States)

    Kogi, Kazutaka

    2008-07-01

    In this paper, practical means of facilitating participatory steps taken in workplace improvement programs in small workplaces were reviewed. The reviewed programs included those organized by partners of our Asian inter-country network for small enterprises, construction sites, home workplaces and agricultural farms. Trainers who commonly acted as facilitators were found to play multiple roles in helping managers, workers and farmers take initiative and achieve immediate improvements. The participatory steps were more successfully facilitated when the trainers supported (a) building on local good practice, (b) focusing on a range of basic ergonomics principles, and (c) stepwise progress through feedback of achievements. The use of action-oriented toolkits comprising low-cost action checklists and group work guides was commonly helpful. The locally adjusted nature of the toolkits seemed essential. Trainers could thus help people build local initiative, plan and implement low-cost ideas through serial group work steps and confirm benefits in a stepwise manner. The review of the results suggested that a local network of trainers trained in the use of locally adjusted toolkits was vital for facilitating effective improvements in different small workplaces.

  3. Improving Voluntary Environmental Management Programs: Facilitating Learning and Adaptation

    Science.gov (United States)

    Genskow, Kenneth D.; Wood, Danielle M.

    2011-05-01

    Environmental planners and managers face unique challenges understanding and documenting the effectiveness of programs that rely on voluntary actions by private landowners. Programs, such as those aimed at reducing nonpoint source pollution or improving habitat, intend to reach those goals by persuading landowners to adopt behaviors and management practices consistent with environmental restoration and protection. Our purpose with this paper is to identify barriers for improving voluntary environmental management programs and ways to overcome them. We first draw upon insights regarding data, learning, and adaptation from the adaptive management and performance management literatures, describing three key issues: overcoming information constraints, structural limitations, and organizational culture. Although these lessons are applicable to a variety of voluntary environmental management programs, we then present the issues in the context of on-going research for nonpoint source water quality pollution. We end the discussion by highlighting important elements for advancing voluntary program efforts.

  4. Facilitating high quality student practice in introductory physics

    Science.gov (United States)

    Johnson, Molly

    2001-07-01

    "Practice makes perfect, but only if you do it right." Typical physics students practice extensively through the large quantities of homework they do. But research in introductory physics instruction shows that despite this practice, students often do not learn much in introductory physics. Students often do not focus their practice on the skills (such as concept interpretation, and generating a physical representation of a problem) that they need in order to solve physics problems flexibly and reliably. They often focus their practice instead on simply getting an answer. By omitting practice of important skills, it is likely that those skills will not be learned. This paper identifies communication difficulties between students and between students and instructors as important sources of barriers to achieving high-quality student practice. Some strategies to address communication difficulties in the context of small group in-class problem solving are proposed. A classroom peer-collaborative structure, Supervised Practice, that implements these strategies is described, and the impact of the classroom design on the quality of student practice is investigated.

  5. Facilitators and barriers in the humanization of childbirth practice in Japan

    Directory of Open Access Journals (Sweden)

    Goulet Lise

    2010-05-01

    Full Text Available Abstract Background Humanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been indentified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres. Methods A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed. Results All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions. Conclusions The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal

  6. Facilitators and barriers in the humanization of childbirth practice in Japan.

    Science.gov (United States)

    Behruzi, Roxana; Hatem, Marie; Fraser, William; Goulet, Lise; Ii, Masako; Misago, Chizuru

    2010-05-27

    Humanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been identified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres. A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed. All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions. The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding

  7. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

    Dahlgaard, Jens J.; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick......The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family...... has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ)....

  8. Situational Analysis of Physical Therapist Clinical Instructors' Facilitation of Students' Emerging Embodiment of Movement in Practice.

    Science.gov (United States)

    Covington, Kyle; Barcinas, Susan J

    2017-02-15

    Physical therapists improve the functional ability of patients after injury and disease. A unique component of their practice is the ability to use the movement of their own bodies to affect change in their patients. This has been recognized as a distinctive attribute of expert physical therapists. The purpose of this qualitative situational analysis study was to examine how physical therapist clinical instructors perceive and facilitate their students' emerging integration of movement in practice. Data collection and analysis was guided by Dall'Alba's theoretical framework for understanding professional ways of being. Data were analyzed using coding and mapping strategies consistent with Clarke's situational analysis techniques. The study included five physical therapist clinical instructors and their respective five physical therapist students. Data were collected during beginning, midterm, and final weeks of the students' clinical internships using participant interviews, observation, and document analysis. Coded data were summarized using situational analysis mapping strategies, resulting in 11 maps. These maps were further analyzed and reduced to five thematic behaviors the clinical instructor enacts as he or she helps facilitate the use of the students' movement in practice: These behaviors are: adapt, prepare, enhance, connect, and develop. The five behaviors are useful when considered as a trajectory of development. This study marks the first description of how physical therapist clinical instructors develop students' use of movement in practice and how to enact behaviors important in students' continued professional development. Findings are important as clinical instructors and academic programs consider how best to prepare students to use movement and develop their skills early in practice.

  9. Facilitating the Practical Use of Coloured Petri Nets

    DEFF Research Database (Denmark)

    Lindstrøm, Bo

    This dissertation is to investigate and advance tools for practical use of CP-nets. This includes development of facilities for creating domain-specific graphical user interfaces, a proposal for facilities for including auxiliary information in a CP-net without modifying the CP-net itself...

  10. A National Study Comparing Baldrige Core Values and Concepts with AACN Indicators of Quality: Facilitating CCNE-Baccalaureate Colleges of Nursing Move toward More Effective Continuous Performance Improvement Practices

    Science.gov (United States)

    Mattin, Deborah C.

    2013-01-01

    The AACN has asked academic leaders to align the performance of their organizations to the prescribed standards within the "Essentials of Baccalaureate Education for Professional Nursing" Practice document and has provided indicators of quality suggestions for program enhancement as a means of promoting continuous performance…

  11. A National Study Comparing Baldrige Core Values and Concepts with AACN Indicators of Quality: Facilitating CCNE-Baccalaureate Colleges of Nursing Move toward More Effective Continuous Performance Improvement Practices

    Science.gov (United States)

    Mattin, Deborah C.

    2013-01-01

    The AACN has asked academic leaders to align the performance of their organizations to the prescribed standards within the "Essentials of Baccalaureate Education for Professional Nursing" Practice document and has provided indicators of quality suggestions for program enhancement as a means of promoting continuous performance…

  12. Understanding the importance of teachers in facilitating student success: Contemporary science, practice, and policy.

    Science.gov (United States)

    Jimerson, Shane R; Haddock, Aaron D

    2015-12-01

    Teacher quality has a vital influence on student success or failure. Thus, further research regarding teacher effectiveness, teacher evaluation, teacher well-being, and teacher contributions is essential to inform school psychologists and allied educational professionals who collaborate and consult with teachers to facilitate student success. In this special topic section of School Psychology Quarterly, a series of 6 articles further elucidate teachers' powerful contributions to student outcomes along with concrete, research-based ways for school psychologists to support and collaborate with teachers. The studies included in the special section describe how teacher support facilitates students' positive academic and social-emotional outcomes and how students' attitudes toward learning moderate the association between the classroom environment and students' academic achievement. Studies also report on the development and validation of self-report measures focused on both teacher subjective well-being and teachers' use of evidence-based practices. Finally, the articles included in the special topic section offer insights and ideas for refining teacher evaluation practices, understanding the factors contributing to program implementation fidelity, and improving prevention, early identification, and intervention efforts aimed at fostering school completion and positive youth development.

  13. Connected Classroom Technology Facilitates Multiple Components of Formative Assessment Practice

    Science.gov (United States)

    Shirley, Melissa L.; Irving, Karen E.

    2015-02-01

    Formative assessment has been demonstrated to result in increased student achievement across a variety of educational contexts. When using formative assessment strategies, teachers engage students in instructional tasks that allow the teacher to uncover levels of student understanding so that the teacher may change instruction accordingly. Tools that support the implementation of formative assessment strategies are therefore likely to enhance student achievement. Connected classroom technologies (CCTs) include a family of devices that show promise in facilitating formative assessment. By promoting the use of interactive student tasks and providing both teachers and students with rapid and accurate data on student learning, CCT can provide teachers with necessary evidence for making instructional decisions about subsequent lessons. In this study, the experiences of four middle and high school science teachers in their first year of implementing the TI-Navigator™ system, a specific type of CCT, are used to characterize the ways in which CCT supports the goals of effective formative assessment. We present excerpts of participant interviews to demonstrate the alignment of CCT with several main phases of the formative assessment process. CCT was found to support implementation of a variety of instructional tasks that generate evidence of student learning for the teacher. The rapid aggregation and display of student learning evidence provided teachers with robust data on which to base subsequent instructional decisions.

  14. Characterization Of Farm Management Practices And Improved ...

    African Journals Online (AJOL)

    Global Approaches to Extension Practice: A Journal of Agricultural Extension ... Like every well-intended innovation, the benefits of the improved systems could only be ... the use of improved farming technologies to realize their full benefits.

  15. Identifying Perceived Barriers and Facilitators to Culturally Competent Practice for School Social Workers

    Science.gov (United States)

    Teasley, Martell; Gourdine, Ruby; Canfield, James

    2010-01-01

    This study presents descriptive findings from self-reported qualitative and quantitative data on barriers and facilitators to culturally competent school social work practice. The study highlights the need for the development of evaluative methods for the purpose of examining how elements within the practice environment affect school social work…

  16. Perceived Barriers and Facilitators to School Social Work Practice: A Mixed-Methods Study

    Science.gov (United States)

    Teasley, Martell; Canifield, James P.; Archuleta, Adrian J.; Crutchfield, Jandel; Chavis, Annie McCullough

    2012-01-01

    Understanding barriers to practice is a growing area within school social work research. Using a convenience sample of 284 school social workers, this study replicates the efforts of a mixed-method investigation designed to identify barriers and facilitators to school social work practice within different geographic locations. Time constraints and…

  17. Examining Perceived Barriers and Facilitators to School Social Work Practice with Homeless Children

    Science.gov (United States)

    Canfield, James P.

    2014-01-01

    School social workers are at the forefront of serving homeless children and youths as they pursue education. Because of the negative impact homelessness can have on academic outcomes for children, understanding what factors are perceived to either hinder or facilitate practice and what factors might influence perceptions of practice with this…

  18. Facilitating communication with patients for improved migraine outcomes.

    Science.gov (United States)

    Buse, Dawn C; Lipton, Richard B

    2008-06-01

    Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. However, skill level and training remain problematic in this area. Fortunately, research has shown that medical communication skills can be successfully taught and acquired, and that improvement in communication skills improves outcomes. The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.

  19. Facilitating Improved Writing among Students through Directed Peer Review

    Science.gov (United States)

    Crossman, Joanne M.; Kite, Stacey L.

    2012-01-01

    This study contributes to scant empirical investigation of peer critique of writing among heterogeneously grouped native and nonnative speakers of English, now commonplace in higher education. This mixed-methods study investigated the use of directed peer review to improve writing among graduate students, the majority of whom were nonnative…

  20. Increasing awareness about self and facilitation practice in preparation for transitioning to a new role – the critical reflective process of becoming a certified professional facilitator

    Directory of Open Access Journals (Sweden)

    Pauline Bergin

    2015-11-01

    Full Text Available Background and context: I have been working as a practice developer in the Australian healthcare system for more than 10 years. For the last seven of those I was a lead facilitator for a practice development programme that is being implemented across a large statewide health service. The programme’s purpose is to create person-centred care environments that enable patient and staff empowerment. My role was in a small team that supported facilitators predominantly at local health district and state levels. The intent was to phase out the team over time as capacity increased and local teams gained the required skills and knowledge to continue implementing the programme. During the two-year final transition phase, a strategic plan was implemented to guide the development of systems and capacity that would support the programme once the team had exited. A decision was made to shorten the phasing-out period and during this transition period I found myself facing an unknown and unpredictable future, for the first time in my career promoting something other than my clinical nursing skills. As I transitioned into an independent facilitator role I wanted to consolidate my expertise as a facilitator, to gain further learning in specific areas and to achieve recognition of the facilitation skill set I had honed over time, and which has now become my way of working. Given that my experience was limited to the healthcare context, diverse though it is, I pondered which of my skills would stand me in good stead to enable groups and organisations as an independent professional facilitator and what additional skills I’d need. I was encouraged to become a certified professional facilitator by colleagues who were using process facilitation and person-centredness more broadly. This paper reflects my experience of the preparation, assessment and accreditation process, the feedback I received from my international assessors and how these are influencing my

  1. Improving evidence-based general practice

    NARCIS (Netherlands)

    Kortekaas, MF

    2016-01-01

    This thesis provides knowledge on how to improve the practice of evidence-based medicine (EBM) by general practitioners (GPs) and GP trainees. EBM is defined as the integration of clinical expertise, patient values and the best available clinical evidence in daily clinical practice. We describe the

  2. Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice.

    LENUS (Irish Health Repository)

    Yadav, B L

    2012-03-01

    Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient\\'s clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses\\' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.

  3. Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice.

    Science.gov (United States)

    Yadav, B L; Fealy, G M

    2012-03-01

    Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.

  4. An evaluation of a framework for facilitating and assessing physiotherapy students' reflection on practice.

    Science.gov (United States)

    Donaghy, Marie; Morss, Kate

    2007-01-01

    Reflective practice is promoted in the health care professions as a developmental process leading to competent and effective practice, although the link between reflection and enhancement of physiotherapy practice remains speculative and conjectural. This article provides evidence that reflection can influence developing practice based on the evaluation of a reflective framework for students on clinical placement. The evaluation explored, in depth, students' experiences and perceptions of its benefits and limitations. Thematic analysis of response data from five focus groups (n = 43) representing three student cohorts resolved significant outcomes-related themes: personal insight, linking reflection to the physiotherapy process, and learning and personal change. Process-related themes focused on strengths and weaknesses of the framework and associated issues. Evidence supports the effectiveness of the framework in facilitating reflection and in linking reflection to higher order cognitive processes such as gaining new insights and understandings, facilitation of systematic enquiry, problem solving, and decision making. Feedback from students indicated that the experience was meaningful and valuable in preparation for practice because they were guided to question themselves and could see the relevance and value of that for their practice. We recommend that educators consider this approach to facilitating reflection in physiotherapy undergraduate education.

  5. The Evolution of a Teacher Community of Practice: Identifying Facilitating and Constraining Factors

    Science.gov (United States)

    Borg, Tracey

    2012-01-01

    This paper presents findings from a larger, qualitative study that explored the potential of a school-based teacher community of practice as a model for a transformative form of teacher professional development. This paper reports on initial findings from a grounded theory exploration of the factors that facilitated and constrained the evolution…

  6. The Evolution of a Teacher Community of Practice: Identifying Facilitating and Constraining Factors

    Science.gov (United States)

    Borg, Tracey

    2012-01-01

    This paper presents findings from a larger, qualitative study that explored the potential of a school-based teacher community of practice as a model for a transformative form of teacher professional development. This paper reports on initial findings from a grounded theory exploration of the factors that facilitated and constrained the evolution…

  7. Barriers and facilitators to the implementation of clinical practice guidelines: A cross-sectional survey among physicians in Estonia

    Directory of Open Access Journals (Sweden)

    Taba Pille

    2012-12-01

    Full Text Available Abstract Background In an era when an increasing amount of clinical information is available to health care professionals, the effective implementation of clinical practice guidelines requires the development of strategies to facilitate the use of these guidelines. The objective of this study was to assess attitudes towards clinical practice guidelines, as well as the barriers and facilitators to their use, among Estonian physicians. The study was conducted to inform the revision of the clinical practice guideline development process and can provide inspiration to other countries considering the increasing use of evidence-based medicine. Methods We conducted an online survey of physicians to assess resource, system, and attitudinal barriers. We also asked a set of questions related to improving the use of clinical practice guidelines and collected free-text comments. We hypothesized that attitudes concerning guidelines may differ by gender, years of experience and practice setting. The study population consisted of physicians from the database of the Department of Continuing Medical Education of the University of Tartu. Differences between groups were analyzed using the Kruskal-Wallis non-parametric test. Results 41% (497/1212 of physicians in the database completed the questionnaire, comprising more than 10% of physicians in the country. Most respondents (79% used treatment guidelines in their daily clinical practice. Lack of time was the barrier identified by the most physicians (42%, followed by lack of medical resources for implementation (32%. The majority of physicians disagreed with the statement that guidelines were not accessible (73% or too complicated (70%. Physicians practicing in outpatient settings or for more than 25 years were the most likely to experience difficulties in guideline use. 95% of respondents agreed that an easy-to-find online database of guidelines would facilitate use. Conclusions Use of updated evidence

  8. [Translation into practice of empowerment strategies for dengue prevention: facilitators and barriers].

    Science.gov (United States)

    Pérez, Dennis; Castro, Marta; Álvarez, Ángel Manuel; Sánchez, Lizet; Toledo, María Eugenia; Matos, Damayanti; Van der Stuyft, Patrick; Lefèvre, Pierre

    2016-02-01

    Objective To identify facilitators and barriers to the process of translating community empowerment strategies into the practice of the national Aedes aegypti control program in Cuba. Methods A case study of the process was conducted from 2005 to 2009 at national and provincial levels of the control program. Data from participant observation, in-depth interviews, and document analysis were triangulated and analyzed inductively and deductively. Results The main facilitators identified included a proposal for an empowerment strategy effective in reducing Aedes aegypti infestation, which was explained in such a way that it could be implemented by program staff; and a control program with national coverage capable of implementing the proposal. The principal barriers were the complexity of the strategy and the absence of organizational changes needed to facilitate its insertion into the control program. Each barrier or facilitator identified was either static or dynamic in nature. Dynamic factors are those that offer signals for action. Conclusions Multiple barriers and facilitators influence the process of translating community empowerment strategies into the practice of the Cuban Aedes aegypti control program. The analysis of these factors as either static or dynamic makes it possible to design more appropriate and effective strategies that can promote the process and increase the likelihood of success.

  9. Developing a facilitation model to promote organisational development in primary care practices.

    NARCIS (Netherlands)

    Rhydderch, S.M.; Edwards, A.; Marshall, M.; Elwyn, G.; Grol, R.P.T.M.

    2006-01-01

    BACKGROUND: The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a prac

  10. Developing a facilitation model to promote organisational development in primary care practices.

    NARCIS (Netherlands)

    Rhydderch, S.M.; Edwards, A.; Marshall, M.; Elwyn, G.; Grol, R.P.T.M.

    2006-01-01

    BACKGROUND: The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a prac

  11. Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Poststroke

    Science.gov (United States)

    Rosenfeldt, Anson B.; Dey, Tanujit; Alberts, Jay L.

    2017-01-01

    OBJECTIVE. To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice. METHOD. Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only. RESULTS. Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice–only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement. CONCLUSION. People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task practice. PMID:28218596

  12. The art and science of cancer education and evaluation: toward facilitating improved patient outcomes.

    Science.gov (United States)

    Johnson, Lenora; Ousley, Anita; Swarz, Jeffrey; Bingham, Raymond J; Erickson, J Bianca; Ellis, Steven; Moody, Terra

    2011-03-01

    Cancer education is a constantly evolving field, as science continues to advance both our understanding of cancer and its effects on patients, families, and communities. Moving discoveries to practice expeditiously is paramount to impacting cancer outcomes. The continuing education of cancer care professionals throughout their practice life is vital to facilitating the adoption of therapeutic innovations. Meanwhile, more general educational programs serve to keep cancer patients, their families, and the public informed of the latest findings in cancer research. The National Cancer Institute conducted an assessment of the current knowledge base for cancer education which involved two literature reviews, one of the general literature of the evaluation of medical and health education efforts, and the other of the preceding 5 years of the Journal of Cancer Education (JCE). These reviews explored a wide range of educational models and methodologies. In general, those that were most effective used multiple methodologies, interactive techniques, and multiple exposures over time. Less than one third of the articles in the JCE reported on a cancer education or communication product, and of these, only 70% had been evaluated for effectiveness. Recommendations to improve the evaluation of cancer education and the educational focus of the JCE are provided.

  13. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-06-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  14. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-10-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  15. Developer Stories: Improving Architecture in Agile Practice

    DEFF Research Database (Denmark)

    Tjørnehøj, Gitte; Jensen, Rolf Njor; Platz, Niels

    2007-01-01

    Within the field of Software Engineering emergence of agile methods has been a hot topic since the late 90s. eXtreme Programming (XP) ([1]) was one of the first agile methods and is one of the most well-known. However research has pointed to weaknesses in XP regarding supporting development...... of viable architectures. To strengthen XP in this regard a new practice: Developer Stories ([2]) was introduced in 2006 - mainly based on a theoretical argumentation. This paper reports from extensive experimentation with, and elaboration of the new practice. Results from this experimentation shows...... that using Developer Stories increases the likelihood of developing a viable architecture through a series of deliberate choices, through creating disciplined and recurring activities that: 1) Facilitate sharing and embodying of knowledge about architectural issues, and 2) heighten visibility of refactorings...

  16. An exploration of tripartite collaboration in developing a strategic approach to the facilitation of practice learning.

    Science.gov (United States)

    Walsh, Pauline; Jones, Kerry

    2005-01-01

    Pre-registration nurse education in United Kingdom has to be delivered within a complex system. Theoretical components are delivered by a Higher Education Institution and the practice components, facilitated and assessed by clinical practitioners within a health service provider institution. The previous decade witnessed a gradual divorce between these two institutions, leading to a confidence and competence deficit in the newly qualified practitioner. The new national agenda for pre-registration nursing was set out in the fitness for practice document, [UKCC, London, 1999]. It required a refocus on the practice aspects of nurse education. It identified the need to strengthen the links between higher education providers and service providers to ensure the delivery of a seamless curriculum. The report recommended closer collaborative working to bridge the theory-practice gap and develop nurses that were competent and fit for purpose at the end of the course. Several pilot sites were identified throughout the country to deliver the new practice focussed curriculum; The University of Wolverhampton was one of these. The focus of this paper will identify the multifaceted developments that facilitate effective practice learning for students, which have been achieved through partnership working and will include the following areas; creation of new practice support roles, communication systems, modes of learning (technology supported learning, problem based learning, experiential learning and simulation), the learning environment, learning opportunities and resources. It is clear that practice learning has many influences, which can either enhance or undermine the student's ability to assimilate knowledge and experience into personal, professional practice. We acknowledge that there are still many areas to be developed and anticipate that these will be informed by the findings of research currently being undertaken within the University and NHS service providers.

  17. Key Elements of Observing Practice: A Data Wise DVD and Facilitator's Guide

    Science.gov (United States)

    Boudett, Kathryn Parker; City, Elizabeth A.; Russell, Marcia K.

    2010-01-01

    Based on the bestselling book "Data Wise: A Step-by-Step Guide to Using Assessment Results to Improve Teaching and Learning", and its companion volume, "Data Wise in Action", this DVD and Facilitator's Guide offer insight into one of the most challenging steps in capturing data about school performance: observing and analyzing instructional…

  18. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

    Directory of Open Access Journals (Sweden)

    Geense Wytske W

    2013-02-01

    Full Text Available Abstract Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based health promotion activities conducted by Dutch general practitioners (GPs and practice nurses (PNs are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder

  19. EFFECTIVE BLENDED LEARNING PRACTICES: Evidence-based Perspectives in ICT-facilitated Education

    OpenAIRE

    2009-01-01

    EFFECTIVE BLENDED LEARNING PRACTICES:Evidence-based Perspectives in ICT-facilitated EducationEdited by Elizabeth Stacey and Philippa Gerbic, Information ScienceReference; 1 edition (March 30, 2009), ISBN-10: 1605662968, 358 pp.Reviewed by Yasin OZARSLANFaculty of Education,Eskisehir Osmangazi University,Eskisehir-TURKEYBlended learning refers to the integration of faceto-face and online learning activities with the goal of maximizing the value of students' experiences in both settings. This b...

  20. Facilitating reflective practice and self-assessment of competence through the use of narratives.

    Science.gov (United States)

    Levett-Jones, Tracy Lynn

    2007-03-01

    Reflective practice is a skill that is central to nursing students' professional development. Although there is an abundance of literature on the value of reflective practice there are few concrete methods that facilitate self-assessment of competence through the use of reflective practice. One such method is narrative reflection. A nursing narrative is a brief recount of an actual situation or episode in clinical practice that is significant because it resulted in new learning and/or new understanding. Narratives provide important opportunities for uncovering nursing practices that often go unnoticed and a new appreciation of the knowledge and skills of clinical practice. Nursing narratives reveal the richness of the clinical knowledge embedded in practice and provide a way for knowledge and practice to be linked together in meaningful dialogue, promoting interpretive analysis and reflection. A narrative approach contextualises knowledge and values and builds upon the clinical experiences of the student. Narratives afford opportunities for nursing students to: Learn from practice through reflection. Describe and critically analyse episodes of their clinical practice. Illuminate and assess their own level of competence by applying competency standards as a benchmark. Identify areas of strength and those requiring development. Develop practice-driven clinical learning objectives. Narratives have proven to be a successful means of developing students' ability to reflect upon and assess competence in a clinically relevant and motivating way. This paper will explore the possibilities that narratives hold for developing clinical acumen, promoting reflective practice, and assessing competence. It will provide an overview of narrative writing, and discuss some of the challenges encountered in the implementation of this clinical learning innovation at the author's university in Australia.

  1. Facilitating the development of moral insight in practice: teaching ethics and teaching virtue.

    Science.gov (United States)

    Begley, Ann M

    2006-10-01

    Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.

  2. Bridging research and practice through the Nursing Research Facilitator Program in British Columbia.

    Science.gov (United States)

    Plamondon, Katrina; Ronquillo, Charlene; Axen, Linda; Black, Agnes; Cummings, Lynn; Chakraborty, Bubli

    2013-12-01

    As Canadian health systems transform to meet changing needs, grounding nursing practice in evidence remains an essential goal for providing safe, high-quality care. nursing research facilitators (NRFs) are strengthening the use of evidence in nursing practice across the province of British Columbia. NRFs are nurses with a research background, whose work is focused on supporting people within health systems to use and do research in their practice and decision-making. Since this role was established in 2009, NRFs have provided facilitative support to over 50 funded research projects, led numerous workshops and journal clubs, and conducted more than 600 research-related consultations. In this paper, we discuss the role and offer exemplars of creative ways in which NRFs are strengthening nurses' engagement in doing and using research by developing capacity for research and evidence-informed practice, building meaningful partnerships and cultivating a culture of curiosity among nurses and other healthcare providers. We reflect on factors contributing to the success of this role and some of the challenges of integration. The paper concludes with a comment on the strategic value of the role.

  3. Quality improvement practices and trends in Denmark

    DEFF Research Database (Denmark)

    Dahlgaard, Jens Jørn; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    It is now well known that the history of quality improvement is neither uniquely American, nor uniquely Japanese, although the contributions from these two nations have received more attention perhaps than those originating elsewhere. This is the first in a series of articles intended to increase...... awareness of quality improvement practices and trends in various European nations, with particular emphasis on western Europe and Scandinavia. Herein the recent history of quality improvement in Denmark is explored and the quality improvement efforts in two Danish companies are chronicled. It is hoped...... that taken in its entirety, this series of articles will contribute to understanding both the rich fabric of European quality improvement that is independent of national boundaries and the colorful national fibers of which the fabric is made....

  4. Facilitators of implementing occupation based practice among Iranian occupational therapists: A qualitative study

    Science.gov (United States)

    Khayatzadeh Mahani, Mohammad; Hassani Mehraban, Afsoon; Kamali, Mohammad; Parvizy, Soroor

    2015-01-01

    Background: The Occupation-Based Practice (OBP) is a central core of occupational therapy (OT).It refers to using a meaningful occupation based on the client’s interests, needs, health and participation in daily life. This study aimed to explore the facilitators of implementing OBP among Iranian occupational therapists. Methods: Fourteen occupational therapists participated in this study. Data were collected through semi-structured interviews, and the sampling method was purposeful. The interviews were continued until data saturation was reached, and data were recorded and transcribed verbatim. Data were analyzed through qualitative content analysis using constant comparative analysis. Results: Our analysis explored two themes: Factors attributed to context, and factors attributed to therapists. The first theme consisted of three subthemes: Educational programs of OT department, public information about OBP and clinical setting compatible with OBP. The second theme also contained three subthemes including: Positive attitude regarding effectiveness of OBP, emphasis on client- centered and family- centered practice and convincing the clients to utilize OBP. Conclusion: The facilitators of implementing OBP are attributed to factors internal to the therapists as well as to issues in the external environment and context. Understanding these factors will help occupational therapists, OT educational staff, administrators and rehabilitation team members to facilitate the implementation of OBP. PMID:26913270

  5. [Combined quantitative and qualitative methods to identify local facilitators of and barriers to physician's adherence to clinical practice guidelines].

    Science.gov (United States)

    Saillour-Glénisson, F; Domecq, S; Pouchadon, M-L; Jacques, B; Sibé, M

    2008-07-01

    The effectiveness of Clinical Practice Guideline (CPG) implementation interventions could be improved by their adaptation to facilitators of and barriers to practice change in each setting. Very few is known about these local factors in French hospitals. Our objectives were to identify the facilitator factors of and barriers to physician's adherence to CPG in internal medicine wards in France and to determine the factors most strongly statistically associated to CPG adherence. Combined qualitative and quantitative methods. Two CPGs were chosen as examples. The settings were internal medicine wards of hospitals of the Aquitaine region voluntary to participate. Qualitative analyses were conducted in the internal medicine wards of 5 hospitals in the Aquitaine region selected among the 12 voluntary hospitals to represent the variability of situations. QUANTITATIVE ANALYSIS: A questionnaire was constituted by the factors retrieved through the qualitative analyses and a previous literature review as barriers or facilitator factors to physician's adherence to CPG and asked the physicians on the degree of CPG adherence. It was sent to each physician of the internal medicine wards of the 12 voluntary hospitals. The responses to the questionnaire allowed the analysis of the frequency of each factor and the strength of the statistical association between these factors and CPG adherence. These analyses focused on the importance of the management, particularly the role of ward head and of the exchange between physicians. The attitude to CPGs varied according to the individual positionnement on the professional hierarchy, function of the quantity of research activities and of the local, regional and national radiance of the ward. Organisational difficulties as professionals and patients turn over, work overload, lack of coordination between wards were organisational barriers to CPG adherence. The quantitative analysis confirmed the role of managerial and organisational factors

  6. Perceptions of Physicians on the Barriers and Facilitators to Integrating Fall Risk Evaluation and Management Into Practice

    Science.gov (United States)

    Chou, William C; Tinetti, Mary E; King, Mary B; Irwin, Kevin; Fortinsky, Richard H

    2006-01-01

    BACKGROUND Falls are common, treatable, and result in considerable morbidity in older adults. However, fall risk factor evaluation and management targeted at high-risk patients is largely neglected in clinical practice. OBJECTIVE To identify barriers and facilitators to the implementation of fall risk management by primary care providers. DESIGN Qualitative study using a semi-structured interview. PARTICIPANTS Primary care providers who received an academic outreach visit. APPROACH Self-reported facilitators and barriers to evaluating and managing fall risk in older patients. RESULTS Physician factors, logistical factors, and patient factors intersect to either facilitate or impede fall risk evaluation and management by primary care providers. Physician factors include awareness, competing risks, appropriateness of referrals, training, and tie-in to familiar activities. Logistical factors include availability of transportation, time requirements of immobile patients, reimbursement, scheduling, family involvement, and utilization of other health care providers. Physicians' perceptions of patient factors include reporting, attitudes toward medication, and positive feedback. CONCLUSION Strategies to improve the adoption of fall risk evaluation and management in primary care should address the specific physician, logistical, and patient barriers perceived by physicians who had received an informative, motivational intervention to assess and manage falls among their patients. PMID:16336618

  7. Two different strategies to facilitate involvement in healthcare improvements: a Swedish county council initiative.

    Science.gov (United States)

    Andersson, Ann-Christine; Idvall, Ewa; Perseius, Kent-Inge; Elg, Mattias

    2014-09-01

    From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance. The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations. Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation. An improvement project in a County Council in Sweden. Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects. Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects. How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

  8. Teachers' Perspectives and Suggestions for Improving Teacher Education to Facilitate Student Learning

    Science.gov (United States)

    Linkenhoker, Dina L.

    2012-01-01

    The purpose of this transcendental phenomenological study is to give teachers a voice to express their self-efficacy beliefs, their opinions about the content and the effectiveness of their teacher preparation programs to facilitate student learning, and to hear their suggestions for improving teacher education to enable future educators to…

  9. What impedes and what facilitates a quality improvement project for older hospitalized patients?

    NARCIS (Netherlands)

    IJkema, R.; Langelaan, M.; Steeg, L. van de; Wagner, C.

    2014-01-01

    Objective: To gain insight into which factors impede, and which facilitate, the implementation of a complex multi-component improvement initiative in hospitalized older patients. Design: A qualitative study based on semi-structured interviews. The three dimensions of Pettigrew and Whipp's theoretica

  10. Assessing and Improving Student Organizations: Resources for Facilitators CD-ROM. The Assessing and Improving Student Organization (AISO) Program

    Science.gov (United States)

    Nolfi, Tricia; Ruben, Brent D.

    2010-01-01

    This companion to the "Guide for Students" and "Student Workbook" includes the complete set of PowerPoint slides, a PDF of the Facilitator's Guide in PPT (PowerPoint) slide show format, and PDFs of all scoring sheets, handouts and project planning guides needed for the AISO (Assessing and Improving Student Organization) process. The Assessing and…

  11. Key facilitators and best practices of hotel-style room service in hospitals.

    Science.gov (United States)

    Sheehan-Smith, Lisa

    2006-04-01

    This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

  12. Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry.

    Science.gov (United States)

    Wilper, Andrew P; Smith, Curtis Scott; Weppner, William

    2013-09-16

    The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. CONTEXT AND SETTING: We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain knowledge and skills though this enterprise

  13. Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry

    Directory of Open Access Journals (Sweden)

    Andrew P. Wilper

    2013-09-01

    Full Text Available Background : The Accreditation Council for Graduate Medical Education (ACGME requires that training programs integrate system-based practice (SBP and practice-based learning and improvement (PBLI into internal medicine residency curricula. Context and setting : We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods : Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes : We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects’ feasibility, impact, and appropriateness. The ‘Curriculum of Inquiry’ generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions : A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and

  14. Practice improvement, part II: collaborative practice and team-based care.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    The Institute of Medicine recommends interprofessional teams to address patients' complex needs. Team care should be structured in a way that uses the highest training levels of its members. Team communication is enhanced through regular meetings (eg, team huddles), and office efficiency is improved through identifying and solving underlying system-level issues (ie, second-order problem solving). Inclusive leadership principles are used to strengthen team practices and meet chronic care model goals. Setting clear goals with measurable outcomes, creating clinical and administrative systems, establishing a clear division of labor among team members who have occupational diversity, and providing ongoing training all facilitate team building. Increasing opportunities for team members to work together, such as with group visits, and providing interprofessional education are ways to encourage adoption of interprofessional practice. Reimbursement for team care includes per member per month payments for such services as care management, pay-for-performance benchmark payments, and payment for non-face-to-face services.

  15. Implementation of a health care policy: An analysis of barriers and facilitators to practice change

    Directory of Open Access Journals (Sweden)

    Sword Wendy

    2005-08-01

    Full Text Available Abstract Background Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies. In 2000, in response to publicity about the shortening length of postpartum hospital stay, the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants. The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change. Methods The data reported came from two studies of postpartum health and service use in Ontario Canada. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. The study samples were drawn from the same five purposefully selected hospitals for both studies. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care practitioners and administrators at each site. Results In both studies, the respondents reflected a population of women who experienced an "average" or non-eventful hospital-based, singleton vaginal delivery. The findings of the second study demonstrated wide variance in implementation of the offer of a 60-hour stay among the sites and focus groups revealed that none of the hospitals acknowledged the 60-hour stay as an official policy. The uptake of the offer of a 60-hour stay was unrelated to the rate of offer. The percentage of women with a hospital stay of less than 25 hours and the number with the guideline that the call be within 48 hours of hospital discharge. Public health

  16. Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'

    Directory of Open Access Journals (Sweden)

    Amorin-Woods Lyndon G

    2012-03-01

    Full Text Available Abstract Background A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. Discussion This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Summary Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

  17. Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'.

    Science.gov (United States)

    Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F

    2012-03-14

    A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

  18. Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules.

    Science.gov (United States)

    Jafri, Wasim; Mumtaz, Khalid; Burdick, William P; Morahan, Page S; Freeman, Rosslynne; Zehra, Tabassum

    2007-10-08

    Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions. This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS). There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02), "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05). 1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.

  19. Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules

    Directory of Open Access Journals (Sweden)

    Morahan Page S

    2007-10-01

    Full Text Available Abstract Background Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL sessions. Methods This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10 assessing i Knowledge Base-content Learning (KBL, ii PBL, iii Student Centered Learning (SCL and iv Group Skills (GS. Results There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02, "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04. Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05. Conclusion 1 Residents are an effective supplement to faculty members for PBL; 2 Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.

  20. The "Peter Pan" syndrome and allergy practice: facilitating adherence through the use of social support.

    Science.gov (United States)

    Patterson, R; McGrath, K G

    2000-01-01

    The complexity of care of some patients in an allergy-immunology practice may be increased by behavioral abnormalities of the patients. Facilitating adherence through the use of social support may be the most effective treatment strategy for some of the most difficult of these patients. We report three patients whose medical management problems were alleviated largely because of the participation of their support system. All three patients were stabilized because of the acceptance of responsibility and support of the physician by the designated member of the patient's support system. The range of social support used to manage nonadherent patients ranged from directly providing instructions to a family member to the consistent presence of a spouse or companion at multiple clinical visits. In all cases, the success in management was attributed largely to the presence of a support system.

  1. Facilitating behavioral learning and habit change in voice therapy—theoretic premises and practical strategies

    DEFF Research Database (Denmark)

    Iwarsson, Jenny

    2014-01-01

    A typical goal of voice therapy is a behavioral change in the patient’s everyday speech. The SLP’s plan for voice therapy should therefore optimally include strategies for automatization. The aim of the present study was to identify and describe factors that promote behavioral learning and habit...... are described and discussed from a learning theory perspective. Nine factors that seem to be relevant to facilitate behavioral learning and habit change in voice therapy are presented, together with related practical strategies and theoretical underpinnings. These are: 1) Cue-altering; 2) Attention exercises; 3...... change in voice behavior and have the potential to affect patient compliance and thus therapy outcome. Research literature from the areas of motor and behavioral learning, habit formation, and habit change was consulted. Also, specific elements from personal experience of clinical voice therapy...

  2. Pharmacists’ views on involvement in pharmacy practice research: Strategies for facilitating participation.

    Directory of Open Access Journals (Sweden)

    Armour C

    2007-06-01

    Full Text Available In order for community pharmacy practice to continue to evolve, pharmacy practice research on potential new services is essential. This requires the active participation of community pharmacists. At present the level of involvement of community pharmacists in pharmacy practice research is minimal. Objectives: To ascertain the attitudes of a group of research-experienced community pharmacists towards participating in research; to investigate the barriers and facilitators to participation; to identify potential strategies to increase the involvement of community pharmacists in research. Methods: A focus group was conducted with a purposive sample of 11 research-experienced community pharmacists. A pharmacist academic moderated the focus group using a semi-structured interview guide. The participants were asked about their attitudes towards research, previous involvement in research, barriers to their involvement and strategies to overcome these barriers. The session was audio-taped and notes were taken by an observer. Thematic analysis of the notes and audio-tape transcripts was conducted.Results: Three themes emerged around pharmacists’ attitudes towards research: pharmacists’ perception of the purpose of research, pharmacists’ motivation for involvement in research, and pharmacists’ desired role in research. Barriers to research participation were grouped into four themes: pharmacists’ mindset, communication, infrastructure (time, money and staff, and skills/knowledge. Strategies to address each of these barriers were suggested.Conclusions: Participants recognised the importance of research towards advancing their profession and this was a motivating factor for involvement in research. They perceived their role in research primarily as data collection. A series of practical strategies to overcome the barriers to participation were offered that researchers may wish to consider when promoting research outcomes and designing research

  3. A Qualitative Study Exploring Facilitators for Improved Health Behaviors and Health Behavior Programs: Mental Health Service Users’ Perspectives

    Directory of Open Access Journals (Sweden)

    Candida Graham

    2014-01-01

    Full Text Available Objective. Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1 facilitators that help mental health service users engage in better health behaviors and (2 the types of health programs mental health service users want to develop. Methods. A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. Results. Four major facilitator themes were identified: (1 factors of empowerment, self-value, and personal growth; (2 the need for social support; (3 pragmatic aspects of motivation and planning; and (4 access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. Conclusions and Implications for Practice. Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

  4. Improving infection control in general practice.

    Science.gov (United States)

    Farrow, S C; Zeuner, D; Hall, C

    1999-03-01

    Infection control measures in the health care setting should protect patients and staff from cross-infection. The prevention of harm is an essential part of good medical practice and failure might result in professional misconduct proceedings by the General Medical Council (GMC) and prosecution under the Health and Safety at Work legislation, as well as civil liability. For a health authority, overall responsibility for public health includes arrangements for the control of communicable diseases and infection in hospital and the community (NHS Management Executive, 1993), a function usually led by the Consultant in Communicable Disease Control (CCDC). This paper describes one district's collaborative approach between public health and GPs to assess and improve local infection control standards.

  5. Improving care for people after stroke: how change was actively facilitated.

    Science.gov (United States)

    Bamford, David; Rothwell, Katy; Tyrrell, Pippa; Boaden, Ruth

    2013-01-01

    This paper aims to report on the approach to change used in the development of a tool to assess patient status six months after stroke (the Greater Manchester Stroke Assessment Tool: GM-SAT). The overall approach to change is based on the Promoting Action on Research Implementation in Health Services (PARiHS) Framework, which involves extensive stakeholder engagement before implementation. A key feature was the use of a facilitator without previous clinical experience. The active process of change involved a range of stakeholders--commissioners, patients and professionals--as well as review of published research evidence. The result of this process was the creation of the GM-SAT. The details of the decision processes within the tool included a range of perspectives; the process of localisation led commissioners to identify gaps in care provision as well as learning from others in terms of how services might be provided and organised. The facilitator role was key at all stages in bringing together the wide range of perspectives; the relatively neutral perceived status of the facilitator enabled resistance to change to be minimised. The output of this project, the GM-SAT, has the potential to significantly improve patients' physical, psychological and social outcomes and optimise their quality of life. This will be explored further in future phases of work. A structured process of change which included multiple stakeholder involvement throughout, localisation of approaches and a dedicated independent facilitator role was effective in achieving the development of a useful tool (GM-SAT).

  6. Facilitating behavioral learning and habit change in voice therapy--theoretic premises and practical strategies.

    Science.gov (United States)

    Iwarsson, Jenny

    2015-12-01

    A typical goal of voice therapy is a behavioral change in the patient's everyday speech. The SLP's plan for voice therapy should therefore optimally include strategies for automatization. The aim of the present study was to identify and describe factors that promote behavioral learning and habit change in voice behavior and have the potential to affect patient compliance and thus therapy outcome. Research literature from the areas of motor and behavioral learning, habit formation, and habit change was consulted. Also, specific elements from personal experience of clinical voice therapy are described and discussed from a learning theory perspective. Nine factors that seem to be relevant to facilitate behavioral learning and habit change in voice therapy are presented, together with related practical strategies and theoretical underpinnings. These are: 1) Cue-altering; 2) Attention exercises; 3) Repetition; 4) Cognitive activation; 5) Negative practice; 6) Inhibition through interruption; 7) Decomposing complex behavior; 8) The 'each time-every time' principle; and 9) Successive implementation of automaticity.

  7. Quality improvement in small office settings: an examination of successful practices

    Directory of Open Access Journals (Sweden)

    Sofaer Shoshanna

    2009-02-01

    Full Text Available Abstract Background Physicians in small to moderate primary care practices in the United States (U.S. ( Methods We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39 that used performance data to drive quality improvement activities. Results Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers. Conclusion These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.

  8. The "evidence-based practice inventory" : reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care

    NARCIS (Netherlands)

    Kaper, Nina M; Swennen, Maartje H J; van Wijk, Arjen J; Kalkman, Cor J; van Rheenen, Nanda; van der Graaf, Yolanda; van der Heijden, Geert J M G

    2015-01-01

    OBJECTIVES: To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim

  9. The "evidence-based practice inventory": reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care

    NARCIS (Netherlands)

    Kaper, N.M.; Swennen, M.H.J.; van Wijk, A.J.; Kalkman, C.J.; van Rheenen, N.; van der Graaf, Y.; van der Heijden, G.J.M.G.

    2015-01-01

    Objectives To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim

  10. Facilitating the implementation of evidence-based practice through contextual support and nursing leadership

    Directory of Open Access Journals (Sweden)

    Kueny A

    2015-06-01

    Full Text Available Angela Kueny,1 Leah L Shever,2 Melissa Lehan Mackin,3 Marita G Titler4 1Luther College, Decorah, IA, 2The University of Michigan Hospital and Health Center, Ann Arbor, MI, 3University of Iowa College of Nursing, Iowa City, IA, 4University of Michigan School of Nursing, Ann Arbor, MI, USA Background/purpose: Nurse managers (NMs play an important role promoting evidence-based practice (EBP on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. Methods: This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. Results: NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality

  11. Improving Video Game Development: Facilitating Heterogeneous Team Collaboration through Flexible Software Processes

    Science.gov (United States)

    Musil, Juergen; Schweda, Angelika; Winkler, Dietmar; Biffl, Stefan

    Based on our observations of Austrian video game software development (VGSD) practices we identified a lack of systematic processes/method support and inefficient collaboration between various involved disciplines, i.e. engineers and artists. VGSD includes heterogeneous disciplines, e.g. creative arts, game/content design, and software. Nevertheless, improving team collaboration and process support is an ongoing challenge to enable a comprehensive view on game development projects. Lessons learned from software engineering practices can help game developers to increase game development processes within a heterogeneous environment. Based on a state of the practice survey in the Austrian games industry, this paper presents (a) first results with focus on process/method support and (b) suggests a candidate flexible process approach based on Scrum to improve VGSD and team collaboration. Results showed (a) a trend to highly flexible software processes involving various disciplines and (b) identified the suggested flexible process approach as feasible and useful for project application.

  12. Strategic contracting practices to improve procurement of health commodities.

    Science.gov (United States)

    Arney, Leslie; Yadav, Prashant; Miller, Roger; Wilkerson, Taylor

    2014-08-01

    Public-sector entities responsible for procurement of essential medicines and health commodities in developing countries often lack the technical capacity to efficiently ensure supply security. Under strict public scrutiny and pressures to be transparent, many agencies continue to use archaic procurement methods and to depend on inflexible forecasts and cumbersome tendering processes. On the basis of semi-structured literature reviews and interviews, we identified framework agreements as a strategic procurement practice used by the U.S. federal government that may also be suitable for global health supply chains. Framework agreements are long-term contracts that provide the terms and conditions under which smaller repeat purchasing orders may be issued for a defined period of time. Such agreements are common in U.S. and United Nations procurement systems and in other developed countries and multilateral organizations. In contrast, framework agreements appear to be seldom used in procurement of health commodities in countries of sub-Saharan Africa. The current practice of floating tenders multiple times a year contributes to long lead times and stock-outs, and it hampers the manufacturer's or supplier's ability to plan and respond to the government's needs. To date, government's use of strategic contracting practices in public procurement of health commodities has not received much attention in most developing countries. It may present an opportunity for substantial improvements in procurement efficiency and commodity availability. Enabling legislation and strengthened technical capacity to develop and manage long-term contracts could facilitate the use of framework contracts in sub-Saharan Africa, with improved supply security and cost savings likely to result.

  13. The expression of glycerol facilitators from various yeast species improves growth on glycerol of Saccharomyces cerevisiae

    DEFF Research Database (Denmark)

    Klein, Mathias; Islam, Zia ul; Knudsen, Peter Boldsen;

    2016-01-01

    of predicted glycerol facilitators (Fps1 homologues) from superior glycerol-utilizing yeast species such as Pachysolen tannophilus, Komagataella pastoris, Yarrowia lipolytica and Cyberlindnera jadinii significantly improves the growth performance on glycerol of the previously selected glycerol-consuming S....... cerevisiae wild-type strain (CBS 6412-13A). The maximum specific growth rate increased from 0.13 up to 0.18 h−1 and a biomass yield coefficient of 0.56 gDW/gglycerol was observed. These results pave the way for exploiting the assets of glycerol in the production of fuels, chemicals and pharmaceuticals based...

  14. Using career nurse mentors to support minority nursing students and facilitate their transition to practice.

    Science.gov (United States)

    Banister, Gaurdia; Bowen-Brady, Helene M; Winfrey, Marion E

    2014-01-01

    The Clinical Leadership Collaborative for Diversity in Nursing was developed through an academe-service partnership focused on supporting minority nursing students and facilitating transition to practice. A key program element is mentoring. Students are paired with an experienced, minority clinical nurse or nurse leader from one of the partnering agencies, who helps guide the student throughout the junior and senior year of school and first year of employment. The mentoring component was evaluated through surveys in which mentors and mentees rated one another and offered open-ended comments on the program's impact. Aspects of mentees rated highest by mentors include manner (courteous and professional), ability to communicate and get along with others, preparation for meetings, and fully utilizing their time with mentors. Aspects of mentors rated highest by mentees include warmth, encouragement, and willingness to listen; enthusiasm for nursing and how they sparked the mentee's interest; and clarity regarding expectations for mentees and how they pushed mentees to achieve high standards. In the open-ended comments, mentees consistently identified mentoring as the program's strongest component. Sixty-four minority students have participated to date with a zero rate of attrition and very low job turnover among graduates.

  15. IMPROVING SITE MANAGEMENT PRACTICES IN THE NIGERIAN ...

    African Journals Online (AJOL)

    Osondu

    technological methods adopted and huge consumption of ... challenging engineering and management problems that occur on .... Communication: Formal lines of communication ..... practices through knowledge management,. Construction.

  16. Improving Teaching Practice through Interdisciplinary Dialog

    Science.gov (United States)

    Cardetti, Fabiana A.; Orgnero, M. Carolina

    2013-01-01

    This study presents the results of a self-study of interdisciplinary work that has generated profound changes in our teaching practices. The research grew out of an interest in exploring the nature of our work and the practices that contribute to its success. Our self-study revealed that our work process consists of five stages and is the product…

  17. Research on Improving Manufacturing Practice Quality in Mechanical Industrial Design

    Directory of Open Access Journals (Sweden)

    Xiaowei Jiang

    2013-07-01

    Full Text Available In order to solve the problems existing in the manufacturing practice of mechanical industrial design, a series of methods and concrete measures are proposed, so as to improve the quality of manufacturing practice of mechanical industrial design. In this study, the problems existing in the manufacturing practice of mechanical industrial design are analyzed detailedly. And the methods and concrete measures including establishing the new mode of manufacturing practice of mechanical industrial design, improving the understanding to manufacturing practice and knowing the major role, establishing a professional characteristic base of manufacturing practice and strengthening the construction of instructor troops of manufacturing practice are proposed, which will certainly have a profound theoretical and practical guiding significance. On this foundation, the research conclusion on improving manufacturing practice quality in mechanical industrial design is done.

  18. Practice improvement, part II: trends in employment versus private practice.

    Science.gov (United States)

    Coleman, Mary Thoesen; Roett, Michelle A

    2013-11-01

    A growing percentage of physicians are selecting employment over solo practice, and fewer family physicians have hospital admission privileges. Results from surveys of recent medical school graduates indicate a high value placed on free time. Factors to consider when choosing a practice opportunity include desire for independence, decision-making authority, work-life balance, administrative responsibilities, financial risk, and access to resources. Compensation models are evolving from the simple fee-for-service model to include metrics that reward panel size, patient access, coordination of care, chronic disease management, achievement of patient-centered medical home status, and supervision of midlevel clinicians. When a practice is sold, tangible personal property and assets in excess of liabilities, patient accounts receivable, office building, and goodwill (ie, expected earnings) determine its value. The sale of a practice includes a broad legal review, addressing billing and coding deficiencies, noncompliant contractual arrangements, and potential litigations as well as ensuring that all employment agreements, leases, service agreements, and contracts are current, have been executed appropriately, and meet regulatory requirements.

  19. A framework to facilitate self-directed learning, assessment and supervision in midwifery practice: A qualitative study of supervisors' perceptions

    NARCIS (Netherlands)

    Embo, M.; Driessen, E.; Valcke, M.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Self-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) a

  20. Grain legume-cereal intercropping: The practical application of diversity, competition and facilitation in arable and organic cropping systems

    DEFF Research Database (Denmark)

    Hauggaard-Nielsen, Henrik; Jørnsgaard, B.; Kinane, J.

    2008-01-01

    Intercropping is the simultaneous cultivation of more than one crop species on the same piece of land and is regarded as the practical application of basic ecological principles such as diversity, competition and facilitation. Field experiments were carried out on a sandy loam soil and a sandy so...

  1. A framework to facilitate self-directed learning, assessment and supervision in midwifery practice: A qualitative study of supervisors' perceptions

    NARCIS (Netherlands)

    Embo, M.; Driessen, E.; Valcke, M.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Self-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) a

  2. How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study

    NARCIS (Netherlands)

    Weijden, T.T. van der; Pieterse, A.H.; Koelewijn-van Loon, M.S.; Knaapen, L.; Legare, F.; Boivin, A.; Burgers, J.S.; Stiggelbout, A.M.; Faber, M.J.; Elwyn, G.

    2013-01-01

    BACKGROUND: To explore how clinical practice guidelines can be adapted to facilitate shared decision making. METHODS: This was a qualitative key-informant study with group discussions and semi-structured interviews. First, 75 experts in guideline development or shared decision making participated in

  3. Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration.

    Science.gov (United States)

    Bidassie, Balmatee; Williams, Linda S; Woodward-Hagg, Heather; Matthias, Marianne S; Damush, Teresa M

    2015-05-14

    Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement. We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators. The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach's role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not

  4. Performance appraisal: a tool for practice improvement.

    Science.gov (United States)

    Gesme, Dean H; Wiseman, Marian

    2011-03-01

    Yours may be among the many oncology practices without an appropriate performance review system in place. Lack of an effective evaluation system increases the risk of inefficiency, poor office morale, and high turnover rates.

  5. EFFECTIVE BLENDED LEARNING PRACTICES: Evidence-based Perspectives in ICT-facilitated Education

    Directory of Open Access Journals (Sweden)

    Reviewed by Yasin OZARSLAN

    2009-07-01

    Full Text Available EFFECTIVE BLENDED LEARNING PRACTICES:Evidence-based Perspectives in ICT-facilitated EducationEdited by Elizabeth Stacey and Philippa Gerbic, Information ScienceReference; 1 edition (March 30, 2009, ISBN-10: 1605662968, 358 pp.Reviewed by Yasin OZARSLANFaculty of Education,Eskisehir Osmangazi University,Eskisehir-TURKEYBlended learning refers to the integration of faceto-face and online learning activities with the goal of maximizing the value of students' experiences in both settings. This book collects new international research into many aspects of blended learningfrom the perspectives of learners, teachers, designers, and professional and academic developers in various disciplines, learningcommunities and universities from around the world. This book addresses the relative newness of online learning within blended environments. The book's broader audience is anyone who isinterested in areas such as blended learning, communities of learning, virtual education, professional learning and community development, instructional technology, flexible learning, distance education and collaborative learning.Blended approaches in teacher education, blending collaborative online learning,blended learning and teaching philosophies, campus-based student learning environments, ICT-enhanced blended learning, learning communities for K-12 teachers, professional development for blended learning, reciprocal mentoring,redesigning initial teacher education, responses to blended environments, strategiesfor blended teaching and learning, virtual learning and real communities are the topics covered in this book.It reviews literature about blended learning in relation to the three sections of the book and discusses strategies for teaching and learning and establishing communities in its different contexts. The chapters of this book provide research perspectives on a range of blended learning issues and contexts and discuss implications for teaching and learning. The

  6. The integration and evaluation of a social-media facilitated journal club to enhance the student learning experience of evidence-based practice: A case study.

    Science.gov (United States)

    Ferguson, Caleb; DiGiacomo, Michelle; Gholizadeh, Leila; Ferguson, Leila E; Hickman, Louise D

    2017-01-01

    Nurses are required to interpret and apply knowledge so communities will receive care based on best available evidence, as opposed to care that is simply based on tradition or authority. Fostering nursing students' critical appraisal skills will assist in their capacity to engage with, interpret and use best evidence. Journal clubs are frequently used approach to engage learners with research and develop critical appraisal skills. Given new flipped and blended approaches to teaching and learning there is need to rejuvenate how research is utilised and integrated within journal clubs to maximise engagement and translation of evidence. This paper provides a case study of a single site Australian university experience of transitioning a traditional physical journal club, to a social media-facilitated club within a postgraduate health subject to stimulate and facilitate engagement with the chosen manuscripts. This case study is based on our own experiences, supported by literature and includes qualitative comments obtained via student feedback surveys during November 2015. Case study. Social media-facilitated journal clubs offer an efficient way to continue developing critical appraisal skills in nursing students. The integration of a social media-facilitated journal clubs increased student attention, engagement with presented activities and overall student satisfaction within this evidence-based practice subject. Future rigorously-designed, large-scale studies are required to evaluate the impact of online journal clubs on the uptake of evidence-based practice, including those resulting in improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Developing a Culture to Facilitate Research Capacity Building for Clinical Nurse Consultants in Generalist Paediatric Practice

    Directory of Open Access Journals (Sweden)

    Lesley Wilkes

    2013-01-01

    Full Text Available This paper reports a research capacity building exercise with a group of CNCs practicing in the speciality of paediatrics in New South Wales (NSW, Australia. It explores the first step in building a research culture, through identifying the research priorities of members of the NSW Child Health Networks Paediatric Clinical Nurse Consultant group, and this forms the major focus of this paper. A nominal group technique (NGT was utilised with sixteen members to identify research topics for investigation which were considered a priority for improving children's health care. The group reviewed and prioritised 43 research topics in children's health which were identified in the literature. As a result of conducting this research prioritisation exercise, the group chose two research topics to investigate: reasons for children representing to the Emergency Department and a comparison of the use of high-flow and low-flow nasal prongs in children with bronchiolitis. The research team will continue to mentor the nurses throughout their research projects which resulted from the NGT. One bridge to leadership development in enhancing patient care is translating knowledge to practice and policy development. This study leads the way for a group of CNCs in paediatric nursing to combine their research capacity and influence clinical knowledge.

  8. Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

    Science.gov (United States)

    Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

    2010-01-01

    Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

  9. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

    Science.gov (United States)

    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

  10. A framework to facilitate self-directed learning, assessment and supervision in midwifery practice: a qualitative study of supervisors' perceptions.

    Science.gov (United States)

    Embo, M; Driessen, E; Valcke, M; van der Vleuten, C P M

    2014-08-01

    Self-directed learning is an educational concept that has received increasing attention. The recent workplace literature, however, reports problems with the facilitation of self-directed learning in clinical practice. We developed the Midwifery Assessment and Feedback Instrument (MAFI) as a framework to facilitate self-directed learning. In the present study, we sought clinical supervisors' perceptions of the usefulness of MAFI. Interviews with fifteen clinical supervisors were audio taped, transcribed verbatim and analysed thematically using Atlas-Ti software for qualitative data analysis. Four themes emerged from the analysis. (1) The competency-based educational structure promotes the setting of realistic learning outcomes and a focus on competency development, (2) instructing students to write reflections facilitates student-centred supervision, (3) creating a feedback culture is necessary to achieve continuity in supervision and (4) integrating feedback and assessment might facilitate competency development under the condition that evidence is discussed during assessment meetings. Supervisors stressed the need for direct observation, and instruction how to facilitate a self-directed learning process. The MAFI appears to be a useful framework to promote self-directed learning in clinical practice. The effect can be advanced by creating a feedback and assessment culture where learners and supervisors share the responsibility for developing self-directed learning. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Participatory design facilitates Person Centred Nursing in service improvement with older people: a secondary directed content analysis.

    Science.gov (United States)

    Wolstenholme, Daniel; Ross, Helen; Cobb, Mark; Bowen, Simon

    2017-05-01

    To explore, using the example of a project working with older people in an outpatient setting in a large UK NHS Teaching hospital, how the constructs of Person Centred Nursing are reflected in interviews from participants in a Co-design led service improvement project. Person Centred Care and Person Centred Nursing are recognised terms in healthcare. Co-design (sometimes called participatory design) is an approach that seeks to involve all stakeholders in a creative process to deliver the best result, be this a product, technology or in this case a service. Co-design practice shares some of the underpinning philosophy of Person Centred Nursing and potentially has methods to aid in Person Centred Nursing implementation. The research design was a qualitative secondary Directed analysis. Seven interview transcripts from nurses and older people who had participated in a Co-design led improvement project in a large teaching hospital were transcribed and analysed. Two researchers analysed the transcripts for codes derived from McCormack & McCance's Person Centred Nursing Framework. The four most expressed codes were as follows: from the pre-requisites: knowing self; from care processes, engagement, working with patient's beliefs and values and shared Decision-making; and from Expected outcomes, involvement in care. This study describes the Co-design theory and practice that the participants responded to in the interviews and look at how the co-design activity facilitated elements of the Person Centred Nursing framework. This study adds to the rich literature about using emancipatory and transformational approaches to Person Centred Nursing development, and is the first study exploring explicitly the potential contribution of Co-design to this area. Methods from Co-design allow older people to contribute as equals in a practice development project, co-design methods can facilitate nursing staff to engage meaningfully with older participants and develop a shared

  12. Evaluation of attention training and metacognitive facilitation to improve reading comprehension in aphasia.

    Science.gov (United States)

    Lee, Jaime B; Moore Sohlberg, McKay

    2013-05-01

    This pilot study investigated the impact of direct attention training combined with metacognitive facilitation on reading comprehension in individuals with aphasia. A single-subject, multiple baseline design was employed across 4 participants to evaluate potential changes in reading comprehension resulting from an 8-week intervention using Attention Process Training-3 (APT-3). The primary outcome measure was a maze reading task. Pre- and posttesting included attention and reading comprehension measures. Visual inspection of graphed performance data across conditions was used as the primary method of analysis. Treatment effect sizes were calculated for changes in reading comprehension probes from baseline to maintenance phases. Two of the study's 4 participants demonstrated improvements in maze reading, with corresponding effect sizes that were small in magnitude according to benchmarks for aphasia treatment research. All 4 participants made improvements on select standardized measures of attention. Interventions that include a metacognitive component with direct attention training may elicit improvements in participants' attention and allocation of resources. Maze passage reading is a repeated measure that appears sensitive to treatment-related changes in reading comprehension. Issues for future research related to measurement, candidacy, and clinical delivery are discussed.

  13. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  14. [2-COM: presentation of an instrument facilitating communication between physicians and carers in daily practice].

    Science.gov (United States)

    Robert, P H; Michel, E; Van Os, J; Altamura, A C; Bobes, J; Gerlach, J; Hellewell, J S E; Kasper, S; Nabel, D

    2007-01-01

    Communication between the patient and the professional carer lies at the heart of all decisions regarding diagnosis and treatment. However, patients and doctors often have divergent views on care needs; 2-COM (for 2-communication) is a simple patient-completed self-report instrument designed in order to facilitate patient-professional carer communication. Aims - To present 2-COM and to examine whether providing patients with an opportunity to identify and discuss their needs would improve communication and induce changes in care. Methods - The 2-COM is a simple list of 20 common problems, or areas of perceived need, that might be experienced by patients with severe mental illness. The list includes problems with housing, relationships, money, lack of activities, psychological distress, sexuality, symptoms and treatment side effects; 2-COM has shown adequate test-retest reliability and is well accepted by patients as a valued aid to communication with their doctor; 134 patients in a clinical diagnosis of schizophrenia or schizoaffective disorder were recruited at seven European centres: Maastricht, Oviedo, Gijon, Hamburg, Copenhagen, Milan and Nice. The assessment took place over 3 out patient clinic visits; at visit 1, the clinician recorded a list of all current interventions, including medication and non-medical treatments, together with demographic information and an assessment of current level of functioning, using the Global Assessment of Functioning scale. Prior to the second visit, patients were randomised to receive either 2-COM or "standard care" - a routine appointment without 2-COM. Immediately after the interview, all patients, whether they had completed 2-COM or not, completed a confidential questionnaire in which they could indicate the perceived quality of communication. Similarly, clinicians completed a repeat of the list of all current interventions, together with an assessment of any changes to the treatment plan implemented after the interview

  15. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified...... that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  16. Improving productivity in academic group practice.

    Science.gov (United States)

    Schroeder, R E

    1995-01-01

    The purposes of this article are to identify all the variables that impact productivity in a group practice, contrast the administrator's and physician's definitions of productivity, discuss current measurement tools and outline the steps in a traditional productivity project. The article identifies key variables that management must address: physician education, goals, feedback and rewards that are critical to the success of any productivity undertaking. Upon completion of this article, the reader will be able to understand the differences in the way administrators and physicians view productivity and be able to identify the vital areas that must be addressed in any effort to increase productivity. While the article focuses on the academic setting, the principles are applicable in any group practice.

  17. How to improve teaching practices: the role of teacher motivation, organizational factors and leadership practices

    NARCIS (Netherlands)

    Thoonen, E.E.J.; Sleegers, P.J.C.; Oort, F.J.; Peetsma, T.T.D.; Geijsel, F.P.

    2011-01-01

    Purpose: Although it is expected that building schoolwide capacity for teacher learning will improve teaching practices, there is little systematic evidence to support this claim. This study aimed to examine the relative impact of transformational leadership practices, school organizational conditio

  18. Developing an holistic assessment protocol on a hospice inpatient ward: staff engagement and my role as a practice development facilitator

    Directory of Open Access Journals (Sweden)

    John Lansdell

    2016-05-01

    Full Text Available Background: In 2014 I received the Richard Tompkins Nurse Development Scholarship, granted through the Foundation of Nursing Studies and including attendance at a five-day International Practice Development Collaborative practice development school, followed by a year’s mentorship. The scholarship aims to foster the delivery of person-centred care, which I hoped to achieve by enhancing holistic nursing assessment on a hospice inpatient ward. Aims: This article is a critical reflection on my learning through the scholarship, specifically related to staff engagement and my role as a practice development facilitator. Conclusions: While the project has not yet reached its conclusion, the learning has been invaluable. I have deepened my understanding of the need for collaboration, inclusion and participation to foster engagement and cultural change. More fundamentally, understanding how different aspects of my role enable change has proved both challenging and constructive, resulting in greater self-awareness and confidence. I remain committed to refining holistic nursing assessment to allow a greater degree of person-centred care in the hospice. Implications for practice: Practice development combines a variety of approaches to realise a shared vision; collaboration, inclusion and participation are central to fostering engagement Balancing different elements of a role (for instance, leader-manager-facilitator has the potential to be confusing and contradictory; awareness of how these elements interrelate promotes effectiveness when introducing change Individuals in a practice development role must ensure they have good sources of support

  19. Structures of Community and Democratic Practices in Graduate Teacher Education, Teacher Change, and Linkages Facilitating Change.

    Science.gov (United States)

    Rainer, Julie A.; Guyton, Edith M.

    2001-01-01

    Examined practices in a constructivist graduate teacher education program, documenting changes in teachers and their practice and analyzing connections between program practices and teacher change. Data from field notes, teacher and faculty interviews, classroom observations, faculty ratings of teachers, and artifacts helped develop a model for…

  20. Structures of Community and Democratic Practices in Graduate Teacher Education, Teacher Change, and Linkages Facilitating Change.

    Science.gov (United States)

    Rainer, Julie A.; Guyton, Edith M.

    2001-01-01

    Examined practices in a constructivist graduate teacher education program, documenting changes in teachers and their practice and analyzing connections between program practices and teacher change. Data from field notes, teacher and faculty interviews, classroom observations, faculty ratings of teachers, and artifacts helped develop a model for…

  1. The "evidence-based practice inventory": reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care.

    Science.gov (United States)

    Kaper, Nina M; Swennen, Maartje H J; van Wijk, Arjen J; Kalkman, Cor J; van Rheenen, Nanda; van der Graaf, Yolanda; van der Heijden, Geert J M G

    2015-11-01

    To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim and evaluate efforts at improving or maximizing EBP. We derived candidate items from existing EBP scales, psychology, and behavioral economics. In an online Delphi study, 537 international expert clinicians, researchers, teachers, and policymakers interested in EBP identified items with sufficient face and content validity. We piloted and validated the resulting draft inventory among 127 clinicians from various specialties and career stages. The Delphi study started with 114 items and resulted in a draft inventory with 29 items in five dimensions. During the pilot, the inventory was easy to complete within 15 minutes and the items showed sufficient response variation. In four of five dimensions, test-retest reliability was substantial to almost perfect and the power to discriminate between groups with different expertise was adequate, whereas internal consistency showed that the items generally measured the same construct. On the basis of internal consistency and factor analysis, we excluded three items. The final EBP inventory consists of 26 items in five dimensions: decision making, subjective norm, attitude, perceived behavior control, and intention and behavior. The EBP inventory was developed with support of EBP experts and validated among various academic clinicians. It shows adequate face and content validity, internal consistency, test-retest reliability, discriminative power, and completion will take <15 minutes. We recommend further evaluation of its value in field trials. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Improving Student's Lab Practices: the Performance Grade

    CERN Document Server

    Lippi, G L

    2015-01-01

    Instilling good laboratory working attitudes in students is a difficult but very important task, especially in the first level courses. The introduction of a grade, based on the observation of work practices during laboratory sessions, can be strongly beneficial towards the acquisition of positive skills covering not only the technical aspects, but also the acquisition of both independence and team work. Explicit suggestions are given for basing the grade on specific observations and a quantitative analysis is performed to guarantee that the higher intrinsic volatility of the Performance Grade does not affect the final laboratory grade.

  3. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    2015-01-01

    Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court...... districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure...

  4. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...

  5. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2015-09-01

    To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Integrative literature review. CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention. © 2015 John Wiley & Sons Ltd.

  6. Exploring reforms while learning to teach science: Facilitating exploration of theory-practice relationships in a teacher education study group

    Science.gov (United States)

    Foster, Jacob G.

    This dissertation inserts a new view into an old problem in teacher education. The study explores the theory-practice gap, the large distance between what preservice science teachers experience in schools, are able to enact, and are told they should hold themselves to in their practice. It does so by narrowing the focus of analysis to a secondary science study group and examining how the facilitator uses sociocultural constructivism to promote discussion. The analysis surfaces key communicative moves made by the facilitator and preservice teachers that yield fruitful discussion of theory-practice relationships. Additionally, the study's use of discourse analysis as a methodology and intertextuality as a conceptual framework opens new directions for applied sociolinguistic research and scholarship in science teacher education. Findings from the study focus on what was discussed and how explorations of theory-practice relationships were facilitated. Preservice teachers in the study group engaged in meaningful conversations about constructivist theory and its application to their students and teaching of science. They discussed many science education topics such as planning science lessons that actively engage students, assessment of content understanding, and management of content-based activities. Discussions of broader science education goals, including implementation of inquiry or development of collaborative communities, were not promoted. Examination of the facilitation illuminates a number of strategies found to be helpful in supporting these explorations. This study shows that facilitation can successfully support preservice teachers to construct understanding of social constructivist assumptions underlying the National Science Education Standards (NSES), as well as a few components of the Standards themselves. The focus on the underlying assumptions suggests that science teacher education should focus on these so that preservice teachers can build a strong

  7. A Practical Research on Lexical Approach: How to Use Chunks to Improve Junior Students’ Writing Skills

    Institute of Scientific and Technical Information of China (English)

    袁英

    2016-01-01

    This article is a practical research on lexical approach,and it tries to present how to use chunks to improve junior writing skills by showing some authentic teaching experience.At the very beginning,it generalizes the background of this article.Then,it gives a wellknown definition and classification of chunks.Next,it presents an example to show how to use chunks facilitate students’writing on the basis of the texts from students’

  8. Cancer: improving early detection and prevention. A community practice randomised trial.

    OpenAIRE

    Dietrich, A J; O'Connor, G. T.; Keller, A.; Carney, P A; Levy, D; Whaley, F. S.

    1992-01-01

    OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early ...

  9. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...... by the introduction of experience-rated malpractice liability insurance. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences and difference-in-discontinuities analyses. We find...

  10. Practical Strategies to Improve Test Efficiency

    Institute of Scientific and Technical Information of China (English)

    DING Zhigang; WANG Hongcheng; LING Lianghe

    2007-01-01

    This paper introduces strategies to detect software bugs in earlier life cycle stage in order to improve test efficiency. Static analysis tool is one of the effective methods to reveal software bugs during software development. Three popular static analysis tools are introduced, two of which, PolySpace and Splint, are compared with each other by analyzing a set of test cases generatedd by the authors. PolySpace can reveal 60% bugs with 100% R/W ratio (ratio of real bugs and total warnings), while Splint reveal 73.3% bugs with 44% R/W ratio. And they are good at finding different categories of bugs. Two strategies are concluded to improve test efficiency, under the guideline that static analysis tools should be used in finding different categories of bugs according to their features. The first one aims at finding bugs as many as possible, while the second concentrates to reduce the average time on bug revelation. Experimental data shows the first strategy can find 100% bugs with 60% RAN ratio, the second one find 80% bugs with 66.7% R/W ratio. Experiment results prove that these two strategies can improve the test efficiency in both fault coverage and testing time.

  11. Teaching Adult Learner Characteristics and Facilitation Strategies through Simulation-Based Practice

    Science.gov (United States)

    Speed, Sally A.; Bradley, Elizabeth; Garland, Krista Vince

    2015-01-01

    This article relates a project in which a curriculum module was developed to help graduate students more effectively manage behaviors of adults in facilitation sessions. The module was piloted in the project and later included in a graduate level course in the Creative Studies Department of SUNY Buffalo State. The curriculum identified…

  12. Imagining and Moving beyond the ESL Bubble: Facilitating Communities of Practice through the ELL Ambassadors Program

    Science.gov (United States)

    Przymus, Steve Daniel

    2016-01-01

    When educators do not facilitate English language learners' (ELLs) social integration in schools, this can perpetuate ELLs' marginalized status and the plateauing of ELLs' English language development. This study highlights a program for secondary ELLs called the ELL Ambassadors program, which partnered ELLs with non-ELLs based on shared…

  13. Integrating Best Practices in Language Intervention and Curriculum Design to Facilitate First Words

    Science.gov (United States)

    Lederer, Susan Hendler

    2014-01-01

    For children developing language typically, exposure to language through the natural, general language stimulation provided by families, siblings, and others is sufficient enough to facilitate language learning (Bloom & Lahey, 1978; Nelson, 1973; Owens, 2008). However, children with language delays (even those who are receptively and…

  14. Directing and Facilitating Distributed Pedagogical Leadership: Best Practices in Early Childhood Education

    Science.gov (United States)

    Bøe, Marit; Hognestad, Karin

    2017-01-01

    This paper uses a hybrid leadership framework to examine how formal teacher leaders at the middle management level direct and facilitate staff resources for distributed pedagogical leadership. By conducting qualitative shadowing, involving video observation, field notes and stimulated recall interviews, and abductive analysis, this study…

  15. Application of quality-improvement methods in a community practice: the Sandhills Pediatrics Asthma Initiative.

    Science.gov (United States)

    Wroth, Thomas H; Boals, Joseph C

    2005-01-01

    This case study demonstrates the use of quality improvement methods to improve asthma care in a busy community practice. The practice used disease-management strategies, such as population identification, self-management education, and performance measurement and feedback. The practice then applied several practice-based quality improvement methods, such as PDSA cycles, to improve care. From 1998 to 2003, process measures, such as staging of asthmatics, use of long-term control medications, use of peak flow meters and spacers, and use of action plans, improved. There was also a substantial decrease in emergency department use and hospitalizations among patients with asthma. Although there have been several studies demonstrating the efficacy of disease management strategies, most lack generalizability to community practices. Often, interventions are so intensive and cumbersome, that they are unlikely to be replicated in primary care setting. Researchers have been unable to determine which components of the interventions are most effective and replicable. Furthermore, many studies of disease management strategies enroll participants who lack the co-morbidities seen in community practice. There are also few studies of disadvantaged populations that face other barriers to care, such as lack of transportation, poor access to specialists, and medical illiteracy. In this case study, there were several unique factors that enabled the practice to improve care for this population. The AccessCare case manager who worked with the practice not only provided data and feedback to the practice team, but also served as an improvement "coach," often pushing the team and facilitating many of the improvement efforts. AccessCare's approach is in contrast to many of the commercial disease management companies' "carve out" models that do not sufficiently involve providers or practices in their interventions. The other necessary ingredient for success in this project was organizational

  16. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  17. Facilitating the improved management of waste in South Africa through a national waste information system.

    Science.gov (United States)

    Godfrey, Linda

    2008-01-01

    Developing a waste information system (WIS) for a country is more than just about collecting routine data on waste; it is about facilitating the improved management of waste by providing timely, reliable information to the relevant role-players. It is a means of supporting the waste governance challenges facing South Africa - challenges ranging from strategic waste management issues at national government to basic operational challenges at local government. The paper addresses two hypotheses. The first is that the identified needs of government can provide a platform from which to design a national WIS framework for a developing country such as South Africa, and the second is that the needs for waste information reflect greater, currently unfulfilled challenges in the sustainable management of waste. Through a participatory needs analysis process, it is shown that waste information is needed by the three spheres of government, to support amongst others, informed planning and decision-making, compliance monitoring and enforcement, community participation through public access to information, human, infrastructure and financial resource management and policy development. These needs for waste information correspond closely with key waste management challenges currently facing the country. A shift in governments approach to waste, in line with national and international policy, is evident from identified current and future waste information needs. However, the need for information on landfilling remains entrenched within government, possibly due to the poor compliance of landfill sites in South Africa and the problems around the illegal disposal of both general and hazardous waste.

  18. Chitosan improves anti-biofilm efficacy of gentamicin through facilitating antibiotic penetration.

    Science.gov (United States)

    Mu, Haibo; Guo, Fan; Niu, Hong; Liu, Qianjin; Wang, Shunchun; Duan, Jinyou

    2014-12-03

    Antibiotic overuse is one of the major drivers in the generation of antibiotic resistant "super bugs" that can potentially cause serious effects on health. In this study, we reported that the polycationic polysaccharide, chitosan could improve the efficacy of a given antibiotic (gentamicin) to combat bacterial biofilms, the universal lifestyle of microbes in the world. Short- or long-term treatment with the mixture of chitosan and gentamicin resulted in the dispersal of Listeria monocytogenes (L. monocytogenes) biofilms. In this combination, chitosan with a moderate molecular mass (~13 kDa) and high N-deacetylation degree (~88% DD) elicited an optimal anti-biofilm and bactericidal activity. Mechanistic insights indicated that chitosan facilitated the entry of gentamicin into the architecture of L. monocytogenes biofilms. Finally, we showed that this combination was also effective in the eradication of biofilms built by two other Listeria species, Listeria welshimeri and Listeria innocua. Thus, our findings pointed out that chitosan supplementation might overcome the resistance of Listeria biofilms to gentamicin, which might be helpful in prevention of gentamicin overuse in case of combating Listeria biofilms when this specific antibiotic was recommended.

  19. Chitosan Improves Anti-Biofilm Efficacy of Gentamicin through Facilitating Antibiotic Penetration

    Directory of Open Access Journals (Sweden)

    Haibo Mu

    2014-12-01

    Full Text Available Antibiotic overuse is one of the major drivers in the generation of antibiotic resistant “super bugs” that can potentially cause serious effects on health. In this study, we reported that the polycationic polysaccharide, chitosan could improve the efficacy of a given antibiotic (gentamicin to combat bacterial biofilms, the universal lifestyle of microbes in the world. Short- or long-term treatment with the mixture of chitosan and gentamicin resulted in the dispersal of Listeria monocytogenes (L. monocytogenes biofilms. In this combination, chitosan with a moderate molecular mass (~13 kDa and high N-deacetylation degree (~88% DD elicited an optimal anti-biofilm and bactericidal activity. Mechanistic insights indicated that chitosan facilitated the entry of gentamicin into the architecture of L. monocytogenes biofilms. Finally, we showed that this combination was also effective in the eradication of biofilms built by two other Listeria species, Listeria welshimeri and Listeria innocua. Thus, our findings pointed out that chitosan supplementation might overcome the resistance of Listeria biofilms to gentamicin, which might be helpful in prevention of gentamicin overuse in case of combating Listeria biofilms when this specific antibiotic was recommended.

  20. Fault Management Practice: A Roadmap for Improvement

    Science.gov (United States)

    Fesq, Lorraine M.; Oberhettinger, David

    2010-01-01

    Autonomous fault management (FM) is critical for deep space and planetary missions where the limited communication opportunities may prevent timely intervention by ground control. Evidence of pervasive architecture, design, and verification/validation problems with NASA FM engineering has been revealed both during technical reviews of spaceflight missions and in flight. These problems include FM design changes required late in the life-cycle, insufficient project insight into the extent of FM testing required, unexpected test results that require resolution, spacecraft operational limitations because certain functions were not tested, and in-flight anomalies and mission failures attributable to fault management. A recent NASA initiative has characterized the FM state-of-practice throughout the spacecraft development community and identified common NASA, DoD, and commercial concerns that can be addressed in the near term through the development of a FM Practitioner's Handbook and the formation of a FM Working Group. Initial efforts will focus on standardizing FM terminology, establishing engineering processes and tools, and training.

  1. Facilitating Lewin's change model with collaborative evaluation in promoting evidence based practices of health professionals.

    Science.gov (United States)

    Manchester, Julianne; Gray-Miceli, Deanna L; Metcalf, Judith A; Paolini, Charlotte A; Napier, Anne H; Coogle, Constance L; Owens, Myra G

    2014-12-01

    Evidence based practices (EBPs) in clinical settings interact with and adapt to host organizational characteristics. The contextual factors themselves, surrounding health professions' practices, also adapt as practices become sustained. The authors assert the need for better planning models toward these contextual factors, the influence of which undergird a well-documented science to practice gap in literature on EBPs. The mechanism for EBP planners to anticipate contextual effects as programs Unfreeze their host settings, create Movement, and become Refrozen (Lewin, 1951) is present in Lewin's 3-step change model. Planning for contextual change appears equally important as planning for the actual practice outcomes among providers and patients. Two case studies from a Geriatric Education Center network will illustrate the synthesis of Lewin's three steps with collaborative evaluation principles. The use of the model may become an important tool for continuing education evaluators or organizations beginning a journey toward EBP demonstration projects in clinical settings.

  2. Facilitering som styringsredskab

    OpenAIRE

    Jørgensen, Karen Overgaard

    2006-01-01

    #This thesis surveys facilitation as a new tool of steering within the public sector in Denmark. It is explored how facilitation is articulated and practiced among facilitators from the public, private and voluntary sector. Furthermore, the facilitator’s challenges by using facilitation are examined. The thesis is based on the presumption that facilitation is articulated by rationalities, which influence how facilitation is practiced and performed. Also, a facilitator is seen as a performer a...

  3. Farmers' adoption of improved vegetable production practices under ...

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-29

    Dec 29, 2008 ... The study was undertaken to evaluate the Fadama phase one vegetable production ... Key words: Adoption, improved vegetable, production practices, farmers and ..... score of the recommended planting distance for telfaria.

  4. Improving Site Management Practices in the Nigerian Construction ...

    African Journals Online (AJOL)

    Improving Site Management Practices in the Nigerian Construction Industry: ... a combination of activities, which turn basic resources into a finished product. ... incorporating all the professionals in the building construction industry are in place.

  5. Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

    Science.gov (United States)

    2013-01-01

    Background England’s extensive NHS patient survey programme has not fulfilled government promises of widespread improvements in patients’ experiences, and media reports of poor nursing care in NHS hospitals are increasingly common. Impediments to the surveys’ impact on the quality of nursing care may include: the fact that they are not ward-specific, so nurses claim “that doesn’t happen on my ward”; nurses’ scepticism about the relevance of patient feedback to their practice; and lack of prompt communication of results. The surveys’ impact could be increased by: conducting ward-specific surveys; returning results to ward staff more quickly; including patients’ written comments in reports; and offering nurses an opportunity to discuss the feedback. Very few randomised trials have been conducted to test the effectiveness of patient feedback on quality improvement and there have been few, if any, published trials of ward-specific patient surveys. Methods Over two years, postal surveys of recent inpatients were conducted at four-monthly intervals in 18 wards in two NHS Trusts in England. Wards were randomly allocated to Basic Feedback (ward-specific printed patient survey results including patients’ written comments sent to nurses by letter); Feedback Plus (in addition to printed results, ward meetings to discuss results and plan improvements) or Control (no active feedback of survey results). Patient survey responses to questions about nursing care were used to compute wards’ average Nursing Care Scores at each interval. Nurses’ reactions to the patient feedback were recorded. Results Conducting ward-level surveys and delivering ward-specific results was feasible. Ward meetings were effective for engaging nurses and challenging scepticism and patients’ written comments stimulated interest. 4,236 (47%) patients returned questionnaires. Nursing Care Scores improved more for Feedback Plus than Basic Feedback or Control (difference between

  6. Improving Your Daily Practice: A Guide for Effective School Leadership

    Science.gov (United States)

    Berkey, Timothy B.

    2009-01-01

    This book will show principals how they can change daily practices to invest more time in the improvement of teaching and learning. It redirects leadership to effective practices in instructional leadership. Contents include an Introduction and the following chapters: (1) Why Change the Way I Lead?; (2) The Path to Effective School Leadership; (3)…

  7. Improving Student Laboratory Performance: How Much Practice Makes Perfect?

    Science.gov (United States)

    Beasley, Warren

    1985-01-01

    Analyzes three approaches (physical, mental, combined practice) to improving freshman chemistry psychomotor laboratory skills. Although no significant differences were found between treatments, there were significant differences when each was compared to the control sections. Mental practice appears to offer an efficient methods for reinforcement…

  8. Improving the safety features of general practice computer systems

    OpenAIRE

    Anthony Avery; Boki Savelyich; Sheila Teasdale

    2003-01-01

    General practice computer systems already have a number of important safety features. However, there are problems in that general practitioners (GPs) have come to rely on hazard alerts when they are not foolproof. Furthermore, GPs do not know how to make best use of safety features on their systems. There are a number of solutions that could help to improve the safety features of general practice computer systems and also help to improve the abilities of healthcare professionals to use these ...

  9. A Typology of best practices for processes improvement

    OpenAIRE

    2005-01-01

    International audience; Benchmarking is currently one of the most effective industrial performance improvement processes. For the company, it is a question of observing, adopting and/or adapting best practices, and this with the aim of improving the performance of some of its processes. The realization of benchmarking, whether it be internal or external, is not however without its difficulties. The first difficulty for the company is to manage to clearly define what a best practice is. We thu...

  10. Facilitating Participation of Students with Severe Disabilities: Aligning School-Based Occupational Therapy Practice with Best Practices in Severe Disabilities

    Science.gov (United States)

    Mu, Keli; Royeen, Charlotte

    2004-01-01

    School-based occupational therapy is the largest employer of occupational therapists. School-based occupational therapists work extensively with students with severe disabilities. Over the past decade, one significant change in the field of severe disabilities has been the advocacy of best practices. This paper discusses the implications of best…

  11. Facilitation visits as a method for implementing change in general practice - What lies beneath the label?

    DEFF Research Database (Denmark)

    Due, Tina Drud

    2016-01-01

    ingen klar og konsistent definition af facilitering, og der er markante variationer i indholdet mellem forskellige facilitatorinterventioner. Facilitatorer beskrives at have mange forskellige roller og mangeartede aktiviteter er beskrevet både inden for enkelte interventioner og på tværs af...... at opgaver blev defineret, uddelegeret og udført. Facilitatorerne udmøntede generelt ikke en også tiltænkt coaching-baseret facilitatorrolle, hvor de under besøgene understøttede interne diskussioner og refleksioner over den besøgte praksis’ organisering og implementering. Studiet identificerede desuden både...

  12. An online practice and educational networking system for technical skills: learning experience in expert facilitated vs. independent learning communities.

    Science.gov (United States)

    Rojas, David; Cheung, Jeffrey J H; Weber, Bryce; Kapralos, Bill; Carnahan, Heather; Bägli, Darius J; Dubrowski, Adam

    2012-01-01

    This study explored the activities of trainees learning technical skills using an educational networking tool with and without expert facilitation. Medical students (participants) were video-recorded practicing suturing and knot tying techniques and the resulting videos were uploaded to an educational networking site. Participants were then divided into two groups (one group containing an expert facilitator while the other group did not) and encouraged to comment on the videos within their group. We monitored the number of logins and comments posted and all participants completed an exit survey. There were no differences between the activities the two groups (p = 0.387). We conclude that the presence of an expert within collaborative Internet environments in not necessary to promote interactivity amongst the learners.

  13. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

    Science.gov (United States)

    Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

    Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

  14. Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

    Science.gov (United States)

    Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-03-01

    To develop standards for high quality in gastrointestinal (GI) endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all GI endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on the requirements for high-quality endoscopy reporting systems in GI endoscopy. Recommendations 1 Endoscopy reporting systems must be electronic. 2 Endoscopy reporting systems should be integrated into hospitals' patient record systems. 3 Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4 Endoscopy reporting systems shall restrict the use of free-text entry to a minimum, and be based mainly on structured data entry. 5 Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6 Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7 Endoscopy reporting systems shall facilitate the inclusion of information on histopathology of detected lesions, patient satisfaction, adverse events, and surveillance recommendations. 8 Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format. 9 Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees. 10 Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.

  15. Barriers and facilitating communication skills for breaking bad news: from the specialists’ practice perspective

    Directory of Open Access Journals (Sweden)

    Enna Catalina Payán

    2009-06-01

    Full Text Available Introduction: Breaking bad news is one of a physician’s most difficult duties. There are several studies related to the patient’s needs, but few reflect on the doctors’ experience.Materials and method: A descriptive, cross-sectional research was carried out to study issues related to the process of delivering bad news which might act as barriers and facilitating skills from the doctor’s point of view. These issues were identified through a self-administered survey.Results: Participant doctors use different strategies to communicate bad news to their patients. Examples of these strategies are: to be familiar with the patients’ medical history, to ensure that there is enough time, to know the patient’s caregivers and/or relatives, to determine the patient’s level of knowledge about his/her condition, to use non-technical words, to give information in small pieces, to assess the patient’s understanding, to devise a joint action plan, among others.Conclusion: The communication barriers that were identified focused on the emotional issues of the communication process, particularly those related to the recognition of own emotions, and the limited training about communication strategies available to doctors. Consequently, there is a need to implement training programs that provide doctors with tools to facilitate the bad news communication process.

  16. A coaching supervision programme to facilitate the mental health in business coaches in South African practice

    OpenAIRE

    2011-01-01

    D.Cur. Supervision is not a new concept in psychiatric nursing. It has a long history in clinical practice to bridge the gap between theory and practice. However, supervision is fairly new and still emerging in the coaching profession. Bluckert (2005:1) says that if one has to trace the references to supervision in coaching books, one will barely find anything before the millennium. It is only now recently that a demand is growing in coaching professions for coaching supervision. The pract...

  17. Podcasting: A New Technological Tool to Facilitate Good Practice in Higher Education

    Science.gov (United States)

    Fernandez, Vicenc; Simo, Pep; Sallan, Jose M.

    2009-01-01

    The literature has frequently highlighted the usefulness of podcasting in higher education; however, there is an important gap between the theory on good practice in higher education and empirical studies about podcasting. With this in mind, we carried out an empirical study on an undergraduate degree course in Information Systems Management. The…

  18. Users' Familiar Situational Contexts Facilitate the Practice of EFL in Elementary Schools with Mobile Devices

    Science.gov (United States)

    Hwang, Wu-Yuin; Chen, Holly S. L.

    2013-01-01

    It is beneficial for students to experience situational learning, especially for English as a foreign language (EFL) learning. Providing more listening and speaking opportunities could help EFL students with English learning. Our research proposes a listening and speaking practice system employing personal digital assistants (PDAs) for situated…

  19. Cultivating a Doctoral Community of Inquiry and Practice: Designing and Facilitating Discussion Board Online Learning Communities

    Science.gov (United States)

    Hauser, Linda; Darrow, Rob

    2013-01-01

    This paper presents a promising and powerful approach used to cultivate a doctoral community of inquiry and practice and harness the intelligence, commitment, and energy of all of its members in a blended learning environment. The discussion board online learning community approach was developed to transform a traditional face-to-face doctoral…

  20. The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training

    Science.gov (United States)

    Sandrey, Michelle A.; Bulger, Sean M.

    2008-01-01

    Objective: The growing importance of evidence based practice in athletic training is necessitating academics and clinicians to be able to make judgments about the quality or lack of the body of research evidence and peer-reviewed standards pertaining to clinical questions. To assist in the judgment process, consensus methods, namely brainstorming,…

  1. Pedagogy before Technology: What Should an ICT Intervention Facilitate in Practical Dance Classes?

    Science.gov (United States)

    Leijen, Ali; Admiraal, Wilfried F.; Wildschut, Liesbeth; Simons, P. Robert-Jan

    2008-01-01

    The aim of the study was to identify the features of the pedagogical context in choreography and dance technique classes which could be viewed as the basis for developing a suitable web-based ICT application to support teaching and learning in practical dance classes. The sample consisted of teachers from four dance academies in the Netherlands.…

  2. Users' Familiar Situational Contexts Facilitate the Practice of EFL in Elementary Schools with Mobile Devices

    Science.gov (United States)

    Hwang, Wu-Yuin; Chen, Holly S. L.

    2013-01-01

    It is beneficial for students to experience situational learning, especially for English as a foreign language (EFL) learning. Providing more listening and speaking opportunities could help EFL students with English learning. Our research proposes a listening and speaking practice system employing personal digital assistants (PDAs) for situated…

  3. Pedagogy before technology: what should an ICT intervention facilitate in practical dance classes?

    NARCIS (Netherlands)

    Ä. Leijen; W.F. Admiraal; L. Wildschut; P.R.J. Simons

    2008-01-01

    The aim of the study was to identify the features of the pedagogical context in choreography and dance technique classes which could be viewed as the basis for developing a suitable web-based ICT application to support teaching and learning in practical dance classes. The sample consisted of teacher

  4. Balancing act. Using the clinic scorecard to improve practice performance.

    Science.gov (United States)

    Scanlan, Art

    2007-02-01

    The balanced scorecard is a strategic management system that impels managers to focus on the performance metrics that drive success. It measures the business process and links a management method for process improvement to strategic goals. A medical practice can use a balanced scorecard to improve operational performance and quality or service, which generates higher levels of patient satisfaction and better financial management.

  5. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice

    DEFF Research Database (Denmark)

    Due, Tina Drud; Thorsen, Thorkil; Kousgaard, Marius Brostrøm

    2014-01-01

    BACKGROUND: The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice...... indicate that a semi-tailored facilitator-based intervention of relatively low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry...

  6. Facilitating best practices in collecting anomalous scattering data for de novo structure solution at the ESRF Structural Biology Beamlines

    Science.gov (United States)

    de Sanctis, Daniele; Oscarsson, Marcus; Popov, Alexander; Svensson, Olof; Leonard, Gordon

    2016-01-01

    The constant evolution of synchrotron structural biology beamlines, the viability of screening protein crystals for a wide range of heavy-atom derivatives, the advent of efficient protein labelling and the availability of automatic data-processing and structure-solution pipelines have combined to make de novo structure solution in macromolecular crystallography a less arduous task. Nevertheless, the collection of diffraction data of sufficient quality for experimental phasing is still a difficult and crucial step. Here, some examples of good data-collection practice for projects requiring experimental phasing are presented and recent developments at the ESRF Structural Biology beamlines that have facilitated these are illustrated. PMID:26960128

  7. Facilitating the development of agency in first-year students. A Practice Report

    Directory of Open Access Journals (Sweden)

    Willem van Schoor

    2012-08-01

    Full Text Available Open distance learning (ODL requires students to take control of their study processes from the beginning in order to achieve study success. To achieve control, first-year students have to understand what agency requires of them and they have to know what to do to exercise agency. An online program was  developed at the University of South Africa (Unisa to facilitate the development of agency in first-year students and a pilot program was conducted with a group of students who had failed an Economics I course to test the program. The data indicated that time management in a variety of contexts was the major debilitating factor for participants. Feedback from the users indicated that they were generally positive about the program structure and contents, as well as their experience in using it. 

  8. Patient advisory groups in practice improvement: sample case presentation with a discussion of best practices.

    Science.gov (United States)

    Angstman, Kurt B; Bender, Robert O; Bruce, Steven M

    2009-01-01

    Using patient advisory groups can affect practice changes and create a patient-centric focus for a primary care practice. A successful patient advisory group has been developed for our primary care clinics. Utilizing this group, we have implemented practice improvement changes that have had a significant impact in patient care. This will be demonstrated in a case presentation involving the implementation of depression care managers at our practice sites. We will review key "best practices," as defined by the group, regarding size, composition, and meeting frequency that can be used for the development of a clinical patient advisory group.

  9. How does sport psychology actually improve athletic performance? A framework to facilitate athletes' and coaches' understanding.

    Science.gov (United States)

    Gee, Chris J

    2010-09-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a competitive contest. Nevertheless, recent research has shown that many athletes, coaches, and sporting administrators are still quite reluctant to seek out the services of a qualified sport psychologist, even if they believe it could help. One of the primary reasons for this hesitation appears to be a lack of understanding about the process and the mechanisms by which these mental skills affect performance. Unlike the "harder sciences" of sport physiology and biochemistry where athletes can see the tangible results in themselves or other athletes (e.g., he or she lifted weights, developed larger muscles, and is now stronger/faster as a result), the unfamiliar and often esoteric nature of sport psychology appears to be impeding a large number of athletes from soliciting these important services. As such, the purpose of this article is to provide the reader with a simple framework depicting how mental skills training translates into improved within-competition performance. This framework is intended to help bridge the general "understanding gap" that is currently being reported by a large number of athletes and coaches, while also helping sport psychology practitioners sell their valuable services to individual athletes and teams.

  10. Coteaching praxis and professional service: facilitating the transition of beliefs and practices

    Science.gov (United States)

    Carambo, Cristobal; Stickney, Clare Tracy

    2009-06-01

    Coteaching is an effective structure for the pre-service practicum as it immerses student teachers in the culture of the school and helps them to learn by working closely at the elbows of their mentor teacher. The collaborative nature of the model fosters beliefs and practices based on shared perspectives and coresponsibility for the quality of the learning environment. Cogenerative dialogues with students insure the inclusion of their voice in the collaboration and foster increased emotional energy and classroom solidarity. The work by Wassell and LaVan (2009) fills an important void in our research on coteaching as it seeks to understand which practices and beliefs survive the transition to professional service. While both teachers included cogenerative dialogues in their interactions with students, we suggest that the reflective practices of a single teacher are qualitatively different from reflections based on the dynamic interactions of multiple adults' coteaching together. We explore strategies that will help administrators and school staff find the human and material resources needed to staff the multiple teacher classroom. Our comments on this paper are informed by our experiences as the academic coordinator and mentor teacher of the learning community in which Jen and Ian completed their pre service practicum and are meant help disseminate this model to as many educational environments as possible.

  11. Students improve patient care and prepare for professional practice: an interprofessional community-based study.

    Science.gov (United States)

    Anderson, Elizabeth Susan; Thorpe, Lucy Nichola

    2014-06-01

    We report on an education model that enables students to contribute to practice while experiencing the realities of complex team-working in the community. The study considers how interprofessional learning impacts on patient care and service delivery. A qualitative study using a realist approach. The views of practice-staff, patients and facilitators on how student team learning impacted on practice was obtained through focus groups, interviews and an e-questionnaire and compared to student analysis as feedback forms. Staff from six Primary Health Care Teams (n = 23) stated that the student teams had offered solutions to improve the quality of patient care and on organisational systems. The positive value of the student work was confirmed by the course facilitators (n = 8). In addition, practitioners were propelled to maintain high professional standards. Patients (n = 23) recalled benefits directly attributable to the student work confirmed by the 434 student feedback forms. Undergraduate interprofessional student teams in mid-training can support and help practice teams, and this subsequently benefits patient care. This practice-based interprofessional learning model offers learning, which is theory-based, and supports positive student contributions. This learning fits today's requirements for positive outcomes from education when mapped against the Kirkpatrick or the NHS (UK) education outcomes framework.

  12. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement.

    Science.gov (United States)

    Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-04-01

    To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: Endoscopy reporting systems must be electronic.Endoscopy reporting systems should be integrated into hospital patient record systems.Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient's satisfaction; adverse events; surveillance recommendations.Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.

  13. Discourse-shifting practices of a teacher and learning facilitator in a bilingual mathematics classroom

    Directory of Open Access Journals (Sweden)

    Tyler, Robyn

    2016-12-01

    Full Text Available In bilingual classrooms, content is often learned simultaneously with a new language. Recent applied linguistics research has identified shifts in discourse made by teachers and learners as they work towards these two goals. Departing from a sociocultural perspective on teaching and learning, this study assumes learners and teachers bring rich and diverse linguistic repertoires to the classroom. This paper examines selected episodes of discourse shifts which took place in a week-long mathematics enrichment programme run by a non-government organisation in rural South Africa. In this Xhosa-English bilingual context, I undertook a small-scale ethnographically-informed case study in which evidence of and comment on discourse shifting was collected in the form of video and audio recordings of lessons and interviews with participants. The focus of the analysis is on the translanguaging strategies (especially register meshing of the teacher and a learning facilitator as they work to make the curriculum accessible to the learners. The argument made in the paper is that the unidirectional notion of discourse shifting from more everyday, spoken, home language discourses to more discipline-specific, written, English discourses is not adequate in explaining the complex multidirectional shifting apparent in my data.

  14. A Teacher Training Model for Improving Social Facilitation in the Inclusive Program

    Science.gov (United States)

    Robinson, Suzanne; Myck-Wayne, Janice

    2016-01-01

    The twofold purpose of this article is to highlight the importance of fostering social competence within inclusive preschool programs and to describe a model for training teachers in research-based social facilitation strategies so as to promote social interaction between children with and without disabilities. This model was developed to address…

  15. A Breakthrough for Josh: How Use of an iPad Facilitated Reading Improvement

    Science.gov (United States)

    McClanahan, Barbara; Williams, Kristen; Kennedy, Ed; Tate, Susan

    2012-01-01

    As part of a diagnosis and tutoring project in an elementary education reading course, a pre-service teacher was encouraged to use an iPad as the vehicle for intervention strategies with a fifth grade struggling reader with Attention Deficit Hyperactivity Disorder. The device not only helped the student focus attention, it facilitated his becoming…

  16. How to Improve Teaching Practices: The Role of Teacher Motivation, Organizational Factors, and Leadership Practices

    Science.gov (United States)

    Thoonen, Erik E. J.; Sleegers, Peter J. C.; Oort, Frans J.; Peetsma, Thea T. D.; Geijsel, Femke P.

    2011-01-01

    Purpose: Although it is expected that building schoolwide capacity for teacher learning will improve teaching practices, there is little systematic evidence to support this claim. This study aimed to examine the relative impact of transformational leadership practices, school organizational conditions, teacher motivational factors, and teacher…

  17. THE ACADEMIC PERFORMANCE OF THE TEACHER AS A FACILITATOR OF LEARNING IN PRACTICE TEACHING SESSIONS

    Directory of Open Access Journals (Sweden)

    Moisés Fuentes-Flores

    2014-07-01

    Full Text Available In this paper we present the results of teachers working at the Official School Dora Madero, with counseling resources in the days approach to teaching practice, emphasizing the use of intellectual skills in interactive and collaborative work with students performed as well as the attitudes within their school work and academic performance throughout the work process. Recognizing these elements that dominate areas and just as the shortcomings in the school context, to achieve institutional transformation and quality. We used multiple regression tests, descriptive statistics, frequencies and percentages, factor analysis of internal structure and variability of the phenomenon, All possible regression, Multiple Regression, Multivariate selection and a possible graph, Item Analysis.

  18. Improving Self-Regulated Learning With a Retrieval Practice Intervention.

    Science.gov (United States)

    Ariel, Robert; Karpicke, Jeffrey D

    2017-06-12

    Repeated retrieval practice is a powerful learning tool for promoting long-term retention, but students use this tool ineffectively when regulating their learning. The current experiments evaluated the efficacy of a minimal intervention aimed at improving students' self-regulated use of repeated retrieval practice. Across 2 experiments, students made decisions about when to study, engage in retrieval practice, or stop learning a set of foreign language word pairs. Some students received direct instruction about how to use repeated retrieval practice. These instructions emphasized the mnemonic benefits of retrieval practice over a less effective strategy (restudying) and told students how to use repeated retrieval practice to maximize their performance-specifically, that they should recall a translation correctly 3 times during learning. This minimal intervention promoted more effective self-regulated use of retrieval practice and better retention of the translations compared to a control group that received no instruction. Students who experienced this intervention also showed potential for long-term changes in self-regulated learning: They spontaneously used repeated retrieval practice 1 week later to learn new materials. These results provide a promising first step for developing guidelines for teaching students how to regulate their learning more effectively using repeated retrieval practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Barriers and facilitators to recruitment of physicians and practices for primary care health services research at one centre

    Directory of Open Access Journals (Sweden)

    Hogg William

    2010-12-01

    Full Text Available Abstract Background While some research has been conducted examining recruitment methods to engage physicians and practices in primary care research, further research is needed on recruitment methodology as it remains a recurrent challenge and plays a crucial role in primary care research. This paper reviews recruitment strategies, common challenges, and innovative practices from five recent primary care health services research studies in Ontario, Canada. Methods We used mixed qualitative and quantitative methods to gather data from investigators and/or project staff from five research teams. Team members were interviewed and asked to fill out a brief survey on recruitment methods, results, and challenges encountered during a recent or ongoing project involving primary care practices or physicians. Data analysis included qualitative analysis of interview notes and descriptive statistics generated for each study. Results Recruitment rates varied markedly across the projects despite similar initial strategies. Common challenges and creative solutions were reported by many of the research teams, including building a sampling frame, developing front-office rapport, adapting recruitment strategies, promoting buy-in and interest in the research question, and training a staff recruiter. Conclusions Investigators must continue to find effective ways of reaching and involving diverse and representative samples of primary care providers and practices by building personal connections with, and buy-in from, potential participants. Flexible recruitment strategies and an understanding of the needs and interests of potential participants may also facilitate recruitment.

  20. How reflective practice improves nurses' critical thinking ability.

    Science.gov (United States)

    Cirocco, Maria

    2007-01-01

    Purposeful reflection is consistent with adult learning theory. It is known to lead to a deeper understanding of issues and to develop judgment and skill. Required by law to ensure members' competence in their professional practice, the College of Nurses of Ontario recommends and has developed a tool for evaluating reflective practice. The tool focuses on key attributes said to be demonstrated by competent practitioners, including critical thinking (CT) and job knowledge. This study aimed to determine whether nurses engage in reflective practice and whether they perceive that it enhances their CT ability. Surveys were sent to 60 gastroenterology nurses at a large teaching hospital; 34 surveys were anonymously returned. All respondents engaged in reflective practice, and 24 reported using the college's tool. Nineteen respondents strongly agreed that their nursing practice had improved as a result. Critical thinking is difficult to assess because of a lack of clear-cut performance criteria. Improvement of CT was difficult to evaluate from the responses, even though all respondents participated in reflective practice. Both CT and reflective practice need to be better defined in order to examine and explain their relationship.

  1. Implementing simulated learning modules to improve students’ pharmacy practice skills and professionalism

    Directory of Open Access Journals (Sweden)

    Fejzic J

    2015-09-01

    Full Text Available Background: Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE has been increasingly used to improve students’ communication and practice skills in Health Education. Objective: Simulated learning modules (SLMs were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students’ (i Practice skills and (ii Professionalism were evaluated. Methods: SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL Program is a schematic, evidence-based professional development resource centred around developing participants’ self-efficacy and generic communication competencies. Students (N=95 completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs. Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers’ reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. Results: Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students’ improved communication

  2. Future improvements and implementation of animal care practices within the animal testing regulatory environment.

    Science.gov (United States)

    Guittin, Pierre; Decelle, Thierry

    2002-01-01

    Animal welfare is an increasingly important concern when considering biomedical experimentation. Many of the emerging regulations and guidelines specifically address animal welfare in laboratory animal care and use. The current revision of the appendix of the European Convention, ETS123 (Council of Europe), updates and improves on the current animal care standardization in Europe. New guidelines from the Organisation for Economic Co-operation and Development and the European Federation of Pharmaceutical Industries Association focus specifically on safety testing. These guidelines will affect the way toxicity studies are conducted and therefore the global drug development process. With the 3Rs principles taken into account, consideration regarding animal welfare will demand changes in animal care practices in regulatory safety testing. The most significant future improvements in animal care and use practices are likely to be environmental enrichment, management of animal pain and distress, and improved application of the humane endpoints. Our challenge is to implement respective guidelines based on scientific data and animal welfare, through a complex interplay of regulatory objective and public opinion. The current goal is to work toward solutions that continue to provide relevant animal models for risk assessment in drug development and that are science based. In this way, future improvements in animal care and use practices can be founded on facts, scientific results, and analysis. Some of these improvements become common practice in some countries. International harmonization can facilitate the development and practical application of "best scientific practices" by the consensus development process that harmonization requires. Since the implementation of good laboratory practices (GLP) standards in safety testing, these new regulations and recommendations represent a new way forward for animal safety studies.

  3. Implementing simulated learning modules to improve students' pharmacy practice skills and professionalism.

    Science.gov (United States)

    Fejzic, Jasmina; Barker, Michelle

    2015-01-01

    Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE) has been increasingly used to improve students' communication and practice skills in Health Education. Simulated learning modules (SLMs) were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students' (i) Practice skills and (ii) Professionalism were evaluated. SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL) Program is a schematic, evidence-based professional development resource centred around developing participants' self-efficacy and generic communication competencies. Students (N=95) completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs). Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers' reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students' improved communication skills and confidence. Teacher reflections observed ecological

  4. Exploring Forms of Triangulation to Facilitate Collaborative Research Practice: Reflections From a Multidisciplinary Research Group

    Directory of Open Access Journals (Sweden)

    Tarja Tiainen

    2006-10-01

    Full Text Available This article contains critical reflections of a multidisciplinary research group studying the human and technological dynamics around some newly offered electronic services in a specific rural area of Finland. For their research, the group adopted ethnography. On facing the challenges of doing ethnographic research in a multidisciplinary setting, the group evolved its own breed of research practice based on multiple forms of triangulation. This implied the use of multiple data sources, methods, theories, and researchers, in different combinations. One of the outcomes of the work is a model for collaborative research. It highlights, among others, the importance of creating a climate for collaboration within the research group and following a process of individual and collaborative writing to achieve the potential benefits of such research. The article also identifies a set of remaining challenges relevant to collaborative research.

  5. Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

    Science.gov (United States)

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

    2013-08-01

    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

  6. Improving child health promotion practices in multiple sectors – outcomes of the Swedish Salut Programme

    Directory of Open Access Journals (Sweden)

    Edvardsson Kristina

    2012-10-01

    Full Text Available Abstract Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1 an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2 an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3 an increased use of motivational interviewing (MI and separate ‘fathers visits’ in child health care 4 improvements in the supply of healthy snacks and beverages in open pre-schools and 5 increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector

  7. Interprofessional Education and Practice Guide No. 1: developing faculty to effectively facilitate interprofessional education.

    Science.gov (United States)

    Hall, Leslie Walter; Zierler, Brenda K

    2015-01-01

    With the growth of interprofessional education (IPE) and practice in health professional schools, faculty members are being asked to assume new roles in leading or delivering interprofessional curriculum. Many existing faculty members feel ill-prepared to face the challenges of this curricular innovation. From 2012-2013, University of Missouri - Columbia and University of Washington partnered with six additional academic health centers to pilot a faculty development course to prepare faculty leaders for IPE. Using a variety of techniques, including didactic teaching, small group exercises, immersion participation in interprofessional education, local implementation of new IPE projects, and peer learning, the program positioned each site to successfully introduce an interprofessional innovation. Participating faculty confirmed the value of the program, and suggested that more widespread similar efforts were worthwhile. This guide briefly describes this faculty development program and identifies key lessons learned from the initiative. Peer learning arising from a faculty development community, adaptation of curricula to fit local context, experiential learning, and ongoing coaching/mentoring, especially as it related to actual participation in IPE activities, were among the key elements of this successful faculty development activity.

  8. Barriers and facilitators to the use of evidence-based best practices.

    Science.gov (United States)

    Leasure, A Renee; Stirlen, Joan; Thompson, Charleen

    2008-01-01

    The continued use of healthcare interventions without an evidence base increases healthcare costs without positively impacting patient care outcomes. Reports disseminated by bodies such as the Institute of Medicine and initiatives such as the Institute for Health Care Improvement's 5 Million Lives Campaign have increased emphasis on improving outcomes. Results of a descriptive correlational study indicated that 64% of the nurses surveyed read 7 or more specialty journals, 53% read 1 or more general nursing journal, 20% did not regularly read any professional journal, and none of the nurses surveyed read a journal that was primarily dedicated to the publication of original research. Almost half of the nurses indicated that the hospital library was the nearest location to conduct searches, and 34% indicated that they did not know what literature-searching capabilities were available to them. Although knowledge in itself is not sufficient for behavior change, it is an essential prerequisite. Regular reading of journals either through personal subscriptions or access through facility libraries can encourage the adoption of new evidence through lifelong learning. Modeling and skill building in use of readily available Internet resources can serve as a mechanism to increase awareness of and skill in accessing current information. Evidence-based changes can then be empirically examined, implemented, and evaluated in examining nursing's contribution to the daily operation of the healthcare organization.

  9. Improving Online Teaching by Using Established Best Classroom Teaching Practices.

    Science.gov (United States)

    Price, Jill M; Whitlatch, Joy; Maier, Cecilia Jane; Burdi, Melissa; Peacock, James

    2016-05-01

    This pilot study explored the effectiveness of an online workshop provided to faculty teaching one course in a large online RN-to-baccalaureate nursing (BSN) program. This exploration helped to fill a gap in knowledge related to implementing best classroom teaching practices into distance education for online nursing students. Focus groups with purposeful sampling (three focus groups: two faculty focus groups with a total of 11 faculty and one student focus group with a total of six students) were used to assess the effectiveness of the workshop and faculty and student perceptions of the seven best classroom teaching practices. Themes derived from the faculty focus groups included reaffirmation, commitments from students, and opportunities for instructor improvement. Themes derived from the student focus group included engagement, availability, encouragement, and diverse learning. Online teaching recommendations, created from the emerged themes of the study, could be considered to improve teaching practices of online nurse educators. J Contin Educ Nurs. 2016;47(5):222-227.

  10. Improving School Leadership. Volume 1: Policy and Practice

    Science.gov (United States)

    OECD Publishing (NJ3), 2008

    2008-01-01

    As countries strive to reform education systems and improve student results, school leadership is high on education policy agendas. But in many countries, the men and women who run schools are overburdened, underpaid and near retirement. And few people are lining up for their jobs. Based on an OECD study of school leadership practices and policies…

  11. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts....

  12. Improving Business School Courses by Applying Lean Principles and Practices

    Science.gov (United States)

    Emiliani, M. L.

    2004-01-01

    Describes the application of lean principles and practices to the design and delivery of a graduate business course on leadership taken by part-time working professional students in a classroom setting. The principal objectives were to improve consistency between what was taught in the course and how the course was taught, eliminate waste, improve…

  13. Best Practices Implementation for Hydropower Efficiency and Utilization Improvement

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Brennan T [ORNL; Zhang, Qin Fen [ORNL; March, Patrick [Hydro Performance Processes, Inc.; Cones, Marvin [Mesa Associates, Inc.; Dham, Rajesh [U.S. Department of Energy; Spray, Michael [New West Technologies, LLC.

    2012-01-01

    By using best practices to manage unit and plant efficiency, hydro owner/operators can achieve significant improvements in overall plant performance, resulting in increased generation and profitability and, frequently, reduced maintenance costs. The Hydropower Advancement Project (HAP) was initiated by the Wind and Hydropower Technologies Program within the U.S. Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy to develop and implement a systematic process with standard methodology, based on the best practices of operations, maintenance and upgrades; to identify the improvement opportunities at existing hydropower facilities; and to predict and trend the overall condition and improvement opportunity within the U.S. hydropower fleet. The HAP facility assessment includes both quantitative condition ratings and data-based performance analyses. However, this paper, as an overview document for the HAP, addresses the general concepts, project scope and objectives, best practices for unit and plant efficiency, and process and methodology for best practices implementation for hydropower efficiency and utilization improvement.

  14. Physician leadership: influence on practice-based learning and improvement.

    Science.gov (United States)

    Prather, Stephen E; Jones, David N

    2003-01-01

    In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical improvement falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for practice-based learning and improvement. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of practice-based learning and improvement is offered as a guide to accelerate change.

  15. Development of an Automated Bone Mineral Density Software Application: Facilitation Radiologic Reporting and Improvement of Accuracy.

    Science.gov (United States)

    Tsai, I-Ta; Tsai, Meng-Yuan; Wu, Ming-Ting; Chen, Clement Kuen-Huang

    2016-06-01

    The conventional method of bone mineral density (BMD) report production by dictation and transcription is time consuming and prone to error. We developed an automated BMD reporting system based on the raw data from a dual energy X-ray absorptiometry (DXA) scanner for facilitating the report generation. The automated BMD reporting system, a web application, digests the DXA's raw data and automatically generates preliminary reports. In Jan. 2014, 500 examinations were randomized into an automatic group (AG) and a manual group (MG), and the speed of report generation was compared. For evaluation of the accuracy and analysis of errors, 5120 examinations during Jan. 2013 and Dec. 2013 were enrolled retrospectively, and the context of automatically generated reports (AR) was compared with the formal manual reports (MR). The average time spent for report generation in AG and in MG was 264 and 1452 s, respectively (p Z scores in AR is 100 %. The overall accuracy of AR and MR is 98.8 and 93.7 %, respectively (p < 0.001). The mis-categorization rate in AR and MR is 0.039 and 0.273 %, respectively (p = 0.0013). Errors occurred in AR and can be grouped into key-in errors by technicians and need for additional judgements. We constructed an efficient and reliable automated BMD reporting system. It facilitates current clinical service and potentially prevents human errors from technicians, transcriptionists, and radiologists.

  16. How Does Sport Psychology Actually Improve Athletic Performance? A Framework to Facilitate Athletes' and Coaches' Understanding

    Science.gov (United States)

    Gee, Chris J.

    2010-01-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a…

  17. How Does Sport Psychology Actually Improve Athletic Performance? A Framework to Facilitate Athletes' and Coaches' Understanding

    Science.gov (United States)

    Gee, Chris J.

    2010-01-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a…

  18. Promote Green Building, Facilitate Energy Efficiency and Emissions Reduction, and Improve Habitat Environment

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    @@ Green building here refers to the practice of creating structures able to best achieve efficient and environmentally friendly use of resources (energy, land, water, materials) throughout the life-cycle so as to offer healthy, convenient and pleasant buildings for people to live and work in in harmony with nature.It has become a worldwide trend in the development of the construction industry.

  19. Promote Green Building, Facilitate Energy Efficiency and Emissions Reduction, and Improve Habitat Environment

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Green building here refers to the practice of creating structures able to best achieve efficient and environmentally friendly use of resources(energy, land, water, materials) throughout the life-cycle so as to offer healthy, convenient and pleasant buildings for people to live and work in in harmony with nature. It has become a worldwide trend in the development of the construction industry.

  20. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement

    Science.gov (United States)

    Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-01-01

    To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE’s viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: Endoscopy reporting systems must be electronic.Endoscopy reporting systems should be integrated into hospital patient record systems.Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient’s satisfaction; adverse events; surveillance recommendations.Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations. PMID:27087943

  1. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-01

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  2. Improving communication: a practical programme for teaching trainees about communication issues in the general practice consultation.

    Science.gov (United States)

    Boulton, M; Griffiths, J; Hall, D; McIntyre, M; Oliver, B; Woodward, J

    1984-07-01

    This paper describes a teaching programme, for use in general practice vocational training, which provides a theoretical and practical framework for exploring key aspects of the consultation with trainees. A particular emphasis is on the educational or 'cognitive' outcomes of the consultation and skills for improving them. The five stages of the programme are described and an example of experience of each stage is given. The paper concludes with an evaluation of the programme by the trainers, trainees and social scientist involved.

  3. Improving European Gas Infrastructure Regulation. Lessons from Theory and Practice

    Energy Technology Data Exchange (ETDEWEB)

    De Joode, J. [Delft University of Technology, Delft (Netherlands); Spanjer, A. [Leiden University, Leiden (Netherlands)

    2010-07-01

    As an instrument to trigger and speed up new investments in gas infrastructure across the European Union, the European Commission has implemented an exemption regime where new investment projects can apply for an exemption from default third party access regulation and tariff regulation. In this contribution we assess access holiday and transaction cost economics' literature and derive conditions for applying an exemption regime. We test whether these conditions are applied in practice by analysing the exemption application process of the Netherlands - UK interconnector (BBL). We conclude that current practice could substantially be improved.

  4. Improving Group Work Practices in Teaching Life Sciences: Trialogical Learning

    Science.gov (United States)

    Tammeorg, Priit; Mykkänen, Anna; Rantamäki, Tomi; Lakkala, Minna; Muukkonen, Hanni

    2017-08-01

    Trialogical learning, a collaborative and iterative knowledge creation process using real-life artefacts or problems, familiarizes students with working life environments and aims to teach skills required in the professional world. We target one of the major limitation factors for optimal trialogical learning in university settings, inefficient group work. We propose a course design combining effective group working practices with trialogical learning principles in life sciences. We assess the usability of our design in (a) a case study on crop science education and (b) a questionnaire for university teachers in life science fields. Our approach was considered useful and supportive of the learning process by all the participants in the case study: the students, the stakeholders and the facilitator. Correspondingly, a group of university teachers expressed that the trialogical approach and the involvement of stakeholders could promote efficient learning. In our case in life sciences, we identified the key issues in facilitating effective group work to be the design of meaningful tasks and the allowance of sufficient time to take action based on formative feedback. Even though trialogical courses can be time consuming, the experience of applying knowledge in real-life cases justifies using the approach, particularly for students just about to enter their professional careers.

  5. Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice.

    Science.gov (United States)

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

    2013-08-01

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

  6. Can sensory attention focused exercise facilitate the utilization of proprioception for improved balance control in PD?

    Science.gov (United States)

    Lefaivre, Shannon C; Almeida, Quincy J

    2015-02-01

    Impaired sensory processing in Parkinson's disease (PD) has been argued to contribute to balance deficits. Exercises aimed at improving sensory feedback and body awareness have the potential to ameliorate balance deficits in PD. Recently, PD SAFEx™, a sensory and attention focused rehabilitation program, has been shown to improve motor deficits in PD, although balance control has never been evaluated. The objective of this study was to measure the effects of PD SAFEx™ on balance control in PD. Twenty-one participants with mild to moderate idiopathic PD completed 12 weeks of PD SAFEx™ training (three times/week) in a group setting. Prior to training, participants completed a pre-assessment evaluating balance in accordance with an objective, computerized test of balance (modified clinical test of sensory integration and balance (m-CTSIB) and postural stability testing (PST)) protocols. The m-CTSIB was our primary outcome measure, which allowed assessment of balance in both eyes open and closed conditions, thus enabling evaluation of specific sensory contributions to balance improvement. At post-test, a significant interaction between time of assessment and vision condition (p=.014) demonstrated that all participants significantly improved balance control, specifically when eyes were closed. Balance control did not change from pre to post with eyes open. These results provide evidence that PD SAFEx™ is effective at improving the ability to utilize proprioceptive information, resulting in improved balance control in the absence of vision. Enhancing the ability to utilize proprioception for individuals with PD is an important intermediary to improving balance deficits.

  7. Assisting nurses to facilitate student and new graduate learning in practice settings: what 'support' do nurses at the bedside need?

    Science.gov (United States)

    Henderson, Amanda; Eaton, Emma

    2013-05-01

    The behaviours of nurses in the community of practice that new graduates and students participate directly contribute to learning. These behaviours are becoming more important with increasing numbers of students and graduates learning in health care contexts. Nurses, whether they assume the role of preceptor, buddy or mentor are pivotal in identifying appropriate learning opportunities for students and graduates, and assimilating these learners into the team. As nurses at the bedside have a designated caseload they need to be supported to perform this important role while delivering health care. The literature reports a number of constraints for nurses when facilitating the learning of others, namely, inadequate preparation about how to foster learning in this context, poor planning at the ward level, lack of reward or recognition for the role, lack of understanding about the specific learning needs of students and new graduates. This discussion paper provides direction for leadership and management teams to effectively support nurses who assume the role of preceptor, buddy or mentor to assist others' learning in the workplace. The recommendations suggest management teams provide for adequate preparation of nurses, effective planning of workload and organisation of work in the clinical area, and mechanisms for timely and specific feedback to maintain nurses interest and motivation in performing the role. Furthermore, senior leadership personnel need to establish a culture where the value of teaching and learning in practice is recognised and fostered by the entire team.

  8. The Role of A Facilitated Online Workspace Component of A Community of Practice: Knowledge Building and Value Creation for NASA

    Science.gov (United States)

    Davey, B.

    2014-12-01

    This study examined the role of an online workspace component of a community in the work of a community of practice. Much has been studied revealing the importance of communities of practice to organizations, project success, and knowledge management and some of these same successes hold true for virtual communities of practice. Study participants were 75 Education and Public Outreach community members of NASA's Science Mission Directorate Earth Forum. In this mixed methods study, online workspace metrics were used to track participation and a survey completed by 21 members was used to quantify participation. For a more detailed analysis, 15 community members (5 highly active users, 5 average users, and 5 infrequent users) selected based on survey responses, were interviewed. Finally, survey data was gathered from 7 online facilitators to understand their role in the community. Data collected from these 21 community members and 5 facilitating members suggest that highly active users (logging into the workspace daily), were more likely to have transformative experiences, co-create knowledge, feel ownership of community knowledge, have extended opportunities for community exchange, and find new forms of evaluation. Average users shared some similar characteristics with both the highly active members and infrequent users, representing a group in transition as they become more engaged and active in the online workspace. Inactive users viewed the workspace as having little value, being difficult to navigate, being mainly for gaining basic information about events and community news, and as another demand on their time. Results show the online workspace component of the Earth Science Education and Outreach Forum is playing an important and emerging role for this community by supporting knowledge building and knowledge sharing, and growing in value for those that utilizing it more frequently. The evidence suggests that with increased participation or "usage" comes

  9. Developing a performance data suite to facilitate lean improvement in a chemotherapy day unit.

    Science.gov (United States)

    Lingaratnam, Senthil; Murray, Danielle; Carle, Amber; Kirsa, Sue W; Paterson, Rebecca; Rischin, Danny

    2013-07-01

    A multidisciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia, developed a performance data suite to support a service improvement project based on lean manufacturing principles in its 19-chair chemotherapy day unit (CDU) and cytosuite chemotherapy production facility. The aims of the project were to reduce patient wait time and improve equity of access to the CDU. A project team consisting of a pharmacist and CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes, analyze root causes, eliminate non-value-adding steps, reduce variation, and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, medical record audits, and interrogation of electronic treatment records were undertaken. This project delivered a 38% reduction in median wait time on the day (from 32 to 20 minutes; P lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU, resulting in improved access to treatment and reduced waiting times on the day.

  10. Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

    Science.gov (United States)

    Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

    2011-04-01

    Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

  11. Meeting physicians' needs: a bottom-up approach for improving the implementation of medical knowledge into practice.

    Science.gov (United States)

    Vaucher, Carla; Bovet, Emilie; Bengough, Theresa; Pidoux, Vincent; Grossen, Michèle; Panese, Francesco; Burnand, Bernard

    2016-07-18

    Multiple barriers to knowledge translation in medicine have been identified (ranging from information overload to abstraction of models), leading to important implementation gaps. This study aimed at assessing the suggestions of practicing physicians for possible improvements of knowledge translation (KT) effectiveness into clinical practice. We used a mixed methods design. French- German- and Italian-speaking general practitioners, psychiatrists, orthopaedic surgeons, cardiologists, and diabetologists practicing in Switzerland were interrogated through semi-structured interviews, focus group discussions, and an online survey. A total of 985 physicians from three regions of Switzerland participated in the online survey, whereas 39 participated in focus group discussions and 14 in face-to-face interviews. Physicians expressed limitations and difficulties related to KT into their daily practice. Several barriers were identified, including influence and pressure of pharmaceutical companies, non-publication of negative results, mismatch between guidelines and practice, education gaps, and insufficient collaboration between research and practice. Suggestions to overcome barriers were improving education concerning the evaluation of scientific publications, expanding applicability of guidelines, having free and easy access to independent journals, developing collaborations between research and practice, and creating tools to facilitate access to medical information. Our study provides suggestions for improving KT into daily medical practice, matching the views, needs and preferences of practicing physicians. Responding to suggestions for improvements brought up by physicians may lead to better knowledge translation, higher professional satisfaction, and better healthcare outcomes.

  12. Global sourcing practices: a framework to improve sourcing strategy implementation

    OpenAIRE

    Mohamad, Marini Nurbanum Binti

    2009-01-01

    The aim of the research reported in this thesis is to gain understanding of global sourcing practices of companies in the UK and to develop a framework to improve sourcing strategy implementation. This research was conducted by carrying out literature review, analysis of case studies through semi-structured interviews, analysis of an online-based survey, development of a global sourcing framework, feedback process and finally the refinement of the framework. The global sourc...

  13. Improved injection needles facilitate germline transformation of the buckeye butterfly Junonia coenia.

    Science.gov (United States)

    Beaudette, Kahlia; Hughes, Tia M; Marcus, Jeffrey M

    2014-01-01

    Germline transformation with transposon vectors is an important tool for insect genetics, but progress in developing transformation protocols for butterflies has been limited by high post-injection ova mortality. Here we present an improved glass injection needle design for injecting butterfly ova that increases survival in three Nymphalid butterfly species. Using the needles to genetically transform the common buckeye butterfly Junonia coenia, the hatch rate for injected Junonia ova was 21.7%, the transformation rate was 3%, and the overall experimental efficiency was 0.327%, a substantial improvement over previous results in other butterfly species. Improved needle design and a higher efficiency of transformation should permit the deployment of transposon-based genetic tools in a broad range of less fecund lepidopteran species.

  14. Data Mining to Facilitate Effective User Navigation and Improve Structure of a Website

    Directory of Open Access Journals (Sweden)

    Shweta Mohod,

    2014-08-01

    Full Text Available Now a days for a company it is very important to have active presence on web to become successful in electronic market. This requirement is fulfilled by an interactive website of a company. Website can be used to sell goods, maintain customer relationships, promotion of goods. By looking at the customer's response towards website we can decide campaign for future products and services. So for this website should be interactive and must be used by user by the way designer wants to. So, it is very important to study navigational behavior of a customer. By analyzing the web logs which records the navigational activity of the customer we can get several sequential patterns which helps us to study whether user is pursuing site's goal or not. Sequences are analyzed with WUM (Web Utilization Miner which gives g-sequence (Generalized Sequence and aggregate tree as an output. On the basis of the structure that is given by WUM, conclusions are studied and it is decided whether site structure needs improvement; The improvements suggested should be minimum but at the same time site should satisfy business goal. A mathematical programming model is used which suggest minimum improvements to site. Improvements which tends to change structure of site are avoided as it may be confusing for old site user.

  15. Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

    Directory of Open Access Journals (Sweden)

    Hannes Karen

    2009-07-01

    Full Text Available Abstract Objective To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs who participated in an 18-month quality improvement program (QIP. This QIP was implemented to promote compliance with international guidelines. Methods Twenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?' Results Most GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles. Conclusion Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

  16. Improving Adolescent Literacy: Effective Classroom and Intervention Practices. IES Practice Guide. NCEE 2008-4027

    Science.gov (United States)

    Kamil, Michael L.; Borman, Geoffrey D.; Dole, Janice; Kral, Cathleen C.; Salinger, Terry; Torgesen, Joseph

    2008-01-01

    The goal of this practice guide is to formulate specific and coherent evidence-based recommendations that educators can use to improve literacy levels among adolescents in upper elementary, middle, and high schools. The target audience is teachers and other school personnel with direct contact with students, such as coaches, counselors, and…

  17. Recipe Modification Improves Food Safety Practices during Cooking of Poultry.

    Science.gov (United States)

    Maughan, Curtis; Godwin, Sandria; Chambers, Delores; Chambers Iv, Edgar

    2016-08-01

    Many consumers do not practice proper food safety behaviors when preparing food in the home. Several approaches have been taken to improve food safety behaviors among consumers, but there still is a deficit in actual practice of these behaviors. The objective of this study was to assess whether the introduction of food safety instructions in recipes for chicken breasts and ground turkey patties would improve consumers' food safety behaviors during preparation. In total, 155 consumers in two locations (Manhattan, KS, and Nashville, TN) were asked to prepare a baked chicken breast and a ground turkey patty following recipes that either did or did not contain food safety instructions. They were observed to track hand washing and thermometer use. Participants who received recipes with food safety instructions (n = 73) demonstrated significantly improved food safety preparation behaviors compared with those who did not have food safety instructions in the recipe (n = 82). In addition, the majority of consumers stated that they thought the recipes with instructions were easy to use and that they would be likely to use similar recipes at home. This study demonstrates that recipes could be a good source of food safety information for consumers and that they have the potential to improve behaviors to reduce foodborne illness.

  18. Mentor mother support for mothers experiencing intimate partner violence in family practice: A qualitative study of three different perspectives on the facilitators and barriers of implementation.

    Science.gov (United States)

    Loeffen, Maartje J W; Daemen, Jasper; Wester, Fred P J F; Laurant, Miranda G H; Lo Fo Wong, Sylvie H; Lagro-Janssen, Antoine L M

    2017-12-01

    Intimate partner violence (IPV) is highly prevalent and associated with physical and mental health problems. Mentor mother support is a low threshold intervention in family practice consisting of support by non-professionals trained to support mothers experiencing IPV. A mentor mother support study showed reduced exposure to IPV and decreased symptoms of depression. Identify factors determining implementation success of mentor mother support in family practice. Individual interviews were conducted with 12 family physicians, 16 abused mothers and three mentor mothers. Four mentor mothers participated in a focus group. Qualitative content analysis was used to analyse the data. The identification and discussion of abuse is hindered by family physicians' attitudes because they considered mothers experiencing IPV as a difficult target group with a responsibility of their own to break out of their violent situation. Some family physicians doubted the partner's violence because he was known as a patient as well. Acceptance of mentor mother support is related to the readiness for change of mothers experiencing IPV. Mentor mothers facilitate acceptance and completion of their support by connecting as a friend who is equal and less threatening than professionals. To improve successful implementation of mentor mother support in primary care, we should focus on family physicians' attitudes towards IPV. To change these attitudes, we recommend continuous training of family physicians. By being paraprofessional friends, mentor mothers offer low threshold support that is complementary to professional support and should be embedded more widely in primary care. [Box: see text].

  19. Practice improvement, part II: update on patient communication technologies.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support.

  20. Zero-tension lysimeters: An improved design to monitor colloid-facilitated contaminant transport in the vadose zone

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, M.L.; Scharf, R.L.; Shang, C.

    1995-04-24

    There is increasing evidence that mobile colloids facilitate the long-distance transport of contaminants. The mobility of fine particles and macromolecules has been linked to the movement of actinides, organic contaminants, and heavy metals through soil. Direct evidence for colloid mobility includes the presence of humic materials in deep aquifers as well as coatings of accumulated clay, organic matter, or sesquioxides on particle or aggregate surfaces in subsoil horizons of many soils. The potential for colloid-facilitated transport of contaminants from hazardous-waste sites requires adequate monitoring before, during, and after in-situ remediation treatments. Zero-tension lysimeters (ZTLs) are especially appropriate for sampling water as it moves through saturated soil, although some unsaturated flow events may be sampled as well. Because no ceramic barrier or fiberglass wick is involved to maintain tension on the water (as is the case with other lysimeters), particles suspended in the water as well as dissolved species may be sampled with ZTLs. In this report, a ZTL design is proposed that is more suitable for monitoring colloid-facilitated contaminant migration. The improved design consists of a cylinder made of polycarbonate or polytetrafluoroethylene (PTFE) that is placed below undisturbed soil material. In many soils, a hydraulically powered tube may be used to extract an undisturbed core of soil before placement of the lysimeter. In those cases, the design has significant advantages over conventional designs with respect to simplicity and speed of installation. Therefore, it will allow colloid-facilitated transport of contaminants to be monitored at more locations at a given site.

  1. Organizational management practices for achieving software process improvement

    Science.gov (United States)

    Kandt, Ronald Kirk

    2004-01-01

    The crisis in developing software has been known for over thirty years. Problems that existed in developing software in the early days of computing still exist today. These problems include the delivery of low-quality products, actual development costs that exceed expected development costs, and actual development time that exceeds expected development time. Several solutions have been offered to overcome out inability to deliver high-quality software, on-time and within budget. One of these solutions involves software process improvement. However, such efforts often fail because of organizational management issues. This paper discusses business practices that organizations should follow to improve their chances of initiating and sustaining successful software process improvement efforts.

  2. [Improving practice and organisation of care: methodology for systematic reviews].

    Science.gov (United States)

    Zaugg, Vincent; Savoldelli, Virginie; Sabatier, Brigitte; Durieux, Pierre

    2014-01-01

    The number of intervention studies designed to improve quality of care is increasing exponentially, making it difficult to access all available information on a given subject. Systematic reviews are tools that provide health professionals with comprehensive and objective information. This article describes the main phases of a systematic review: formulating the research question, search and selection of studies, data extraction and analysis, assessment of the methodological quality of studies, and synthesis of the results. Interventions designed to improve professional practices and organisation of care have specific characteristics that determine the methodology of systematic reviews. For example, the often substantial heterogeneity between populations, organisations, and intervention settings among studies must be taken into account, which makes meta-analysis more difficult. Knowledge on specific features of systematic reviews designed to improve quality of care is essential to ensure a good review of the literature, or to evaluate the level of evidence of published systematic reviews.

  3. The impact of the `Getting Practical: Improving Practical Work in Science' continuing professional development programme on teachers' ideas and practice in science practical work

    Science.gov (United States)

    Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael

    2014-09-01

    Background:Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The 'Getting Practical' CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of practical work through initiating changes in teachers' predominantly 'hands-on' approach to practical work to one which manifests a more equitable balance between 'hands-on' and 'minds-on'. Purpose:To evaluate the impact of the Getting Practical: Improving Practical Work in Science CPD programme on teachers' ideas and practice in science practical work in primary and secondary schools in England. Programme description:The CPD programme was designed to improve the effectiveness of science practical work in developing conceptual understanding in primary and secondary schools in England. Sample:Ten teachers of primary science and 20 secondary science teachers. Design and methods:The study employed a condensed fieldwork strategy with data collected using interviews, observational field notes and pre- and post-CPD training observations in practical lessons within 30 schools. Results:Whilst the CPD programme was effective in getting teachers to reflect on the ideas associated with the Getting Practical programme, it was much less effective in bringing about changes in actual teaching practice. Conclusion:The findings suggest that if change, rather than only an enhanced awareness of the issues, is to be brought about in established teaching practice then there is a need for ongoing support over an extended period of time. Furthermore, the impact of such CPD is more likely to be effective if it is undertaken by a senior member of a department or school with the full support of the SMT.

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

    Directory of Open Access Journals (Sweden)

    Travison Thomas G

    2007-11-01

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

  5. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Marwick, Charis A; Scott, Claire L; Charani, Esmita; McNeil, Kirsty; Brown, Erwin; Gould, Ian M; Ramsay, Craig R; Michie, Susan

    2017-02-09

    Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and

  6. Developing a monitoring method facilitating continual improvements in the sorting of waste at recycling centres.

    Science.gov (United States)

    Krook, Joakim; Eklund, Mats

    2010-01-01

    Beneficial use of waste relies on efficient systems for collection and separation. In Sweden, a bring system involving recycling centres for collection of bulky, electr(on)ic and hazardous waste has been introduced. A significant share of this waste is incorrectly sorted, causing downstream environmental implications. At present, however, there is a lack of affordable and accurate monitoring methods for providing the recycling centres with the necessary facts for improving the sorting of waste. The aim of this study was therefore to evaluate the usability of a simplified and potentially more suitable waste monitoring method for recycling centres. This method is based on standardised observations where the occurrence of incorrect sorting is monitored by taking digital pictures of the waste which then are analysed according to certain guidelines. The results show that the developed monitoring method could offer a resource-efficient and useful tool for proactive quality work at recycling centres, involving continuous efforts in developing and evaluating measures for improved sorting of waste. More research is however needed in order to determine to what extent the obtained results from the monitoring method are reliable.

  7. Social networks improve leaderless group navigation by facilitating long-distance communication

    Directory of Open Access Journals (Sweden)

    Nikolai W. F. BODE, A. Jamie WOOD, Daniel W. FRANKS

    2012-04-01

    Full Text Available Group navigation is of great importance for many animals, such as migrating flocks of birds or shoals of fish. One theory states that group membership can improve navigational accuracy compared to limited or less accurate individual navigational ability in groups without leaders (“Many-wrongs principle”. Here, we simulate leaderless group navigation that includes social connections as preferential interactions between individuals. Our results suggest that underlying social networks can reduce navigational errors of groups and increase group cohesion. We use network summary statistics, in particular network motifs, to study which characteristics of networks lead to these improvements. It is networks in which preferences between individuals are not clustered, but spread evenly across the group that are advantageous in group navigation by effectively enhancing long-distance information exchange within groups. We suggest that our work predicts a base-line for the type of social structure we might expect to find in group-living animals that navigate without leaders [Current Zoology 58 (2: 329-341, 2012].

  8. Social networks improve leaderless group navigation by facilitating long-distance communication

    Institute of Scientific and Technical Information of China (English)

    Nikolai W.F.BODE; A.Jamie WOOD; Daniel W.FRANKS

    2012-01-01

    Group navigation is of great importance for many animals,such as migrating flocks of birds or shoals of fish.One theory states that group membership can improve navigational accuracy compared to limited or less accurate individual navigational ability in groups without leaders ("Many-wrongs principle").Here,we simulate leaderless group navigation that includes social connectious as preferential interactions between individuals.Our results suggest that underlying social networks can reduce navigational errors of groups and increase group cohesion.We use network summary statistics,in particular network motifs,to study which characteristics of networks lead to these improvements.It is networks in which preferences between individuals are not clustered,but spread evenly across the group that are advantageous in group navigation by effectively enhancing long-distance information exchange within groups.We suggest that our work predicts a base-line for the type of social structure we might expect to find in group-living animals that navigate without leaders [Current Zoology 58 (2):329-341,2012].

  9. Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

    Science.gov (United States)

    McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

    2014-01-01

    We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  10. A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.

    Science.gov (United States)

    Varkey, Prathibha; Karlapudi, Sudhakar; Rose, Steven; Nelson, Roger; Warner, Mark

    2009-03-01

    The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

  11. Facilitating Settlement at the Arbitration Table: Comparing Views on Settlement Practice Among Arbitration Practitioners in East Asia and the West

    Directory of Open Access Journals (Sweden)

    Shahla Ali

    2011-10-01

    Full Text Available This article presents a cross cultural examination of how international arbitrators in East Asian and Western countries view the goal of settlement in international arbitration. The result of a 115 person survey and 64 follow up interviews shed light on the underlying cultural attitudes and approaches to settlement in international arbitration as practiced in diverse regions. The findings indicate that arbitration practitioner’s perceptions of the frequency of compromise decision in international arbitration demonstrate a high degree of convergence across regions. At the same time, cultural and socio-economic distinctions are reflected in varying arbitrator perceptions regarding the arbitrators’ role in settlement, whether settlement is regarded as a goal in arbitration and the types of efforts made pre-arbitration to settle disputes. In particular, arbitrators working in the East Asian region regard the goal of facilitating voluntary settlement in the context of international arbitration with greater importance and generally make greater efforts pre-arbitration to settle disputes as compared with counterparts in the West.DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=1934138

  12. Evaluating information literacy educators' practices before and after the course facilitating information literacy education: from tutor to learner-centred.

    Science.gov (United States)

    Andretta, Susie

    2011-09-01

    The article gives an account of a study on the impact of facilitating information literacy education (FILE) on its participants, health librarians who have attended this course between 2007 and 2010. The analysis presented here is based on the first stage of the research, funded by the Higher Education Academy Information and Computer Sciences and consisting of an online survey. This survey was conducted in Autumn 2010 and examined the respondents' examples of information literacy practice before and after FILE. Two main outcomes can be drawn from the data. First, that overall the respondents' provision of information literacy education has shifted from a tutor-centred approach (where the trainer decides what the learner needs) to a learner-centred approach (where the learner decides what he/she needs). And secondly, that the impact of FILE should be seen in terms of a self-perpetuating professional development, rather than measured in terms of specific changes that occur at set times (e.g., at the end of the course or 6 months after completion). As one FILE participant puts it: 'When FILE ends your career as an information literacy professional starts.' © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

  13. Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

    Science.gov (United States)

    Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

    2016-02-01

    Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project.

  14. From crossbreeding to biotechnology-facilitated improvement of banana and plantain.

    Science.gov (United States)

    Ortiz, Rodomiro; Swennen, Rony

    2014-01-01

    The annual harvest of banana and plantain (Musa spp.) is approximately 145 million tons worldwide. About 85% of this global production comes from small plots and kitchen or backyard gardens from the developing world, and only 15% goes to the export trade. Musa acuminata and Musa balbisiana are the ancestors of several hundreds of parthenocarpic Musa diploid and polyploid cultivars, which show multiple origins through inter- and intra-specific hybridizations from these two wild diploid species. Generating hybrids combining host plant resistance to pathogens and pests, short growth cycles and height, high fruit yield, parthenocarpy, and desired quality from the cultivars remains a challenge for Musa crossbreeding, which started about one century ago in Trinidad. The success of Musa crossbreeding depends on the production of true hybrid seeds in a crop known for its high levels of female sterility, particularly among polyploid cultivars. All banana export cultivars grown today are, however, selections from somatic mutants of the group Cavendish and have a very narrow genetic base, while smallholders in sub-Saharan Africa, tropical Asia and Latin America use some bred-hybrids (mostly cooking types). Musa improvement goals need to shift to address emerging threats because of the changing climate. Innovative cell and molecular biology tools have the potential to enhance the pace and efficiency of genetic improvement in Musa. Micro-propagation has been successful for high throughput of clean planting materials while in vitro seed germination assists in obtaining seedlings after inter-specific and across ploidy hybridization. Flow cytometry protocols are used for checking ploidy among genebank accessions and breeding materials. DNA markers, the genetic maps based on them, and the recent sequencing of the banana genome offer means for gaining more insights in the genetics of the crops and to identifying genes that could lead to accelerating Musa betterment. Likewise, DNA

  15. An interactive web-based learning unit to facilitate and improve intrapartum nursing care of nursing students.

    Science.gov (United States)

    Gerdprasert, Sailom; Pruksacheva, Tassanee; Panijpan, Bhinyo; Ruenwongsa, Pintip

    2011-07-01

    First clinical exposures are stressful situations for nursing students, especially, when practicing on the labour ward. The purpose of this study was to develop intrapartum nursing care web-based learning to facilitate students' acquisition of conceptual knowledge and performance skills. This web-based learning unit integrated the 5E-model and information technology with the lecture content. Eighty four nursing students were recruited in the study. The control group received traditional teaching, while the experimental group was supplemented with the web-based learning unit on intrapartum nursing care. The results showed that the students in the experimental group had significant higher scores in conceptual knowledge and performance skill. The students also had significant lower scores in ignorance - related stress when compared to those of the control group. The students supplemented with the web-based course showed a strong positive attitude toward the new learning method.

  16. Assessing the Use of Metaphors to Facilitate and Improve the Effectiveness of Climate Change Communication

    Science.gov (United States)

    Walsh-Thomas, J.; Maibach, E.

    2014-12-01

    Metaphors are sometimes used in science communication to explain unfamiliar scientific concepts and processes in more familiar terms. Empirical research has shown that metaphors can help audiences better understand complicated scientific concepts. A growing number of metaphors are used to explain various climate science concepts, but the only empirical evaluation of climate metaphors to date (van der Linden et al, 2014, Climatic Change) found that medical and bridge safety metaphors did not enhance the effectiveness of a simple corrective statement about the scientific consensus on human-caused climate change. Drawing on a recent meta-analysis by Sopory and Dillard (2002, Hum Commun. Res.), we will briefly review what is known about appropriate metaphor usage in communicating scientific concepts. We will also present preliminary findings from an experiment currently underway to further explain the conditions in which metaphors are likely to help in communicating climate science concepts. We hypothesize that metaphors will be more effective in communicating high complexity climate science concepts that are less easily understood by the public than more easily understood low complexity concepts (such as scientific consensus on climate change). We also hypothesize that the more familiar people are with the referent (performance enhancing drugs in baseball is a metaphor about "the climate system on steroids"), the more effective the metaphor will be. To test these hypotheses, we are randomly assigning ~1000 adults - approximately representative of the US adult population - to read one brief passage in which one of four relatively simple or complex climate concepts is presented and explained with or without a metaphor. The outcome measures will include climate change belief, concern, knowledge, and involvement. This study is intended to add to the knowledge base about use of metaphors in science communication, and provide practical advice to climate communicators.

  17. Improved Radiation Dosimetry/Risk Estimates to Facilitate Environmental Management of Plutonium-Contaminated Sites

    Energy Technology Data Exchange (ETDEWEB)

    Scott, Bobby R.; Tokarskaya, Zoya B.; Zhuntova, Galina V.; Osovets, Sergey V.; Syrchikov, Victor A., Belyaeva, Zinaida D.

    2007-12-14

    This report summarizes 4 years of research achievements in this Office of Science (BER), U.S. Department of Energy (DOE) project. The research described was conducted by scientists and supporting staff at Lovelace Respiratory Research Institute (LRRI)/Lovelace Biomedical and Environmental Research Institute (LBERI) and the Southern Urals Biophysics Institute (SUBI). All project objectives and goals were achieved. A major focus was on obtaining improved cancer risk estimates for exposure via inhalation to plutonium (Pu) isotopes in the workplace (DOE radiation workers) and environment (public exposures to Pu-contaminated soil). A major finding was that low doses and dose rates of gamma rays can significantly suppress cancer induction by alpha radiation from inhaled Pu isotopes. The suppression relates to stimulation of the body's natural defenses, including immunity against cancer cells and selective apoptosis which removes precancerous and other aberrant cells.

  18. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Brown, Erwin; Charani, Esmita; Fenelon, Lynda; Gould, Ian M; Holmes, Alison; Ramsay, Craig R; Wiffen, Philip J; Wilcox, Mark

    2013-04-30

    included any professional or structural interventions as defined by EPOC. The intervention had to include a component that aimed to improve antibiotic prescribing to hospital inpatients, either by increasing effective treatment or by reducing unnecessary treatment. The results had to include interpretable data about the effect of the intervention on antibiotic prescribing or microbial outcomes or relevant clinical outcomes. Two authors extracted data and assessed quality. We performed meta-regression of ITS studies to compare the results of persuasive and restrictive interventions. Persuasive interventions advised physicians about how to prescribe or gave them feedback about how they prescribed. Restrictive interventions put a limit on how they prescribed; for example, physicians had to have approval from an infection specialist in order to prescribe an antibiotic. We standardized the results of some ITS studies so that they are on the same scale (percent change in outcome), thereby facilitating comparisons of different interventions. To do this, we used the change in level and change in slope to estimate the effect size with increasing time after the intervention (one month, six months, one year, etc) as the percent change in level at each time point. We did not extrapolate beyond the end of data collection after the intervention. The meta-regression was performed using standard weighted linear regression with the standard errors of the coefficients adjusted where necessary. For this update we included 89 studies that reported 95 interventions. Of the 89 studies, 56 were ITSs (of which 4 were controlled ITSs), 25 were RCT (of which 5 were cluster-RCTs), 5 were CBAs and 3 were CCTs (of which 1 was a cluster-CCT).Most (80/95, 84%) of the interventions targeted the antibiotic prescribed (choice of antibiotic, timing of first dose and route of administration). The remaining 15 interventions aimed to change exposure of patients to antibiotics by targeting the decision to treat

  19. Sintered cadmium telluride nanocrystal photovoltaics: Improving chemistry to facilitate roll-to-roll fabrication

    Science.gov (United States)

    Kurley, James Matthew, III

    Recent interest in clean, renewable energy has increased importance on cost-effective and materials efficient deposition methods. Solution-processed solar cells utilizing cadmium telluride nanocrystal inks offer a viable method for reducing cost, increasing materials effectiveness, and decreasing the need for fossil fuels in the near future. Initial work focused on developing a useful platform for testing new chemistries for solubilizing and depositing nanocrystal inks. Layer-by-layer deposition using a combination of spincoating, cadmium chloride treatment, and annealing created a photovoltaic-grade CdTe absorber layer. In conjunction with layer-by-layer deposition, a device architecture of ITO/CdTe/ZnO/Al was utilized to create power conversion efficiencies of over 12% with the help of current/light soaking. Detailed exploration of device geometry, capacitance measurements, and intensity- and temperature-dependent testing determined the ITO/CdTe interface required additional scrutiny. This initial investigation sparked three new. avenues of research: create an Ohmic contact to CdTe, remove the cadmium chloride bath treatment, and create a roll-to-roll friendly process. Improved contact between ITO and CdTe was achieved by using a variety of materials already proven to create Ohmic contact to CdTe. While most of these materials were previously employed using standard approaches, solution-processed analogs were explored. The cadmium chloride bath treatment proved inconsistent, wasteful, and difficult to utilize quickly. It was removed by using trichlorocadmate-capped nanocrystals to combine the semiconductor with the required grain growth agent. To establish roll-to-roll friendly process, the deposition method was improved, heating source changed, and cadmium chloride bath step was removed. Spraycoating or doctor-blading the trichlorocadmate-capped nanocrystals followed by annealing with an IR lamp established a process that can deposit CdTe in a high throughput

  20. Breast cancer practice guidelines: evaluation and quality improvement.

    Science.gov (United States)

    Edge, S B

    1997-11-01

    The utility of practice guidelines in breast cancer management remains unproved. This paper examines the scope and goals of published guidelines and their utility in the process of breast cancer treatment quality improvement. Although existing breast cancer guidelines vary widely in scope and intent, they provide a framework for meaningful quality-of-care evaluation. Among the few comprehensive breast cancer guideline programs are those developed by the Ontario Cancer Treatment Practice Guidelines Initiative, the Revlon/UCLA Breast Center, the Association of Community Cancer Centers (ACCC), the Society of Surgical Oncology (SSO), and the National Comprehensive Cancer Network (NCCN). Ultimately, guidelines will prove useful only if they are utilized as part of a comprehensive program to improve quality, cost-effectiveness, and outcomes. To accomplish this, they must include mechanisms for revision and evaluation. The evaluation of guideline utility in quality improvement, particularly in breast cancer care, is a complex long-term process, which should include input from practitioners, institutions, payors, and government.

  1. Skill analysis part 3: improving a practice skill.

    Science.gov (United States)

    Price, Bob

    In this, the third and final article in a series on practice skill analysis, attention is given to imaginative ways of improving a practice skill. Having analysed and evaluated a chosen skill in the previous two articles, it is time to look at new ways to proceed. Creative people are able to be analytical and imaginative. The process of careful reasoning involved in analysing and evaluating a skill will not necessarily be used to improve it. To advance a skill, there is a need to engage in more imaginative, free-thinking processes that allow the nurse to think afresh about his or her chosen skill. Suggestions shared in this article are not exhaustive, but the material presented does illustrate measures that in the author's experience seem to have potential. Consideration is given to how the improved skill might be envisaged (an ideal skill in use). The article is illustrated using the case study of empathetic listening, which has been used throughout this series.

  2. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward.

    Science.gov (United States)

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice.

  3. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

    Science.gov (United States)

    Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

    Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

  4. Guided Inquiry Facilitated Blended Learning to Improve Metacognitive and Learning Outcome of High School Students

    Science.gov (United States)

    Suwono, H.; Susanti, S.; Lestari, U.

    2017-04-01

    The learning activities that involve the students to learn actively is one of the characteristics of a qualified education. The learning strategy that involves students’ active learning is guided inquiry. Learning problems today are growing metacognitive skills and cognitive learning outcomes. It is the research and development of learning module by using 4D models of Thiagarajan. The first phase is Define, which analyses the problems and needs required by the prior preparation of the module. The second phase is Design, which formulates learning design and devices to obtain the initial draft of learning modules. The third stage is Develop, which is developing and writing module, module validation, product testing, revision, and the resulting an end-product results module development. The fourth stage is Disseminate, which is disseminating of the valid products. Modules were validated by education experts, practitioners, subject matter experts, and expert of online media. The results of the validation module indicated that the module was valid and could be used in teaching and learning. In the validation phase of testing methods, we used experiments to know the difference of metacognitive skills and learning outcomes between the control group and experimental group. The experimental design was a one group pretest-posttest design. The results of the data analysis showed that the modules could enhance metacognitive skills and learning outcomes. The advantages of this module is as follows, 1) module is accompanied by a video link on a website that contains practical activities that are appropriate to Curriculum 2013, 2) module is accompanied by a video link on a website that contains about manual laboratory activities that will be used in the classroom face-to-face, so that students are ready when doing laboratory activities, 3) this module can be online through chat to increase students’ understanding. The disadvantages of this module are the material presented in

  5. Quality improvement – rival or ally of practice development?

    Directory of Open Access Journals (Sweden)

    Gavin Lavery

    2016-05-01

    Full Text Available The majority of nurses, doctors, allied health professionals and other healthcare staff possess a strong desire to provide the best possible care and experience for their patients. Unfortunately, this sometimes falls short of what was planned or intended (Institute of Medicine, 2001, p 23. The gap between care intended and care delivered can be explained by problems with systems and processes and/or people and culture. The narrowing of this gap is the focus of many strategies, methodologies and approaches. Practice development is described as ‘an activity focused on developing people and practice for the ultimate purpose of achieving high-quality person-centred care’ and a ‘methodology that aims to achieve effective workplace cultures that are person-centred’ (Shaw, 2012; Manley et al., 2014. Practice development undoubtedly has a strong focus on people and culture and the potential to change processes and systems. Another approach, widely referred to as quality improvement, aims to improve safety, effectiveness and person-centredness in healthcare using principles proven effective in other industries such as manufacturing – notably car manufacturing (Toyota, oil production, nuclear power and aviation. The fundamental principles of quality improvement for healthcare include making care reliable (every patient receiving care as intended every time, using well-designed processes and reducing variation (agreeing a consistent way to provide care. At first glance this may appear to be an approach suited only to systems and processes. However, better processes, designed by those who use them, resulting in fewer errors and less re-working or working around problems, can reduce stress on staff, offer greater job satisfaction with improved morale and free up time to provide person-centred care. In his report, A Promise to Learn – a Commitment to Act (2013, p 24, Professor Don Berwick says: ‘Mastery of quality and patient safety sciences and

  6. Electrotactile feedback improves performance and facilitates learning in the routine grasping task

    Directory of Open Access Journals (Sweden)

    Milica Isaković

    2016-06-01

    Full Text Available Aim of this study was to investigate the feasibility of electrotactile feedback in closed loop training of force control during the routine grasping task. The feedback was provided using an array electrode and a simple six-level spatial coding, and the experiment was conducted in three amputee subjects. The psychometric tests confirmed that the subjects could perceive and interpret the electrotactile feedback with a high success rate. The subjects performed the routine grasping task comprising 4 blocks of 60 grasping trials. In each trial, the subjects employed feedforward control to close the hand and produce the desired grasping force (four levels. First (baseline and the last (validation session were performed in open loop, while the second and the third session (training included electrotactile feedback. The obtained results confirmed that using the feedback improved the accuracy and precision of the force control. In addition, the subjects performed significantly better in the validation vs. baseline session, therefore suggesting that electrotactile feedback can be used for learning and training of myoelectric control.

  7. Impact of Company Size on Manufacturing Improvement Practices: An empirical study

    Science.gov (United States)

    Syan, C. S.; Ramoutar, K.

    2014-07-01

    There is a constant search for ways to achieve a competitive advantage through new manufacturing techniques. Best performing manufacturing companies tend to use world-class manufacturing (WCM) practices. Although the last few years have witnessed phenomenal growth in the use of WCM techniques, their effectiveness is not well understood specifically in the context of less developed countries. This paper presents an empirical study to investigate the impact of company size on improving manufacturing performance in manufacturing organizations based in Trinidad and Tobago (T&T). Empirical data were collected via a questionnaire survey which was send to 218 manufacturing firms in T&T. Five different company sizes and seven different industry sectors were studied. The analysis of survey data was performed with the aid of Statistical Package for Social Sciences (SPSS) software. The study signified facilitating and impeding factors towards improving manufacturing performance. Their relative impact/importance is dependent on varying company size and industry sectors. Findings indicate that T&T manufacturers are still practicing traditional approaches, when compared with world class manufacturers. In the majority of organizations, these practices were not 100% implemented even though they started the implementation process more than 5 years ago. The findings provided some insights in formulating more optimal operational strategies, and later develop action plans towards more effective implementation of WCM in T&T manufacturers.

  8. Transfusing Wisely: Clinical Decision Support Improves Blood Transfusion Practices.

    Science.gov (United States)

    Jenkins, Ian; Doucet, Jay J; Clay, Brian; Kopko, Patricia; Fipps, Donald; Hemmen, Eema; Paulson, Debra

    2017-08-01

    The cost and risks of red blood cell (RBC) transfusions, along with evidence of overuse, suggest that improving transfusion practices is a key opportunity for health systems to improve both the quality and value of patient care. Previous work, which included a BestPractice Advisory (BPA), was adapted in a quality improvement project designed to reduce both exposure to unnecessary blood products and costs. A prospective, pre-post study was conducted at an academic medical center with a diverse patient population. All noninfant inpatients without gastrointestinal bleeding who were not within 12 hours of surgical procedures were included. The interventions were education, a BPA, and other enhancements to the computerized provider order entry system. The percentage of multiunit (≥ 2 units) RBC transfusions decreased from 59.9% to 41.7% during the intervention period and to 19.7% postintervention (p < 0.0001). The percentage of inpatient RBC transfusion units administered for hemoglobin (Hb) ≥ 7 g/dL declined from 72.3% to 57.8% during the intervention period and to 38.0% for the postintervention period (p < 0.0001). The overall rate of inpatient RBC transfusion (units administered per 1,000 patient-days without exclusions) decreased from 89.8 to 78.1 during the intervention period and to 72.7 during the postintervention period (p <0.0001). The estimated annual cost savings was $1,050,750. The interventions reduced multiunit transfusions (by 67.1%) and transfusions for Hb ≥ 7 g/dL (by 47.4%). The improvement in the overall transfusion rate (19.0%) was less marked, limited by better baseline performance relative to other centers. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  9. Yoga practice improves executive function by attenuating stress levels.

    Science.gov (United States)

    Gothe, Neha P; Keswani, Rahul K; McAuley, Edward

    2016-12-01

    Prolonged activation of the hypothalamus-pituitary-adrenal system is thought to have deleterious effects on brain function. Neuroendocrine studies suggest that brain exposure to higher cortisol concentrations contribute to cognitive deficits as we age. Mind-body techniques such as yoga have shown to improve stress levels by restoring the body's sympathetic-parasympathetic balance. The objective of this study was to determine whether yoga practice moderated the stress response resulting in improved executive function. Sedentary community dwelling older adults (N=118, Mean age=62.02) were randomized to an 8-week yoga intervention or a stretching control group. At baseline and following 8 weeks, all participants completed measures of executive function, self-reported stress and anxiety and provided saliva samples before and after cognitive testing to assess cortisol. Yoga participants showed improved accuracy on executive function measures and an attenuated cortisol response compared to their stretching counterparts who showed increased cortisol levels and poor cognitive performance at follow up. The change in cortisol levels as well as self-reported stress and anxiety levels predicted performance on the running span task, n-back working memory and task switching paradigm (β's=0.27-0.38, p's≤0.05 for yoga and β's=-0.37-0.47, p's≤0.01 for stretching control). Eight weeks of regular yoga practice resulted in improved working memory performance that was mediated by an attenuated response to stress as measured by self-report stress and objective salivary cortisol measurements. This trial offers evidence for non-traditional physical activity interventions such as yoga that may be helpful in restoring HPA balance in older adults, thereby preventing cognitive decline. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Development and early experience from an intervention to facilitate teamwork between general practices and allied health providers: the Team-link study

    Directory of Open Access Journals (Sweden)

    Zwar Nick

    2010-04-01

    Full Text Available Abstract Background This paper describes the development and implementation of an intervention to facilitate teamwork between general practice and outside allied and community health services and providers. Methods A review of organizational theory and a qualitative study of 9 practices was used to design an intervention which was applied in four Divisions of General Practice and 26 urban practices. Clinical record review and qualitative interviews with participants were used to determine the key lessons from its implementation. Results Facilitating teamwork across organizational boundaries was very challenging. The quality of the relationship between professionals was of key importance. This was enabled by joint education and direct communication between providers. Practice nurses were key links between general practices and allied and community health services. Conclusions Current arrangements for Team Care planning provide increased opportunities for access to allied health. However the current paper based system is insufficient to build relationships or effectively share roles as part of a patient care team. Facilitation is feasible but constrained by barriers to communication and trust.

  11. Development and early experience from an intervention to facilitate teamwork between general practices and allied health providers: the Team-link study.

    Science.gov (United States)

    Harris, Mark F; Chan, Bibiana C; Daniel, Christopher; Wan, Qing; Zwar, Nick; Davies, Gawaine Powell

    2010-04-27

    This paper describes the development and implementation of an intervention to facilitate teamwork between general practice and outside allied and community health services and providers. A review of organizational theory and a qualitative study of 9 practices was used to design an intervention which was applied in four Divisions of General Practice and 26 urban practices. Clinical record review and qualitative interviews with participants were used to determine the key lessons from its implementation. Facilitating teamwork across organizational boundaries was very challenging. The quality of the relationship between professionals was of key importance. This was enabled by joint education and direct communication between providers. Practice nurses were key links between general practices and allied and community health services. Current arrangements for Team Care planning provide increased opportunities for access to allied health. However the current paper based system is insufficient to build relationships or effectively share roles as part of a patient care team. Facilitation is feasible but constrained by barriers to communication and trust.

  12. Clinical scientists improving clinical practices: in thoughts and actions.

    Science.gov (United States)

    Apel, Kenn

    2014-04-01

    In this article, the author comments on aspects of Kamhi's (2014) article, which caused the author to think more deeply about definitions of language, theories of learning, and how these two core components of intervention prepare clinical scientists as they search the literature for new knowledge. Interprofessional collaborative practice as a model for team-based intervention in school settings is also discussed. The article addresses aspects of Kamhi's article that aligned or did not align with the author's definition of language and theory of learning and explains why considering these alignments is important for clinical scientists. Two challenges to staying current with the research base are also described, and suggestions are offered for addressing these challenges. Finally, the article provides an overview of interprofessional collaborative practice. Clinical scientists should continue to strive to use their knowledge of what language is and how it is learned, combined with the best available scientific information, to best serve their clients. Combining their thoughts and actions, they undoubtedly will continuously improve their clinical practices.

  13. Kidney Failure and Liver Allocation: Current Practices and Potential Improvements.

    Science.gov (United States)

    Saxena, Varun; Lai, Jennifer C

    2015-09-01

    In February 2002, the United Network for Organ Sharing implemented a system for prioritizing candidates for liver transplantation that was based on the risk of 90-day mortality as determined by the Model for End-Stage Liver Disease (MELD) score. As the MELD score is driven in part by serum creatinine as a marker of kidney function, the prevalence of kidney dysfunction and failure in patients with end-stage liver disease at the time of listing and at transplantation has steadily risen. In this review, we discuss current practices in liver transplantation in patients with kidney dysfunction focusing briefly on the decision to perform simultaneous liver-kidney transplantation. We then discuss pitfalls to the current practices of liver transplantation in patients with kidney dysfunction. We conclude by discussing potential improvements to current practices including the use of the MELD-Na score, alternatives to creatinine and creatinine-based equation for estimating kidney function, and the use of intraoperative kidney replacement therapy during liver transplantation.

  14. An Exploration of Teachers' Narratives: What Are the Facilitators and Constraints Which Promote or Inhibit "Good" Formative Assessment Practices in Schools?

    Science.gov (United States)

    Sach, Elizabeth

    2015-01-01

    This paper set out to explore teachers' narratives in order to understand some of the facilitators and constraints which promote or inhibit good formative assessment practices in schools. A "responsive interview" approach was used to probe a small sample of lower and middle school teachers' perceptions of formative assessment.…

  15. Can health care teams improve primary care practice?

    Science.gov (United States)

    Grumbach, Kevin; Bodenheimer, Thomas

    2004-03-10

    In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.

  16. Improving haemophilia patient care through sharing best practice.

    Science.gov (United States)

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Benefits, Facilitators, Barriers, and Strategies to Improve Pesticide Protective Behaviors: Insights from Farmworkers in North Carolina Tobacco Fields.

    Science.gov (United States)

    Walton, AnnMarie Lee; LePrevost, Catherine E; Linnan, Laura; Sanchez-Birkhead, Ana; Mooney, Kathi

    2017-06-23

    Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino farmworkers perceive little control over their occupational health. Using the Health Belief Model as a theoretical guide, we explored the perceptions of Latino farmworkers working in tobacco in North Carolina (n = 72) about benefits and facilitators of pesticide protective behaviors as well as barriers, and strategies to overcome barriers to their use. Interviews were conducted with participants at farmworker housing during non-work time. Qualitative data were analyzed using ATLAS.ti. Farmworkers recognized pesticide protective behaviors as helping them to not get sick and stay healthy. Farmworkers perceived work experience as facilitating protective behaviors. Wetness in the field was the most commonly cited barrier to protective behavior use. To overcome this barrier, farmworkers suggested use of water-resistant outerwear, as well as packing a change of clothes for mid-day, with space and time to change provided by employers. Examination of the efficacy and feasibility of farmworkers' suggestions for addressing barriers is warranted. Training and behavior modeling by experienced peers may improve behavior adoption and perceived control.

  18. Implementation of quality improvement skills by primary care teams: case study of a large academic practice.

    Science.gov (United States)

    Watts, Brook; Lawrence, Renée H; Singh, Simran; Wagner, Carol; Augustine, Sarah; Singh, Mamta K

    2014-04-01

    Continuous quality improvement (QI) is important to primary care in general, and is emphasized as a key tenet of the primary care patient-centered medical home (PCMH) model. While team-based QI activities within the PCMH model are expected, concerns exist as to how successful efforts have been at implementing team-driven QI projects. To (a) identify opportunities and challenges to QI efforts in a large primary care practice in order to (b) develop action plans to facilitate QI work into primary care teams. We obtained qualitative and quantitative information about existing primary care team QI initiatives. Eleven interdisciplinary primary care teams and 4 facilitators/coaches. We conducted unstructured interviews and gathered documentation from primary care team members about QI efforts to (a) characterize team-based QI progress and (b) identify barriers and facilitators. In the 18 months since local leadership prioritized conducting team-based QI projects, team members described multiple exposures to QI training, coaching resources, and data/analysis support. No team developed a formal aim statement. Six of the 11 teams completed any steps beyond the initial team discussion. Four teams attempted to apply an intervention. Challenges included team time and competing demands/priorities; 3 of the 4 teams attempting to implement a project credited a data/informatics facilitator for their progress. In this large academic primary care clinic setting, interdisciplinary team training in QI, support for data collection, and dedicated coaching resources produced few sustainable continuous QI initiatives. Several potentially modifiable barriers to initiation, completion, and sustainability of QI initiatives by primary care teams were identified.

  19. Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people

    National Research Council Canada - National Science Library

    Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

    2014-01-01

    .... The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill...

  20. Facilitating improved road safety based on increased knowledge about driving behaviour and profiling sub-groups of drivers

    DEFF Research Database (Denmark)

    Martinussen, Laila Marianne

    with underlying mechanisms of lack of focus, emotional stress, recklessness and confusion, and hence it is highly important to further explore means to making drivers become more focused or attentive when driving, and to deal with emotional responses in traffic like impatience and frustration (Article 1). 2......The aim of the Ph.D. study presented in this thesis was to facilitate improved road safety through increased understanding of methods used to measure driving behaviour, and through increased knowledge about driving behaviour in sub-groups of drivers. More specifically, the usefulness of the Driver...... Behaviour Questionnaire (DBQ) within a Danish context was explored, sub-groups of drivers differing in their potential danger in traffic were identified, and the relationship between implicit attitudes towards safe and risky driving and self-reported driving behaviour was explored. The methods applied were...

  1. Light-emitting conjugated polymers with microporous network architecture: interweaving scaffold promotes electronic conjugation, facilitates exciton migration, and improves luminescence.

    Science.gov (United States)

    Xu, Yanhong; Chen, Long; Guo, Zhaoqi; Nagai, Atsushi; Jiang, Donglin

    2011-11-09

    Herein we report a strategy for the design of highly luminescent conjugated polymers by restricting rotation of the polymer building blocks through a microporous network architecture. We demonstrate this concept using tetraphenylethene (TPE) as a building block to construct a light-emitting conjugated microporous polymer. The interlocked network successfully restricted the rotation of the phenyl units, which are the major cause of fluorescence deactivation in TPE, thus providing intrinsic luminescence activity for the polymers. We show positive "CMP effects" that the network promotes π-conjugation, facilitates exciton migration, and improves luminescence activity. Although the monomer and linear polymer analogue in solvents are nonemissive, the network polymers are highly luminescent in various solvents and the solid state. Because emission losses due to rotation are ubiquitous among small chromophores, this strategy can be generalized for the de novo design of light-emitting materials by integrating the chromophores into an interlocked network architecture.

  2. A degradable, bioactive, gelatinized alginate hydrogel to improve stem cell/growth factor delivery and facilitate healing after myocardial infarction.

    Science.gov (United States)

    Della Rocca, Domenico G; Willenberg, Bradley J; Ferreira, Leonardo F; Wate, Prateek S; Petersen, John W; Handberg, Eileen M; Zheng, Tong; Steindler, Dennis A; Terada, Naohiro; Batich, Christopher D; Byrne, Barry J; Pepine, Carl J

    2012-11-01

    Despite remarkable effectiveness of reperfusion and drug therapies to reduce morbidity and mortality following myocardial infarction (MI), many patients have debilitating symptoms and impaired left ventricular (LV) function highlighting the need for improved post-MI therapies. A promising concept currently under investigation is intramyocardial injection of high-water content, polymeric biomaterial gels (e.g., hydrogels) to modulate myocardial scar formation and LV adverse remodeling. We propose a degradable, bioactive hydrogel that forms a unique microstructure of continuous, parallel capillary-like channels (Capgel). We hypothesize that the innovative architecture and composition of Capgel can serve as a platform for endogenous cell recruitment and drug/cell delivery, therefore facilitating myocardial repair after MI.

  3. Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

    Directory of Open Access Journals (Sweden)

    Qingyan Ma

    2016-10-01

    Full Text Available Introduction: Qualitative research on antiretroviral therapy (ART adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. Methods: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research approach to assess the confidence of review findings. Results: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025, children living with HIV (two studies, n=46, adolescents living with HIV (four studies, n=70 and pregnant women living with HIV (one study, n=79. Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay

  4. Efficacy of proprioceptive neuromuscular facilitation techniques versus traditional prosthetic training for improving ambulatory function in transtibial amputees

    Directory of Open Access Journals (Sweden)

    Pallavi Sahay, MPT

    2014-06-01

    Full Text Available The objective of this randomized controlled trial was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF techniques in comparison to traditional prosthetic training (TPT in improving ambulatory function in transtibial amputees. Thirty study participants (19 men and 11 women with unilateral transtibial amputation participated in the study. They were randomly allocated to either the traditional training group (i.e., TPT (n = 15 or the PNF training group (n = 15. The treatment in the TPT group consisted of weight-bearing, weight-shifting, balance, and gait exercises for 30 minutes daily for 10 treatment sessions. In the PNF group, the same activities were performed by employing PNF principles and techniques. The outcome measures were gait parameters (e.g., stride width, step length, and stride length and the Locomotor Capabilities Index (LCI. The between-group comparisons at the end of the trial showed that the PNF group showed significant improvement in gait parameters and in the LCI, compared to the TPT group (p < 0.05. The results of the study suggested that prosthetic training based on proprioceptive feedback is more effective than the traditional prosthetic programme in improving ambulatory function.

  5. Opportunities for improving, adapting and introducing emollient therapy and improved newborn skin care practices in Africa.

    Science.gov (United States)

    Duffy, Jean L; Ferguson, Rebecca M; Darmstadt, Gary L

    2012-04-01

    Infections and complications from prematurity cause a majority of global neonatal deaths. Recent evidence has demonstrated the life-saving ability of topical emollient therapy in resource-poor settings. With the potential to reduce infection and neonatal mortality by 41 and 26%, respectively, emollient therapy is a promising option for improving newborn care. While application of oil to the newborn is nearly universal in South Asia, little is known about this behavior in Africa. This article draws on literature regarding neonatal skin care in Africa to describe behaviors, motivations and potential for introducing topical emollients. Oil massage does not appear to be universal. When oil massage occurs, substances of unknown toxicity and possibly damaging massage practices are used; thus, there is scope for introduction of improved therapeutic practices. Overall, more research is needed to develop the evidence base of current neonatal skin care behaviors in Africa, and to determine emollient therapy effectiveness there.

  6. Effective Interpersonal Communication: A Practical Guide to Improve Your Life.

    Science.gov (United States)

    Vertino, Kathleen A

    2014-09-30

    Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow's hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and experiences as a longtime provider of care in the mental health field, the author offers multiple practical strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.

  7. Managing boundaries in primary care service improvement: A developmental approach to communities of practice

    Science.gov (United States)

    2012-01-01

    Background Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. Methods The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester—a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010–2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. Findings The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors

  8. Managing boundaries in primary care service improvement: A developmental approach to communities of practice

    Directory of Open Access Journals (Sweden)

    Kislov Roman

    2012-10-01

    Full Text Available Abstract Background Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs, this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. Methods The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC for Greater Manchester—a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010–2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. Findings The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas

  9. Managing boundaries in primary care service improvement: a developmental approach to communities of practice.

    Science.gov (United States)

    Kislov, Roman; Walshe, Kieran; Harvey, Gill

    2012-10-15

    Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester-a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong

  10. Improving classroom practices: the impact of leadership, school organizational conditions, and teacher factors

    NARCIS (Netherlands)

    Thoonen, E.E.J.

    2012-01-01

    Schools are challenged to improve classroom practices as they are expected to enhance students’ motivation. While leadership, school organizational conditions and teacher factors are considered essential for improving classroom practices, more should be known about the interplay between school

  11. Improving classroom practices: the impact of leadership, school organizational conditions, and teacher factors

    NARCIS (Netherlands)

    Thoonen, E.E.J.

    2012-01-01

    Schools are challenged to improve classroom practices as they are expected to enhance students’ motivation. While leadership, school organizational conditions and teacher factors are considered essential for improving classroom practices, more should be known about the interplay between school inter

  12. Contextualizing learning to improve care using collaborative communities of practices.

    Science.gov (United States)

    Jeffs, Lianne; McShane, Julie; Flintoft, Virginia; White, Peggy; Indar, Alyssa; Maione, Maria; Lopez, A J; Bookey-Bassett, Sue; Scavuzzo, Lauren

    2016-09-02

    The use of interorganizational, collaborative approaches to build capacity in quality improvement (QI) in health care is showing promise as a useful model for scaling up and accelerating the implementation of interventions that bridge the "know-do" gap to improve clinical care and provider outcomes. Fundamental to a collaborative approach is interorganizational learning whereby organizations acquire, share, and combine knowledge with other organizations and have the opportunity to learn from their respective successes and challenges in improvement areas. This learning approach aims to create the conditions for collaborative, reflective, and innovative experiential systems that enable collective discussions regarding daily practice issues and finding solutions for improvement. The concepts associated with interorganizational learning and deliberate learning activities within a collaborative 'Communities-of-practice'(CoP) approach formed the foundation of the of an interactive QI knowledge translation initiative entitled PERFORM KT. Nine teams participated including seven teams from two acute care hospitals, one from a long term care center, and one from a mental health sciences center. Six monthly CoP learning sessions were held and teams, with the support of an assigned mentor, implemented a QI project and monitored their results which were presented at an end of project symposium. 47 individuals participated in either a focus group or a personal interview. Interviews were transcribed and analyzed using an iterative content analysis. Four key themes emerged from the narrative dataset around experiences and perceptions associated with the PERFORM KT initiative: 1) being successful and taking it to other levels by being systematic, structured, and mentored; 2) taking it outside the comfort zone by being exposed to new concepts and learning together; 3) hearing feedback, exchanging stories, and getting new ideas; and 4) having a pragmatic and accommodating approach to

  13. Frontline experiences of a practice redesign to improve self-management of obesity in safety net clinics.

    Science.gov (United States)

    AuYoung, Mona; Duru, O Kenrik; Ponce, Ninez A; Mangione, Carol M; Rodriguez, Hector P

    2015-01-01

    Teamlets of physicians and medical assistants may help improve obesity management in primary care settings. We aimed to understand the barriers and facilitators of implementing a teamlet approach to managing obesity in 3 safety net clinics. Key stakeholder interviews (n = 21) were conducted both during early implementation of practice change and 6 months later. Patient surveys (n = 393) examined obese patient activation and health status. Insufficient program resources and limited patient engagement due to external factors were implementation barriers despite fairly high patient activation. Staff members need time and resources to execute new responsibilities to support obesity management in safety net settings. Because of high turnover, multiple supporters may improve sustainability.

  14. Checklist for early recognition and treatment of acute illness: International collaboration to improve critical care practice.

    Science.gov (United States)

    Vukoja, Marija; Kashyap, Rahul; Gavrilovic, Srdjan; Dong, Yue; Kilickaya, Oguz; Gajic, Ognjen

    2015-02-04

    Processes to ensure world-wide best-practice for critical care delivery are likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit (ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources (included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices (as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.

  15. Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting.

    Science.gov (United States)

    Attard, Melanie; McArthur, Alexa; Riitano, Dagmara; Aromataris, Edoardo; Bollen, Chris; Pearson, Alan

    2015-01-01

    Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.

  16. Repeating Knowledge Application Practice to Improve Student Performance in a Large, Introductory Science Course

    Science.gov (United States)

    Fujinuma, Ryosuke; Wendling, Laura A.

    2015-11-01

    There is a tendency for lecture-based instruction in large introductory science courses to strongly focus on the delivery of discipline-specific technical terminology and fundamental concepts, sometimes to the detriment of opportunities for application of learned knowledge in evidence-based critical-thinking activities. We sought to improve student performance on evidence-based critical-thinking tasks through the implementation of peer learning and problem-based learning tutorial activities. Small-group discussions and associated learning activities were used to facilitate deeper learning through the application of new knowledge. Student performance was assessed using critical-thinking essay assignments and a final course exam, and student satisfaction with tutorial activities was monitored using online surveys. Overall, students expressed satisfaction with the small-group-discussion-based tutorial activities (mean score 7.5/10). Improved critical thinking was evidenced by improved student performance on essay assignments during the semester, as well as a 25% increase in mean student scores on the final course exam compared to previous years. These results demonstrate that repeated knowledge application practice can improve student learning in large introductory-level science courses.

  17. Improving the global efficiency in small hydropower practice

    Science.gov (United States)

    Razurel, P.; Gorla, L.; Crouzy, B.; Perona, P.

    2015-12-01

    The global increase in energy production from renewable sources has seen river exploitation for small hydropower plants to also grow considerably in the last decade. River intakes used to divert water from the main course to the power plant are at the base of such practice. A key issue concern with finding innovative concepts to both design and manage such structures in order to improve classic operational rules. Among these, the Minimal Flow Release (MFR) concept has long been used in spite of its environmental inconsistency.In this work, we show that the economical and ecological efficiency of diverting water for energy production in small hydropower plants can be improved towards sustainability by engineering a novel class of flow-redistribution policies. We use the mathematical form of the Fermi-Dirac statistical distribution to define non-proportional dynamic flow-redistribution rules, which broadens the spectrum of dynamic flow releases based on proportional redistribution. The theoretical background as well as the economic interpretation is presented and applied to three case studies in order to systematically test the global performance of such policies. Out of numerical simulations, a Pareto frontier emerges in the economic vs environmental efficiency plot, which show that non-proportional distribution policies improve both efficiencies with respect to those obtained from some traditional MFR and proportional policies. This picture is shown also for long term climatic scenarios affecting water availability and the natural flow regime.In a time of intense and increasing exploitation close to resource saturation, preserving natural river reaches requires to abandon inappropriate static release policies in favor of non-proportional ones towards a sustainable use of the water resource.

  18. Implementation of interprofessional education (IPE) in 16 U.S. medical schools: Common practices, barriers and facilitators.

    Science.gov (United States)

    West, Courtney; Graham, Lori; Palmer, Ryan T; Miller, Marissa Fuqua; Thayer, Erin K; Stuber, Margaret L; Awdishu, Linda; Umoren, Rachel A; Wamsley, Maria A; Nelson, Elizabeth A; Joo, Pablo A; Tysinger, James W; George, Paul; Carney, Patricia A

    2016-09-01

    Enhanced patient outcomes and accreditation criteria have led schools to integrate interprofessional education (IPE). While several studies describe IPE curricula at individual institutions, few examine practices across multiple institutions. To examine the IPE integration at different institutions and determine gaps where there is potential for improvement. In this mixed methods study, we obtained survey results from 16 U.S. medical schools, 14 of which reported IPE activities. The most common collaboration was between medical and nursing schools (93%). The prevalent format was shared curriculum, often including integrated modules (57%). Small group activities represented the majority (64%) of event settings, and simulation-based learning, games and role-play (71%) were the most utilized learning methods. Thirteen schools (81.3%) reported teaching IPE competencies, but significant variation existed. Gaps and barriers in the study include limitations of using a convenience sample, limited qualitative analysis, and survey by self-report. Most IPE activities focused on the physician role. Implementation challenges included scheduling, logistics and financial support. A need for effective faculty development as well as measures to examine the link between IPE learning outcomes and patient outcomes were identified.

  19. Improving care transitions: current practice and future opportunities for pharmacists.

    Science.gov (United States)

    Hume, Anne L; Kirwin, Jennifer; Bieber, Heather L; Couchenour, Rachel L; Hall, Deanne L; Kennedy, Amy K; LaPointe, Nancy M Allen; Burkhardt, Crystal D O; Schilli, Kathleen; Seaton, Terry; Trujillo, Jennifer; Wiggins, Barbara

    2012-11-01

    During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to

  20. Costs and benefits of transforming primary care practices: a qualitative study of North Carolina's Improving Performance in Practice.

    Science.gov (United States)

    Reiter, Kristin L; Halladay, Jacqueline R; Mitchell, C Madeline; Ward, Kimberly; Lee, Shoou-Yih D; Steiner, Beat; Donahue, Katrina E

    2014-01-01

    Primary care organizations must transform care delivery to realize the Institute for Healthcare Improvement's Triple Aim of better healthcare, better health, and lower healthcare costs. However, few studies have considered the financial implications for primary care practices engaged in transformation. In this qualitative, comparative case study, we examine the practice-level personnel and nonpersonnel costs and the benefits involved in transformational change among 12 primary care practices participating in North Carolina's Improving Performance in Practice (IPIP) program. We found average annual opportunity costs of $21,550 ($6,659 per full-time equivalent provider) for maintaining core IPIP activities (e.g., data management, form development and maintenance, meeting attendance). This average represents the cost of a 50% full-time equivalent registered nurse or licensed practical nurse. Practices were able to limit transformation costs by scheduling meetings during relatively slow patient care periods and by leveraging resources such as the assistance of IPIP practice coaches. Still, the costs of practice transformation were not trivial and would have been much higher in the absence of these efforts. Benefits of transformation included opportunities for enhanced revenue through reimbursement incentives and practice growth, improved efficiency and care quality, and maintenance of certification. Given the potentially high costs for some practices, policy makers may need to consider reimbursement and other strategies to help primary care practices manage the costs of practice redesign.

  1. THE 7 STAGE MODEL FOR FACILITATING MORAL CASE DELIBERATION IN HEALTH-CARE INSTITUTIONS: A PRACTICAL ILLUSTRATION OF A META-MODEL.

    Science.gov (United States)

    de Bree, Menno; Veening, Eite

    2016-01-01

    During a moral case deliberation-session, health care professionals come together in order to reflect on a moral issue they have to deal with. Since the whole process of sorting facts out, identifying moral issues, formulating and weighing arguments et cetera, can be quite complex, there should always be a well-trained facilitator present, who safeguards the flow of the session. In order to train and to assess the quality of these facilitators, we developed the so-called 7 stage model of moral case deliberation. This model is a meta-model, describing all the stages and all the activities that take place during each mcd-session--regardless of variables like the type of case that is being discussed, the number of participants, or the reflection method that is being applied. These 7 stages are: introduction, case selection, method selection, factual exploration, analysis, conclusion and rounding off. The model makes it possible to describe all the tasks facilitators at least have to perform in order to steer their group through theses stages in a fruitful and efficient way. It also makes it possible to identify the minimum generic competencies each facilitator should master, in order to perform these tasks successfully. In this paper, we introduce the model (to our knowledge, the first of its kind), discuss some of the most important theoretical backgrounds, provide a theoretical justification, and above all, give a practical illustration of how the model can be applied when facilitating an mcd-session.

  2. Improving imaging utilization through practice quality improvement (maintenance of certification part IV): a review of requirements and approach to implementation.

    Science.gov (United States)

    Griffith, Brent; Brown, Manuel L; Jain, Rajan

    2014-04-01

    The purposes of this article are to review the American Board of Radiology requirements for practice quality improvement and to describe our approach to improving imaging utilization while offering a guide to implementing similar projects at other institutions, emphasizing the plan-do-study-act approach. There is increased emphasis on improving quality in health care. Our institution has undertaken a multiphase practice quality improvement project addressing the appropriate utilization of screening cervical spinal CT in an emergency department.

  3. Current practices and improved recommendations for treating hereditary fructose intolerance.

    Science.gov (United States)

    Bell, L; Sherwood, W G

    1987-06-01

    A study of treatment practices of pediatric centers managing hereditary fructose intolerance and a review of recent literature on this subject were undertaken in an attempt to establish the degree of dietary liberalization allowable with age and the acceptability of foods containing trace amounts of fructose. The information was needed to plan optimal therapy and thus avoid the consequences of the disorder, namely intestinal dysfunction, metabolic imbalance, and hepatic and renal damage. Fifty responses to 113 letters to centers in Canada and the United States, as well as data from The Hospital for Sick Children, Toronto, Ontario, identified only 29 affected children and provided information on their care, including food lists and literature references. Major principles of treatment were similar, but the approach to allowing and quantifying dietary fructose differed. In response to the apparent need for standardization of treatment, the authors formulated improved recommendations for the control of dietary fructose (less than 1.5 gm/day). Only a few foods of vegetable origin are allowed, including a limited selection of vegetables and cereal products from grain endosperm. Repeated dietary counseling is advocated with regard to allowed foods, sweeteners, and medications to ensure long-term dietary compliance.

  4. Improving religious slaughter practices in the U.S.

    Directory of Open Access Journals (Sweden)

    Temple Grandin

    2006-05-01

    Full Text Available Cet article, fondé sur trente années d’expérience dans les abattoirs, explore les aspects techniques de l’abattage des animaux de boucherie en Amérique du Nord, tout particulièrement l’abattage religieux, kasher et halal. La description minutieuse des différentes méthodes utilisées vise à éclairer les éléments posant problème et faisant atteinte au « bien-être » des animaux. L’auteur propose ensuite des mesures permettant d’améliorer le traitement des différentes espèces d’animaux et d’alléger les souffrances au moment de l’abattage.This paper, based on thirty years of experience in developing equipment for handling cattle, explores the technical aspects of animal slaughtering in Northern America, particularly halal and kosher slaughter practices. It gives first hand description of the different methods which are in use, always in relation to animal welfare concerns. The author then draws concrete conclusions regarding means of ensuring an improved treatment for all types of animals to be slaughtered.

  5. Improving consistency in student evaluation at affiliated family practice centers.

    Science.gov (United States)

    Rabinowitz, H K

    1986-01-01

    The Department of Family Medicine at Jefferson Medical College has since 1974 been successful in administering a required third-year family medicine clerkship, providing students with a structured, didactic, and experiential curriculum in six affiliated family practice centers. Prior analysis (1976-1981) had indicated, however, that variation existed in evaluating similar students, depending on the clerkship training site, i.e., three sites graded students in a significantly different fashion than the three other sites. Utilizing these data to focus on the evaluation process, a comprehensive and specific six-point plan was developed to improve consistency in evaluations at the different training sites. This plan consisted of a yearly meeting of affiliate faculty, assigning predoctoral training administrative responsibility to one faculty member at each training site, increased telephone communication, affiliate-faculty attendance at the university site evaluation session, faculty rotation to spend time at other training sites, and financial reimbursement to the affiliate training sites. After intervention, analysis (1981-1983) indicated that five of the six clerkship sites now grade students in a consistent fashion, with only one affiliate using different grading standards. The intervention was therefore judged to be successful for five of the six training sites, allowing for better communication and more critical and consistent evaluation of medical students.

  6. Experienced barriers and facilitators for integrating smoking cessation advice and support into daily dental practice. A short report

    NARCIS (Netherlands)

    Rosseel, J.P.; Jacobs, J.E.; Hilberink, S.R.; Maassen, I.M.; Segaar, D.; Plasschaert, A.J.M.; Grol, R.P.T.M.

    2011-01-01

    In a controlled study, primary care dental professionals in the intervention group were encouraged to provide smoking cessation advice and support for all smoking patients with the help of a stage-based motivational protocol. The barriers and facilitators reported by the dental professionals on two

  7. Improving access for patients – a practice manager questionnaire

    Directory of Open Access Journals (Sweden)

    Brown James S

    2006-06-01

    Full Text Available Abstract Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256 had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006, urban practices (p Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study.

  8. Optimizing strategies to improve interprofessional practice for veterans, part 1

    Directory of Open Access Journals (Sweden)

    Bhattacharya SB

    2014-04-01

    sustainability of IPP programs is crucial for the health of our veterans. This project uncovered tools to improve the GEM IPP model for our veterans that can be incorporated nationally. Despite the lengthy nature of IPP models, patients and families appreciated the thoroughness, requested transportation and food, and responded well to reminder phone calls. A keen eye on these issues and concomitant medical complexity needs to be observed when planning IPP models to ensure sustainability.Keywords: interprofessional practice, veterans, geriatric evaluation and management

  9. Improving Public Engagement With Climate Change: Five "Best Practice" Insights From Psychological Science.

    Science.gov (United States)

    van der Linden, Sander; Maibach, Edward; Leiserowitz, Anthony

    2015-11-01

    Despite being one of the most important societal challenges of the 21st century, public engagement with climate change currently remains low in the United States. Mounting evidence from across the behavioral sciences has found that most people regard climate change as a nonurgent and psychologically distant risk-spatially, temporally, and socially-which has led to deferred public decision making about mitigation and adaptation responses. In this article, we advance five simple but important "best practice" insights from psychological science that can help governments improve public policymaking about climate change. Particularly, instead of a future, distant, global, nonpersonal, and analytical risk that is often framed as an overt loss for society, we argue that policymakers should (a) emphasize climate change as a present, local, and personal risk; (b) facilitate more affective and experiential engagement; (c) leverage relevant social group norms; (d) frame policy solutions in terms of what can be gained from immediate action; and (e) appeal to intrinsically valued long-term environmental goals and outcomes. With practical examples we illustrate how these key psychological principles can be applied to support societal engagement and climate change policymaking.

  10. Screenwriting: A Strategy for the Improvement of Writing Instructional Practices

    Directory of Open Access Journals (Sweden)

    Amado Hernán

    2010-11-01

    Full Text Available This article presents a pedagogical experience that addresses the use of an instructional strategy called screenwriting aimed at improving the teaching of writing in an educational context. This pedagogical intervention took place in a private English language school, where three adult students willingly participated to create their own short scripts. The idea was to introduce and reinforce the importance of screenwriting to observe its usefulness in education. Students participated in writing workshops for a 3-month period. The workshops included the respective screenwriting theory and activities that helped them to achieve completion of their final stories. Students’ final pieces proved that the writing instructional practices were enriching and beneficial. En este artículo se presenta una experiencia pedagógica sobre el uso de una estrategia instruccional llamada "la escritura de guiones", y cuyo objetivo es mejorar la enseñanza de la escritura en un contexto educativo. Esta intervención pedagógica tuvo lugar en una institución privada, dedicada a la enseñanza de lengua inglesa, donde tres estudiantes adultos participaron en la creación de sus propios guiones cortos. La idea era introducir y reforzar la importancia de la escritura de guiones para observar su utilidad en la educación. Los estudiantes participaron durante tres meses en talleres de escritura creativa. Estos incluyeron teoría y actividades para la escritura de guiones respectivos que los ayudaron a lograr sus historias finales. Los trabajos finales de los estudiantes mostraron que las prácticas instruccionales de escritura fueron enriquecedoras y benéficas.

  11. Interactive Reading in Preschool: Improving Practice through Professional Development

    Science.gov (United States)

    Kindle, Karen J.

    2013-01-01

    Shared reading is a common practice in preschool classrooms and is purported to develop oral language, print concepts, and listening comprehension. The actual practice of reading aloud differed greatly among observed classrooms resulting in variations in potential positive effects. This study examines the potential effects of professional…

  12. Interactive Reading in Preschool: Improving Practice through Professional Development

    Science.gov (United States)

    Kindle, Karen J.

    2013-01-01

    Shared reading is a common practice in preschool classrooms and is purported to develop oral language, print concepts, and listening comprehension. The actual practice of reading aloud differed greatly among observed classrooms resulting in variations in potential positive effects. This study examines the potential effects of professional…

  13. Facilitators and barriers to chlamydia testing in general practice for young people using a theoretical model (COM-B): a systematic review protocol

    Science.gov (United States)

    McDonagh, Lorraine K; Saunders, John M; Cassell, Jackie; Bastaki, Hamad; Hartney, Thomas; Rait, Greta

    2017-01-01

    Introduction Chlamydia is a key health concern with high economic and social costs. There were over 200 000 chlamydia diagnoses made in England in 2015. The burden of chlamydia is greatest among young people where the highest prevalence rates are found. Annual testing for sexually active young people is recommended; however, many of those at risk do not receive testing. General practice has been identified as an ideal setting for testing, yet efforts to increase testing in this setting have not been effective. One theoretical model which may provide insight into the underpinnings of chlamydia testing is the Capability, Opportunity and Motivation Model of Behaviour (COM-B model). The aim of this systematic review is to: (1) identify barriers and facilitators to chlamydia testing for young people in general practice and (2) use a theoretical model to conduct a behavioural analysis of chlamydia testing behaviour. Methods and analysis Qualitative, quantitative and mixed methods studies published after 2000 will be included. Seven databases (MEDLINE, PubMed, EMBASE, Informit, PsycInfo, Scopus, Web of Science) will be searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. Risk of bias will be assessed using the Critical Appraisal Skills Programme. Data regarding study design and key findings will be extracted. The data will be analysed using thematic analysis and the resultant factors will be mapped onto the COM-B model components. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethics and dissemination Ethical approval is not required. The results will be disseminated via submission for publication to a peer-review journal when complete and for presentation at national and international conferences. The review findings will be used to inform the development of interventions to facilitate effective and efficient

  14. Improving access to yoga: barriers to and motivators for practice among health professions students.

    Science.gov (United States)

    Brems, Christiane; Justice, Lauren; Sulenes, Kari; Girasa, Lisa; Ray, Julia; Davis, Madison; Freitas, Jillian; Shean, Margaret; Colgan, Dharmakaya

    2015-01-01

    Yoga is gaining momentum as a popular and evidence-based, integrative health care and self-care practice. The characteristics of yoga practitioners are not proportional to the demographics of the general population, especially with respect to gender and ethnicity. Several access barriers have been implicated (eg, time, cost, and access to teachers). No studies have explored the barriers to practice among health professions students. Their participation in yoga is deemed important because they are future health professionals who will make referrals to other services. Research has shown that providers who practice yoga refer more patients to yoga. To increase yoga practice among health professions students, an understanding must be developed of factors that interfere with or facilitate a regular yoga practice. The current study intended to identify such barriers and motivators. This study was a small population survey. The setting was a private university in the northwestern United States, including students in 3 of its colleges and 10 professional programs. All students (N = 1585) in the programs of the 10 health professions received e-mail requests for participation. The Acceptability of Yoga Survey was developed for purposes of a larger yoga perceptions study and implemented with health professions students. Participants were solicited via e-mail; the survey was administered online. The current study used data from that survey. Of the 498 usable, completed surveys (ie, a response rate of approximately 30%), 478 were relevant to the current study. The sample's demographics--78% women and 79% white--did not differ significantly from the population's demographics. The findings revealed the existence of common barriers that were related to (1) time; (2) cost; (3) lack of pragmatic information about access to yoga classes and teachers; and (4) stereotypes related to flexibility, athleticism, and typical yoga practitioners. Motivators included athleticism, health

  15. Improving Student Commitment to Healthcare-Related Design Practice by Improving the Studio Learning Experience.

    Science.gov (United States)

    Tan, Lindsay; Hong, Miyoung; Albert, Taneshia West

    2017-01-01

    This case study explores the influence of the healthcare design studio experience on students' short-term professional goals as measured through rates of healthcare-related certification and internship/employment. The value and relevance of interior design is evident in the healthcare design sector. However, interior design students may not perceive this value if it is not communicated through their design education. Students' experience in the design studio plays a crucial role in determining career choices, and students may be more committed to career goals when there is clear connection between major coursework and professional practice. The authors compared healthcare-related certification and internship/employment levels between two student cohorts in a capstone undergraduate interior design healthcare design studio course. The first cohort was led by the existing curriculum. The second cohort was led by the revised curriculum that specifically aimed at encouraging students to commit to healthcare-related design practice. When measured at 3 months from graduation, the second cohort, led by the revised curriculum, saw a 30% increase in Evidence-based Design Accreditation and Certification exam pass rates and a 40% increase in healthcare-related internship/employment. The challenge of interior design education is to instill in emerging professionals not only professional competence but also those professional attitudes that will make them better prepared to design spaces that improve quality of life, particularly in healthcare environments. The results exceeded the project goals, and so this could be considered a promising practice for courses focused on healthcare design education.

  16. Study of Practicability of Improved Irwin's Surface Wind Sensor

    National Research Council Canada - National Science Library

    Junji KATAGIRI; Toshio TSURUMI; Takeshi OHKUMA; Hisao MARUKAWA

    2009-01-01

      The practicability of a surface wind sensor (SWS) is examined by comparing the mean and fluctuating wind velocities obtained from this instrument with those measured by an omni-directional multi-channel anemometer (OMA...

  17. Facilitating Changes in College Teaching Practices: Instructional Reform, Identity Conflict and Professional Community in a K-20 Partnership

    Science.gov (United States)

    Olitsky, Stacy

    2015-08-01

    In this paper, I explain variation in the adoption of student-centred teaching practices among college faculty members in a program designed to promote K-20 instructional reform. I analyze data from a qualitative study of a Math and Science Partnership in order to understand why some faculty members had undergone extensive changes to their practices whereas others had not, even though both groups had demonstrated changes in their beliefs. Findings show that when collective identities focused on reform become more salient than the role identities associated with their teaching positions, faculty members are able to persist through the loss of self-efficacy that results from struggles with new student-centred practices. This study demonstrates how professional communities can enhance "collective efficacy", thereby affecting whether the cognitive dissonance that accompanies professional development leads to instructional change rather than disengagement from reform initiatives.

  18. The PMAC Code of Marketing Practices: Time for improvement?

    OpenAIRE

    Desjardins, J. G.

    1997-01-01

    In this issue (see pages 351 to 356) Dr. Joel Lexchin proposes reforms that could help the Pharmaceutical Manufacturers Association of Canada (PMAC) adapt its Code of Marketing Practices to changing times. The PMAC code reflects the ethical concerns of drug manufacturers and speaks to the need for high standards in promotional activities. The code is a commendable beginning, but it does not go far enough in ensuring ethical practice. The PMAC should take this opportunity to address the concer...

  19. Nursing clinical handover improvement practices among acute inpatients in a tertiary hospital in Sydney: a best practice implementation project.

    Science.gov (United States)

    Wainwright, Craig; Wright, Kylie M

    2016-10-01

    The nursing handover normally occurs at the beginning of a nurse's shift and is considered essential for continuity of care. Nursing handovers have the potential to communicate accurate information about a patient's condition, treatment and anticipated needs but also to be ineffective or even harmful if information is incomplete or omitted. The Australian Commission on Safety and Quality in Health Care has recognized clinical handover as a National Standard, thus reinforcing its importance. This project aimed to conduct an audit of nursing clinical handover practices to implement evidence-based best practice recommendations to assess the effectiveness of these strategies to maximize the effectiveness of clinical handover across 11 units in a large tertiary hospital. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 330 observations of nursing clinical handover was conducted and measured against seven best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit. The baseline audit revealed significant deficits between current practice and best practice in all but one criterion. Barriers for implementation of nursing clinical handover best practice criteria were identified by the project team, and a bundled education strategy was implemented. There were significantly improved outcomes across all best practice criteria in the follow-up audit. The findings showed how audits may be used to promote best practice in healthcare and that focused education and provision of relevant resources can have an immediate and positive impact on clinical practice. Some of the measured criteria improved to a moderate degree, leaving room for improvement; however, by the end of the project attitudes toward nursing clinical handover had been "transformed" from a passive routine "must do

  20. Barriers and facilitators to evidence based care of type 2 diabetes patients : experiences of general practitioners participating to a quality improvement program

    NARCIS (Netherlands)

    Goderis, G.; Borgermans, L.D.A.; Mathieu, C.; Broeke, C. Van Den; Hannes, K.; Heyrman, J.; Grol, R.P.T.M.

    2009-01-01

    ABSTRACT: OBJECTIVE: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines. METHODS: Twenty

  1. Letting Go and Letting the Angels Grow: Using Etienne Wenger's Community of Practice Theory to Facilitate Teacher Education

    Science.gov (United States)

    Breen, Paul

    2015-01-01

    This paper describes a small-scale qualitative research study conducted within a community of English Language teachers, and explores how teacher development workshops can be used to foster or cultivate Communities of Practice. The study was situated in a Language Centre within the domain of UK Higher Education where there was an institutional…

  2. Mediating Community Participation: Practice of Support Workers in Initiating, Facilitating or Disrupting Encounters between People with and without Intellectual Disability

    Science.gov (United States)

    Bigby, Christine; Wiesel, Ilan

    2015-01-01

    Promoting community participation for people with intellectual disability through encounter with strangers is an integral part of the mission of disability support workers. This paper offers detailed micro-level analysis of the practices of support workers when they accompany a person with intellectual disability outside their home and explores…

  3. Learning facilitating leadership

    DEFF Research Database (Denmark)

    Rasmussen, Lauge Baungaard; Hansen, Mette Sanne

    2016-01-01

    This paper explains how engineering students at a Danish university acquired the necessary skills to become emergent facilitators of organisational development. The implications of this approach are discussed and related to relevant viewpoints and findings in the literature. The methodology deplo....... By connecting the literature, the authors’ and engineering students’ reflections on facilitator skills, this paper adds value to existing academic and practical discussions on learning facilitating leadership....

  4. Visual explorer facilitator's guide

    CERN Document Server

    Palus, Charles J

    2010-01-01

    Grounded in research and practice, the Visual Explorer™ Facilitator's Guide provides a method for supporting collaborative, creative conversations about complex issues through the power of images. The guide is available as a component in the Visual Explorer Facilitator's Letter-sized Set, Visual Explorer Facilitator's Post card-sized Set, Visual Explorer Playing Card-sized Set, and is also available as a stand-alone title for purchase to assist multiple tool users in an organization.

  5. Improving Synthetic Biology Communication: Recommended Practices for Visual Depiction and Digital Submission of Genetic Designs.

    Science.gov (United States)

    Hillson, Nathan J; Plahar, Hector A; Beal, Jacob; Prithviraj, Ranjini

    2016-06-17

    Research is communicated more effectively and reproducibly when articles depict genetic designs consistently and fully disclose the complete sequences of all reported constructs. ACS Synthetic Biology is now providing authors with updated guidance and piloting a new tool and publication workflow that facilitate compliance with these recommended practices and standards for visual representation and data exchange.

  6. Practices of Assistive Technology Implementation and Facilitation: Experiences of Teachers of Students with Visual Impairments in Singapore

    Science.gov (United States)

    Wong, Meng Ee; Law, Janet S. P.

    2016-01-01

    Assistive technology is defined by the Individuals With Disabilities Education Improvement Act (IDEIA) of 2004 as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability"…

  7. An advisory tool to improve management practices affecting calf and heifer welfare on dairy farms.

    Science.gov (United States)

    Vasseur, E; Rushen, J; de Passillé, A M; Lefebvre, D; Pellerin, D

    2010-09-01

    veterinarians. Six months after the on-farm visit, recommended practices were implemented in many of these areas. Voluntary improvements in animal welfare can be facilitated by using appropriate tools to educate producers and help them change their attitudes toward calf management and animal welfare.

  8. Recruitment and retention of pregnant women into clinical research trials: an overview of challenges, facilitators, and best practices.

    Science.gov (United States)

    Frew, Paula M; Saint-Victor, Diane S; Isaacs, Margaret Brewinski; Kim, Sonnie; Swamy, Geeta K; Sheffield, Jeanne S; Edwards, Kathryn M; Villafana, Tonya; Kamagate, Ouda; Ault, Kevin

    2014-12-15

    Pregnant women are a vulnerable group who are needed in clinical research studies to advance prevention and treatment options for this population. Yet, pregnant women remain underrepresented in clinical research. Through the lens of the socioecological model, we highlight reported barriers and facilitators to recruitment and retention of pregnant women in studies that sought their participation. We trace historical, policy-based reasons for the exclusion of pregnant women in clinical studies to present-day rationale for inclusion of this group. The findings highlight why it has been difficult to recruit and retain this population over time. A body of literature suggests that integrative sampling and recruitment methods that leverage the influence and reach of prenatal providers will overcome recruitment challenges. We argue that these strategies, in combination with building strong engagement with existing community-based organizations, will enable teams to more effectively promote and retain pregnant women in future longitudinal cohort studies.

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

    NARCIS (Netherlands)

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

    2015-01-01

    Background: 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

  10. Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study

    National Research Council Canada - National Science Library

    Oakley, B; Nightingale, J; Moran, CG; Moppett, IK

    2017-01-01

      Objectives To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual...

  11. CONTINUOUS IMPROVEMENT PRACTICE IN LARGE ENTERPRISES: STUDY RESULTS

    Directory of Open Access Journals (Sweden)

    Dorota Stadnicka

    2015-03-01

    Full Text Available Continuous improvement is indispensable for ensuring the company's development and its survival on the constantly changing global market. Continuous improvement is particularly important in the quality and production management systems. A company should deliver a product compliant with a client's requirements in a specified time and at an appropriate price. That is why, continuous improvement refers to different areas of an organization's functioning and it is an integral part of Lean Manufacturing. This article presents the results of the study conducted in production enterprises on a limited area. The aim of the study was the assessment of the implementation of continuous improvement in Lean Manufacturing, and, in particular, employees' involvement in the problem identification and in reporting improvements as well as the way of motivating employees to involve themselves. The authors also tried to identify the factors influencing the elements of a continuous improvement system.

  12. Facilitating the transition to practice: a weekend retreat curriculum for business-of-medicine education of United States anesthesiology residents.

    Science.gov (United States)

    Holak, Elena J; Kaslow, Olga; Pagel, Paul S

    2010-10-01

    Anesthesiology residents in the United States (US) not only must develop the clinical skills needed to provide independent patient care, but also are required to become familiar with the business aspects of the modern health care system. Unfortunately, practice management education may be inadequate during anesthesiology residency training. The authors describe the design and implementation of a weekend retreat curriculum in business-of-medicine education for anesthesiology residents. Experts were recruited to discuss interviewing skills, contract law and negotiation, billing and reimbursement, insurance, malpractice, and financial planning. A strict lecture didactic format was avoided, and presentations were designed to encourage speaker-audience interaction. The program was relatively simple to design and implement, satisfied several Accreditation Council of Graduate Medical Education core competencies for US anesthesiology education, may be altered as practice management evolves, and may be adapted to accommodate the needs of programs in other countries.

  13. Mediating Community Participation: Practice of Support Workers in Initiating, Facilitating or Disrupting Encounters between People with and without Intellectual Disability.

    Science.gov (United States)

    Bigby, Christine; Wiesel, Ilan

    2015-07-01

    Promoting community participation for people with intellectual disability through encounter with strangers is an integral part of the mission of disability support workers. This paper offers detailed micro-level analysis of the practices of support workers when they accompany a person with intellectual disability outside their home and explores the subtle differences which make some staff practices more effective than others in promoting more convivial encounters with strangers. Based on 160 h of observations of twenty-six adults with intellectual disability in a variety of public places, and interviews and focus groups with their support workers, the paper points to some of the critical judgements support workers need to make when considering whether, when and how to initiate or intervene in such encounters.

  14. Improving Visual Acuity of Myopes through Operant Training: The Evaluation of Psychological and Physiological Mechanisms Facilitating Acuity Enhancement

    Science.gov (United States)

    1988-12-01

    covert servo-controlled tracking optometer (Cornsweet & Crane, 1970) that made the near-instantaneous feedback of monocular accommodative state possible...and Crane infrared- optometer measures of accommodation into auditory tones that reflected the instantaneous refractive state of the eye. While an...performance change might as well have been facilitated by blur interpretation. Nonobtrusive incorporation of a covert tracking optometer (Cornsweet & Crane

  15. Improvements in Limb Kinetic Apraxia by Repetition of a Newly Designed Facilitation Exercise in a Patient with Corticobasal Degeneration

    Science.gov (United States)

    Kawahira, Kazumi; Noma, Tomokazu; Iiyama, Junichi; Etoh, Seiji; Ogata, Atsuko; Shimodozono, Megumi

    2009-01-01

    Corticobasal degeneration is a progressive neurological disorder characterized by a combination of parkinsonism and cortical dysfunction such as limb kinetic apraxia, alien limb phenomenon, and dementia. To study the effect of repetitive facilitation exercise (RFE) in a patient with corticobasal degeneration, we used a newly designed facilitation…

  16. Improving product development practice: An action-research based approach

    DEFF Research Database (Denmark)

    Harmsen, Hanne

    the widely published normative advice. While there may be several reasons for discrepancies between research results and prac-tice this paper focuses on problems of implementation of the identified success factors. Within the research area of NPD-management there has been numerous surveys as well as case...

  17. Improving Teaching and Learning: Three Models to Reshape Educational Practice

    Science.gov (United States)

    Roberson, Sam

    2014-01-01

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

  18. Practical methods to improve the development of computational software

    Energy Technology Data Exchange (ETDEWEB)

    Osborne, A. G.; Harding, D. W.; Deinert, M. R. [Department of Mechanical Engineering, University of Texas, Austin (United States)

    2013-07-01

    The use of computation has become ubiquitous in science and engineering. As the complexity of computer codes has increased, so has the need for robust methods to minimize errors. Past work has show that the number of functional errors is related the number of commands that a code executes. Since the late 1960's, major participants in the field of computation have encouraged the development of best practices for programming to help reduce coder induced error, and this has lead to the emergence of 'software engineering' as a field of study. Best practices for coding and software production have now evolved and become common in the development of commercial software. These same techniques, however, are largely absent from the development of computational codes by research groups. Many of the best practice techniques from the professional software community would be easy for research groups in nuclear science and engineering to adopt. This paper outlines the history of software engineering, as well as issues in modern scientific computation, and recommends practices that should be adopted by individual scientific programmers and university research groups. (authors)

  19. School Policies and Practices that Improve Indoor Air Quality

    Science.gov (United States)

    Jones, Sherry Everett; Smith, Alisa M.; Wheeler, Lani S.; McManus, Tim

    2010-01-01

    Background: To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. Methods: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of…

  20. Design in Practice: Scenarios for Improving Management Education

    Science.gov (United States)

    Schlenker, Lee; Chantelot, Sébastien

    2014-01-01

    Despite the increasing attention given to design in business, Design Thinking has had little impact on the quality of business school education. Building upon the foundations of long-standing critiques of management education and the potential for student-centric learning, the authors propose that the use of Design in Practice can significantly…

  1. Using Retrieval Practice and Metacognitive Skills to Improve Content Learning

    Science.gov (United States)

    Littrell-Baez, Megan K.; Friend, Angela; Caccamise, Donna; Okochi, Christine

    2015-01-01

    Classroom tests have been traditionally used to assess student growth and content mastery. However, a wealth of research in cognitive and educational psychology has demonstrated that retrieval practice (testing) as a form of low-stakes, rather than traditional high-stakes testing, can also be used as an effective pedagogical tool, improving…

  2. Regular Football Practice Improves Autonomic Cardiac Function in Male Children

    Science.gov (United States)

    Fernandes, Luis; Oliveira, Jose; Soares-Miranda, Luisa; Rebelo, Antonio; Brito, Joao

    2015-01-01

    Background: The role of the autonomic nervous system (ANS) in the cardiovascular regulation is of primal importance. Since it has been associated with adverse conditions such as cardiac arrhythmias, sudden death, sleep disorders, hypertension and obesity. Objectives: The present study aimed to investigate the impact of recreational football practice on the autonomic cardiac function of male children, as measured by heart rate variability. Patients and Methods: Forty-seven male children aged 9 - 12 years were selected according to their engagement with football oriented practice outside school context. The children were divided into a football group (FG; n = 22) and a control group (CG; n = 25). The FG had regular football practices, with 2 weekly training sessions and occasional weekend matches. The CG was not engaged with any physical activity other than complementary school-based physical education classes. Data from physical activity, physical fitness, and heart rate variability measured in time and frequency domains were obtained. Results: The anthropometric and body composition characteristics were similar in both groups (P > 0.05). The groups were also similar in time spent daily on moderate-to-vigorous physical activities (FG vs. CG: 114 ± 64 vs. 87 ± 55 minutes; P > 0.05). However, the FG performed better (P football practice presented enhanced physical fitness and autonomic function, by increasing vagal tone at rest. PMID:26448848

  3. Handling Practicalities in Agricultural Policy Optimization for Water Quality Improvements

    Science.gov (United States)

    Bilevel and multi-objective optimization methods are often useful to spatially target agri-environmental policy throughout a watershed. This type of problem is complex and is comprised of a number of practicalities: (i) a large number of decision variables, (ii) at least two inte...

  4. Improving Clinical Practices for Children with Language and Learning Disorders

    Science.gov (United States)

    Kamhi, Alan G.

    2014-01-01

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

  5. Use of fluconazole in daily practice: still room for improvement.

    NARCIS (Netherlands)

    Natsch, S.S.; Steeghs, M.H.M.; Hekster, Y.A.; Meis, J.F.G.M.; Meer, J.W.M. van der; Kullberg, B.J.

    2001-01-01

    One hundred courses of fluconazole treatment in a university hospital and 81 courses in a non-university teaching hospital have been analysed in a prospective audit to evaluate prescribing practices. The quality of treatments was assessed by an infectious disease specialist and a pharmacist accordin

  6. A practical manual to assess and improve farm performances

    NARCIS (Netherlands)

    Aarts, H.F.M.; Grignard, A.; Boonen, J.; Haan, de M.; Hennart, S.; Oenema, J.; Lorinquer, E.; Sylvain, F.; Herrmann, K.; Elsaesser, M.; Castellan, E.; Kohnen, H.

    2013-01-01

    The business of a dairy farmer is to supply society with dairy products in a way that provides him sufficient income and satisfaction. But he has to avoid farming practices hampering the rural area to deliver other valuable products, like clean drinking water, biodiversity, and attractive recreation

  7. School Policies and Practices that Improve Indoor Air Quality

    Science.gov (United States)

    Jones, Sherry Everett; Smith, Alisa M.; Wheeler, Lani S.; McManus, Tim

    2010-01-01

    Background: To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. Methods: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of…

  8. Improving patient safety culture in general practice: An interview study

    NARCIS (Netherlands)

    N.J. Verbakel (Natasha J.); A.A. de Bont (Antoinette); T.J. Verheij; C. Wagner (Cordula); D.L.M. Zwart (Dorien Lyd Marieke)

    2015-01-01

    textabstractBackground When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an interventio

  9. The Principal's Guide to Instructional Improvement: Theory to Practice

    Science.gov (United States)

    Krajewski, Robert

    2012-01-01

    Beginning with an abridged history of administrative and clinical supervision, "The Principal's Guide to Instructional Improvement" offers principals both background information, as well as comprehensive models and examples, to analyze and improve teacher instruction. Based on the principle of teacher growth, rather than teacher evaluation, this…

  10. Facilitating Out-of-Home Caregiving Through Health Information Technology: Survey of Informal Caregivers’ Current Practices, Interests, and Perceived Barriers

    Science.gov (United States)

    Piette, John D; Jenchura, Emily C; Asch, Steven M; Rosland, Ann-Marie

    2013-01-01

    Background Many patients with chronic conditions are supported by out-of-home informal caregivers—family members, friends, and other individuals who provide care and support without pay—who, if armed with effective consumer health information technology, could inexpensively facilitate their care. Objective We sought to understand caregivers’ use of, interest in, and perceived barriers to health information technology for out-of-home caregiving. Methods We conducted 2 sequential Web-based surveys with a national sample of individuals who provide out-of-home caregiving to an adult family member or friend with a chronic illness. We queried respondents about their use of health information technology for out-of-home caregiving and used multivariable regression to investigate caregiver and care-recipient characteristics associated with caregivers’ technology use for caregiving. Results Among 316 out-of-home caregiver respondents, 34.5% (109/316) reported using health information technology for caregiving activities. The likelihood of a caregiver using technology increased significantly with intensity of caregiving (as measured by number of out-of-home caregiving activities). Compared with very low intensity caregivers, the adjusted odds ratio (OR) of technology use was 1.88 (95% CI 1.01-3.50) for low intensity caregivers, 2.39 (95% CI 1.11-5.15) for moderate intensity caregivers, and 3.70 (95% CI 1.62-8.45) for high intensity caregivers. Over 70% (149/207) of technology nonusers reported interest in using technology in the future to support caregiving. The most commonly cited barriers to technology use for caregiving were health system privacy rules that restrict access to care-recipients’ health information and lack of familiarity with programs or websites that facilitate out-of-home caregiving. Conclusions Health information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care

  11. Rural electrification, climate change, and local economies: Facilitating communication in development policy and practice on Nicaragua's Atlantic Coast

    Science.gov (United States)

    Casillas, Christian E.

    I explore the role of information and communication in the world of institution-led development. Through a series of case studies from the Atlantic Coast of Nicaragua, I present several projects and their implications for uncovering information that may lead to greater local benefit from externally-planned development projects. In order to construct policies and implement projects, development institutions collect, analyze, and simplify information, collapsing messy physical and social realities into narrow sets of metrics. In addition, local stakeholders often aren't privy to the analysis and assumptions of the "expert" planners. An evolved set of methods for dialogue and planning, which focus on sharing available information, can help facilitate outcomes that are more beneficial for targeted groups. Carbon abatement cost curves provide a clear example where the relations of complex social, economic, and environmental systems are reduced to a narrow set of metrics, specifically the cost of carbon mitigation and the total tons reduced. When the carbon abatement cost curve is applied to the community level, it reveals information and allows for conclusions obscured by aggregated national level studies. I show that there are opportunities for augmenting the limited metrics of these cost curves to include those that relate to welfare, beginning to highlight how costs and savings are distributed among stakeholders. In particular, the benefits to the most marginalized groups are heavily dependent on planners taking a pro-poor approach. However, planners typically remain blind to the priorities, capabilities, and values of the target stakeholders. There is a dearth of methods that effectively open up the development expert's black box of project designs, allowing their proposed solutions to be transparent to the target beneficiaries. I address this challenge through the presentation of a participatory modeling process that was utilized with groups of artisanal fishers

  12. Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices.

    Science.gov (United States)

    Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E

    2016-01-01

    Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.

  13. Linking outcomes management and practice improvement. Structured care methodologies: evolution and use in patient care delivery.

    Science.gov (United States)

    Cole, L; Houston, S

    1999-01-01

    Structured care methodologies are tools that provide a comprehensive approach to patient care delivery. These tools have evolved in their application and purpose over the years. In many situations, multiple tools are needed to obtain the best outcomes for a patient. The presence of a SCM does not preclude clinical judgment. On the contrary, the fundamental purpose of any SCM is to assist practitioners in implementing practice patterns associated with good clinical judgment, research-based interventions, and improved patient outcomes. These tools support smooth operation and appropriate use of resources, establish a means of patient management across the continuum of care, facilitate collaboration among disciplines, reflect patient outcomes, and provide outcomes data. Data from SCMs permit benchmarking, comparison of pre-implementation and post-implementation outcomes, development of action plans for quality enhancement, identification of high-risk patients, identification of issues and problems in the system that require interventions, and the development of research protocols and studies. Structured care methodology development and implementation can be challenging, rewarding, and at times frustrating. When used appropriately, these tools can have a major impact on the standardization of care and the achievement of desired outcomes. However, individual patient needs may supersede adherence to a tool. The challenge then becomes one of balancing the unique needs of each patient and appropriate use of SCMs. Change comes slowly, but persistence pays off.

  14. Business intelligence: using insight to improve the value and performance of your practice.

    Science.gov (United States)

    Coan, Tim

    2007-01-01

    Using information to improve the value of your practice can be a great way to create leverage and improve the performance of your practice. Business intelligence (BI) is the result of a complete system that produces meaningful insights by providing the information necessary to make business decisions. Changes made from these insights improve both the performance and value of your practice. It is important to identify the key elements required of a good BI system and the areas within a practice that can directly benefit from an effective BI system.

  15. Improving product development practice: An action-research based approach

    DEFF Research Database (Denmark)

    Harmsen, Hanne

    In studies of new product development it has often been concluded that to a large extent new product suc-cess is tunder the influence of companies and long lists of direct norma-tive guide-lines have been formulated. Nevertheless descriptive studi that deve-lopment practice is still far from the ...... these change processes, and it is particularly the advantages and disadvantages of this - traditionally not very popular - research approach that is in focus in this paper.......In studies of new product development it has often been concluded that to a large extent new product suc-cess is tunder the influence of companies and long lists of direct norma-tive guide-lines have been formulated. Nevertheless descriptive studi that deve-lopment practice is still far from...

  16. Alternative Practices to Improve Surface Fleet Fuel Efficiency

    Science.gov (United States)

    2014-09-01

    practices that, if changed, could provide significant fuel savings for fossil fuel ships. Recent and potential future budget cuts give fuel conservation...changed, could provide significant fuel savings for fossil fuel ships. Recent and potential future budget cuts give fuel conservation and efficiency...Figure 1. Navy fossil fuel expenditure for FY 2013 (after Dhoran 2014). .......................1 Figure 2. Fuel curves for a DDG showing GPH burned as

  17. Integrating Safe Sleep Practices into a Pediatric Hospital: Outcomes of a Quality Improvement Project.

    Science.gov (United States)

    Rowe, Angela D; Sisterhen, Laura L; Mallard, Ellen; Borecky, Betsy; Schmid, Barbara; Rettiganti, Mallikarjuna; Luo, Chunqiao

    2016-01-01

    A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital. The intervention involved education of staff and standardization of infant sleep practices utilizing a multifaceted approach. Staff surveys and environmental audits were conducted pre- and post-intervention. Safe Sleep Environment (SSE) audits showed an improvement from 23% to 34% (psafe sleep practices have the potential to reduce infant mortality.

  18. adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    Dr.Adesope

    Improved production technologies of sweet potato were jointly developed by .... that income is positively related to farmers' adoption of new technologies. ... intercrop and harvesting technique but low for planting space and planting pattern.

  19. adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    Dr.Adesope

    Key words: adoption, improved aquaculture, shrimp farmers ..... technical manpower for pond construction or unawareness of the techniques at the time of construction of farm. .... The First Indian Fisheries Forum Proceedings. Asian Fish. Soc.

  20. Hybrid practices as a means to implement quality improvement: A comparative qualitative study in a Dutch and Swedish hospital.

    Science.gov (United States)

    Quartz-Topp, Julia; Sanne, Johan M; Pöstges, Heide

    2016-11-15

    Managers and scholars commonly perceive resistance from professionals as hampering the implementation of quality improvement (QI) and refer to the incompatibility of clinical and managerial approaches to QI as a reason. Yet a growing body of research indicates that, in practice, these two approaches rather blend into hybrid practices that embody different types of QI-related knowledge and values. This opens up a new perspective on implementation challenges that moves attention away from resistance against managerial QI toward difficulties for clinicians to draw together different types of knowledge and values within their clinical work. So far, little is known about how managers can support clinicians to generate hybrid QI practices. The aim of this study was to deepen our understanding of how managers can support the generation of hybrid practices that help clinicians to integrate QI into their everyday work. We draw on comparative qualitative research including 21 semistructured interviews, documentary analysis, and participant observation that we conducted in one Dutch and one Swedish hospital over a period of 8 months in 2011/2012. Hospital managers designed hybrid forums, tools, and professional roles in order to facilitate the integration of different QI practices, knowledge, and values. This integration generated new hybrid practices and an infrastructure for QI that has potential to support clinicians in their efforts to align different demands. New opportunities to implement QI emerge when we change the implementation problem from clinical resistance to the need of support for clinicians to develop hybrid QI practices. Hospital managers then have to intentionally organize for the generation of hybrid practices by designing, for example, hybrid forums, tools, and professional roles that integrate different knowledge and values in a nonhierarchical way.

  1. Lessons learned while conducting a clinical trial to facilitate evidence-based practice: the neophyte researcher experience.

    Science.gov (United States)

    Brim, Carla B; Schoonover, Heather D

    2009-08-01

    Health care is incredibly complex. Now, more than ever, health care providers are being called on to deliver care that is based on evidence and is consistent with current professional knowledge. Educators often struggle to find time when staff are available to participate in scheduled education. The work of nursing staff is to provide patient care. This article describes the journey of neophyte researchers who conducted a clinical trial as a strategy to implement evidence-based practice. Although educational opportunities for the staff were included as part of the trial, there were also many challenges applicable to the neophyte researcher role. Those challenges included the participants' neophyte knowledge and perception of the research process, vendor relationships, data collection methods, staff perceptions, and the culture of the institution itself.

  2. Regular Football Practice Improves Autonomic Cardiac Function in Male Children

    Directory of Open Access Journals (Sweden)

    Fernandes

    2015-09-01

    Full Text Available Background The role of the autonomic nervous system (ANS in the cardiovascular regulation is of primal importance. Since it has been associated with adverse conditions such as cardiac arrhythmias, sudden death, sleep disorders, hypertension and obesity. Objectives The present study aimed to investigate the impact of recreational football practice on the autonomic cardiac function of male children, as measured by heart rate variability. Patients and Methods Forty-seven male children aged 9 - 12 years were selected according to their engagement with football oriented practice outside school context. The children were divided into a football group (FG; n = 22 and a control group (CG; n = 25. The FG had regular football practices, with 2 weekly training sessions and occasional weekend matches. The CG was not engaged with any physical activity other than complementary school-based physical education classes. Data from physical activity, physical fitness, and heart rate variability measured in time and frequency domains were obtained. Results The anthropometric and body composition characteristics were similar in both groups (P > 0.05. The groups were also similar in time spent daily on moderate-to-vigorous physical activities (FG vs. CG: 114 ± 64 vs. 87 ± 55 minutes; P > 0.05. However, the FG performed better (P < 0.05 in Yo-Yo intermittent endurance test (1394 ± 558 vs. 778 ± 408 m and 15-m sprint test (3.06 ± 0.17 vs. 3.20 ± 0.23 s. Also, the FG presented enhanced autonomic function. Significant differences were detected (P < 0.05 between groups for low frequency normalized units (38.0 ± 15.2 vs. 47.3 ± 14.2 n.u (normalized units, high frequency normalized units (62.1 ± 15.2 vs. 52.8 ± 14.2 n.u., and LF:HF ratio (0.7 ± 0.4 vs. 1.1 ± 0.6 ms2. Conclusions Children engaged with regular football practice presented enhanced physical fitness and autonomic function, by increasing vagal tone at rest.

  3. Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care.

    Science.gov (United States)

    Tropea, Joanne; LoGiudice, Dina; Liew, Danny; Roberts, Carol; Brand, Caroline

    2017-03-01

    Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care. A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents' current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care. A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low. The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

  4. Research To Support Improved Practice in Indian Education.

    Science.gov (United States)

    Swisher, Karen Gayton; Tippeconnic, John W., III

    In recent years, various task forces and studies, including the White House Conference on Indian Education, have established that research on Indian education, history, and culture must consider the Native perspective and involve Native researchers. Improving Indian education depends upon good research. Aspects of Indigenous education and…

  5. Adapting Job Analysis Methodology to Improve Evaluation Practice

    Science.gov (United States)

    Jenkins, Susan M.; Curtin, Patrick

    2006-01-01

    This article describes how job analysis, a method commonly used in personnel research and organizational psychology, provides a systematic method for documenting program staffing and service delivery that can improve evaluators' knowledge about program operations. Job analysis data can be used to increase evaluators' insight into how staffs…

  6. Driving Performance Improvements by Integrating Competencies with Human Resource Practices

    Science.gov (United States)

    Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

    2010-01-01

    This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

  7. Driving Performance Improvements by Integrating Competencies with Human Resource Practices

    Science.gov (United States)

    Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

    2010-01-01

    This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

  8. Program Manager Medium and Heavy Tactical Vehicles Needs to Improve Acquisition Practices

    Science.gov (United States)

    2015-05-05

    5 , 2 0 1 5 Program Manager Medium and Heavy Tactical Vehicles Needs to Improve Acquisition Practices Report No. DODIG-2015-116 Report...TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Program Manager Medium and Heavy Tactical Vehicles Needs to Improve... Medium and Heavy Tactical Vehicles Needs to Improve Acquisition Practices Visit us at www.dodig.mil Objective The objective was to assess the propriety

  9. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m......, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case. PARTICIPANTS: 28 cases from 10 studies were included, representing 148 461 patients seeking care for suspected malaria. INTERVENTIONS: The interventions included different mRDT training......RDT-negative patients; a more directive intervention approach and local preferences for ACTs. CONCLUSIONS: Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities...

  10. Practice of contemporary dance improves cognitive flexibility in aging.

    Science.gov (United States)

    Coubard, Olivier A; Duretz, Stéphanie; Lefebvre, Virginie; Lapalus, Pauline; Ferrufino, Lena

    2011-01-01

    As society ages and frequency of dementia increases exponentially, counteracting cognitive aging decline is a challenging issue for countries of the developed world. Previous studies have suggested that physical fitness based on cardiovascular and strength training helps to improve attentional control in normal aging. However, how motor activity based on motor-skill learning can also benefit attentional control with age has been hitherto a neglected issue. This study examined the impact of contemporary dance (CD) improvisation on attentional control of older adults, as compared to two other motor training programs, fall prevention and Tai Chi Chuan. Participants performed setting, suppressing, and switching attention tasks before and after 5.7-month training in either CD or fall prevention or Tai Chi Chuan. Results indicated that CD improved switching but not setting or suppressing attention. In contrast, neither fall prevention nor Tai Chi Chuan showed any effect. We suggest that CD improvisation works as a training for change, inducing plasticity in flexible attention.

  11. The practical problem of improving quality in multicenter dialysis facilities.

    Science.gov (United States)

    Balter, Paul

    2003-01-01

    Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success.

  12. Improving standards of radiation protection in medical practice

    Energy Technology Data Exchange (ETDEWEB)

    Ginjaume, M.; Ortega, X. [Institute of Energy Technology, Universitat Politecnica de Catalunya - UPC (Spain); Carinou, E. [Greek Atomic Energy Commission - GAEC (Greece); Vanhavere, F. [Belgian Nuclear Research Centre, SCK.CEN (Belgium); Clairand, I. [Institut de Radioprotection et de Surete Nucleaire - IRSN (France); Gualdrini, G. [Ente per le Nuove Tecnologie, l' Energia e l' Ambiente - ENEA (Italy); Sans-Merce, M. [University Hospital Center Vaudois - CHUV (Switzerland)

    2010-07-01

    The use of ionizing radiation has led to major improvements in the diagnosis and treatment of patients. However, new developments in medical technology and the increased complexity of medical radiation techniques can produce high doses to medical personnel. In particular, interventional radiology and cardiology and nuclear medicine have been identified as fields where medical staff can receive potentially high doses. Within this framework, the ORAMED project, a collaborative project funded by the EU FP7, proposes new methodologies to improve standards of protection for medical staff. The main studied topics presented in this paper include extremity and eye-lens protection in interventional radiology and cardiology, extremity dosimetry in nuclear medicine, especially in therapy and positron emission tomography, and the evaluation and the improvement of active personal dosemeters used in pulsed medical radiation fields. An extensive dose measurement campaign of doses received in extremities and eye-lenses in more than 60 hospitals from 9 European countries has been undertaken. The analysis of the results highlights the most critical procedures and the effectiveness of the protection measures. (authors)

  13. Solid recovered fuels in the cement industry--semi-automated sample preparation unit as a means for facilitated practical application.

    Science.gov (United States)

    Aldrian, Alexia; Sarc, Renato; Pomberger, Roland; Lorber, Karl E; Sipple, Ernst-Michael

    2016-03-01

    One of the challenges for the cement industry is the quality assurance of alternative fuel (e.g., solid recovered fuel, SRF) in co-incineration plants--especially for inhomogeneous alternative fuels with large particle sizes (d95⩾100 mm), which will gain even more importance in the substitution of conventional fuels due to low production costs. Existing standards for sampling and sample preparation do not cover the challenges resulting from these kinds of materials. A possible approach to ensure quality monitoring is shown in the present contribution. For this, a specially manufactured, automated comminution and sample divider device was installed at a cement plant in Rohožnik. In order to prove its practical suitability with methods according to current standards, the sampling and sample preparation process were validated for alternative fuel with a grain size >30 mm (i.e., d95=approximately 100 mm), so-called 'Hotdisc SRF'. Therefore, series of samples were taken and analysed. A comparison of the analysis results with the yearly average values obtained through a reference investigation route showed good accordance. Further investigations during the validation process also showed that segregation or enrichment of material throughout the comminution plant does not occur. The results also demonstrate that compliance with legal standards regarding the minimum sample amount is not sufficient for inhomogeneous and coarse particle size alternative fuels. Instead, higher sample amounts after the first particle size reduction step are strongly recommended in order to gain a representative laboratory sample.

  14. Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

    Science.gov (United States)

    Clarke, Christina M; Persaud, Drepaul David

    2011-03-01

    Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

  15. Building Self-Control Strength: Practicing Self-Control Leads to Improved Self-Control Performance

    OpenAIRE

    Muraven, Mark

    2010-01-01

    Self-control performance may be improved by the regular practice of small acts of self-control. Ninety-two adults’ self-control capacity was assessed using the stop signal paradigm before they started practicing self-control and again at the end of two weeks. Participants who practiced self-control by cutting back on sweets or squeezing a handgrip exhibited significant improvement in stop signal performance relative to those who practiced tasks that did not require self-control. Participants ...

  16. How Positive Practices Can Accelerate Transformation To a Lean Improvement Culture

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus; Hansen, David; Lilja, Johan

    2016-01-01

    With increasing pressure on creating more value with fewer resources, many organizations pursue continuous improvement culture and practices in daily operations.In operations management Lean and the Toyota Way have been continuous improvement role models for describing tools and culture. However......, the cultural transformation has been reported difficult to achieve. This study investigates how practices in daily operations can be used to purposely support the cultural transformation. During an explorative case study 9 practices were identified and analysed. The study showed that positive practices based...... on appreciative inquiry andpositive psychology were particularly effective in accelerating cultural transformation....

  17. Implementation of renal key performance indicators: promoting improved clinical practice.

    Science.gov (United States)

    Toussaint, Nigel D; McMahon, Lawrence P; Dowling, Gregory; Soding, Jenny; Safe, Maria; Knight, Richard; Fair, Kathleen; Linehan, Leanne; Walker, Rowan G; Power, David A

    2015-03-01

    In the Australian state of Victoria, the Renal Health Clinical Network (RHCN) of the Department of Health Victoria established a Renal Key Performance Indicator (KPI) Working Group in 2011. The group developed four KPIs related to chronic kidney disease and dialysis. A transplant working group of the RHCN developed two additional KPIs. The aim was to develop clinical indicators to measure performance of renal services to drive service improvement. A data collection and benchmarking programme was established, with data provided monthly to the Department using a purpose-designed website portal. The KPI Working Group is responsible for analysing data each quarter and ensuring indicators remain accurate and relevant. Each indicator has clear definitions and targets, and assess (i) patient education, (ii) timely creation of vascular access for haemodialysis, (iii) proportion of patients dialysing at home, (iv) incidence of dialysis-related peritonitis, (v) incidence of pre-emptive renal transplantation, and (vi) timely listing of patients for deceased donor transplantation. Most KPIs have demonstrated improved performance over time with limited gains notably in two: the proportion of patients dialysing at home (KPI 3) and timely listing patients for transplantation (KPI 6). KPI implementation has been established in Victoria for 2 years, providing performance data without additional funding. The six Victorian KPIs are measurable, relevant and modifiable, and implementation relies on enthusiasm and goodwill of physicians and nurses involved in collecting data. The KPIs require further evaluation, but adoption of a similar programme by other jurisdictions could lead to improved national outcomes. © 2014 Asian Pacific Society of Nephrology.

  18. Improving risk management: from lame excuses to principled practice.

    Science.gov (United States)

    Paté-Cornell, Elisabeth; Cox, Louis Anthony

    2014-07-01

    The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame-shifting "lame excuses" for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning-especially from near-misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk-reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management.

  19. Improving statistical reasoning theoretical models and practical implications

    CERN Document Server

    Sedlmeier, Peter

    1999-01-01

    This book focuses on how statistical reasoning works and on training programs that can exploit people''s natural cognitive capabilities to improve their statistical reasoning. Training programs that take into account findings from evolutionary psychology and instructional theory are shown to have substantially larger effects that are more stable over time than previous training regimens. The theoretical implications are traced in a neural network model of human performance on statistical reasoning problems. This book apppeals to judgment and decision making researchers and other cognitive scientists, as well as to teachers of statistics and probabilistic reasoning.

  20. Learning leadership skills in practice through quality improvement.

    Science.gov (United States)

    Gamble, James; Vaux, Emma

    2014-02-01

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

  1. Global and cultural perinatal nursing research: improving clinical practice.

    Science.gov (United States)

    Callister, Lynn Clark

    2011-01-01

    High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.

  2. Jonathan E. Rhoads lecture 2012: improving patient care with practice-based research.

    Science.gov (United States)

    Dickerson, Roland N

    2012-09-01

    Practice-based research plays a pivotal role for improving patient care as its primary intent is to solve a clinical dilemma or problem encountered in clinical practice. Its results are immediately applicable to day-to-day clinical practice and essential to the growth of an evidence-based clinical practice. This review emphasizes the importance of this type of research. In addition, it serves to identify common sources for project conception and gives examples based on personal experiences of the author as a clinical practitioner, educator, and researcher. Common barriers to practice-based research are discussed as well as potential solutions offered for consideration.

  3. Improving standard practices for prediction in ungauged basins: Bayesian approach

    Science.gov (United States)

    Prieto, Cristina; Le-Vine, Nataliya; García, Eduardo; Medina, Raúl

    2015-04-01

    In hydrological modelling, the prediction of flows in ungauged basins is still a defiance. Among the different alternatives to quantify and reduce the uncertainty in the predictions, a Bayesian framework has proven to be advantageous. This framework allows flow prediction in ungauged basins based on regionalised hydrological indices. Being grounded on probability theory, the procedure requires a number of assumptions and decisions to be made. Among the most important ones are 1) selection of representative hydrological signatures, 2) selection of regionalization model functional form, and 3) a 'perfect' model/ input assumption. The contribution of this research is to address these three assumptions. First, to reduce an extensive set of available hydrological signatures we select a compact orthogonal set of information pieces using Principal Component Analysis. This advances the standard practice of semi-empirical selection of individual hydrological signatures. Second, we use functional-form-assumption-free Random Forests to regionalize the selected information. This allows the traditional assumption of linear regression between catchment properties and characteristics of hydrological response to be relaxes. And third, we propose utilizing non-traditional metrics to flag-up possible model/ input errors: Bayes' Factor and a newly-proposed 'Suitability' test. This addresses the typical non-realistic assumption that model is 'perfect' and the input is noise-free. The proposed methodological developments are illustrated for the empirical challenge of flow prediction in rivers in Northern Spain.

  4. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  5. Seeking Best Practices: A Conceptual Framework for Planning and Improving Evidence-Based Practices

    Science.gov (United States)

    Schooley, Michael W.; Anderson, Lynda A.; Kochtitzky, Chris S.; DeGroff, Amy S.; Devlin, Heather M.; Mercer, Shawna L.

    2013-01-01

    How can we encourage ongoing development, refinement, and evaluation of practices to identify and build an evidence base for best practices? On the basis of a review of the literature and expert input, we worked iteratively to create a framework with 2 interrelated components. The first — public health impact — consists of 5 elements: effectiveness, reach, feasibility, sustainability, and transferability. The second — quality of evidence — consists of 4 levels, ranging from weak to rigorous. At the intersection of public health impact and quality of evidence, a continuum of evidence-based practice emerges, representing the ongoing development of knowledge across 4 stages: emerging, promising, leading, and best. This conceptual framework brings together important aspects of impact and quality to provide a common lexicon and criteria for assessing and strengthening public health practice. We hope this work will invite and advance dialogue among public health practitioners and decision makers to build and strengthen a diverse evidence base for public health programs and strategies. PMID:24331280

  6. Practice of contemporary dance improves cognitive flexibility in aging

    Directory of Open Access Journals (Sweden)

    Olivier A. Coubard

    2011-09-01

    Full Text Available As society ages and frequency of dementia increases exponentially, counteracting cognitive aging decline is a challenging issue for countries of the developed world. Previous studies have suggested that physical fitness based on cardiovascular and strength training helps to improve attentional control in normal aging. However, how motor activity based on motor-skill learning can also benefit attentional control with age has been hitherto a neglected issue. This study examined the impact of contemporary dance (CD improvisation on attentional control of older adults, as compared to two other motor training programs, fall prevention and Tai Chi Chuan. Participants performed setting, suppressing, and switching attention tasks before and after 5.7-month training in either CD or fall prevention or Tai Chi Chuan. Results indicated that CD improved switching but not setting or suppressing attention. In contrast, neither fall prevention nor Tai Chi Chuan showed any effect. We suggest that CD improvisation works as a training for change, inducing plasticity in flexible attention.

  7. Improvement in physiological and psychological parameters after six months of yoga practice in military men

    Directory of Open Access Journals (Sweden)

    Kliger Kissinger Fernandes Rocha

    2012-06-01

    Full Text Available Mind-body practices such as yoga are believed to have potential beneficial effects on cognition, as well as on emotional control and on improvement of stress tolerance. However, previous studies were mainly performed on eastern experienced practitioners, or in unhealthy subjects undergoing concomitant conventional therapies. In addition, several kinds of physical exercises have also shown to improve several aspects of mental and body health. Further investigation is needed on the effects of yoga practice per se, even as the possible preventive benefits of this practice on healthy subjects. This study investigated the effects of yoga on memory and on psychophysiological parameters related to stress, as well as offering a possible relationship between these measurements. A controlled trial comparing yoga practice and conventional physical exercises was carried out with yoga-naïve healthy military men. Data from memory tests, salivary cortisol levels and stress, anxiety, and depression inventories were assessed before and after six months of yoga practice. There were significant improvements of the performance on the memory tests, which were accompanied by improvements in psychophysiological parameters in the yoga-practitioners. Improvements were detected when yoga practitioners were compared to non-practitioners, as well as when comparisons were conducted between basal and after practice outcomes. The results indicated that yoga can effectively improve memory after six months of regular practice, along with psychophysiological measurements related to anxiety, depression and stress in healthy subjects. Yoga could be an effective treatment of anxiety, depression and stress. Furthermore, an indirect influence of parameters related to emotional state on cognitive improvement promoted by yoga practice can be proposed. Taken together with previous work, the present results point out to an important application of yoga practice in preventive health care

  8. Practice and Verification of Creative Engineering Education for Consecutive Improvement

    Science.gov (United States)

    Okada, Masato; Kaneda, Naoto; Muranaka, Takayuki; Tanaka, Kazuhiko; Yamamoto, Yukio; Kitagawa, Hirokazu

    This paper shows that effects of creative education program through the development of sliding bearings in the mechanical engineering department. In this program, the sliding bearings are designed and performance assessed at project team. In the beginning, the shape of a new sliding bearing is examined and suggested. When the suggested one obtains desired performance by the simulation program that is manufactured by CAD/CAM system and Machining Center. After estimation of geometry basis on shape measure, the produced one is measured the floating distance at performance test. The student can independently experience a consecutive improvement process by doing these processes twice in this program. The result with high attendance degree of satisfaction is gotten from the questionnaire about the member of a class.

  9. How to improve the performance of a good medical practice team: twelve techniques.

    Science.gov (United States)

    Hills, Laura

    2013-01-01

    It is incredibly easy to ignore the medical practice team that is doing a good job. However, when we allow good performers to continue as they are, they probably won't improve. Their performance may even worsen. This is unfortunate because with a little bit of effort and support, good performers can often learn to excel. This article offers 12 techniques medical practice managers can use to bring their team members from good performance to excellent. It describes how to use goal-setting, work assignments, modeling, confidence building, team retreats, rewards, incentives, and reinforcement to ratchet up a good medical practice team's performance. This article also identifies the signs of medical employee mediocrity. It describes why setting higher expectations of your medical practice employees will ultimately improve their performance. Finally, this article suggests 10 practical and affordable strategies that medical practice managers can use to reinforce excellent performance in their good employees.

  10. The promise of multimedia technology for STI/HIV prevention: frameworks for understanding improved facilitator delivery and participant learning.

    Science.gov (United States)

    Khan, Maria R; Epperson, Matthew W; Gilbert, Louisa; Goddard, Dawn; Hunt, Timothy; Sarfo, Bright; El-Bassel, Nabila

    2012-10-01

    There is increasing excitement about multimedia sexually transmitted infection (STI) and HIV prevention interventions, yet there has been limited discussion of how use of multimedia technology may improve STI/HIV prevention efforts. The purpose of this paper is to describe the mechanisms through which multimedia technology may work to improve the delivery and uptake of intervention material. We present conceptual frameworks describing how multimedia technology may improve intervention delivery by increasing standardization and fidelity to the intervention material and the participant's ability to learn by improving attention, cognition, emotional engagement, skills-building, and uptake of sensitive material about sexual and drug risks. In addition, we describe how the non-multimedia behavioral STI/HIV prevention intervention, Project WORTH, was adapted into a multimedia format for women involved in the criminal justice system and provide examples of how multimedia activities can more effectively target key mediators of behavioral change in this intervention.

  11. Changing physician behavior: interventions to improve prescription writing practices in a secondary level hospital in Delhi

    Directory of Open Access Journals (Sweden)

    Dipanweeta Routray

    2014-10-01

    Conclusion: Combining different intervention seems a noble approach to improve the prescription writing practices with respect to completeness and inclusion of generic drugs, drugs from EDL. [Int J Basic Clin Pharmacol 2014; 3(5.000: 840-844

  12. Improvement in physiological and psychological parameters after 6 months of yoga practice.

    Science.gov (United States)

    Rocha, K K F; Ribeiro, A M; Rocha, K C F; Sousa, M B C; Albuquerque, F S; Ribeiro, S; Silva, R H

    2012-06-01

    Yoga is believed to have beneficial effects on cognition, attenuation of emotional intensity and stress reduction. Previous studies were mainly performed on eastern experienced practitioners or unhealthy subjects undergoing concomitant conventional therapies. Further investigation is needed on the effects of yoga per se, as well as its possible preventive benefits on healthy subjects. We investigated the effects of yoga on memory and psychophysiological parameters related to stress, comparing yoga practice and conventional physical exercises in healthy men (previously yoga-naïve). Memory tests, salivary cortisol levels and stress, anxiety, and depression inventories were assessed before and after 6 months of practice. Yoga practitioners showed improvement of the memory performance, as well as improvements in psychophysiological parameters. The present results suggest that regular yoga practice can improve aspects of cognition and quality of life for healthy individuals. An indirect influence of emotional state on cognitive improvement promoted by yoga practice can be proposed.

  13. Usage of Practices Promoted by School Improvement Grants. NCEE 2015-4019

    Science.gov (United States)

    Dragoset, Lisa; James-Burdumy, Susanne; Hallgren, Kristin; Perez-Johnson, Irma; Herrmann, Mariesa; Tuttle, Christina; Angus, Megan Hague; Herman, Rebecca; Murray, Matthew; Tanenbaum, Courtney; Graczewski, Cheryl

    2015-01-01

    The American Recovery and Reinvestment Act of 2009 injected $7 billion into two of the Obama administration's signature competitive education grant programs: Race to the Top (RTT) and School Improvement Grants (SIG). While RTT focused on state policies and SIG focused on school practices, both programs promoted related policies and practices,…

  14. Practical Measurement and Productive Persistence: Strategies for Using Digital Learning System Data to Drive Improvement

    Science.gov (United States)

    Krumm, Andrew E.; Beattie, Rachel; Takahashi, Sola; D'Angelo, Cynthia; Feng, Mingyu; Cheng, Britte

    2016-01-01

    This paper outlines the development of practical measures of productive persistence using digital learning system data. Practical measurement refers to data collection and analysis approaches originating from improvement science; productive persistence refers to the combination of academic and social mindsets as well as learning behaviours that…

  15. Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.

    Science.gov (United States)

    Academy for Educational Development, Washington, DC.

    The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…

  16. Accountability Policies and Teacher Decision Making: Barriers to the Use of Data to Improve Practice

    Science.gov (United States)

    Ingram, Debra; Louis, Karen Seashore; Schroeder, Roger G.

    2004-01-01

    One assumption underlying accountability policies is that results from standardized tests and other sources will be used to make decisions about school and classroom practice. We explore this assumption using data from a longitudinal study of nine high schools nominated as leading practitioners of Continuous Improvement (CI) practices. We use the…

  17. Facilitating Knowledge Sharing

    DEFF Research Database (Denmark)

    Holdt Christensen, Peter

    Abstract This paper argues that knowledge sharing can be conceptualized as different situations of exchange in which individuals relate to each other in different ways, involving different rules, norms and traditions of reciprocity regulating the exchange. The main challenge for facilitating...... and the intermediaries regulating the exchange, and facilitating knowledge sharing should therefore be viewed as a continuum of practices under the influence of opportunistic behaviour, obedience or organizational citizenship behaviour. Keywords: Knowledge sharing, motivation, organizational settings, situations...

  18. Evaluation of a Practice-Development Initiative to Improve Breastfeeding Rates

    OpenAIRE

    Barnes, Margaret; Cox, Julie; Doyle, Bronwyn; Reed, Rachel

    2010-01-01

    The benefits of breastfeeding for infant, mother, family, and community are well recognized, and increasing breastfeeding rates is considered an important health-promotion strategy. Improving breastfeeding knowledge and practice among individuals caring for breastfeeding women is considered an important aspect of this strategy. The practice-development initiative described in this article aimed to improve hospital-based breastfeeding rates through the implementation of The Ten Steps to Succes...

  19. Strengthening care teams to improve adherence in cystic fibrosis: a qualitative practice assessment and quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Gardner AJ

    2017-04-01

    Full Text Available Allison J Gardner,1 Alice L Gray,2 Staci Self,3 Jeffrey S Wagener4 1Med-IQ, LLC, Baltimore, MD, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, 3Division of Pediatric Pulmonology, University of Alabama at Birmingham, Birmingham, AL, 4Department of Pediatrics, University of Colorado Medical School, Aurora, CO, USA Background: Treatment regimens for patients with cystic fibrosis (CF are complex, time consuming, and burdensome, and adherence to CF treatment is suboptimal. CF care teams play a critical role in supporting patients’ chronic self-management skills, but there is no uniform method for assessing patients’ adherence to treatment or standard interventions to help patients improve when necessary.Methods: Between May 2015 and March 2016, care team members from 10 CF centers in the USA participated in a practice assessment and quality improvement (QI initiative. The intervention included a baseline practice assessment survey, personalized continuing medical education (CME-certified Webconferences with expert study faculty, targeted reinforcement of key practice points, and follow-up online survey and telephone interviews to evaluate the benefits and limitations of the intervention.Results: Responses to the baseline practice assessment survey were received from 50 multidisciplinary care team members representing 10 CF centers. Primary barriers to adherence-related aspects of care in their clinics were motivating patients and caregivers to improve adherence and obtaining accurate information about adherence from patients. At the conclusion of the initiative, participants reported improvements in communication within their care team, implementation of new approaches to asking about adherence, and a renewed commitment to asking patients and caregivers about adherence at each clinic visit.Conclusion: Structured QI interventions that bring multidisciplinary care teams together to

  20. Functionalization of graphene oxide nanostructures improves photoluminescence and facilitates their use as optical probes in preclinical imaging.

    Science.gov (United States)

    Prabhakar, Neeraj; Näreoja, Tuomas; von Haartman, Eva; Şen Karaman, Didem; Burikov, Sergey A; Dolenko, Tatiana A; Deguchi, Takahiro; Mamaeva, Veronika; Hänninen, Pekka E; Vlasov, Igor I; Shenderova, Olga A; Rosenholm, Jessica M

    2015-06-21

    Recently reported photoluminescent nanographene oxides (nGOs), i.e. nanographene oxidised with a sulfuric/nitric acid mixture (SNOx method), have tuneable photoluminescence and are scalable, simple and fast to produce optical probes. This material belongs to the vast class of photoluminescent carbon nanostructures, including carbon dots, nanodiamonds (NDs), graphene quantum dots (GQDs), all of which demonstrate a variety of properties that are attractive for biomedical imaging such as low toxicity and stable photoluminescence. In this study, the nGOs were organically surface-modified with poly(ethylene glycol)-poly(ethylene imine) (PEG-PEI) copolymers tagged with folic acid as the affinity ligand for cancer cells expressing folate receptors. The functionalization enhanced both the cellular uptake and quantum efficiency of the photoluminescence as compared to non-modified nGOs. The nGOs exhibited an excitation dependent photoluminescence that facilitated their detection with a wide range of microscope configurations. The functionalized nGOs were non-toxic, they were retained in the stained cell population over a period of 8 days and they were distributed equally between daughter cells. We have evaluated their applicability in in vitro and in vivo (chicken embryo CAM) models to visualize and track migratory cancer cells. The good biocompatibility and easy detection of the functionalized nGOs suggest that they could address the limitations faced with quantum dots and organic fluorophores in long-term in vivo biomedical imaging.

  1. Moving from theory to research to practice. Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients.

    Science.gov (United States)

    Remien, Robert H; Stirratt, Michael J; Dognin, Joanna; Day, Emily; El-Bassel, Nabila; Warne, Patricia

    2006-12-01

    There is a dearth of evidence on the relative efficacy of intervention modalities to improve and maintain patient adherence to antiretroviral medications. Although empiric findings from research on HIV/AIDS, other diseases, and chronic medical conditions consistently demonstrate that social support plays an important role in facilitating adherence, few HIV/AIDS interventions have directly targeted this factor. Ewart's social action theory emphasizes the role of social relationships in behavior change and provides a comprehensive and useful guide to the development of interventions for adherence. We describe the development, content, and testing of SMART Couples, an effective antiretroviral adherence intervention that is grounded in social action theory and designed to enhance social support for ART adherence. Finally, we discuss some of the challenges of translating findings from the randomized clinical trial of this intervention into clinical practice and offer recommendations for integration of lessons learned into ongoing clinical care.

  2. Functionalization of graphene oxide nanostructures improves photoluminescence and facilitates their use as optical probes in preclinical imaging

    Science.gov (United States)

    Prabhakar, Neeraj; Näreoja, Tuomas; von Haartman, Eva; Şen Karaman, Didem; Burikov, Sergey A.; Dolenko, Tatiana A.; Deguchi, Takahiro; Mamaeva, Veronika; Hänninen, Pekka E.; Vlasov, Igor I.; Shenderova, Olga A.; Rosenholm, Jessica M.

    2015-06-01

    Recently reported photoluminescent nanographene oxides (nGOs), i.e. nanographene oxidised with a sulfuric/nitric acid mixture (SNOx method), have tuneable photoluminescence and are scalable, simple and fast to produce optical probes. This material belongs to the vast class of photoluminescent carbon nanostructures, including carbon dots, nanodiamonds (NDs), graphene quantum dots (GQDs), all of which demonstrate a variety of properties that are attractive for biomedical imaging such as low toxicity and stable photoluminescence. In this study, the nGOs were organically surface-modified with poly(ethylene glycol)-poly(ethylene imine) (PEG-PEI) copolymers tagged with folic acid as the affinity ligand for cancer cells expressing folate receptors. The functionalization enhanced both the cellular uptake and quantum efficiency of the photoluminescence as compared to non-modified nGOs. The nGOs exhibited an excitation dependent photoluminescence that facilitated their detection with a wide range of microscope configurations. The functionalized nGOs were non-toxic, they were retained in the stained cell population over a period of 8 days and they were distributed equally between daughter cells. We have evaluated their applicability in in vitro and in vivo (chicken embryo CAM) models to visualize and track migratory cancer cells. The good biocompatibility and easy detection of the functionalized nGOs suggest that they could address the limitations faced with quantum dots and organic fluorophores in long-term in vivo biomedical imaging.Recently reported photoluminescent nanographene oxides (nGOs), i.e. nanographene oxidised with a sulfuric/nitric acid mixture (SNOx method), have tuneable photoluminescence and are scalable, simple and fast to produce optical probes. This material belongs to the vast class of photoluminescent carbon nanostructures, including carbon dots, nanodiamonds (NDs), graphene quantum dots (GQDs), all of which demonstrate a variety of properties that are

  3. Phylogenetic and functional analysis of the Cation Diffusion Facilitator (CDF family: improved signature and prediction of substrate specificity

    Directory of Open Access Journals (Sweden)

    Jeandroz Sylvain

    2007-04-01

    Full Text Available Abstract Background The Cation Diffusion Facilitator (CDF family is a ubiquitous family of heavy metal transporters. Much interest in this family has focused on implications for human health and bioremediation. In this work a broad phylogenetic study has been undertaken which, considered in the context of the functional characteristics of some fully characterised CDF transporters, has aimed at identifying molecular determinants of substrate selectivity and at suggesting metal specificity for newly identified CDF transporters. Results Representative CDF members from all three kingdoms of life (Archaea, Eubacteria, Eukaryotes were retrieved from genomic databases. Protein sequence alignment has allowed detection of a modified signature that can be used to identify new hypothetical CDF members. Phylogenetic reconstruction has classified the majority of CDF family members into three groups, each containing characterised members that share the same specificity towards the principally-transported metal, i.e. Zn, Fe/Zn or Mn. The metal selectivity of newly identified CDF transporters can be inferred by their position in one of these groups. The function of some conserved amino acids was assessed by site-directed mutagenesis in the poplar Zn2+ transporter PtdMTP1 and compared with similar experiments performed in prokaryotic members. An essential structural role can be assigned to a widely conserved glycine residue, while aspartate and histidine residues, highly conserved in putative transmembrane domains, might be involved in metal transport. The potential role of group-conserved amino acid residues in metal specificity is discussed. Conclusion In the present study phylogenetic and functional analyses have allowed the identification of three major substrate-specific CDF groups. The metal selectivity of newly identified CDF transporters can be inferred by their position in one of these groups. The modified signature sequence proposed in this work can be

  4. Improving adolescent social competence and behavior: a randomized trial of an 11-week equine facilitated learning prevention program.

    Science.gov (United States)

    Pendry, Patricia; Carr, Alexa M; Smith, Annelise N; Roeter, Stephanie M

    2014-08-01

    There is growing evidence that promoting social competence in youth is an effective strategy to prevent mental, emotional, and behavioral disorders in adulthood. Research suggests that programs delivered in collaboration with schools are particularly effective when they target social and emotional skill building, utilize an interactive instructional style, provide opportunities for youth participation and self-direction, and include explicit attempts to enhance youth social competence. A relatively new but popular approach that incorporates these characteristics is human animal interaction, which can be implemented in educational settings. We report the results from a randomized clinical trial examining the effects of an 11-week equine facilitated learning (EFL) program on the social competence and behavior of 5th-8th grade children. Children (N = 131) were recruited through referral by school counselors and school-based recruitment and then screened for low social competence. Researchers randomly assigned children to an experimental (n = 53) or waitlisted control group (n = 60). Children in the experimental group participated in an 11-week EFL program consisting of once-weekly, 90-min sessions of individual and team-focused activities, whereas children in the control group served as a wait-listed control and participated 16 weeks later. Parents of children in both groups rated child social competence at pretest and posttest. Three independent raters observed and reported children's positive and negative behavior using a validated checklist during each weekly session. Results indicated that program participation had a moderate treatment effect (d = .55) on social competence (p = .02) that was independent of pretest levels, age, gender, and referral status. Results showed that higher levels of program attendance predicted children's trajectories of observed positive (β = .500; p = .003) and negative behavior (β = -.062; p < .001) over the 11-week program.

  5. Implementing practice management strategies to improve patient care: the EPIC project.

    Science.gov (United States)

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

    2012-01-01

    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  6. Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

    Science.gov (United States)

    Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

    2017-03-09

    Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence

  7. Facilitating innovation: an action-oriented approach and participatory methodology to improve innovative social practice in agriculture.

    NARCIS (Netherlands)

    Engel, P.G.H.

    1995-01-01

    This study focuses upon the social organization of innovation. It makes use of insights from knowledge and information systems research, development sociology, management science and applied philosophy and seeks answers to the following questions: What do social actors, individuals and/or organizati

  8. Facilitating innovation : an action-oriented approach and participatory methodology to improve innovative social practice in agriculture

    NARCIS (Netherlands)

    Engel, P.G.H.

    1995-01-01

    This study focuses upon the social organization of innovation. It makes use of insights from knowledge and information systems research, development sociology, management science and applied philosophy and seeks answers to the following questions: What do social actors, individuals and/or organizati

  9. Evaluation of a practice-based intervention to improve the management of pediatric asthma.

    Science.gov (United States)

    Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

    2011-02-01

    Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.

  10. Sector-Led Improvement in Children's Services: A Lever for Evidence-Informed Practice?

    Science.gov (United States)

    Holmes, Dez; Brookes, Carole

    2014-01-01

    The drive for sector-led improvement within children's services has a more prominent place in improving outcomes for children and young people than ever before. Concurrently, the imperative to access and utilise evidence to inform practice has become increasingly important, enabling scarce resources to be allocated according to "what…

  11. The Superintendent's Leadership Role in School Improvement: Relationships between Authenticity and Best Practices

    Science.gov (United States)

    Bird, James J.; Dunaway, David M.; Hancock, Dawson R.; Wang, Chuang

    2013-01-01

    The purpose of this study was to explore the relationship between superintendent leadership and the operational processes of school improvement. School district superintendents (N = 226) from six southeastern states were surveyed concerning their leadership authenticity and school improvement practices. Descriptive statistics, analyzes of…

  12. Lean methodology: an evidence-based practice approach for healthcare improvement.

    Science.gov (United States)

    Johnson, Pauline M; Patterson, Claire J; OʼConnell, Mary P

    2013-12-10

    Lean methodology, an evidence-based practice approach adopted from Toyota, is grounded on the pillars of respect for people and continuous improvement. This article describes the use of Lean methodology to improve healthcare outcomes for patients with community-acquired pneumonia. Nurse practitioners and other clinicians should be knowledgeable about this methodology and become leaders in Lean transformation.

  13. Changing classroom practices: the role of school-wide capacity for sustainable improvement

    NARCIS (Netherlands)

    Sleegers, P.J.C.; Thoonen, E.E.J.; Oort, F.J.; Peetsma, T.T.D.

    2014-01-01

    Purpose: Elementary schools have been confronted with large-scale educational reforms as strategies to improve the educational quality. While building school-wide capacity for improvement is considered critical for changing teachers’ classroom practices, there is still little empirical evidence for

  14. Changing classroom practices: the role of school-wide capacity for sustainable improvement

    NARCIS (Netherlands)

    Sleegers, P.J.C.; Thoonen, Eric E.J.; Oort, Frans J.; Peetsma, Thea T.D.

    2015-01-01

    Purpose – Elementary schools have been confronted with large-scale educational reforms as strategies to improve the educational quality. While building school-wide capacity for improvement is considered critical for changing teachers’ classroom practices, there is still little empirical evidence for

  15. Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification.

    Science.gov (United States)

    Lee, Cindy S; Wadhwa, Vibhor; Kruskal, Jonathan B; Larson, David B

    2015-10-01

    Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice.

  16. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin

    2015-03-01

    Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

  17. Leveraging mobile smart devices to improve interprofessional communications in inpatient practice setting: A literature review.

    Science.gov (United States)

    Aungst, Timothy Dy; Belliveau, Paul

    2015-01-01

    As mobile smart device use has increased in society, the healthcare community has begun using these devices for communication among professionals in practice settings. The purpose of this review is to describe primary literature which reports on the experiences with interprofessional healthcare communication via mobile smart devices. Based on these findings, this review also addresses how these devices may be utilized to facilitate interprofessional education (IPE) in health professions education programs. The literature search revealed limited assessments of mobile smart device use in clinical practice settings. In available reports, communication with mobile smart devices was perceived as more effective and faster among interdisciplinary members. Notable drawbacks included discrepancies in the urgency labeling of messages, increased interruptions associated with constant accessibility to team members, and professionalism breakdowns. Recently developed interprofessional competencies include an emphasis on ensuring that health profession students can effectively communicate on interprofessional teams. With the increasing reliance on mobile smart devices in the absence of robust benefit and risk assessments on their use in clinical practice settings, use of these devices may be leveraged to facilitate IPE activities in health education professions programs while simultaneously educating students on their proper use in patient care settings.

  18. Report on best practice for improved μ-IM injection moulding simulation

    DEFF Research Database (Denmark)

    Tosello, Guido; Costa, Franco; Hansen, Hans Nørgaard

    2010-01-01

    Data analysis and simulations on micro-moulding experiments have been conducted. Micro moulding simulations have been executed taking into account actual processing conditions implementation in the software. Numerous aspects of the simulation set-up have been considered in order to improve the si....... However, the major role of heat transfer coefficient has been highlighted and simulated results in terms of flow length prediction improved. A best practice methodology for improved micro moulding simulations has been established....

  19. Report on best practice for improved μ-IM injection moulding simulation

    DEFF Research Database (Denmark)

    Tosello, Guido; Costa, Franco; Hansen, Hans Nørgaard

    2010-01-01

    Data analysis and simulations on micro-moulding experiments have been conducted. Micro moulding simulations have been executed taking into account actual processing conditions implementation in the software. Numerous aspects of the simulation set-up have been considered in order to improve the si....... However, the major role of heat transfer coefficient has been highlighted and simulated results in terms of flow length prediction improved. A best practice methodology for improved micro moulding simulations has been established....

  20. Evaluating professionalism, practice-based learning and improvement, and systems-based practice: utilization of a compliance form and correlation with conflict styles.

    Science.gov (United States)

    Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

    2010-09-01

    The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Our analysis of 18 residents for academic year 2007-2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles

  1. Facilitating improvements in laboratory report writing skills with less grading: a laboratory report peer-review process.

    Science.gov (United States)

    Brigati, Jennifer R; Swann, Jerilyn M

    2015-05-01

    Incorporating peer-review steps in the laboratory report writing process provides benefits to students, but it also can create additional work for laboratory instructors. The laboratory report writing process described here allows the instructor to grade only one lab report for every two to four students, while giving the students the benefits of peer review and prompt feedback on their laboratory reports. Here we present the application of this process to a sophomore level genetics course and a freshman level cellular biology course, including information regarding class time spent on student preparation activities, instructor preparation, prerequisite student knowledge, suggested learning outcomes, procedure, materials, student instructions, faculty instructions, assessment tools, and sample data. T-tests comparing individual and group grading of the introductory cell biology lab reports yielded average scores that were not significantly different from each other (p = 0.13, n = 23 for individual grading, n = 6 for group grading). T-tests also demonstrated that average laboratory report grades of students using the peer-review process were not significantly different from those of students working alone (p = 0.98, n = 9 for individual grading, n = 6 for pair grading). While the grading process described here does not lead to statistically significant gains (or reductions) in student learning, it allows student learning to be maintained while decreasing instructor workload. This reduction in workload could allow the instructor time to pursue other high-impact practices that have been shown to increase student learning. Finally, we suggest possible modifications to the procedure for application in a variety of settings.

  2. Facilitating Improvements in Laboratory Report Writing Skills with Less Grading: A Laboratory Report Peer-Review Process

    Directory of Open Access Journals (Sweden)

    Jennifer R. Brigati

    2015-02-01

    Full Text Available Incorporating peer-review steps in the laboratory report writing process provides benefits to students, but it also can create additional work for laboratory instructors. The laboratory report writing process described here allows the instructor to grade only one lab report for every two to four students, while giving the students the benefits of peer review and prompt feedback on their laboratory reports. Here we present the application of this process to a sophomore level genetics course and a freshman level cellular biology course, including information regarding class time spent on student preparation activities, instructor preparation, prerequisite student knowledge, suggested learning outcomes, procedure, materials, student instructions, faculty instructions, assessment tools, and sample data. T-tests comparing individual and group grading of the introductory cell biology lab reports yielded average scores that were not significantly different from each other (p = 0.13, n = 23 for individual grading, n = 6 for group grading. T-tests also demonstrated that average laboratory report grades of students using the peer-review process were not significantly different from those of students working alone (p = 0.98, n = 9 for individual grading, n = 6 for pair grading. While the grading process described here does not lead to statistically significant gains (or reductions in student learning, it allows student learning to be maintained while decreasing instructor workload. This reduction in workload could allow the instructor time to pursue other high-impact practices that have been shown to increase student learning. Finally, we suggest possible modifications to the procedure for application in a variety of settings.

  3. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience.

    Science.gov (United States)

    Luxford, Karen; Safran, Dana Gelb; Delbanco, Tom

    2011-10-01

    To investigate organizational facilitators and barriers to patient-centered care in US health care institutions renowned for improving the patient care experience. A qualitative study involving interviews of senior staff and patient representatives. Semi-structured interviews focused on organizational processes, senior leadership, work environment, measurement and feedback mechanisms, patient engagement and information technology and access. Eight health care organizations across the USA with a reputation for successfully promoting patient-centered care. Forty individuals, including chief executives, quality directors, chief medical officers, administrative directors and patient committee representatives. Interviewees reported that several organizational attributes and processes are key facilitators for making care more patient-centered: (i) strong, committed senior leadership, (ii) clear communication of strategic vision, (iii) active engagement of patient and families throughout the institution, (iv) sustained focus on staff satisfaction, (v) active measurement and feedback reporting of patient experiences, (vi) adequate resourcing of care delivery redesign, (vii) staff capacity building, (viii) accountability and incentives and (ix) a culture strongly supportive of change and learning. Interviewees reported that changing the organizational culture from a 'provider-focus' to a 'patient-focus' and the length of time it took to transition toward such a focus were the principal barriers against transforming delivery for patient-centered care. Organizations that have succeeded in fostering patient-centered care have gone beyond mainstream frameworks for quality improvement based on clinical measurement and audit and have adopted a strategic organizational approach to patient focus.

  4. Improving the dependability of research in personality and social psychology: recommendations for research and educational practice.

    Science.gov (United States)

    Funder, David C; Levine, John M; Mackie, Diane M; Morf, Carolyn C; Sansone, Carol; Vazire, Simine; West, Stephen G

    2014-02-01

    In this article, the Society for Personality and Social Psychology (SPSP) Task Force on Publication and Research Practices offers a brief statistical primer and recommendations for improving the dependability of research. Recommendations for research practice include (a) describing and addressing the choice of N (sample size) and consequent issues of statistical power, (b) reporting effect sizes and 95% confidence intervals (CIs), (c) avoiding "questionable research practices" that can inflate the probability of Type I error, (d) making available research materials necessary to replicate reported results, (e) adhering to SPSP's data sharing policy, (f) encouraging publication of high-quality replication studies, and (g) maintaining flexibility and openness to alternative standards and methods. Recommendations for educational practice include (a) encouraging a culture of "getting it right," (b) teaching and encouraging transparency of data reporting, (c) improving methodological instruction, and (d) modeling sound science and supporting junior researchers who seek to "get it right."

  5. Facilitating organisational development using a group-based formative assessment and benchmarking method: design and implementation of the International Family Practice Maturity Matrix.

    Science.gov (United States)

    Elwyn, Glyn; Bekkers, Marie-Jet; Tapp, Laura; Edwards, Adrian; Newcombe, Robert; Eriksson, Tina; Braspenning, Jozé; Kuch, Christine; Adzic, Zlata Ozvacic; Ayankogbe, Olayinka; Cvetko, Tatjana; In 't Veld, Kees; Karotsis, Antonis; Kersnik, Janko; Lefebvre, Luc; Mecini, Ilir; Petricek, Goranka; Pisco, Luis; Thesen, Janecke; Turón, José María; van Rossen, Edward; Grol, Richard

    2010-12-01

    Well-organised practices deliver higher-quality care. Yet there has been very little effort so far to help primary care organisations achieve higher levels of team performance and to help them identify and prioritise areas where quality improvement efforts should be concentrated. No attempt at all has been made to achieve a method which would be capable of providing comparisons--and the stimulus for further improvement--at an international level. The development of the International Family Practice Maturity Matrix took place in three phases: (1) selection and refinement of organisational dimensions; (2) development of incremental scales based on a recognised theoretical framework; and (3) testing the feasibility of the approach on an international basis, including generation of an automated web-based benchmarking system. This work has demonstrated the feasibility of developing an organisational assessment tool for primary care organisations that is sufficiently generic to cross international borders and is applicable across a diverse range of health settings, from state-organised systems to insurer-based health economies. It proved possible to introduce this assessment method in 11 countries in Europe and one in Africa, and to generate comparison benchmarks based on the data collected. The evaluation of the assessment process was uniformly positive with the view that the approach efficiently enables the identification of priorities for organisational development and quality improvement at the same time as motivating change by virtue of the group dynamics. We are not aware of any other organisational assessment method for primary care which has been 'born international,' and that has involved attention to theory, dimension selection and item refinement. The principal aims were to achieve an organisational assessment which gains added value by using interaction, engagement comparative benchmarks: aims which have been achieved. The next step is to achieve wider

  6. [Medical practice and clinical research: keys to generate knowledge and improve care].

    Science.gov (United States)

    Martínez Castuera-Gómez, Carla; Talavera, Juan O

    2013-01-01

    The increased quality in medical care may be immediately accomplished if clinical research is integrated into daily clinical practice. In the generation of medical knowledge are four steps: an unanswered question awakened from clinical practice, the critical analysis of specialized literature, the development of a research protocol, and, finally, the publication of outcomes. Decision making and continuous training are becoming part of an effective strategy of medical attention improvement.

  7. Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control

    OpenAIRE

    2012-01-01

    Mindfulness-based meditation practices involve various attentional skills, including the ability to sustain and focus ones attention. During a simple mindful breathing practice, sustained attention is required to maintain focus on the breath while cognitive control is required to detect mind wandering. We thus hypothesized that regular, brief mindfulness training would result in improvements in the self-regulation of attention and foster changes in neuronal activity related to attentional con...

  8. Using clinical indicators to facilitate quality improvement via the accreditation process: an adaptive study into the control relationship.

    Science.gov (United States)

    Chuang, Sheuwen; Howley, Peter P; Hancock, Stephen

    2013-07-01

    The aim of the study was to determine accreditation surveyors' and hospitals' use and perceived usefulness of clinical indicator reports and the potential to establish the control relationship between the accreditation and reporting systems. The control relationship refers to instructional directives, arising from appropriately designed methods and efforts towards using clinical indicators, which provide a directed moderating, balancing and best outcome for the connected systems. Web-based questionnaire survey. Australian Council on Healthcare Standards' (ACHS) accreditation and clinical indicator programmes. Seventy-three of 306 surveyors responded. Half used the reports always/most of the time. Five key messages were revealed: (i) report use was related to availability before on-site investigation; (ii) report use was associated with the use of non-ACHS reports; (iii) a clinical indicator set's perceived usefulness was associated with its reporting volume across hospitals; (iv) simpler measures and visual summaries in reports were rated the most useful; (v) reports were deemed to be suitable for the quality and safety objectives of the key groups of interested parties (hospitals' senior executive and management officers, clinicians, quality managers and surveyors). Implementing the control relationship between the reporting and accreditation systems is a promising expectation. Redesigning processes to ensure reports are available in pre-survey packages and refined education of surveyors and hospitals on how to better utilize the reports will support the relationship. Additional studies on the systems' theory-based model of the accreditation and reporting system are warranted to establish the control relationship, building integrated system-wide relationships with sustainable and improved outcomes.

  9. Measuring and Facilitating Client Engagement with Financial Incentives: Implications for Improving Clinical Outcomes in a Mental Health Setting.

    Science.gov (United States)

    Kotwicki, Raymond J; Balzer, Alexandra M; Harvey, Philip D

    2016-09-26

    Significant numbers of individuals with severe mental illnesses are difficult to engage in treatment services, presenting challenges for care. To be able to assess the relationship between engagement and discharge outcomes, we modified the "Milestones of Recovery Scale". This scale was modified for content to match the current clinical setting, evaluated for inter-rater reliability after modification in a sample of 233 cases receiving psychiatric rehabilitation, and then was administered to 423 additional psychiatric rehabilitation clients over a 24-month study period. In an effort to determine whether provision of financial incentives lead to sustained increases in client engagement, a cut off for client eligibility for financial incentives was evaluated on the basis of the reliability study and the course of engagement was related to receipt of this incentive and successful completion of treatment in a new sample of 423 patients. Of this sample, 78 % received an initial financial incentive during treatment (were initially engaged), and 93.3 % of that subgroup sustained this level of engagement it over their entire course of treatment. Of the 22 % of cases not receiving an initial incentive, only 5.4 % improved in their engagement to levels required for the incentive. Longitudinal analysis demonstrated that individuals who maintained or increased their level of engagement over time were more likely to complete treatment in accordance with planned treatment goals. The initial engagement and the course of engagement in treatment predicted successful completion, but incentives did not lead to increased engagement in initially poorly engaged patients. These data are interpreted in terms of the likely success of extrinsic rewards to increase engagement in mental health services.

  10. SCXTREME Framework: A Customized Approach of Process Improvements in Agile Blend with CMMI Practices in Pakistan

    Directory of Open Access Journals (Sweden)

    Samina Jan

    2013-02-01

    Full Text Available The proposed framework shows the customized approach that improves the software development process by using the Agile techniques. The proposed research work blends the CMMI practices according to Agile methods of development (specially Scrum, because Scrum is extremely used by Pakistani firms CMMI is a model for the process improvement within organization, but it is too expensive to implement all practices of CMMI for each level. So for small size organizations, at level 2, 3 there are some practices which are helpful in managing and defining their software development process. By implementing the proposed framework, organizations can improve their maturity and capability level.There are several problems while working on Agile, many management areas can be neglected. In SCXTREME there are eight process area selected from CMMI and fit them according to Agile, so agile can be suitable for Pakistani organization by implementing some process area at level 2 and level 3.

  11. Improving the Management of Cost and Scope in Software Projects Using Agile Practices

    Directory of Open Access Journals (Sweden)

    Adriano Olimpio Tonelli

    2013-03-01

    Full Text Available While organizations want to develop software products with reduced cost and flexible scope, stories aboutthe applicability of agile practices to improve project development and performance in the softwareindustry are scarce and focused on specific methodologies such as Scrum and XP. Given these facts, thispaper aims to investigate, through practitioners' perceptions of value, which agile practices are being usedto improve two performance criteriafor software projects—cost and scope. Using a multivariate statisticaltechnique known as Exploratory Factor Analysis (EFA,the results suggest that the use of agile practicescan be represented infactors which describedifferent applicationsin software development processtoimprove cost and scope.Also, we conclude that some agile practices should be used together in order to getbetter efficiency on cost and scope in fourdevelopmentaspects: improving (a team abilities, (bmanagement of requirements, (c quality of the code developed, and (d delivery of software on-budget andon-time

  12. The Availability of Original Data and Statistics: An Improvement in Good Publication Practice

    Directory of Open Access Journals (Sweden)

    Morselli-Labate AM

    2003-11-01

    Full Text Available The purpose of this paper is to highlight the aspects of good publication practices, with particular reference to data analysis, and to propose an innovative initiative for improving the quality of scientific information in this field. Several committees within the scientific community provide information and publish guidelines in order to support scientists in the application of good publication practices and to improve quality in medical research. Those guidelines suggest that the possibility of verifying the original data warrants the reliability of the published results by reducing the occurrence of misconduct related to data analysis. The initiative proposed in this article is aimed at making the original data and the statistical reports available to the scientific community together with the actual paper. Such a practice is undoubtedly an improvement in the quality of publication permitting verification of the results as well as allowing for further elaboration of the same data.

  13. Talking about the elephant in the room: Improving fundamental assessment practices

    Directory of Open Access Journals (Sweden)

    Betty Gill

    2015-08-01

    Full Text Available This paper reports on an institution-wide strategy to improve first year assessment practices. Assessment is central to the student experience and to informing their developing conceptions of themselves as students. Despite this central importance, much national and international literature raises questions about the fitness-for-purpose of assessment practices in higher education. The reported strategy was developed in response to analysis of student feedback, which suggested, like the literature, substantial opportunity for improvement. Student feedback on their assessment experience was validated by an audit of first session assessment and used to inform the strategy. A significant improvement in quantitative and qualitative measures of student satisfaction across routine data sources is provided to demonstrate impact. This supports a conclusion that the first year student experience can be impacted by the systemic application of a small number of fundamental good practice assessment strategies which are outlined.

  14. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-01-22

    In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.

  15. The New Product Development Improvement Motives and Practices of Miles and Snow's Prospectors, Analysers and Defenders

    DEFF Research Database (Denmark)

    Laugen, Bjørge Timenes; Boer, Harry; Acur, Nuran

    2006-01-01

    Marketing, strategic management and contingency theory suggest that different strategies require different practices. The new product development (NPD) literature, however, hardly addresses the product development practices needed to support different strategies. An analysis of eight prospectors......, twenty-seven analysers and seven defenders (Miles and Snow, 1978) suggests that the NPD improvement motives and practices of these three types of strategies are less different than we expected. Our explanation for this finding is that the three strategic types are growing towards each other, forced...

  16. Integrating digital image management software for improved patient care and optimal practice management.

    Science.gov (United States)

    Starr, Jon C

    2006-06-01

    Photographic images provide vital documentation of preoperative, intraoperative, and postoperative results in the clinical dermatologic surgery practice and can document histologic findings from skin biopsies, thereby enhancing patient care. Images may be printed as part of text documents, transmitted via electronic mail, or included in electronic medical records. To describe existing computer software that integrates digital photography and the medical record to improve patient care and practice management. A variety of computer applications are available to optimize the use of digital images in the dermatologic practice.

  17. Improvement of neurofeedback therapy for improved attention through facilitation of brain activity using local sinusoidal extremely low frequency magnetic field exposure.

    Science.gov (United States)

    Zandi Mehran, Yasaman; Firoozabadi, Mohammad; Rostami, Reza

    2015-04-01

    Traditional neurofeedback (NF) is a training approach aimed at altering brain activity using electroencephalography (EEG) rhythms as feedback. In NF training, external factors such as the subjects' intelligence can have an effect. In contrast, a low-energy NF system (LENS) does not require conscious effort from the subject, which results in fewer attendance sessions. However, eliminating the subject role seems to eliminate an important part of the NF system. This study investigated the facilitating effect on the theta-to-beta ratio from NF training, using a local sinusoidal extremely low frequency magnetic field (LSELF-MF) versus traditional NF. Twenty-four healthy, intelligent subjects underwent 10 training sessions to enhance beta (15-18 Hz), and simultaneously inhibit theta (4-7 Hz) and high beta (22-30 Hz) activity, at the Cz point in a 3-boat-race video game. Each session consisted of 3 statuses, PRE, DURING, and POST. In the DURING status, the NF training procedure lasted 10 minutes. Subjects were led to believe that they would be exposed to a magnetic field during NF training; however, 16 of the subjects who were assigned to the experimental group were really exposed to 45 Hz-360 µT LSELF-MF at Cz. For the 8 other subjects, only the coil was located at the Cz point with no exposure. The duty cycle of exposure was 40% (2-second exposure and 3-second pause). The results show that the theta-to-beta ratio in the DURING status of each group differs significantly from the PRE and POST statuses. Between-group analysis shows that the theta-to-beta ratio in the DURING status of the experimental group is significantly (P < .001) lower than in the sham group. The result shows the effect of LSELF-MF on NF training.

  18. Does self-control improve with practice? Evidence from a six-week training program.

    Science.gov (United States)

    Miles, Eleanor; Sheeran, Paschal; Baird, Harriet; Macdonald, Ian; Webb, Thomas L; Harris, Peter R

    2016-08-01

    Can self-control be improved through practice? Several studies have found that repeated practice of tasks involving self-control improves performance on other tasks relevant to self-control. However, in many of these studies, improvements after training could be attributable to methodological factors (e.g., passive control conditions). Moreover, the extent to which the effects of training transfer to real-life settings is not yet clear. In the present research, participants (N = 174) completed a 6-week training program of either cognitive or behavioral self-control tasks. We then tested the effects of practice on a range of measures of self-control, including lab-based and real-world tasks. Training was compared with both active and no-contact control conditions. Despite high levels of adherence to the training tasks, there was no effect of training on any measure of self-control. Trained participants did not, for example, show reduced ego depletion effects, become better at overcoming their habits, or report exerting more self-control in everyday life. Moderation analyses found no evidence that training was effective only among particular groups of participants. Bayesian analyses suggested that the data were more consistent with a null effect of training on self-control than with previous estimates of the effect of practice. The implication is that training self-control through repeated practice does not result in generalized improvements in self-control. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  19. Customizing a clinical data warehouse for housestaff education in practice-based learning and improvement.

    Science.gov (United States)

    Lyman, J; Schorling, J; May, N; Scully, K; Sarafian, N; Nadkarni, M; Voss, J

    2006-01-01

    We developed Systems and Practice Analysis for Resident Competencies (SPARC), a Web-based tool to support teaching the practice-based learning and improvement (PBLI) ACGME competencies. SPARC allows Department of Medicine residents to explore de-identified, population-based data about their patient panels with peer comparisons. Data primarily comes from an existing data warehouse that has been customized for this application. Our preliminary evaluation suggests that it improves residents' abilities in PBLI, is easy to use, and perceived as important and useful by the housestaff.

  20. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

    Science.gov (United States)

    Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

    2016-06-29

    The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is

  1. Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement.

    Science.gov (United States)

    Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna; Nyström, Monica Elisabeth

    2016-07-29

    Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results. Published by the BMJ Publishing Group Limited. For

  2. Effectiveness of improvement plans in primary care practice accreditation: a clustered randomized trial.

    Directory of Open Access Journals (Sweden)

    Elvira Nouwens

    Full Text Available BACKGROUND: Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM. METHOD: A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22 were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23 could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project. RESULTS: No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale. CONCLUSIONS: The focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes. ClinicalTrials.gov NCT00791362.

  3. Overexpression of CD44 in neural precursor cells improves trans-endothelial migration and facilitates their invasion of perivascular tissues in vivo.

    Directory of Open Access Journals (Sweden)

    Cyrille Deboux

    Full Text Available Neural precursor (NPC based therapies are used to restore neurons or oligodendrocytes and/or provide neuroprotection in a large variety of neurological diseases. In multiple sclerosis models, intravenously (i.v -delivered NPCs reduced clinical signs via immunomodulation. We demonstrated recently that NPCs were able to cross cerebral endothelial cells in vitro and that the multifunctional signalling molecule, CD44 involved in trans-endothelial migration of lymphocytes to sites of inflammation, plays a crucial role in extravasation of syngeneic NPCs. In view of the role of CD44 in NPCs trans-endothelial migration in vitro, we questioned presently the benefit of CD44 overexpression by NPCs in vitro and in vivo, in EAE mice. We show that overexpression of CD44 by NPCs enhanced over 2 folds their trans-endothelial migration in vitro, without impinging on the proliferation or differentiation potential of the transduced cells. Moreover, CD44 overexpression by NPCs improved significantly their elongation, spreading and number of filopodia over the extracellular matrix protein laminin in vitro. We then tested the effect of CD44 overexpression after i.v. delivery in the tail vein of EAE mice. CD44 overexpression was functional invivo as it accelerated trans-endothelial migration and facilitated invasion of HA expressing perivascular sites. These in vitro and in vivo data suggest that CD44 may be crucial not only for NPC crossing the endothelial layer but also for facilitating invasion of extravascular tissues.

  4. Facilitation of learning: part 1.

    Science.gov (United States)

    Warburton, Tyler; Trish, Houghton; Barry, Debbie

    2016-04-06

    This article, the fourth in a series of 11, discusses the context for the facilitation of learning. It outlines the main principles and theories for understanding the process of learning, including examples which link these concepts to practice. The practical aspects of using these theories in a practice setting will be discussed in the fifth article of this series. Together, these two articles will provide mentors and practice teachers with knowledge of the learning process, which will enable them to meet the second domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice on facilitation of learning.

  5. Professional Learning Communities Facilitator's Guide for the What Works Clearinghouse Practice Guide: Foundational Skills to Support Reading for Understanding in Kindergarten through 3rd Grade. REL 2016-277

    Science.gov (United States)

    Kosanovich, Marcia; Foorman, Barbara

    2016-01-01

    The Regional Educational Laboratory (REL) Southeast developed a Professional Learning Community (PLC) Facilitators Guide to support educators in the implementation of recommendations from the What Works Clearinghouse's. The practice guide focuses on the foundational reading skills that enable students to read words, relate those words to their…

  6. Three case studies of three high school teachers' definitions, beliefs, and implementation practices of inquiry-based science method including barriers to and facilitators of successful implementation

    Science.gov (United States)

    Blackburn-Morrison, Kimberly D.

    This study involved three teachers in various stages of implementation of inquiry-based science method. The cases were chosen because one participant was a novice in using inquiry-based science method, one participant was in her second year of implementation, and the third participant was experienced with inquiry-based science method. The cases were set in a rural high school in three different science classrooms. One of the classrooms was a regular biology class. One of the classrooms was an honors oceanography class and another was an advanced placement environmental science classroom. Data sources included interviews, observations, and document collection. Interviews, observations, and document collection were used to triangulate data. Each classroom was observed five times. Interviews were conducted at the beginning of the semester with each participant and at the end of the semester. Follow-up interviews were conducted after each observation. Documents were collected such as each teacher's lesson plans, student work, and assignments. Data was initially organized according to the research areas of teacher's definition, teacher's beliefs, teacher's barriers to implementation, and teacher's enablers to implementation. Then, patterns emerging from each of these cases were organized. Lastly, patterns emerging across cases were compared in a cross-case analysis. Patterns shared between cases were: Participants related inquiry-based science method with hands-on learning activities. Participants saw students as the center of the learning process. Participants had positive beliefs about constructivist learning practices that were strengthened after implementation of inquiry-based teaching. Facilitators of successful implementation of inquiry-based science method were positive student motivation, students' retention of knowledge, and a positive experience for lower level students. Barriers to successful implementation were teachers not having complete control of the

  7. An appreciative inquiry approach to practice improvement and transformative change in health care settings.

    Science.gov (United States)

    Carter, Caroline A; Ruhe, Mary C; Weyer, Sharon; Litaker, David; Fry, Ronald E; Stange, Kurt C

    2007-01-01

    Amid tremendous changes and widespread dissatisfaction with the current health care system, many approaches to improve practice have emerged; however, their effects on quality of care have been disappointing. This article describes the application of a new approach to promote organizational improvement and transformation that is built upon collective goals and personal motivations, invites participation at all levels of the organization and connected community, and taps into latent creativity and energy. The essential elements of the appreciative inquiry (AI) process include identification of an appreciative topic and acting on this theme through 4 steps: Discovery, Dream, Design, and Destiny. We describe each step in detail and provide a case study example, drawn from a composite of practices, to highlight opportunities and challenges that may be encountered in applying AI. AI is a unique process that offers practice members an opportunity to reflect on the existing strengths within the practice, leads them to discover what is important, and builds a collective vision of the preferred future. New approaches such as AI have the potential to transform practices, improve patient care, and enhance individual and group motivation by changing the way participants think about, approach, and envision the future.

  8. Practicing a functional task improves steadiness with hand muscles in older adults.

    Science.gov (United States)

    Marmon, Adam R; Gould, Jeffrey R; Enoka, Roger M

    2011-08-01

    Improvements in steadiness with practice have been associated with enhanced performance on a functional task in old adults. The aims of the study were to examine the specificity of the association between steadiness and a functional task and to assess the influence of practicing a functional task on force steadiness of hand muscles. Twenty-three older adults (≥70 yr) participated in the study and were assigned to either a practice group (n = 15) or a control group (n = 8). Subjects completed two testing sessions that were 2 wk apart. The practice group completed six additional sessions to practice a functional task (Grooved Pegboard). Tests included maximal voluntary contractions (MVC), force steadiness (precision pinch and index finger abduction) at three target forces (5%, 15%, and 25% MVC), and the Grooved Pegboard test. The associations between strength, steadiness, and the time needed to complete the Grooved Pegboard test were examined. In addition, MVC force, steadiness, and pegboard time were compared between the two testing sessions. The time needed to complete the Grooved Pegboard test was associated with index finger abduction steadiness for two of the three target forces (15% and 25% MVC) but was not associated with pinch steadiness. Practice significantly reduced the time needed to complete the Grooved Pegboard test and improved steadiness in both tasks. Force steadiness provides an appropriate index of hand function, especially when measured at low forces.

  9. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    Science.gov (United States)

    Kennelly, S; Kennedy, N P; Corish, C A; Flanagan-Rughoobur, G; Glennon-Slattery, C; Sugrue, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  10. Impact of Training on Improving Proper Handwashing Practices among Elementary School Students

    Directory of Open Access Journals (Sweden)

    Theruna Huthamaputiran

    2017-06-01

    Full Text Available Background: Hand washing is among the most effective ways to prevent diseases. In Indonesia, only a quarter of the entire population practice proper handwashing techniques. Of these, children are the most vulnerable group for contracting diseases. Nevertheless, they also are crucial agent for behavior transformation as they are keen and open to new ideas. Therefore, this study was conducted to determine if training would have an improvement on a proper hand washing practices among elementary school students. Methods:An observational descriptive study design using random sampling was conducted from September to November 2013 in Jatinangor Subdistrict, West Java, Indonesia using primary data of one hundred elementary school students from four elementary schools. Questionnaires were given after informed consent. A demonstration on hand washing techniques and education on proper hand washing practices was then given. Two weeks later, the same questionnaire was given to measure the influence of the training. The collected data were presented using frequency tabulation. Results: Before the training on proper hand washing practices was conducted, only 86.9% students were practicing it properly. After the training was given, 90.7% of the students were doing it properly. For the hand washing technique, only 66.8% of students knew the correct steps before the intervention was given and 78.7% students did them correctly after the intervention. Conclusions:The training shows an overall improvement on the students’ hand washing practices.   DOI: 10.15850/amj.v4n2.1073

  11. Rolipram improves facilitation of contextual fear extinction in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced mouse model of Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Ken-ichi Kinoshita

    2017-05-01

    Full Text Available Cognitive impairment often occurs in Parkinson's disease (PD, but the mechanism of onset remains unknown. Recently, we reported that PD model mice produced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP show facilitation of hippocampal memory extinction, which may be the cause of cognitive impairment in PD. When we examined the cAMP/CREB signaling in the hippocampus, decreased levels of cAMP and phosphorylated CREB were observed in the dentate gyrus (DG of MPTP-treated mice. Administration of rolipram improved the memory deficits with concomitant recovery of cAMP and phosphorylated CREB levels, suggesting that reduced cAMP/CREB signaling in the DG leads to cognitive impairment in MPTP-treated mice.

  12. Facilitating the use of non-standard in vivo studies in health risk assessment of chemicals: a proposal to improve evaluation criteria and reporting.

    Science.gov (United States)

    Beronius, Anna; Molander, Linda; Rudén, Christina; Hanberg, Annika

    2014-06-01

    To improve data availability in health risk assessment of chemicals and fill information gaps there is a need to facilitate the use of non-standard toxicity studies, i.e. studies not conducted according to any standardized toxicity test guidelines. The purpose of this work was to propose criteria and guidance for the evaluation of reliability and relevance of non-standard in vivo studies, which could be used to facilitate systematic and transparent evaluation of such studies for health risk assessment. Another aim was to propose user friendly guidance for reporting of non-standard studies intended to promote an improvement in reporting of studies that could be of use in risk assessment. Requirements and recommendations for the design and execution of in vivo toxicity studies were identified from The Organisation for Economic Co-operation and Development (OECD) test guidelines, and served as basis for the data evaluation criteria and reporting guidelines. Feedback was also collected from experts within the field of toxicity testing and risk assessment and used to construct a two-tiered framework for study evaluation, as well as refine the reporting guidelines. The proposed framework emphasizes the importance of study relevance and an important aspect is to not completely dismiss studies from health risk assessment based on very strict criteria for reliability. The suggested reporting guidelines provide researchers with a tool to fulfill reporting requirements as stated by regulatory agencies. Together, these resources provide an approach to include all relevant data that may fill information gaps and reduce scientific uncertainty in health risk assessment conclusions, and subsequently also in chemical policy decisions. Copyright © 2014 John Wiley & Sons, Ltd.

  13. Practice development plans to improve the primary care management of acute asthma: randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Price David

    2007-04-01

    Full Text Available Abstract Background Our professional development plan aimed to improve the primary care management of acute asthma, which is known to be suboptimal. Methods We invited 59 general practices in Grampian, Scotland to participate. Consenting practices were randomised to early and delayed intervention groups. Practices undertook audits of their management of all acute attacks (excluding children under 5 years occurring in the 3 months preceding baseline, 6-months and 12-months study time-points. The educational programme [including feedback of audit results, attendance at a multidisciplinary interactive workshop, and formulation of development plan by practice teams] was delivered to the early group at baseline and to the delayed group at 6 months. Primary outcome measure was recording of peak flow compared to best/predicted at 6 months. Analyses are presented both with, and without adjustment for clustering. Results 23 consenting practices were randomised: 11 to early intervention. Baseline practice demography was similar. Six early intervention practices withdraw before completing the baseline audit. There was no significant improvement in our primary outcome measure (the proportion with peak flow compared to best/predicted at either the 6 or 12 month time points after adjustment for baseline and practice effects. However, the between group difference in the adjusted combined assessment score, whilst non-significant at 6 months (Early: 2.48 (SE 0.43 vs. Delayed 2.26 (SE 0.33 p = 0.69 reached significance at 12 m (Early:3.60 (SE 0.35 vs. Delayed 2.30 (SE 0.28 p = 0.02. Conclusion We demonstrated no significant benefit at the a priori 6-month assessment point, though improvement in the objective assessment of attacks was shown after 12 months. Our practice development programme, incorporating audit, feedback and a workshop, successfully engaged the healthcare team of participating practices, though future randomised trials of educational

  14. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

    Science.gov (United States)

    Montano, Maria F; Mehdi, Harshal; Nash, David B

    2016-11-01

    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  15. Advanced practice quality improvement project: how to influence physician radiologic imaging ordering behavior.

    Science.gov (United States)

    Durand, Daniel J; Kohli, Marc D

    2014-12-01

    With growing pressure on the health care sector to improve quality and reduce costs, the stakes associated with imaging appropriateness have never been higher. Although radiologists historically functioned as imaging gatekeepers, this role has been deprioritized in the recent past. This article discusses several potential practice quality improvement projects that can help radiologists regain their role as valued consultants and integral members of the care team. By applying the PDSA framework, radiologists can incrementally optimize their practice's consultation service. While it can be expected that different strategies will gain traction in different environments, it is our hope that the methodology described here will prove useful to most or all practices as a starting point. In addition, we discuss several other influencing techniques that extend beyond traditional consultation services.

  16. Improving farming practices reduces the carbon footprint of spring wheat production.

    Science.gov (United States)

    Gan, Yantai; Liang, Chang; Chai, Qiang; Lemke, Reynald L; Campbell, Con A; Zentner, Robert P

    2014-11-18

    Wheat is one of the world's most favoured food sources, reaching millions of people on a daily basis. However, its production has climatic consequences. Fuel, inorganic fertilizers and pesticides used in wheat production emit greenhouse gases that can contribute negatively to climate change. It is unknown whether adopting alternative farming practices will increase crop yield while reducing carbon emissions. Here we quantify the carbon footprint of alternative wheat production systems suited to semiarid environments. We find that integrating improved farming practices (that is, fertilizing crops based on soil tests, reducing summerfallow frequencies and rotating cereals with grain legumes) lowers wheat carbon footprint effectively, averaging -256 kg CO2 eq ha(-1) per year. For each kg of wheat grain produced, a net 0.027-0.377 kg CO2 eq is sequestered into the soil. With the suite of improved farming practices, wheat takes up more CO2 from the atmosphere than is actually emitted during its production.

  17. Improvement of best practice in early breast cancer : Actionable surgeon and hospital factors

    NARCIS (Netherlands)

    Gort, Marjan; Broekhuis, Manda; Otter, Rene; Klazinga, Niek S.

    To identify actionable elements for improving best practice, this study examined the relative effects of patient, surgeon and hospital factors on surgical treatment variation of 2,929 early breast cancer patients, diagnosed from January 1998 to January 2002 in the region of the Comprehensive Cancer

  18. What Do You Say When...?: Best Practice Language for Improving Student Behavior

    Science.gov (United States)

    Holloman, Hal; Yates, Peggy H.

    2010-01-01

    Do you remember a time when you used the right words at the right moment, and they made all the difference? With the aim of helping you repeat that experience every day, this book provides hundreds of examples of what we call "Best Practice Language" (BPL), a research-based technique designed to help teachers use words to improve student…

  19. Improving Learning and Teaching in Transnational Education: Can Communities of Practice Help?

    Science.gov (United States)

    Keay, Jeanne; May, Helen; O' Mahony, Joan

    2014-01-01

    This article builds on the key findings of the UK Higher Education Academy study "Transnational Education Learning and Teaching" to explore the way in which Wenger's characteristics of communities of practice could help provide a theoretical framework for improving communication and creating more effective transnational education…

  20. A Community of Practice among Educators, Researchers and Scientists for Improving Science Teaching in Southern Mexico

    Science.gov (United States)

    Cisneros-Cohernour, Edith J.; Lopez-Avila, Maria T.; Barrera-Bustillos, Maria E.

    2007-01-01

    This paper presents findings of a project aimed to improve the quality of science education in Southeast Mexico by the creation of a community of practice among scientists, researchers and teachers, involved in the design, implementation and evaluation of a professional development program for mathematics, chemistry, biology and physics secondary…

  1. Use of Mobile Applications for Hospital Discharge Letters - Improving Handover at Point of Practice

    NARCIS (Netherlands)

    Maher, Bridget; Drachsler, Hendrik; Kalz, Marco; Hoare, Cathal; Sorensen, Humphrey; Lezcano, Leonardo; Henn, Pat; Specht, Marcus

    2013-01-01

    Maher, B., Drachsler, H., Kalz, M., Hoare, C., Sorensen, H., Lezcano, L., Henn, P., & Specht, M. (2013). Use of Mobile Applications for Hospital Discharge Letters - Improving Handover at Point of Practice. International Journal of Mobile and Blended Learning, 5(4), 29. IGI Global.

  2. Practical Recommendations to Improve the Quality of Training and Methodical Support of Professional Teacher Education

    Science.gov (United States)

    Grebennikov, Valery V.; Grudtsina, Ludmila Yu.; Marchuk, Nikolay N.; Sangadgiev, Badma V.; Kudyashev, Nail K.

    2016-01-01

    The research urgency is caused by the transition to the knowledge society and new demands for training and methodical provision of professional pedagogical education. The purpose of this paper is to develop practical recommendations to improve the quality of training and methodical support of professional pedagogical education. The leading…

  3. Practical measures for improving the ecological state of lake Marken using in depth system knowledge

    NARCIS (Netherlands)

    Genseberger, M.; Noordhuis, R.; Thiange, C.X.O.; Boderie, P.M.A.

    2015-01-01

    For Lake Marken in the Netherlands, high suspended sediment concentrations result in reduced ecological values and prevent goals and standards from being met (Water Framework Directive, Natura 2000). A practical measure to improve the ecology that is currently studied is the construction of sheltere

  4. Improving Teachers' Practices through Supervision and Observations by School Principals: An Action Research Project

    Science.gov (United States)

    Taylor, Latasha M.

    2013-01-01

    This study focused on the impact of a new observation tool for principals to utilize and the effects it has on improving teachers' instruction and influencing best practices. The action research project explored the impact and influence that a well-developed observation tool could possess to help address areas of need; essentially, focusing on how…

  5. The Practical Relevance of Accountability Systems for School Improvement: A Descriptive Analysis of California Schools

    Science.gov (United States)

    Mintrop, Heinrich; Trujillo, Tina

    2007-01-01

    In search for the practical relevance of accountability systems for school improvement, the authors ask whether practitioners traveling between the worlds of system-designated high- and low-performing schools would detect tangible differences in educational quality and organizational effectiveness. In comparing nine exceptionally high and low…

  6. What Is the Best Way to Achieve Broader Reach of Improved Practices in Higher Education?

    Science.gov (United States)

    Kezar, Adrianna

    2011-01-01

    This article examines a common problem in higher education--how to create more widespread use of improved practices, often commonly referred to as innovations. I argue that policy models of scale-up are often advocated in higher education but that they have a dubious history in community development and K-12 education and that higher education…

  7. Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.

    Science.gov (United States)

    Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

    2014-09-18

    Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of

  8. Perioperative care map improves compliance with best practices for the morbidly obese.

    Science.gov (United States)

    Solsky, Ian; Edelstein, Alex; Brodman, Michael; Kaleya, Ronald; Rosenblatt, Meg; Santana, Calie; Feldman, David L; Kischak, Patricia; Somerville, Donna; Mudiraj, Santosh; Leitman, I Michael; Shamamian, Peter

    2016-12-01

    Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients. A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013. Pre- and postintervention surveys were sent to participants in 2012 and in 2015 to evaluate changes in clinical practice. A chart audit performed postintervention determined physician compliance with distributed guidelines. In the study, 567 physicians completed the survey in 2012 and 375 physicians completed the survey in 2015. Postintervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese, operatively treated patients to comply with best practices preoperatively (89% vs 59%), intraoperatively (71% vs 54%), postoperatively (80% vs 57%), and overall (88% vs 72%). Results were similar when surgeons and anesthesiologists were analyzed separately. A chart audit of 170 cases from the 4 hospitals found that 167 (98%) cases were compliant with best practices. After care map distribution, the percentage of physicians who reported changing their management to match best practices significantly improved. These findings highlight the beneficial impact this educational intervention can have on physician behavior. Continued investigation is needed to evaluate the influence of this intervention on clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Checklist Model to Improve Work Practices in Small-Scale Demolition Operations with Silica Dust Exposures

    Directory of Open Access Journals (Sweden)

    Paul Succop

    2012-01-01

    Full Text Available A systematic approach was developed to review, revise and adapt existing exposure control guidance used in developed countries for use in developing countries. One-page employee and multiple-page supervisor guidance sheets were adapted from existing documents using a logic framework and workers were trained to use the information to improve work practices. Interactive, hands-on training was delivered to 26 workers at five small-scale demolition projects in Maputo City, Mozambique, and evaluated. A pre-and-post walkthrough survey used by trained observers documented work practice changes. Worker feedback indicated that the training was effective and useful. Workers acquired knowledge (84% increase, p < 0.01 and applied the work practice guidance. The difference of proportions between use of work practice components before and after the intervention was statistically significant (p < 0.05. Changes in work practices following training included preplanning, use of wet methods and natural ventilation and end-of-task review. Respirable dust measurements indicated a reduction in exposure following training. Consistency in observer ratings and observations support the reliability and validity of the instruments. This approach demonstrated the short-term benefit of training in changing work practices; follow-up is required to determine the long-term impact on changes in work practices, and to evaluate the need for refresher training.

  10. Development of a practice framework for improving nurses' responses to intimate partner violence.

    Science.gov (United States)

    Bradbury-Jones, Caroline; Clark, Maria T; Parry, Jayne; Taylor, Julie

    2017-08-01

    The aim of this article is to discuss critically the theoretical concepts of awareness, recognition and empowerment as manifested in intimate partner violence and to show how these can be translated into a practice framework for improving nurses' response. Intimate partner violence is a universal problem and is considered a significant public health issue. Nurses are in an ideal position to recognise and respond to intimate partner violence, but many lack confidence in this area of practice. In our previous empirical work, we identified three concepts through which nurses' responses to intimate partner violence can be understood: awareness, recognition and empowerment. In this article, we advance nursing knowledge by showing how these concepts can form a practice framework to improve nurses' responses to intimate partner violence. A discussion paper and development of a practice framework to improve nurses' responses to intimate partner violence. The framework comprises three principal needs of women and three related key requirements for nurses to meet these needs. Arising from these are a range of practice outcomes: enhanced understanding of intimate partner violence, increased confidence in recognising intimate partner violence, establishment of trusting relationships, increased likelihood of disclosure and optimised safety. Nurses sometimes lack confidence in recognising and responding to intimate partner violence. Awareness, recognition and empowerment are important concepts that can form the basis of a framework to support them. When nurses feel empowered to respond to intimate partner violence, they can work together with women to optimise their safety. Access to adequate and timely intimate partner violence education and training is important in improving nurses' responses to intimate partner violence. Getting this right can lead to enhanced safety planning and better health outcomes for women who experience intimate partner violence. Although difficult to

  11. The integration of psychology in pediatric oncology research and practice: collaboration to improve care and outcomes for children and families.

    Science.gov (United States)

    Kazak, Anne E; Noll, Robert B

    2015-01-01

    Childhood cancers are life-threatening diseases that are universally distressing and potentially traumatic for children and their families at diagnosis, during treatment, and beyond. Dramatic improvements in survival have occurred as a result of increasingly aggressive multimodal therapies delivered in the context of clinical research trials. Nonetheless, cancers remain a leading cause of death in children, and their treatments have short- and long-term impacts on health and well-being. For over 35 years, pediatric psychologists have partnered with pediatric oncology teams to make many contributions to our understanding of the impact of cancer and its treatment on children and families and have played prominent roles in providing an understanding of treatment-related late effects and in improving quality of life. After discussing the incidence of cancer in children, its causes, and the treatment approaches to it in pediatric oncology, we present seven key contributions of psychologists to collaborative and integrated care in pediatric cancer: managing procedural pain, nausea, and other symptoms; understanding and reducing neuropsychological effects; treating children in the context of their families and other systems (social ecology); applying a developmental perspective; identifying competence and vulnerability; integrating psychological knowledge into decision making and other clinical care issues; and facilitating the transition to palliative care and bereavement. We conclude with a discussion of the current status of integrating knowledge from psychological research into practice in pediatric cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  12. Electronic medical records as tools for quality improvement in ambulatory practice: theory and a case study.

    Science.gov (United States)

    Ornstein, S M; Jenkins, R G; MacFarlane, L; Glaser, A; Snyder, K; Gundrum, T

    1998-11-01

    Information management is critical in today's health care environment. Traditional paper-based medical records are inadequate information management tools. Electronic medical records (EMRs) overcome many problems with paper records and are ideally suited to help physicians increase productivity and improve the quality of care they provide. The Department of Family Medicine at the Medical University of South Carolina uses the Practice Partner Patient Record EMR system. Department members have developed a quality improvement model based on this EMR system. The model has been used to improve care for acute bronchitis, diabetes mellitus, tobacco abuse, asthma, and postmenopausal osteoporosis.

  13. Best Practices for Chemotherapy Administration in Pediatric Oncology: Quality and Safety Process Improvements (2015).

    Science.gov (United States)

    Looper, Karen; Winchester, Kari; Robinson, Deborah; Price, Andrea; Langley, Rachel; Martin, Gina; Jones, Sally; Holloway, Jodi; Rosenberg, Susanne; Flake, Susan

    2016-01-01

    The administration of chemotherapy to children with cancer is a high-risk process that must be performed in a safe and consistent manner with high reliability. Clinical trials play a major role in the treatment of children with cancer; conformance to chemotherapy protocol requirements and accurate documentation in the medical record are critical. Inconsistencies in the administration and documentation of chemotherapy were identified as opportunities for errors to occur. A major process improvement was initiated to establish best practices for nurses who administer chemotherapy to children. An interdisciplinary team was formed to evaluate the current process and to develop best practices based on current evidence, protocol requirements, available resources, and safety requirements. The process improvement focused on the establishment of standardized and safe administration techniques, exact administration times, and consistent electronic documentation that could easily be retrieved in medical record audits. Quality improvement tools including SBAR (Situation, Background, Assessment, Recommendation), process mapping, PDSA (Plan, Do. Study, Act) cycles, and quality metrics were used with this process improvement. The team established best practices in chemotherapy administration to children that have proven to be safe and reliable. Follow-up data have demonstrated that the project was highly successful and improved accuracy, patient and nurse safety, and effectiveness of chemotherapy administration.

  14. Water Governance in England: Improving Understandings and Practices through Systemic Co-Inquiry

    Directory of Open Access Journals (Sweden)

    Natalie Foster

    2016-11-01

    Full Text Available In 2015, water governance in England finds itself part way through perhaps the most significant changes since the privatisation of the water industry in 1989. Each of the changes is a response to the specific challenges that fall within the realm of improving water governance. However, they also raise many questions: How will the changes play out in practice? Will they work together to form a coherent ’whole’? Can collaborative and competitive approaches really co-exist? This research aims to engage researchers, policy-makers and practitioners in a systemic co-inquiry in order to improve understandings and practices in relation to water governance in England. The two workshops undertaken as part of the research focused on the current and future water governance situation in England, respectively. The findings from the workshops demonstrate that the systemic co-inquiry process generally proved very successful and useful for this group of stakeholders. The workshops provided the opportunity for participants to share, explore and challenge their ideas, knowledge and experiences in water governance; and in doing so, they brought about shared understandings, revealed new insights and identified concerted actions to improve (transform water governance. However, it is recognised that whilst significant progress has been made towards improving understanding and practices in relation to water governance in England, there is still further work required in order to implement these improvements on a local, national or global scale.

  15. Brazilian National System for the Monitoring and Improvement of Compounding Practices: program outcomes.

    Science.gov (United States)

    de Souza, Hugo Guedes; Favaro, Alvaro; Andrade, Alba Lívia; Gomes, Lenir Yago; Garcez, Maria do Carmo

    2012-01-01

    Compounding pharmacies in Brazil have to comply with a complex and strict set of drug manufacturing regulations. The authors reported in the International Journal of Pharmaceutical Compounding (November/December 2009, Volume 13, Issue 6) on the development and implementation of a National System for the Monitoring and Improvement of Compounding Practices in Brazil, a process-focused program aiming to help compounding pharmacies improve drug manufacturing processes and meet the standards set forth by the applicable legislation This article reports the results obtained in the first three editions of the National System for the Monitoring and Improvement of Compounding Practices in Brazil (2006-2010) and presents new foci explored in the 2011 cycle. The results obtained over the years demonstrate that participating in the National System for the Monitoring and Improvement of Compounding Practices in Brazil has helped pharmacies achieve legal compliance and improve the quality of their preparations, which has contributed substantially to meeting quality standards never before achieved in the compounding sector in Brazil.

  16. Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Padilha, J M; Sousa, P A F; Pereira, F M S

    2017-03-13

    To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. © 2017 International Council of Nurses.

  17. Overcoming early barriers to PCMH practice improvement in family medicine residencies.

    Science.gov (United States)

    Fernald, Douglas H; Deaner, Nicole; O'Neill, Caitlin; Jortberg, Bonnie T; degruy, Frank Verloin; Dickinson, W Perry

    2011-01-01

    Residency programs face inevitable challenges as they redesign their practices for higher quality care and resident training. Identifying and addressing early barriers can help align priorities and thereby augment the capacity to change. Evaluation of the Colorado Family Medicine Residency PCMH Project included iterative qualitative analysis of field notes, interviews, and documents to identify early barriers to change and strategies to overcome them. Nine common but not universal barriers were identified: (1) a practice's history reflected some negative past experiences with quality improvement or routines incompatible with transformative change, (2) leadership gaps were evident in unprepared practice leaders or hierarchical leadership, (3) resistance and skepticism about change were expressed through cynicism aimed at change or ability to change, (4) unproductive team processes were reflected in patterns of canceled meetings, absentee leaders, or lack of accountability, (5) knowledge gaps about the Patient-centered Medical Home (PCMH) were apparent from incomplete dissemination about the project or planned changes, (6) EHR implementation distracted focus or stalled improvement activity, (7) sponsoring organizations' constraints emerged from staffing rules and differing priorities, (8) insufficient staff participation resulted from traditional role expectations and structures, and (9) communication was hampered by ineffective methods and part-time faculty and residents. Early barriers responded to varying degrees to specific interventions by practice coaches. Some barriers that interfere with practices getting started with cultural and structural transformation can be addressed with persistent attention and reflection from on-site coaches and by realigning the talents, leaders, and priorities already in these residency programs.

  18. Implementation of Sustainable Soil Management Practices to Improve Crop Production in the Different Ethiopian Agro Systems

    Science.gov (United States)

    García Moreno, R.; Gameda, S.; Diaz Alvarez, M. C.; Selasie, Y. G.

    2012-04-01

    Agriculture in Ethiopia is one of first priority since close to 10 In this context, the Ethiopian crop production faces to the following soil management challenges: lack of updated soil data, macro and micro nutrient depletion, acidity, salinity and soil surface erosion and crusting. One of the biggest issues is the loss of arable land, above 137 T/yr, reaching during some particularly dried periods until 300 T/yr. In this context, the authors constituted a working group of experts from Spanish and Ethiopian universities, local producers and international and governmental organisms to analyse the problems related to the different agro ecological zones found in Ethiopia and the management practices of different local producers. The study produced the trends to implement in the different areas to improve soil management practices in order to contribute to increase the crop production mainly to achieve food security problems. The analyse produced different working fields for the next years for addressing soil degradation, improving land resources management practices, increasing agricultural productivity, updating the available soil data, developing an international program of education, transferring of knowledge from similar study cases and implementing economical tools to help producers to assure income after severe edapho-climatic events. The practical work and the projects developed for the next period is addressed to smallholder farms belonging to the different 34 agro ecological zones identified in Ethiopia, each of them with very specific environmental, cultural and soil management practices.

  19. More black box to explore: how quality improvement collaboratives shape practice change.

    Science.gov (United States)

    Shaw, Eric K; Chase, Sabrina M; Howard, Jenna; Nutting, Paul A; Crabtree, Benjamin F

    2012-01-01

    Quality improvement collaboratives (QICs) are used extensively to promote quality improvement in health care. Evidence of their effectiveness is limited, prompting calls to "open up the black box" to better understand how and why such collaboratives work. We selected a cohort of 5 primary care practices that participated in a 6-month intervention study aimed at improving colorectal cancer screening rates. Using an immersion/crystallization technique, we analyzed qualitative data that included audio recordings and field notes of QICs and practice-based team meetings. Three themes emerged from our analysis: (1) practice staff became empowered through and drew on the QICs to advance change efforts in the face of leader/physician resistance; (2) a mix of content and media in the QIC program was important for reaching all participants; (3) resources offered at the QIC did little to spur practice change efforts. QICs offer a potentially powerful way of disseminating health care innovations through enhanced strategies for learning and change. Creating collaborative environments in which diverse participants learn, listen, reflect, and share together can enable them to take back to their own organizations key messages and change strategies that benefit them the most.

  20. Framework and implementation for improving physics essential skills via computer-based practice: Vector math

    Science.gov (United States)

    Mikula, Brendon D.; Heckler, Andrew F.

    2017-06-01

    We propose a framework for improving accuracy, fluency, and retention of basic skills essential for solving problems relevant to STEM introductory courses, and implement the framework for the case of basic vector math skills over several semesters in an introductory physics course. Using an iterative development process, the framework begins with a careful identification of target skills and the study of specific student difficulties with these skills. It then employs computer-based instruction, immediate feedback, mastery grading, and well-researched principles from cognitive psychology such as interleaved training sequences and distributed practice. We implemented this with more than 1500 students over 2 semesters. Students completed the mastery practice for an average of about 13 min /week , for a total of about 2-3 h for the whole semester. Results reveal large (>1 SD ) pretest to post-test gains in accuracy in vector skills, even compared to a control group, and these gains were retained at least 2 months after practice. We also find evidence of improved fluency, student satisfaction, and that awarding regular course credit results in higher participation and higher learning gains than awarding extra credit. In all, we find that simple computer-based mastery practice is an effective and efficient way to improve a set of basic and essential skills for introductory physics.

  1. Framework and implementation for improving physics essential skills via computer-based practice: Vector math

    Directory of Open Access Journals (Sweden)

    Brendon D. Mikula

    2017-05-01

    Full Text Available We propose a framework for improving accuracy, fluency, and retention of basic skills essential for solving problems relevant to STEM introductory courses, and implement the framework for the case of basic vector math skills over several semesters in an introductory physics course. Using an iterative development process, the framework begins with a careful identification of target skills and the study of specific student difficulties with these skills. It then employs computer-based instruction, immediate feedback, mastery grading, and well-researched principles from cognitive psychology such as interleaved training sequences and distributed practice. We implemented this with more than 1500 students over 2 semesters. Students completed the mastery practice for an average of about 13  min/week, for a total of about 2–3 h for the whole semester. Results reveal large (>1  SD pretest to post-test gains in accuracy in vector skills, even compared to a control group, and these gains were retained at least 2 months after practice. We also find evidence of improved fluency, student satisfaction, and that awarding regular course credit results in higher participation and higher learning gains than awarding extra credit. In all, we find that simple computer-based mastery practice is an effective and efficient way to improve a set of basic and essential skills for introductory physics.

  2. Improving the process of community-based student nurse practice through a high-fidelity simulated clinical experience.

    Science.gov (United States)

    Gotwals, Beth; Yeager, Shelley T

    2014-01-01

    Simulation can be used to facilitate knowledge and practice with clients/families in the community. Because student nurses appreciate the opportunity to practice skills in a nonthreatening environment, and faculty welcome the opportunity to observe all students providing a home visit to a similar type of client, the authors developed such a simulation. In this article, they outline the process taken to develop and evaluate a high-fidelity community simulated clinical experience.

  3. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement

    Science.gov (United States)

    Lofters, AK; Vahabi, M; Prakash, V; Banerjee, L; Bansal, P; Goel, S; Dunn, S

    2017-01-01

    Background Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. Materials and methods Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. Results Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. Discussion Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as

  4. The PMAC code of marketing practices: time for improvement? Pharmaceutical Manufacturers Association of Canada.

    Science.gov (United States)

    Desjardins, J G

    1997-02-01

    In this issue (see pages 351 to 356) Dr. Joel Lexchin proposes reforms that could help the Pharmaceutical Manufacturers Association of Canada (PMAC) adapt its Code of Marketing Practices to changing times. The PMAC code reflects the ethical concerns of drug manufacturers and speaks to the need for high standards in promotional activities. The code is a commendable beginning, but it does not go far enough in ensuring ethical practice. The PMAC should take this opportunity to address the concerns raised by Lexchin. For example, proactive assessment of advertising would improve the current system.

  5. THE NEED TO IMPROVE PRACTICAL INFORMATION SYSTEM IN AGRICULTURE AND SPECIALIZED INDUSTRY

    Directory of Open Access Journals (Sweden)

    Romeo Cătălin CREŢU

    2015-04-01

    Full Text Available In Romania, the establishment of the market economy has required the elaboration and implementation of agricultural, alimentary and nutritional policies, based on scientific criteria, to ensure that the structure of Romanian agriculture would come close to that of the European Union agriculture. Agricultural policy needs to be coherent, flexible and directed towards the economic, social and environmental protection performance. Worldwide practice shows that empiric experience of economic agents does not suffice, but requires plenty of scientific knowledge. The hereby study undertakes to carry out a radiography of the production potential of agricultural operations in Romania and to demonstrate the need for improving practical information systems in agriculture and specialized industry.

  6. Cholera vaccination campaign contributes to improved knowledge regarding cholera and improved practice relevant to waterborne disease in rural Haiti.

    Directory of Open Access Journals (Sweden)

    Omowunmi Aibana

    2013-11-01

    Full Text Available Haiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti.We administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811. An OCV campaign occurred from May-June 2012 after which we administered identical surveys to 518 households randomly chosen from the same region in September 2012. We compared responses pre- and post-OCV campaign. Post-vaccination, there was improved knowledge with significant increase in percentage of respondents with ≥ 3 correct responses on cholera transmission mechanisms (odds ratio[OR] 1.91; 95% confidence interval[CI] 1.52-2.40, preventive methods (OR 1.83; 95% CI 1.46-2.30, and water treatment modalities (OR 2.75; 95% CI 2.16-3.50. Relative to pre-vaccination, participants were more likely post-OCV to report always treating water (OR 1.62; 95% CI 1.28-2.05. Respondents were also more likely to report hand washing with soap and water >4 times daily post-vaccine (OR 1.30; 95% CI 1.03-1.64. Knowledge of treating water as a cholera prevention measure was associated with practice of always treating water (OR 1.47; 95% CI 1.14-1.89. Post-vaccination, knowledge was associated with frequent hand washing (OR 2.47; 95% CI 1.35-4.51.An OCV campaign in rural Haiti was associated with significant improvement in cholera knowledge and practices related to waterborne disease. OCV can be part of comprehensive cholera control and reinforce, not detract from, other control efforts in Haiti.

  7. Cholera Vaccination Campaign Contributes to Improved Knowledge Regarding Cholera and Improved Practice Relevant to Waterborne Disease in Rural Haiti

    Science.gov (United States)

    Aibana, Omowunmi; Franke, Molly; Teng, Jessica; Hilaire, Johanne; Raymond, Max; Ivers, Louise C.

    2013-01-01

    Background Haiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV) might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti. Methodology/Principal Findings We administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811). An OCV campaign occurred from May–June 2012 after which we administered identical surveys to 518 households randomly chosen from the same region in September 2012. We compared responses pre- and post-OCV campaign. Post-vaccination, there was improved knowledge with significant increase in percentage of respondents with ≥3 correct responses on cholera transmission mechanisms (odds ratio[OR] 1.91; 95% confidence interval[CI] 1.52–2.40), preventive methods (OR 1.83; 95% CI 1.46–2.30), and water treatment modalities (OR 2.75; 95% CI 2.16–3.50). Relative to pre-vaccination, participants were more likely post-OCV to report always treating water (OR 1.62; 95% CI 1.28–2.05). Respondents were also more likely to report hand washing with soap and water >4 times daily post-vaccine (OR 1.30; 95% CI 1.03–1.64). Knowledge of treating water as a cholera prevention measure was associated with practice of always treating water (OR 1.47; 95% CI 1.14–1.89). Post-vaccination, knowledge was associated with frequent hand washing (OR 2.47; 95% CI 1.35–4.51). Conclusion An OCV campaign in rural Haiti was associated with significant improvement in cholera knowledge and practices related to waterborne disease. OCV can be part of comprehensive cholera control and reinforce, not detract from, other control efforts in Haiti. PMID:24278498

  8. The importance, challenges and prospects of taking work practices into account for healthcare quality improvement.

    Science.gov (United States)

    Allen, Davina

    2016-06-20

    Purpose - The purpose of this paper is to underline the importance of taking work practices into account for quality improvement (QI) purposes, highlight some of the challenges of doing so, and suggest strategies for future research and practice. Patient status at a glance, a Lean-inspired QI intervention designed to alleviate nurses of their knowledge mobilisation function, is deployed as an illustrative case. Design/methodology/approach - Ethnographic data and practice-based theories are utilised to describe nurses' knowledge mobilisation work. The assumptions about knowledge sharing embedded in patient status at a glance white boards (PSAGWBs) are analysed drawing on actor network theory. Findings - There is a disparity between nurses' knowledge mobilisation practices and the scripts that inform the design of PSAGWBs. PSAGWBs are designed to be intermediaries and to transport meaning without transformation. When nurses circulate knowledge for patient management purposes, they operate as mediators, translating diverse information sources and modifying meaning for different audiences. PSAGWBs are unlikely to relieve nurses of their knowledge mobilisation function and may actually add to the burdens of this work. Despite this nurses have readily embraced this QI intervention. Research limitations/implications - The study is limited by its focus on a single case and by the inferential (rather than the empirical) nature of its conclusions. Originality/value - This paper illustrates the importance of taking practice into account in healthcare QI, points to some of the challenges of doing so and highlights the potential of practice-based approaches in supporting progress in this field.

  9. Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice

    Science.gov (United States)

    Gupta, Vivek K.; Gupta, Veer B.

    2016-01-01

    Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT) and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines. PMID:27854266

  10. Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice.

    Science.gov (United States)

    Gupta, Vivek K; Gupta, Veer B

    2016-11-15

    Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT) and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines.

  11. Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice

    Directory of Open Access Journals (Sweden)

    Vivek K. Gupta

    2016-11-01

    Full Text Available Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines.

  12. Overcoming synecdoche: why practice development and quality improvement approaches should be better integrated

    Directory of Open Access Journals (Sweden)

    Kim Manley

    2017-05-01

    Full Text Available We are pleased to be provided with an opportunity to comment on the thoughtful article by Gavin Lavery about the relationship between practice development and quality improvement, published in 2016 in the IPDJ. We also respect and value the opportunity to bring different perspectives together – something alluded to in Lavery’s article when discussing the relationship between service improvement and quality improvement. We acknowledge Lavery’s humility and openness to different perspectives as demonstrated by his willingness to participate in a foundation practice development school. We also accept that there are many different ways of achieving the same outcomes, by using a range of tools flexibly based on shared and common principles, as well as knowing the people you work with and being clear about purpose. At a time of scant resources in healthcare, it is vital that we avoid duplication and integrate approaches if service users are to experience the continuity and seamlessness of a person-centred approach to meeting the health and social care needs of individuals and communities. Lavery makes reference to ‘systems and processes’. It is important when discussing systems that we have a sense of shared meaning, as systems comprise structures, processes and patterns of behaviour. It is often the latter that are most challenging to address when trying to develop practice and improve quality (McCormack et al., 2008. Patterns of behaviours are an important focus when engaging staff in learning and reflection. Helping practitioners to become self-aware about the consequences of their actions on others (enlightenment, particularly in relation to being person-centred, has a strong history in practice development, linked to using the workplace as the main resource for active learning (Dewing, 2008. While these insights have relevance for both practice development and quality improvement, it is the former, through its theoretical development

  13. Protected Areas and Human Displacement: Improving the Interface between Policy and Practice

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    Krueger Linda

    2009-01-01

    Full Text Available Despite a growing and increasingly sophisticated set of international policy guidance and norms governing issues of equity and the rights of indigenous and local people, conservationists continue to face moral and practical dilemmas in the application of these guidelines in the field, especially in cases where conservationists seek to restrict access to natural resources. One source of the dilemma is that successful implementation of international covenants may require a stronger enabling environment (in the form of fairness, legitimacy of political actors, transparency and accountability than typically exists on the ground. Conservationists also need to be better informed about existing best practice on community participation. However, both policy and practice can be ultimately strengthened by an iterative process in which practitioners provide regular input to policy development in order to improve the normative basis for successful conservation.

  14. Patient Perspectives on Improving Oral Health-Care Practices Among People Living with HIV/AIDS

    Science.gov (United States)

    Rajabiun, Serena; Fox, Jane E.; McCluskey, Amanda; Guevara, Ernesto; Verdecias, Niko; Jeanty, Yves; DeMayo, Michael; Mofidi, Mahyar

    2012-01-01

    This qualitative study explored the impact on oral health-care knowledge, attitudes, and practices among 39 people living with HIV/AIDS (PLWHA) participating in a national initiative aimed at increasing access to oral health care. Personal values and childhood dental experiences, beliefs about the importance of oral health in relation to HIV health, and concerns for appearance and self-esteem were found to be determinants of oral health knowledge and practice. Program participation resulted in better hygiene practices, improved self-esteem and appearance, relief of pain, and better physical and emotional health. In-depth exploration of the causes for these changes revealed a desire to continue with dental care due to the dental staff and environmental setting, and a desire to maintain overall HIV health, including oral health. Our findings emphasize the importance of addressing both personal values and contextual factors in providing oral health-care services to PLWHA. PMID:22547879

  15. [Use of PubMed to improve evidence-based medicine in routine urological practice].

    Science.gov (United States)

    Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P

    2013-03-01

    Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.

  16. Learning to teach: how a formal teaching qualification improved our practice.

    Science.gov (United States)

    Lipczynska, Sonya; Crowley, Clare

    2015-09-01

    In this article, guest writers Sonya Lipczynska and Clare Crowley from King's College London discuss the learning that occurred when they undertook a Postgraduate Certificate in Academic Practice in Higher Education (PGCAPHE). In particular, they identify how their exploration of relevant learning and teaching theory on the course helped them to evaluate their library instruction teaching practice with medical and dental students. They highlight how they made changes and improvements to the delivery of these sessions based on greater consideration of inclusivity and the characteristics of both individuals and broader student groups. They also discuss the successes of new teaching practices that they experimented with, and reflect on how they have developed as educators as a result of this. H.S.

  17. Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand.

    Directory of Open Access Journals (Sweden)

    Dan Allman

    Full Text Available BACKGROUND: This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. METHODS: In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP guided this work. RESULTS: Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs. Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. DISCUSSION: Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical

  18. Improving ethical and participatory practice for marginalized populations in biomedical HIV prevention trials: lessons from Thailand.

    Science.gov (United States)

    Allman, Dan; Ditmore, Melissa Hope; Kaplan, Karyn

    2014-01-01

    This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired. In-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work. Fourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will. Biomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where

  19. A Practice Improvement Project to Reduce Cesarean Surgical Site Infection Rates.

    Science.gov (United States)

    Holland, Cindra; Foster, Peggy; Ulrich, Deborah; Adkins, Kathryn

    We implemented an evidence-based practice improvement project at a health care facility in the Midwestern United States to address the increasing rate of cesarean surgical site infections. Women who experienced cesarean birth were cared for using a standardized evidence-based protocol including preoperative and postoperative care and education. In addition, a team-created educational video was used by both women and their families during the postoperative period and at home after discharge. This new protocol resulted in a decrease in the rate of cesarean surgical site infections from 1.35% in 2013 to 0.7% in 2014 and 0.36% in 2015. Our interdisciplinary approach to integrate best-practice strategies resulted in decreased infection rates and improved patient satisfaction scores. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  20. Does the introduction of nursing home culture change practices improve quality?

    Science.gov (United States)

    Miller, Susan C; Lepore, Michael; Lima, Julie C; Shield, Renee; Tyler, Denise A

    2014-09-01

    To understand whether nursing home (NH) introduction of culture change practices is associated with improved quality. NH-level panel study using multivariate fixed-effects statistical modeling to estimate the effect of culture change introduction on quality outcomes. Eight hundred twenty-four U.S. NHs with culture change practice involvement beginning between 2005 and 2010. Directors of nursing and nursing home administrators. A culture change practice score (derived from a 2009/10 national NH survey) was used to stratify NHs according to practice implementation (high (scores in the top quartile; n = 217) vs other (n = 607)). NH-level outcomes included prevalence of seven care practices and three resident outcomes, health-related and quality-of-life weighted survey deficiencies, and average number of hospitalizations per resident year. For NHs with high practice implementation, introduction of culture change was associated with a significant decrease in prevalence of restraints, tube feeding, and pressure ulcers; an increase in the proportion of residents on bladder training programs; and a small decrease in the average number of hospitalizations per resident year (coefficient -0.04, standard error (SE) 0.02, P = .06). For NHs with lower practice implementation (practice scores in lower three quartiles), introduction was associated with fewer health-related (coefficient -5.26, SE 3.05; P = .09) and quality-of-life (coefficient -0.10, SE 0.05; P = .04) survey deficiencies, although these NHs also had small statistically significant increases in the prevalence of residents with urinary tract infections and in average hospitalizations per resident year (coefficient 0.03, SE 0.01, P = .02). The introduction of NH culture change appears to result in significant improvements in some care processes and outcomes in NHs with high practice implementation. For other NHs, culture change introduction results in fewer survey deficiencies. © 2014, Copyright the