WorldWideScience

Sample records for facilitating practice improvement

  1. Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.

    Science.gov (United States)

    McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D

    2018-04-01

    Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged. We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices. The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects. © 2018 Annals of Family Medicine, Inc.

  2. Practice Facilitator Strategies for Addressing Electronic Health Record Data Challenges for Quality Improvement: EvidenceNOW.

    Science.gov (United States)

    Hemler, Jennifer R; Hall, Jennifer D; Cholan, Raja A; Crabtree, Benjamin F; Damschroder, Laura J; Solberg, Leif I; Ono, Sarah S; Cohen, Deborah J

    2018-01-01

    Practice facilitators ("facilitators") can play an important role in supporting primary care practices in performing quality improvement (QI), but they need complete and accurate clinical performance data from practices' electronic health records (EHR) to help them set improvement priorities, guide clinical change, and monitor progress. Here, we describe the strategies facilitators use to help practices perform QI when complete or accurate performance data are not available. Seven regional cooperatives enrolled approximately 1500 small-to-medium-sized primary care practices and 136 facilitators in EvidenceNOW, the Agency for Healthcare Research and Quality's initiative to improve cardiovascular preventive services. The national evaluation team analyzed qualitative data from online diaries, site visit field notes, and interviews to discover how facilitators worked with practices on EHR data challenges to obtain and use data for QI. We found facilitators faced practice-level EHR data challenges, such as a lack of clinical performance data, partial or incomplete clinical performance data, and inaccurate clinical performance data. We found that facilitators responded to these challenges, respectively, by using other data sources or tools to fill in for missing data, approximating performance reports and generating patient lists, and teaching practices how to document care and confirm performance measures. In addition, facilitators helped practices communicate with EHR vendors or health systems in requesting data they needed. Overall, facilitators tailored strategies to fit the individual practice and helped build data skills and trust. Facilitators can use a range of strategies to help practices perform data-driven QI when performance data are inaccurate, incomplete, or missing. Support is necessary to help practices, particularly those with EHR data challenges, build their capacity for conducting data-driven QI that is required of them for participating in practice

  3. Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

    Science.gov (United States)

    Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

    2018-01-01

    To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.

  4. 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.

  5. Use of a structured template to facilitate practice-based learning and improvement projects.

    Science.gov (United States)

    McClain, Elizabeth K; Babbott, Stewart F; Tsue, Terance T; Girod, Douglas A; Clements, Debora; Gilmer, Lisa; Persons, Diane; Unruh, Greg

    2012-06-01

    The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

  6. Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit.

    Science.gov (United States)

    Wiechula, Rick; Kitson, Alison; Marcoionni, Danni; Page, Tammy; Zeitz, Kathryn; Silverston, Heidi

    2009-12-01

    This paper reports on a structured facilitation program where seven interdisciplinary teams conducted projects aimed at improving the care of the older person in the acute sector. Aims  To develop and implement a structured intervention known as the Knowledge Translation (KT) Toolkit to improve the fundamentals of care for the older person in the acute care sector. Three hypotheses were tested: (i) frontline staff can be facilitated to use existing quality improvement tools and techniques and other resources (the KT Toolkit) in order to improve care of older people in the acute hospital setting; (ii) fundamental aspects of care for older people in the acute hospital setting can be improved through the introduction and use of specific evidence-based guidelines by frontline staff; and (iii) innovations can be introduced and improvements made to care within a 12-month cycle/timeframe with appropriate facilitation. Methods  Using realistic evaluation methodology the impact of a structured facilitation program (the KT Toolkit) was assessed with the aim of providing a deeper understanding of how a range of tools, techniques and strategies may be used by clinicians to improve care. The intervention comprised three elements: the facilitation team recruited for specific knowledge, skills and expertise in KT, evidence-based practice and quality and safety; the facilitation, including a structured program of education, ongoing support and communication; and finally the components of the toolkit including elements already used within the study organisation. Results  Small improvements in care were shown. The results for the individual projects varied from clarifying issues of concern and planning ongoing activities, to changing existing practices, to improving actual patient outcomes such as reducing functional decline. More importantly the study described how teams of clinicians can be facilitated using a structured program to conduct practice improvement activities

  7. 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

  8. Facilitating innovation : an action-oriented approach and participatory methodology to improve innovative social practice in agriculture

    OpenAIRE

    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 organizations, actually do to innovate their practices? How do they organize themselves? Can this be managed or facilitated, and if so, how? The research is exploratory rather than concl...

  9. 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 explores...

  10. 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.

  11. Facilitators for practice change in Spanish community pharmacy.

    Science.gov (United States)

    Gastelurrutia, Miguel A; Benrimoj, S I Charlie; Castrillon, Carla C; de Amezua, María J Casado; Fernandez-Llimos, Fernando; Faus, Maria J

    2009-02-01

    To identify and prioritise facilitators for practice change in Spanish community pharmacy. Spanish community pharmacies. Qualitative study. Thirty-three semi-structured interviews were conducted with community pharmacists (n = 15) and pharmacy strategists (n = 18), and the results were examined using the content analysis method. In addition, two nominal groups (seven community pharmacists and seven strategists) were formed to identify and prioritise facilitators. Results of both techniques were then triangulated. Facilitators for practice change. Twelve facilitators were identified and grouped into four domains (D1: Pharmacist; D2: Pharmacy as an organisation; D3: Pharmaceutical profession; D4: Miscellaneous). Facilitators identified in D1 include: the need for more clinical education at both pre- and post-graduate levels; the need for clearer and unequivocal messages from professional leaders about the future of the professional practice; and the need for a change in pharmacists' attitudes. Facilitators in D2 are: the need to change the reimbursement system to accommodate cognitive service delivery as well as dispensing; and the need to change the front office of pharmacies. Facilitators identified in D3 are: the need for the Spanish National Professional Association to take a leadership role in the implementation of cognitive services; the need to reduce administrative workload; and the need for universities to reduce the gap between education and research. Other facilitators identified in this study include: the need to increase patients' demand for cognitive services at pharmacies; the need to improve pharmacist-physician relationships; the need for support from health care authorities; and the need for improved marketing of cognitive services and their benefits to society, including physicians and health care authorities. Twelve facilitators were identified. Strategists considered clinical education and pharmacists' attitude as the most important, and

  12. Facilitating practical knowledge by using ECT

    Directory of Open Access Journals (Sweden)

    Rita Jentoft

    2009-11-01

    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.

  13. Strategies facilitating practice change in pediatric cancer: a systematic review.

    Science.gov (United States)

    Robinson, Paula D; Dupuis, Lee L; Tomlinson, George; Phillips, Bob; Greenberg, Mark; Sung, Lillian

    2016-09-01

    By conducting a systematic review, we describe strategies to actively disseminate knowledge or facilitate practice change among healthcare providers caring for children with cancer and we evaluate the effectiveness of these strategies. We searched Ovid Medline, EMBASE and PsychINFO. Fully published primary studies were included if they evaluated one or more professional intervention strategies to actively disseminate knowledge or facilitate practice change in pediatric cancer or hematopoietic stem cell transplantation. Data extracted included study characteristics and strategies evaluated. In studies with a quantitative analysis of patient outcomes, the relationship between study-level characteristics and statistically significant primary analyses was evaluated. Of 20 644 titles and abstracts screened, 146 studies were retrieved in full and 60 were included. In 20 studies, quantitative evaluation of patient outcomes was examined and a primary outcome was stated. Eighteen studies were 'before and after' design; there were no randomized studies. All studies were at risk for bias. Interrupted time series was never the primary analytic approach. No specific strategy type was successful at improving patient outcomes. Literature describing strategies to facilitate practice change in pediatric cancer is emerging. However, major methodological limitations exist. Studies with robust designs are required to identify effective strategies to effect practice change. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Influences of peer facilitation in general practice - a qualitative study

    DEFF Research Database (Denmark)

    Due, Tina Drud; Kousgaard, Marius Brostrøm; Waldorff, Frans Boch

    2018-01-01

    of the visited practices to gain a more detailed understanding of how peer facilitation influenced practices and how they valued the facilitation. METHODS: The facilitation intervention was conducted in general practice in the Capital Region of Denmark with the purpose of supporting the implementation of chronic...... visits had increased their knowledge and skills as well as their motivation and confidence to change. These positive influences were ascribed to a) the facilitation approach b) the credibility and know-how associated with the facilitators' being peers c) the recurring visits providing protected time...... and invoking a sense of commitment. Despite these positive influences, both the facilitation and the change process were impeded by several challenges, e.g. competing priorities, heavy workload, problems with information technology and in some cases inadequate facilitation. CONCLUSION: Practice facilitation...

  15. 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.

  16. 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

  17. A creative analysis of the role of practice development facilitators in a critical care environment

    Directory of Open Access Journals (Sweden)

    Tanya Heyns

    2017-10-01

    Full Text Available Practice development focuses on methods to address the quality of care and advance healthcare practices. The role of practice development facilitators to address challenges of delivering evidence-based person-centred care in the critical care environment was determined by using a nominal group technique. Eleven participants from public and private healthcare services reached consensus on seven clusters: theory-practice application, facilitation of learning, increasing collaboration, effective communication, facilitation of change, time management and role modelling. The clusters were visually represented as a hot air balloon. Competence as facilitators is of vital importance to ensure knowledge translation with the aim to improve quality.

  18. Facilitating Mathematical Practices through Visual Representations

    Science.gov (United States)

    Murata, Aki; Stewart, Chana

    2017-01-01

    Effective use of mathematical representation is key to supporting student learning. In "Principles to Actions: Ensuring Mathematical Success for All" (NCTM 2014), "use and connect mathematical representations" is one of the effective Mathematics Teaching Practices. By using different representations, students examine concepts…

  19. Improving Corporate Governance Practices

    OpenAIRE

    M. Huse; J. Gabrielsson; A. Minichilli

    2009-01-01

    Peak performing organizations may benefit from active value creating boards. Suggestions to improve board behaviour and corporate governance practices are presented in this article. The suggestions result from findings in the “Valued Creating Board” research programme. However, active boards working in a shareholder activism framework may destroy rather than support value creation processes within firms. In peak performing organizations corporate governance practices should be designed and de...

  20. 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 ...

  1. The practical theologian as decentred but influential facilitator

    Directory of Open Access Journals (Sweden)

    H. Elmo Pienaar

    2012-02-01

    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.

  2. Design Facilitation as Emerging Practice: Analyzing How Designers Support Multi-stakeholder Co-creation

    Directory of Open Access Journals (Sweden)

    Manuela Aguirre

    Full Text Available Designers increasingly find themselves facilitating large-scale design events. Yet few have explored design facilitation as an emerging practice. This article examines the design facilitation practices used in two Norwegian case studies of multi-stakeholder events. We focus on the contextually designed tools designers create to help them facilitate. We then explore some critical dimensions of design facilitation. When used as visual overlays, facilitators’ explicit knowledge of these dimensions can improve their capacity to analyze, evaluate, and plan how to design and use contextual tools during design events. By plotting how designers use facilitation tools sequentially during events, we render the flow of design facilitation practice visible and accessible. We suggest that an explicit awareness of these dimensions and flows can enable designers to build more inclusive and inspiring tools, orchestrate the flow of long-term participatory processes more deliberately, and better equip participants to work with complex systemic change.

  3. Shared learning in general practice--facilitators and barriers.

    Science.gov (United States)

    van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

    2013-03-01

    Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

  4. Best Practices to Promote Diversity and Facilitate Inclusion

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, Mark A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Snyder, Johann D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-10-01

    The intent of this guide is to provide a set of “best practices” for leaders to promote diversity and facilitate inclusion within their organization and throughout Sandia National Laboratories. These “best practices” are derived from personal experiences and build upon existing resources at Sandia to help us effect change to realize an inclusive work environment. As leaders, we play a critical role in setting the vision and shaping the culture of the organization by communicating expectations and modeling inclusive behavior. The “best practices” in this guide are presented in the spirit of promoting a learning culture that values continuous improvement in the ongoing effort to make diversity and inclusion an integral part of all that we do at Sandia. This guide seeks to articulate the importance of leading through example, taking positive actions, raising awareness of practices that provide an inclusive environment, and creating a space that welcomes diverse perspectives and input.

  5. Safeguards Implementation Practices Guide on Facilitating IAEA Verification Activities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2014-12-15

    The IAEA implements safeguards pursuant to agreements concluded with States. It is in the interests of both States and the IAEA to cooperate to facilitate the practical implementation of safeguards. Such cooperation is explicitly required under all types of safeguards agreement. Effective cooperation depends upon States and the IAEA sharing a common understanding of their respective rights and obligations. To address this, in 2012 the IAEA published Services Series 21, Guidance for States Implementing Comprehensive Safeguards Agreements and Additional Protocols, which aimed at enhancing understanding of the safeguards obligations of both States and the IAEA and at improving their cooperation in safeguards implementation. States may establish different processes and procedures at the national level, and set up different systems as required to meet their safeguards obligations. Indeed, a variety of approaches are to be expected, owing to such differences as the size and complexity of States’ nuclear programmes and their regulatory framework. The purpose of this Safeguards Implementation Practices (SIP) Guide is to share the experiences and good practices as well as the lessons learned by both States and the IAEA, acquired over the many decades of safeguards implementation. The information contained in the SIP Guides is provided for explanatory purposes and use of the Guides is not mandatory. The descriptions in the SIP Guides have no legal status and are not intended to add to, subtract from, amend or derogate from, in any way, the rights and obligations of the IAEA and the States set forth in The Structure and Content of Agreements between the Agency and States Required in Connection with the Treaty on the Non-Proliferation of Nuclear Weapons (issued as INFCIRC/153 (Corrected)) and Model Protocol Additional to the Agreement(s) between State(s) and the International Atomic Energy Agency for the Application of Safeguards (issued as INFCIRC/540 (Corrected)). This SIP

  6. Safeguards Implementation Practices Guide on Facilitating IAEA Verification Activities

    International Nuclear Information System (INIS)

    2014-01-01

    The IAEA implements safeguards pursuant to agreements concluded with States. It is in the interests of both States and the IAEA to cooperate to facilitate the practical implementation of safeguards. Such cooperation is explicitly required under all types of safeguards agreement. Effective cooperation depends upon States and the IAEA sharing a common understanding of their respective rights and obligations. To address this, in 2012 the IAEA published Services Series 21, Guidance for States Implementing Comprehensive Safeguards Agreements and Additional Protocols, which aimed at enhancing understanding of the safeguards obligations of both States and the IAEA and at improving their cooperation in safeguards implementation. States may establish different processes and procedures at the national level, and set up different systems as required to meet their safeguards obligations. Indeed, a variety of approaches are to be expected, owing to such differences as the size and complexity of States’ nuclear programmes and their regulatory framework. The purpose of this Safeguards Implementation Practices (SIP) Guide is to share the experiences and good practices as well as the lessons learned by both States and the IAEA, acquired over the many decades of safeguards implementation. The information contained in the SIP Guides is provided for explanatory purposes and use of the Guides is not mandatory. The descriptions in the SIP Guides have no legal status and are not intended to add to, subtract from, amend or derogate from, in any way, the rights and obligations of the IAEA and the States set forth in The Structure and Content of Agreements between the Agency and States Required in Connection with the Treaty on the Non-Proliferation of Nuclear Weapons (issued as INFCIRC/153 (Corrected)) and Model Protocol Additional to the Agreement(s) between State(s) and the International Atomic Energy Agency for the Application of Safeguards (issued as INFCIRC/540 (Corrected)). This SIP

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

    Directory of Open Access Journals (Sweden)

    Immaculate S. Muthathi

    2017-08-01

    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 clinical learning environment so as to support students’ adaptation to clinical practice.

  8. 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.

  9. Implementation Practices of Finland in Facilitating IAEA Verification Activities

    International Nuclear Information System (INIS)

    Martikka, E.; Ansaranta, T.; Honkamaa, T.; Hamalainen, M.

    2015-01-01

    The Member States provide the information to the IAEA according to the Safeguards Agreements and Additional Protocols. For example, the requirements to provide the reports and declarations are very general and there are no explanation what the IAEA is looking for from that information. It is important for the States to understand how their efforts to collect and provide information, and to facilitate IAEA verification activities, contribute to the achievement of objectives and finally to draw conclusions on the exclusively peaceful use of nuclear materials in a State. The IAEA is producing a new series of guidance called Safeguards Implementation Practices, SIP, guides, which are shedding light on the requirements and sharing the good practices of States. It is hoped that the SIP Guides will create a better understanding of the needs of the IAEA and the important role of States and facility operators in achieving safeguards objectives. The guides are also important for the States to share their lessons learned and good practices for the benefit of other States that might be developing their capabilities or enhancing their processes and procedures. The way is very wide and long, when a State decides to start up a new nuclear programme. At first there is a need for legislation, regulatory body, contact point, international agreements and then finally practical implementation of the safeguards in the nuclear facilities. There are a lot of issues to be prepared in advance to facilitate the IAEA's implementation of verification activities successfully, effectively and with the good quality. Using the structure of the IAEA's draft SIP Guide on Facilitating Verification Activities as a framework, this paper will describe the most relevant implementation practices and experiences in Finland. (author)

  10. Improving Practice through Research.

    Science.gov (United States)

    Rose, Terry L.

    1989-01-01

    The article discusses the need for communication of research findings involving exceptional individuals, the need for resolution of the research-practice dichotomy, and the types of papers which will appear in the new column. (JDD)

  11. Clinical librarians as facilitators of nurses' evidence-based practice.

    Science.gov (United States)

    Määttä, Sylvia; Wallmyr, Gudrun

    2010-12-01

    The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.

  12. 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

  13. 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...

  14. 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 institutionalized. The project did not change the teaching format, but introduced facilitated study-groups using peer learning. Itwas successful in increasing students’ well-being. While peer learning and study groups are well-known in higher education, facilitation is a different and novel tool. We argue...... that facilitation makes study groups more inclusive, and they provide the potential for deep learning by structuring the learning situation...

  15. Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.

    Science.gov (United States)

    Jakubec, Sonya L; Parboosingh, John; Colvin, Barbara

    2014-01-01

    Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. The purpose of this paper is to describe an innovative COP facilitator's course and report on the experiences of participants in the first course. In response to this need and emerging evidence, an on-line COP facilitator's course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey. A total of 15 of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback. While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage

  16. Caring presence in practice: facilitating an appreciative discourse in nursing.

    Science.gov (United States)

    du Plessis, E

    2016-09-01

    To report on an appreciation of caring presence practised by nurses in South Africa in order to facilitate an appreciative discourse in nursing and a return to caring values and attitudes. Appreciative reports on caring presence are often overlooked. Media may provide a platform for facilitating appreciation for caring presence practised by nurses. Such an appreciation may foster further practice of caring presence and re-ignite a caring ethos in nursing. This article provides an appreciative discourse on caring presence in nursing in the form of examples of caring presence practised by nurses. An anecdotal approach was followed. Social media, namely narratives on caring presence shared by nurses on a Facebook page, and formal media, namely news reports in which nurses are appreciated for their efforts, were used. Deductive content analysis was applied to analyse the narratives and news reports in relation to a definition of caring presence and types of caring presence. The analysis of the narratives and news reports resulted in an appreciative discourse in which examples of nurses practising caring presence could be provided. Examples of nurses practising caring presence could be found, and an appreciative discourse could be initiated. Appreciation ignites positive action and ownership of high-quality health care. Leadership should thus cultivate a culture of appreciating nurses, through using media, and encourage nurses to share how caring presence impact on quality in health care. © 2016 International Council of Nurses.

  17. Practice management companies improve practices' financial position.

    Science.gov (United States)

    Dupell, T

    1997-11-01

    To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

  18. Facilitators of transforming primary care: a look under the hood at practice leadership.

    Science.gov (United States)

    Donahue, Katrina E; Halladay, Jacqueline R; Wise, Alison; Reiter, Kristin; Lee, Shoou-Yih Daniel; Ward, Kimberly; Mitchell, Madeline; Qaqish, Bahjat

    2013-01-01

    This study examined how characteristics of practice leadership affect the change process in a statewide initiative to improve the quality of diabetes and asthma care. We used a mixed methods approach, involving analyses of existing quality improvement data on 76 practices with at least 1 year of participation and focus groups with clinicians and staff in a 12-practice subsample. Existing data included monthly diabetes or asthma measures (clinical measures) and monthly practice implementation, leadership, and practice engagement scores rated by an external practice coach. Of the 76 practices, 51 focused on diabetes and 25 on asthma. In aggregate, 50% to 78% made improvements within in each clinical measure in the first year. The odds of making practice changes were greater for practices with higher leadership scores (odds ratios = 2.41-4.20). Among practices focused on diabetes, those with higher leadership scores had higher odds of performing nephropathy screening (odds ratio = 1.37, 95% CI, 1.08-1.74); no significant associations were seen for the intermediate outcome measures of hemoglobin A1c, blood pressure, and cholesterol. Focus groups revealed the importance of a leader, typically a physician, who believed in the transformation work (ie, a visionary leader) and promoted practice engagement through education and cross-training. Practices with greater change implementation also mentioned the importance of a midlevel operational leader who helped to create and sustain practice changes. This person communicated and interacted well with, and was respected by both clinicians and staff. In the presence of a vision for transformation, operational leaders within practices can facilitate practice changes that are associated with clinical improvement.

  19. From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice.

    Science.gov (United States)

    Ellis, Isabelle; Howard, Peter; Larson, Ann; Robertson, Jeanette

    2005-01-01

    This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery. Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP). A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants. The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.

  20. 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.

  1. Improvement in Visual Search with Practice : Mapping Learning-Related Changes in Neurocognitive Stages of Processing

    NARCIS (Netherlands)

    Clark, Kait; Appelbaum, L. Gregory; van den Berg, Berry; Mitroff, Stephen R.; Woldorff, Marty G.

    2015-01-01

    Practice can improve performance on visual search tasks; the neural mechanisms underlying such improvements, however, are not clear. Response time typically shortens with practice, but which components of the stimulus-response processing chain facilitate this behavioral change? Improved search

  2. 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

  3. "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.

  4. 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.

  5. Iranian pediatric nurse's experience: The facilitators of the learning of ethical practices

    Directory of Open Access Journals (Sweden)

    Kobra Karami

    2017-01-01

    Full Text Available Background: Ethical care is a core value in nursing. Pediatric nurses are in direct and continuous contact with children and their parents. They manage their lives and health. As part of the pediatric nurses' daily work, ethical issues play an important role in making decisions, are important to make decisions, and this capability is only achieved by ethical practice. This study aimed to explore the factors facilitating the learning of ethical practice among Iranian pediatric nurses. Materials and Methods: This study is a conventional qualitative content analysis based on the Graneheim and Lundman method. It was conducted through semi-structured interviews with two focus groups, incorporating 28 nurses working in pediatric wards. Unstructured observation and field notes were other methods of data collection. Purposive sampling continued until data saturation was ensured. All interviews were tape recorded and transcribed in verbatim. Results: Three main categories and 12 subcategories emerged from this study. The facilitating factors include (1 individual competencies (knowledge, experience, emotional intelligence, and loving children, (2 ethical imprinting (responsibility, reflection, empathy, and ethical beliefs, and (3 an environment that nurtures moral values (organizational, spiritual, family, and cultural environments as facilitating factors. Conclusions: The promotion of nurses' competencies, ethical virtues, and imprinting, as well as improvement of the quality of nursing care must be the top priority of the health team. Undoubtedly, the success of the health care system is not possible without ensuring that pediatric nurses learn ethical practices.

  6. Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

    Science.gov (United States)

    Reime, Marit Hegg; Johnsgaard, Tone; Kvam, Fred Ivan; Aarflot, Morten; Breivik, Marit; Engeberg, Janecke Merethe; Brattebø, Guttorm

    2016-11-01

    Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n = 262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Recommended programming practices to facilitate the portability of science computer programs

    International Nuclear Information System (INIS)

    Anon.

    1983-01-01

    This standard recommends programming practices to facilitate the portability of computer programs prepared for scientific and engineering computations. These practices are intended to simplify implementation, conversion, and modification of computer programs

  8. Using Reflective Practice to Facilitate Conversations and Transform Instructional Practice for Middle School Science Teachers

    Science.gov (United States)

    Higdon, Robbie L.

    The process of teaching, especially inquiry, is complex and requires extended time for developing one's instructional practice (Loucks-Horsley, Stiles, Mundry, Love, & Hewson, 2010). The implementation of a continued cycle of self-reflection can engage teachers in analyzing their prior experiences and understandings about their instructional practice to promote the accommodation of new concepts and transform their practice. However, many teachers have difficulty engaging in the cognitive dissonance needed to identify those problems and promote their own growth without support. As one's professional practice becomes more repetitive and routine, it is difficult for the practitioner to recognize opportunities in which to contemplate one's habitual actions (Schon, 1983). In this multi-case study, two middle school science teachers who were engaged within a sustained professional development initiative participated in a series of one-on-one reflective dialogues regarding the decisions they made about the utilization of inquiry-based instruction. In addition, these teachers were asked to reflect upon the criteria used to determine how and when to implement these inquiry-based practices. These reflective dialogue sessions provided the opportunity to observe teacher conceptions and stimulate teacher cognitive dissonance about instructional practice. Qualitative analysis of data collected from these reflective dialogues along with informal and formal classroom observations of instructional practice uncovered diverse perceptions regarding the implementation of inquiry-based methods into present teaching practice. The use of reflective dialogue within the existing structure of the professional development initiative allowed for the facilitators of the professional development initiative to tailor ongoing support and their effective implementation of inquiry-based instruction. Additional research is needed to investigate the impact of reflective dialogue in achieving

  9. 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

  10. 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)....

  11. Disclosure of HIV Status in Rural Tanzania: Practices, Facilitators ...

    African Journals Online (AJOL)

    In Tanzania, HIV counselling and testing practices are now widely accepted as the cornerstone of HIV prevention programmes. Within HIV testing and counselling, emphasis is placed on the importance of individuals to disclose their HIV status. Despite increasing focus on disclosure of HIV status, relatively little is known ...

  12. 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...

  13. A care improvement program acting as a powerful learning environment to support nursing students learning facilitation competencies.

    Science.gov (United States)

    Jukema, Jan S; Harps-Timmerman, Annelies; Stoopendaal, Annemiek; Smits, Carolien H M

    2015-11-01

    Change management is an important area of training in undergraduate nursing education. Successful change management in healthcare aimed at improving practices requires facilitation skills that support teams in attaining the desired change. Developing facilitation skills in nursing students requires formal educational support. A Dutch Regional Care Improvement Program based on a nationwide format of change management in healthcare was designed to act as a Powerful Learning Environment for nursing students developing competencies in facilitating change. This article has two aims: to provide comprehensive insight into the program components and to describe students' learning experiences in developing their facilitation skills. This Dutch Regional Care Improvement Program considers three aspects of a Powerful Learning Environment: self-regulated learning; problem-based learning; and complex, realistic and challenging learning tasks. These three aspects were operationalised in five distinct areas of facilitation: increasing awareness of the need for change; leadership and project management; relationship building and communication; importance of the local context; and ongoing monitoring and evaluation. Over a period of 18 months, 42 nursing students, supported by trained lecturer-coaches, took part in nine improvement teams in our Regional Care Improvement Program, executing activities in all five areas of facilitation. Based on the students' experiences, we propose refinements to various components of this program, aimed at strengthenin the learning environment. There is a need for further detailed empirical research to study the impact this kind of learning environment has on students developing facilitation competencies in healthcare improvement. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. 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.

  15. Continuous Improvement in Schools: Understanding the Practice

    Science.gov (United States)

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  16. Facilitating Transfer of Skills and Strategies in Occupational Therapy Practice: Practical Application of Transfer Principles.

    Science.gov (United States)

    Babulal, Ganesh M; Foster, Erin R; Wolf, Timothy J

    2016-01-01

    In Occupational Therapy (OT) practice, practitioners assume that the skills and strategies taught to clients during rehabilitation will transfer to performance and participation in everyday life. Despite transfer serving as a practice foundation, outcome studies conclude that this assumption of transfer is not occurring and it often results in decreased efficacy of rehabilitation. This paper investigated key aspects of transfer and found concepts in the psychology literature that can support transfer of skills and strategies in OT. Six key principles proposed from educational psychology can serve as a guide for practitioners to better train for transfer. In this paper, we discuss the six principles and apply concepts from psychology. Each principle is supported with examples of how they may be incorporated OT practice. If occupational therapists understand these principles and implement them in treatment, the efficacy of treatment may improve for many populations.

  17. 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. (c) 2015 APA, all rights reserved).

  18. Improving practical atmospheric dispersion models

    International Nuclear Information System (INIS)

    Hunt, J.C.R.; Hudson, B.; Thomson, D.J.

    1992-01-01

    The new generation of practical atmospheric dispersion model (for short range ≤ 30 km) are based on dispersion science and boundary layer meteorology which have widespread international acceptance. In addition, recent improvements in computer skills and the widespread availability of small powerful computers make it possible to have new regulatory models which are more complex than the previous generation which were based on charts and simple formulae. This paper describes the basis of these models and how they have developed. Such models are needed to satisfy the urgent public demand for sound, justifiable and consistent environmental decisions. For example, it is preferable that the same models are used to simulate dispersion in different industries; in many countries at present different models are used for emissions from nuclear and fossil fuel power stations. The models should not be so simple as to be suspect but neither should they be too complex for widespread use; for example, at public inquiries in Germany, where simple models are mandatory, it is becoming usual to cite the results from highly complex computational models because the simple models are not credible. This paper is written in a schematic style with an emphasis on tables and diagrams. (au) (22 refs.)

  19. Barriers and facilitators to learn and improve through morbidity and mortality conferences: a qualitative study.

    Science.gov (United States)

    de Vos, Marit S; Hamming, Jaap F; Marang-van de Mheen, Perla J

    2017-11-12

    To explore barriers and facilitators to successful morbidity and mortality conferences (M&M), driving learning and improvement. This is a qualitative study with semistructured interviews. Inductive, thematic content analysis was used to identify barriers and facilitators, which were structured across a pre-existing framework for change in healthcare. Dutch academic surgical department with a long tradition of M&M. An interview sample of surgeons, residents and physician assistants (n=12). A total of 57 barriers and facilitators to successful M&M, covering 18 themes, varying from 'case type' to 'leadership', were perceived by surgical staff. While some factors related to M&M organisation, others concerned individual or social aspects. Eight factors, of which four were at the social level, had simultaneous positive and negative effects (eg, 'hierarchy' and 'team spirit'). Mediating pathways for M&M success were found to relate to available information , staff motivation and realisation processes. This study provides leads for improvement of M&M practice, as well as for further research on key elements of successful M&M. Various factors were perceived to affect M&M success, of which many were individual and social rather than organisational factors, affecting information and realisation processes but also staff motivation. Based on these findings, practical recommendations were formulated to guide efforts towards best practices for M&M. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Improving practical reasoning and argumentation

    OpenAIRE

    Baumtrog, Michael David

    2015-01-01

    This thesis justifies the need for and develops a new integrated model of practical reasoning and argumentation. After framing the work in terms of what is reasonable rather than what is rational (chapter 1), I apply the model for practical argumentation analysis and evaluation provided by Fairclough and Fairclough (2012) to a paradigm case of unreasonable individual practical argumentation provided by mass murderer Anders Behring Breivik (chapter 2). The application shows that by following t...

  1. 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

  2. A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice.

    Science.gov (United States)

    Duncombe, Daphne C

    2018-03-01

    To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best method for successfully incorporating evidence-based practice into nursing

  3. Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care.

    Science.gov (United States)

    Bourgault, Annette M; Upvall, Michele J; Graham, Alison

    2018-06-01

    Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba , derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. To explore the use of gemba boards and gemba huddles to facilitate practice change. Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted. ©2018 American Association of Critical-Care Nurses.

  4. A facilitated process towards finding options for improved livestock ...

    African Journals Online (AJOL)

    A participatory multi-stakeholder process of finding options for improving livestock production in the severely degraded communal grazing area of Sterkspruit in South Africa was conducted. Interviews were conducted with individual livestock keepers from two sites to gather data on their demographic characteristics, ...

  5. Appreciative Inquiry for quality improvement in primary care practices.

    Science.gov (United States)

    Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C

    2011-01-01

    To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

  6. Flowing like a river: facilitation in practice development and the evolution of critical-creative companionship

    Directory of Open Access Journals (Sweden)

    Angie Titchen

    2018-05-01

    Full Text Available Beginnings: Using a river landscape metaphor, the purpose of this paper is to locate critical creativity in the evolution of practice development in the UK and show how it can be facilitated through critical-creative companionship. Critical creativity is a new landscape for practice development that has evolved through three decades of a deepening understanding of: the philosophical foundations of practice development (bedrocks; paradigms (landscapes; projects/studies (gardens; and practice development/research roles, relationships and skills (gardeners. As a practice development practitioner, facilitator and researcher, I have helped shape the course of the river, peaking with the slow-burn, yet intense, co-creation of critical creativity. Panorama, flow and transformation: A panoramic view of the river is offered as it changes over time. This view includes the river’s changes of flow and direction, powered by different philosophical and theoretical influences and resultant transformations in practice development practice/research and facilitation. Unfolding: I telescope in on the critical creativity landscape, showing how it is a synthesis of previous influences and how the critical companionship of my earlier work flowed gently into critical-creative companionship. I show broad-brush how critical-creative companions help people to use the philosophical, theoretical and methodological mandalas of critical creativity, not only in their practice development, but also in their own being and becoming critical-creative companions. Conclusion and implications for practice development and inquiry: Critical-creative companions help people to work in the gardens of critical creativity to embody and live what might seem difficult, complex and mysterious. Becoming a critical-creative companion takes time. It requires a scholarly approach to practice and the development of enabling facilitation skills and experiential and theoretical understanding

  7. Recurrent population improvement of rice breeding facilitated with male sterility

    International Nuclear Information System (INIS)

    Fujimaki, Hiroshi

    1982-01-01

    A new rice breeding system has been developed, making use of genic male sterility to utilize diverse breeding materials and to promote genetic recombination. In this system, recurrent selection technique and introgressive hybridization were used to increase the frequencies of producing desired genotypes and to improve the population in succession. To promote genetic recombination by the recurrent selection technique, intermating within the population is necessary, and to introduce useful germ plasms by the introgressive hybridization, back crossing with new genetic material is necessary. These can be done efficiently by using the recessive alleles for male sterility, and the representative models for thisF type of breeding were presented. (Kaihara, S.)

  8. 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

  9. Advancing knowledge on practice change: linking facilitation to the senses framework.

    Science.gov (United States)

    Cooper, Julie; Meyer, Julienne; Holman, Cheryl

    2013-06-01

    To explore the facilitating factors that enabled staff on a rehabilitation ward for older people engage in change activities. The importance of facilitation in practice change is widely acknowledged; however, little nursing research has taken place in relation to its nature. Following identification in the early phases of an action research study that learned helplessness states and the use of socially structured defence techniques were preventing staff on a rehabilitation ward for older people from engaging in practice development, some change was achieved. What facilitated this to take place needed to be explored. An action research approach was used. Data gained from 13 in-depth interviews with staff and managers together with three years of researcher field notes were analysed using thematic analysis. The continuous presence and neutrality of the researcher who worked together with staff on their issues of concern using a flexible ward-based approach, combined with giving staff the opportunity to explore what it was like for them working in this area, were considered key in helping staff to engage with change. Analysis of findings suggests that the senses framework presents a theoretical approach to facilitation that can help staff move out of learned helplessness states and reduce the need for the use of socially structured defence techniques. This study identifies a facilitation approach that enabled staff to engage with practice change. Although carried out in the UK, its findings have wider relevance through the application of a theoretical perspective for practice change facilitation that has not before been considered in this literature, and which is likely to be of interest to those involved in practice change internationally. © 2013 Blackwell Publishing Ltd.

  10. Practical Approaches to Quality Improvement for Radiologists.

    Science.gov (United States)

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

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

  11. Improvement of the severe accident practice tool

    International Nuclear Information System (INIS)

    Kawasaki, Ikuo; Takahashi, Shunsuke

    2016-01-01

    We developed the severe accident (SA) practice tool based on lessons learned in the accident at the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Station. We utilized the developed SA practice tool and carried out the SA training for some employees of Kansai Electric Power Co., Inc. Afterwards, we examined the opinions given by trainees attending the training lecture and improved the SA practice tool to achieve a better educational effect. The main changes we made were improvement of the practice scenario for EAL judgments and addition of functions to the practice tool such as the EAL explanation document indication. As a result of having carried out the SA education using this practice tool, we determined the tool users could make the right EAL judgment and report the communication vote. Finally, we confirmed that the knowledge necessary for SA correspondence could be given satisfactorily by this practice tool. (author)

  12. Effectiveness of a quality-improvement program in improving management of primary care practices

    Science.gov (United States)

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

  13. Developer Stories: Improving Architecture in Agile Practice

    DEFF Research Database (Denmark)

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

    2007-01-01

    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...

  14. 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.

  15. 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.

  16. Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

    Science.gov (United States)

    Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

    2015-07-01

    To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. 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

  18. Online mentoring and peer support: using learning technologies to facilitate entry into a community of practice

    Directory of Open Access Journals (Sweden)

    Lori Lockyer

    2002-12-01

    Full Text Available A vital aspect of any professional education is the opportunity for students to engage in meaningful practical experiences. In pre-service teacher education in Australia, this vital teaching practice component has undergone challenges in recent years due to increasing student numbers (linked to the increasing demand for new teachers and limited resources in university and school sectors. As such, initiatives to enhance the practical component of this professional degree have been sought. This paper details the methodology and outcomes associated with a pilot project that utilized asynchronous Web-based communication tools to facilitate mentoring and peer support through the teaching practice experience. Analysis of the online discussions and interviews with participants provides an indication of the nature of the interactions and the perceived value of the intervention, and informs the potential for larger-scale implementation.

  19. Facilitating and obstructing factors for development of learning in clinical practice: a student perspective.

    Science.gov (United States)

    Löfmark, A; Wikblad, K

    2001-04-01

    The aim of this study was to provide information on what the student nurses found facilitating and obstructing for their learning during clinical practice. Earlier studies of experiences of learning in clinical practice have shown that factors as the possibilities of variations of experiences, the culture of the workplace, and communication between the educational institution and health care facilities are of importance. Less is known about the opportunities which students are given in order to practise the skills that they will be expected to perform as new graduate nurses. The experiences of 47 degree student nurses from two colleges in Sweden were gathered in weekly diaries during their final period of clinical practice. A content analysis technique was used to analyse their diaries. The students emphasized responsibility and independence, opportunities to practise different tasks, and receiving feedback as facilitating factors. Other perceived promoting factors included perceptions of control of the situation and understanding of the 'total picture'. Examples of obstructing factors were the nurses as supervisors not relying on the students, supervision that lacked continuity and lack of opportunities to practise. Perception of their own insufficiency and low self-reliance were drawbacks for some students. Recommended proposals are presented to lecturers and supervising staff concerning organizational and educational changes, and changes of attitudes for elucidating the students' experiences of different facilitating and obstructing factors. Changes may contribute to making easier the students' transition into the nursing profession.

  20. Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review.

    Science.gov (United States)

    Meursinge Reynders, Reint; Ronchi, Laura; Ladu, Luisa; Di Girolamo, Nicola; de Lange, Jan; Roberts, Nia; Mickan, Sharon

    2016-09-23

    Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs. Methods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information. Three surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias

  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. Do Clinical Practice Guidelines Improve Quality?

    Science.gov (United States)

    Baldassari, Cristina M

    2017-07-01

    Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

  3. 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.

  4. Learning, Action and Solutions in Action Learning: Investigation of Facilitation Practice Using the Concept of Living Theories

    Science.gov (United States)

    Sanyal, Chandana

    2018-01-01

    This paper explores the practice of action learning (AL) facilitation in supporting AL set members to address their 'messy' problems through a self-reflexive approach using the concept of 'living theory' [Whitehead, J., and J. McNiff. 2006. "Action Research Living Theory." London: Sage]. The facilitation practice is investigated through…

  5. Using Data to Improve Educational Practice

    Directory of Open Access Journals (Sweden)

    Matthijs Koopmans

    2017-04-01

    Full Text Available Review of the book “Action Research in the Classroom: Helping Teachers Assess and Improve their Work” by Sr. Mary Ann Jacobs and Bruce S. Cooper There are many ways in which research can contribute to the improvement of educational practice, and action research is one of them. Action research bridges the gap that typically separates research from practice by having practitioners conduct specific projects to address their own questions and improve their effectiveness based on the answers they obtain. One of the advantages of this type of research is that results are often immediately accessible and have actionable implications. Thus, action research is a good tool for making improvements to the field based on evidence.

  6. Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

    Science.gov (United States)

    Tonna, Antonella; McCaig, Dorothy; Diack, Lesley; West, Bernice; Stewart, Derek

    2014-10-01

    The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. To develop consensus guidance to facilitate service redesign around pharmacist prescribing. UK hospital practice. The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.

  7. Can information technology improve my ambulatory practice ...

    African Journals Online (AJOL)

    eHealth is the use of information and communication technologies for health. mHealth is the use of mobile technology in health. As with all information technology (IT), advances in development are rapidly taking place. The application of such technology to individual ambulatory anaesthesia practice should improve the ...

  8. Exploring the barriers to and facilitators of implementing research into practice.

    Science.gov (United States)

    Johnston, Bridget; Coole, Carol; Narayanasamy, Melanie; Feakes, Ruth; Whitworth, Gillian; Tyrell, Tracy; Hardy, Beth

    2016-08-02

    District and community nursing roles have changed rapidly in recent years. Community nurses are increasingly being tasked with carrying out multiple roles, which require them to put research into practice and use evidence-based tools and interventions. The implementation of interventions and tools needs to be developed from empirical research, requiring evidence, to be translated into practice. However, this process may be compromised or enhanced by a number of factors. This exploratory, descriptive qualitative study sought to identify barriers and facilitators to community nurses implementing research into practice. Four focus groups were conducted with registered community nurses and district nurses (n=22). Analysis identified four main themes: keeping up to date with evidence; using a clinical tool; education/training and implementation. Findings suggest that there are barriers at a personal, professional and organisational level. Strategies are suggested to overcome these obstacles.

  9. Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers.

    Science.gov (United States)

    Antunes, Bárbara; Harding, Richard; Higginson, Irene J

    2014-02-01

    Many patient-reported outcome measures have been developed in the past two decades, playing an increasingly important role in palliative care. However, their routine use in practice has been slow and difficult to implement. To systematically identify facilitators and barriers to the implementation of patient-reported outcome measures in different palliative care settings for routine practice, and to generate evidence-based recommendations, to inform the implementation process in clinical practice. Systematic literature review and narrative synthesis. Medline, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Embase and British Nursing Index were systematically searched from 1985. Hand searching of reference lists for all included articles and relevant review articles was performed. A total of 3863 articles were screened. Of these, 31 articles met the inclusion criteria. First, data were integrated in the main themes: facilitators, barriers and lessons learned. Second, each main theme was grouped into either five or six categories. Finally, recommendations for implementation on outcome measures at management, health-care professional and patient levels were generated for three different points in time: preparation, implementation and assessment/improvement. Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting. Having a coordinator throughout the implementation process seems to be key. Ongoing cognitive and emotional processes of each individual should be taken into consideration during changes. The educational component prior to the implementation is crucial. This could promote ownership and correct use of the measure by clinicians, potentially improving practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making.

  10. Production Practice During Language Learning Improves Comprehension.

    Science.gov (United States)

    Hopman, Elise W M; MacDonald, Maryellen C

    2018-04-01

    Language learners often spend more time comprehending than producing a new language. However, memory research suggests reasons to suspect that production practice might provide a stronger learning experience than comprehension practice. We tested the benefits of production during language learning and the degree to which this learning transfers to comprehension skill. We taught participants an artificial language containing multiple linguistic dependencies. Participants were randomly assigned to either a production- or a comprehension-learning condition, with conditions designed to balance attention demands and other known production-comprehension differences. After training, production-learning participants outperformed comprehension-learning participants on vocabulary comprehension and on comprehension tests of grammatical dependencies, even when we controlled for individual differences in vocabulary learning. This result shows that producing a language during learning can improve subsequent comprehension, which has implications for theories of memory and learning, language representations, and educational practices.

  11. Facilitating person-centred after-death care: unearthing assumptions, tradition and values through practice development

    Directory of Open Access Journals (Sweden)

    Barbara Anderson

    2017-05-01

    Full Text Available Background: West Park Healthcare Centre, a complex continuing care and rehabilitation setting in Ontario, Canada has implemented practice development as one method of facilitating person-centred, evidence-informed practices. West Park is planning the construction of a new hospital, with a target construction timeline of 2018-21. Practice development is an internationally established transformation model (Manley et al., 2008 that can breathe life into the necessary but often burdensome process of policy revision in healthcare settings. Aims: The aim of this article is to share how practice development was used to review and revise West Park’s after-death care policy. The process entailed an integration of a broad span of evidence and intentional challenge of ‘habit-based’ ways. Such an approach to policy revision is needed if practice leaders are to use evidence to help achieve transformative changes in practice. Conclusions: Our after death-care policy involved processes that were antithetical to our shared vision for person-centred practices. Unquestioned, longstanding traditional approaches to after-death care needed to be questioned. Through the transformative journey at personal and organisational levels of applying practice development principles to this process, we were successful in bringing forward a policy that supports end-of-life plans of care, choice and person-centred after-death care practices and language. Implications for practice: •\tHealthcare organisations can review after-death care by exploring different sources of evidence, including research, clinical experience, local audit and patient experience, to challenge taken-for-granted practices •\tConsultation with funeral professionals will be valuable in terms of establishing what they do and do not need from a healthcare organisation •\tFellow patients do not need to be ‘protected’ from the after-death care process and appreciate having a voice on how it is

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

    NARCIS (Netherlands)

    Ijkema, R.; Langelaan, M.; van de Steeg, L.; 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

  13. Improving coding accuracy in an academic practice.

    Science.gov (United States)

    Nguyen, Dana; O'Mara, Heather; Powell, Robert

    2017-01-01

    Practice management has become an increasingly important component of graduate medical education. This applies to every practice environment; private, academic, and military. One of the most critical aspects of practice management is documentation and coding for physician services, as they directly affect the financial success of any practice. Our quality improvement project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. Design: single group, pretest-posttest. military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess improvement between 2 intervention periods, both aggregate and by year group. Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. Didactic teaching and small group discussion sessions did not improve overall coding accuracy in a residency practice. Future interventions could focus on educating providers at the individual level.

  14. Sustainable Entrepreneurship Orientation: A Reflection on Status-Quo Research on Factors Facilitating Responsible Managerial Practices

    Directory of Open Access Journals (Sweden)

    Sascha Kraus

    2018-02-01

    Full Text Available With the global financial system having undergone vast changes since the financial crisis of 2007, scientific research concerning the investor’s point of view on sustainable investments has drastically increased. However, there remains a lack of research focused on the entrepreneur’s angle regarding sustainable oriented investments. The aim of this paper is to contribute to the understanding of sustainable financial markets by bringing together entrepreneurial and financial research. This paper provides a structured literature review, based on which the authors identify three relevant levels that they believe have an effect on the successful implementation of managerial sustainable practices; these are the individual, the firm, and the contextual levels. The results show that on the individual level sustainable entrepreneurs tend to derive their will to act more sustainably from their personal values or traits. On the organizational level, though, it can be concluded that an small and medium sized enterprise’s internal culture and the reconfiguration of resources are critical determinants for adopting a sustainable entrepreneurial orientation. Finally, on the contextual level, researchers have focused on a better understanding of how entrepreneurs can help society and the environment through sustainable entrepreneurship, and how they can act as role models or change agents in light of the fact that the choice of investing or financing based on sustainability is still in its infancy. By providing an overview on facilitating factors for responsible managerial practices on the entrepreneur’s side, this research contributes to a better understanding for both theory and practice on how sustainable practices can be implemented and facilitated.

  15. Independent Coactors May Improve Performance and Lower Workload: Viewing Vigilance Under Social Facilitation.

    Science.gov (United States)

    Claypoole, Victoria L; Szalma, James L

    2018-04-01

    The purpose of the present study was to examine the effects of an independent coactor on vigilance task performance. It was hypothesized that the presence of an independent coactor would improve performance in terms of the proportion of false alarms while also increasing perceived workload and stress. Vigilance, or the ability to maintain attention for extended periods, is of great interest to human factors psychologists. Substantial work has focused on improving vigilance task performance, typically through motivational interventions. Of interest to vigilance researchers is the application of social facilitation as a means of enhancing vigilance. Social facilitation seeks to explain how social presence may improve performance. A total of 100 participants completed a 24-min vigil either alone or in the presence of an independent (confederate) coactor. Participants completed measures of perceived workload and stress. The results indicated that performance (i.e., proportion of false alarms) was improved for those who completed the vigil in the presence of an independent coactor. Interestingly, perceived workload was actually lower for those who completed the vigil in the presence of an independent coactor, although perceived stress was not affected by the manipulation. Authors of future research should extend these findings to other forms of social facilitation and examine vigilance task performance in social contexts in order to determine the utility of social presence for improving vigilance. The use of coactors may be an avenue for organizations to consider utilizing to improve performance because of its relative cost-effectiveness and easy implementation.

  16. Improved delivery of cardiovascular care (IDOCC through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

    Directory of Open Access Journals (Sweden)

    Akbari Ayub

    2011-09-01

    Full Text Available Abstract Background There is a need to find innovative approaches for translating best practices for chronic disease care into daily primary care practice routines. Primary care plays a crucial role in the prevention and management of cardiovascular disease. There is, however, a substantive care gap, and many challenges exist in implementing evidence-based care. The Improved Delivery of Cardiovascular Care (IDOCC project is a pragmatic trial designed to improve the delivery of evidence-based care for the prevention and management of cardiovascular disease in primary care practices using practice outreach facilitation. Methods The IDOCC project is a stepped-wedge cluster randomized control trial in which Practice Outreach Facilitators work with primary care practices to improve cardiovascular disease prevention and management for patients at highest risk. Primary care practices in a large health region in Eastern Ontario, Canada, were eligible to participate. The intervention consists of regular monthly meetings with the Practice Outreach Facilitator over a one- to two-year period. Starting with audit and feedback, consensus building, and goal setting, the practices are supported in changing practice behavior by incorporating chronic care model elements. These elements include (a evidence-based decision support for providers, (b delivery system redesign for practices, (c enhanced self-management support tools provided to practices to help them engage patients, and (d increased community resource linkages for practices to enhance referral of patients. The primary outcome is a composite score measured at the level of the patient to represent each practice's adherence to evidence-based guidelines for cardiovascular care. Qualitative analysis of the Practice Outreach Facilitators' written narratives of their ongoing practice interactions will be done. These textual analyses will add further insight into understanding critical factors impacting

  17. 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.

  18. 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

  19. Improving Bridging from Informatics Practice to Theory.

    Science.gov (United States)

    Lehmann, C U; Gundlapalli, A V

    2015-01-01

    In 1962, Methods of Information in Medicine ( MIM ) began to publish papers on the methodology and scientific fundamentals of organizing, representing, and analyzing data, information, and knowledge in biomedicine and health care. Considered a companion journal, Applied Clinical Informatics ( ACI ) was launched in 2009 with a mission to establish a platform that allows sharing of knowledge between clinical medicine and health IT specialists as well as to bridge gaps between visionary design and successful and pragmatic deployment of clinical information systems. Both journals are official journals of the International Medical Informatics Association. As a follow-up to prior work, we set out to explore congruencies and interdependencies in publications of ACI and MIM. The objectives were to describe the major topics discussed in articles published in ACI in 2014 and to determine if there was evidence that theory in 2014 MIM publications was informed by practice described in ACI publications in any year. We also set out to describe lessons learned in the context of bridging informatics practice and theory and offer opinions on how ACI editorial policies could evolve to foster and improve such bridging. We conducted a retrospective observational study and reviewed all articles published in ACI during the calendar year 2014 (Volume 5) for their main theme, conclusions, and key words. We then reviewed the citations of all MIM papers from 2014 to determine if there were references to ACI articles from any year. Lessons learned in the context of bridging informatics practice and theory and opinions on ACI editorial policies were developed by consensus among the two authors. A total of 70 articles were published in ACI in 2014. Clinical decision support, clinical documentation, usability, Meaningful Use, health information exchange, patient portals, and clinical research informatics emerged as major themes. Only one MIM article from 2014 cited an ACI article. There

  20. 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...

  1. Baccalaureate Minority Nursing Students Perceived Barriers and Facilitators to Clinical Education Practices: An Integrative Review.

    Science.gov (United States)

    Graham, Crystal L; Phillips, Shannon M; Newman, Susan D; Atz, Teresa W

    2016-01-01

    This integrative review synthesized baccalaureate minority nursing students' perceptions of their clinical experiences. The diversity of the nursing workforce does not mirror the United States population. Attrition rates of minority nursing students remain higher than rates for White students. Literature examining facilitators and barriers to minority student success predominantly focuses on academic factors, excluding those relevant to clinical education. An integrative review using literature from nursing and education. Three common perceived barriers were identified: discrimination from faculty, peers, nursing staff, and patients; bias in faculty grading practices; and isolation. Although little is known about the relationship between clinical failures and overall attrition, this review provides evidence that minority students encounter significant barriers in clinical education. To increase the diversity of the nursing workforce, faculty must address these issues and make modifications to ensure an equal opportunity at a quality education for all students.

  2. Infrastructure for large-scale quality-improvement projects: early lessons from North Carolina Improving Performance in Practice.

    Science.gov (United States)

    Newton, Warren P; Lefebvre, Ann; Donahue, Katrina E; Bacon, Thomas; Dobson, Allen

    2010-01-01

    Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project. A coalition was formed to include professional societies, North Carolina AHEC, Community Care of North Carolina, insurers, and other organizations. Wave One started with 18 practices in 2 of 9 regions of the state. Quality-improvement consultants recruited practices. Over 80 percent of practices attended all quarterly regional meetings. In 9 months, almost all diabetes measures improved, and a bundled asthma measure improved from 33 to 58 percent. Overall, the magnitude of improvement was clinically and statistically significant (P = .001). Quality improvements were maintained on review 1 year later. Wave Two has spread to 103 practices in all 9 regions of the state, with 42 additional practices beginning the enrollment process. Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state.

  3. A structured, extended training program to facilitate adoption of new techniques for practicing surgeons.

    Science.gov (United States)

    Greenberg, Jacob A; Jolles, Sally; Sullivan, Sarah; Quamme, Sudha Pavuluri; Funk, Luke M; Lidor, Anne O; Greenberg, Caprice; Pugh, Carla M

    2018-01-01

    Laparoscopic inguinal hernia repair has been shown to have significant benefits when compared to open inguinal hernia repair, yet remains underutilized in the United States. The traditional model of short, hands-on, cognitive courses to enhance the adoption of new techniques fails to lead to significant levels of practice implementation for most surgeons. We hypothesized that a comprehensive program would facilitate the adoption of laparoscopic inguinal hernia repair (TEP) for practicing surgeons. A team of experts in simulation, coaching, and hernia care created a comprehensive training program to facilitate the adoption of TEP. Three surgeons who routinely performed open inguinal hernia repair with greater than 50 cases annually were recruited to participate in the program. Coaches were selected based on their procedural expertise and underwent formal training in surgical coaching. Participants were required to evaluate all aspects of the educational program and were surveyed out to one year following completion of the program to assess for sustained adoption of TEP. All three participants successfully completed the first three steps of the seven-step program. Two participants completed the full course, while the third dropped out of the program due to time constraints and low case volume. Participant surgeons rated Orientation (4.7/5), GlovesOn training (5/5), and Preceptored Cases (5/5) as highly important training activities that contributed to advancing their knowledge and technical performance of the TEP procedure. At one year, both participants were performing TEPs for "most of their cases" and were confident in their ability to perform the procedure. The total cost of the program including all travel, personal coaching, and simulation was $8638.60 per participant. Our comprehensive educational program led to full and sustained adoption of TEP for those who completed the course. Time constraints, travel costs, and case volume are major considerations for

  4. Pharmacists' views on involvement in pharmacy practice research: Strategies for facilitating participation.

    Science.gov (United States)

    Armour, Carol; Brillant, Martha; Krass, Ines

    2007-01-01

    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. 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. 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. 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. 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 projects.

  5. 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

  6. 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

  7. 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.

  8. Successful Transition to Elementary School and the Implementation of Facilitative Practices Specified in the Reggio-Emilia Philosophy

    Science.gov (United States)

    Schneider, Barry H.; Manetti, Mara; Frattini, Laura; Rania, Nadia; Santo, Jonathan Bruce; Coplan, Robert J.; Cwinn, Eli

    2014-01-01

    Systematic, mandated facilitation of school transitions is an important but understudied aspect of the Reggio-Emilia approach to early childhood education admired internationally as best practice. We studied the links between Northern Italian transition practices and academic achievement, school liking, cooperativeness, and problem behaviors. We…

  9. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach.

    Science.gov (United States)

    Jackson, Ben; Marshall, Michelle; Schofield, Susie

    2017-11-01

    Physician associates (PAs) are described as one solution to workforce capacity in primary care in the UK. Despite new investment in the role, how effective this will be in addressing unmet primary care needs is unclear. To investigate the barriers and facilitators to the integration of PAs into the general practice workforce. A modified grounded theory study in a region unfamiliar with the PA role. No a priori themes were assumed. Themes generated from stakeholder interviews informed a literature review and theoretical framework, and were then tested in focus groups with GPs, advanced nurse practitioners (ANPs), and patients. Recorded data were transcribed verbatim, and organised using NVivo version 10.2.2, with iterative analysis of emergent themes. A reflexive diary and independent verification of coding and analysis were included. There were 51 participants (30 GPs, 11 ANPs, and 10 patients) in eight focus groups. GPs, ANPs, and patients recognised that support for general practice was needed to improve access. GPs expressed concerns regarding PAs around managing medical complexity and supervision burden, non-prescriber status, and medicolegal implications in routine practice. Patients were less concerned about specific competencies as long as there was effective supervision, and were accepting of a PA role. ANPs highlighted their own negative experiences entering advanced clinical practice, and the need for support to counteract stereotypical and prejudicial attitudes CONCLUSION: This study highlights the complex factors that may impede the introduction of PAs into UK primary care. A conceptual model is proposed to help regulators and educationalists support this integration, which has relevance to other proposed new roles in primary care. © British Journal of General Practice 2017.

  10. 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.

  11. Improving nuclear envelope dynamics by EBV BFRF1 facilitates intranuclear component clearance through autophagy.

    Science.gov (United States)

    Liu, Guan-Ting; Kung, Hsiu-Ni; Chen, Chung-Kuan; Huang, Cheng; Wang, Yung-Li; Yu, Cheng-Pu; Lee, Chung-Pei

    2018-02-26

    Although a vesicular nucleocytoplasmic transport system is believed to exist in eukaryotic cells, the features of this pathway are mostly unknown. Here, we report that the BFRF1 protein of the Epstein-Barr virus improves vesicular transport of nuclear envelope (NE) to facilitate the translocation and clearance of nuclear components. BFRF1 expression induces vesicles that selectively transport nuclear components to the cytoplasm. With the use of aggregation-prone proteins as tools, we found that aggregated nuclear proteins are dispersed when these BFRF1-induced vesicles are formed. BFRF1-containing vesicles engulf the NE-associated aggregates, exit through from the NE, and putatively fuse with autophagic vacuoles. Chemical treatment and genetic ablation of autophagy-related factors indicate that autophagosome formation and autophagy-linked FYVE protein-mediated autophagic proteolysis are involved in this selective clearance of nuclear proteins. Remarkably, vesicular transport, elicited by BFRF1, also attenuated nuclear aggregates accumulated in neuroblastoma cells. Accordingly, induction of NE-derived vesicles by BFRF1 facilitates nuclear protein translocation and clearance, suggesting that autophagy-coupled transport of nucleus-derived vesicles can be elicited for nuclear component catabolism in mammalian cells.-Liu, G.-T., Kung, H.-N., Chen, C.-K., Huang, C., Wang, Y.-L., Yu, C.-P., Lee, C.-P. Improving nuclear envelope dynamics by EBV BFRF1 facilitates intranuclear component clearance through autophagy.

  12. Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses.

    Science.gov (United States)

    Sinclair, Peter M; Day, Jenny; Levett-Jones, Tracy; Kable, Ashley

    2017-10-01

    Opportunistic screening in general practice (GP) is a cost-effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia. An eight-item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses. Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non-claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence. The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting. © 2016 Asian Pacific Society of Nephrology.

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

    Science.gov (United States)

    Kueny, Angela; Shever, Leah L; Lehan Mackin, Melissa; Titler, Marita G

    2015-01-01

    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. 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. 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-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

  14. 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

  15. 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.

  16. Envisaging the use of evidence-based practice (EBP): how nurse academics facilitate EBP use in theory and practice across Australian undergraduate programmes.

    Science.gov (United States)

    Malik, Gulzar; McKenna, Lisa; Griffiths, Debra

    2017-09-01

    This paper is drawn from a grounded theory study that aimed to investigate processes undertaken by academics when integrating evidence-based practice into undergraduate curricula. This paper focuses on how nurse academics facilitated students to apply evidence-based practice in theory and practice. Facilitating undergraduate nursing students to develop skills within an evidence-based practice framework is vital to achieving evidence-based care. Studies on evidence-based practice conducted globally suggests that there is a need to investigate approaches used by nurse academics in facilitating students' understanding and use of evidence-based practice during their nurse education. Employing constructivist grounded theory approach, 23 nurse academics across Australian universities were interviewed and nine observed during their teaching. Some study participants shared their unit guides to enrich analysis. Data analysis was performed by following Charmaz's approach of coding procedures; as a result, four categories were constructed. This paper focuses on the category conceptualised as Envisaging the use of evidence-based practice. Findings revealed that most academics-assisted students to use evidence in academic-related activities. Recognising the importance of evidence-based practice in practice, some also expected students to apply evidence-based practice during clinical experiences. However, the level of students' appreciation for evidence-based practice during clinical experiences was unknown to participants and was influenced by practice-related barriers. Acknowledging these challenges, academics were engaged in dialogue with students and suggested the need for academia-practice collaboration in combating the cited barriers. Ensuring academics are supported to emphasise clinical application of evidence-based practice requires strategies at school and practice levels. Faculty development, engagement of clinical nurses with evidence-based practice, supportive

  17. Determining the barriers and facilitators to adopting best practices in the management of poststroke unilateral spatial neglect: results of a qualitative study.

    Science.gov (United States)

    Petzold, Anita; Korner-Bitensky, Nicol; Salbach, Nancy M; Ahmed, Sara; Menon, Anita; Ogourtsova, Tatiana

    2014-01-01

    A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process. To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN. Focus group methodology elicited information from 9 acute care occupational therapists. Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices. It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians' best practice management of poststroke USN.

  18. The Usefulness of Clinical-Practice-Based Laboratory Data in Facilitating the Diagnosis of Dengue Illness

    Directory of Open Access Journals (Sweden)

    Jien-Wei Liu

    2013-01-01

    Full Text Available Alertness to dengue and making a timely diagnosis is extremely important in the treatment of dengue and containment of dengue epidemics. We evaluated the complementary role of clinical-practice-based laboratory data in facilitating suspicion/diagnosis of dengue. One hundred overall dengue (57 dengue fever [DF] and 43 dengue hemorrhagic fever [DHF] cases and another 100 nondengue cases (78 viral infections other than dengue, 6 bacterial sepsis, and 16 miscellaneous diseases were analyzed. We separately compared individual laboratory variables (platelet count [PC] , prothrombin time [PT], activated partial thromboplastin time [APTT], alanine aminotransferase [ALT], and aspartate aminotransferase [AST] and varied combined variables of DF and/or DHF cases with the corresponding ones of nondengue cases. The sensitivity, specificity, accuracy, positive predictive value (PPV, and negative predictive value (NPV in the diagnosis of DF and/or DHF were measured based on these laboratory variables. While trade-off between sensitivity and specificity, and/or suboptimal PPV/NPV was found at measurements using these variables, prolonged APTT + normal PT + PC < 100 × 109 cells/L had a favorable sensitivity, specificity, PPV, and NPV in diagnosis of DF and/or DHF. In conclusion, these data suggested that prolonged APTT + normal PT + PC < 100 × 109 cells/L is useful in evaluating the likelihood of DF and/or DHF.

  19. Reduction of errors during practice facilitates fundamental movement skill learning in children with intellectual disabilities.

    Science.gov (United States)

    Capio, C M; Poolton, J M; Sit, C H P; Eguia, K F; Masters, R S W

    2013-04-01

    Children with intellectual disabilities (ID) have been found to have inferior motor proficiencies in fundamental movement skills (FMS). This study examined the effects of training the FMS of overhand throwing by manipulating the amount of practice errors. Participants included 39 children with ID aged 4-11 years who were allocated into either an error-reduced (ER) training programme or a more typical programme in which errors were frequent (error-strewn, ES). Throwing movement form, throwing accuracy, and throwing frequency during free play were evaluated. The ER programme improved movement form, and increased throwing activity during free play to a greater extent than the ES programme. Furthermore, ER learners were found to be capable of engaging in a secondary cognitive task while manifesting robust throwing accuracy performance. The findings support the use of movement skills training programmes that constrain practice errors in children with ID, suggesting that such approach results in improved performance and heightened movement engagement in free play. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.

  20. 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.

  1. Towards accessible integrated palliative care: Perspectives of leaders from seven European countries on facilitators, barriers and recommendations for improvement.

    Science.gov (United States)

    den Herder-van der Eerden, Marlieke; Ewert, Benjamin; Hodiamont, Farina; Hesse, Michaela; Hasselaar, Jeroen; Radbruch, Lukas

    2017-01-01

    Literature suggests that integrated palliative care (IPC) increases the quality of care for palliative patients at lower costs. However, knowledge on models encompassing all integration levels for successfully implementing IPC is scarce. The purpose of this paper is to describe the experiences of IPC leaders in seven European countries regarding core elements, facilitators and barriers of IPC implementation and provides recommendations for future policy and practice. A qualitative interview study was conducted between December 2013 and May 2014. In total, 34 IPC leaders in primary and secondary palliative care or public health in Belgium, Germany, Hungary, Ireland, the Netherlands, Spain and the UK were interviewed. Transcripts were analysed using thematic data analysis. IPC implementation efforts involved a multidisciplinary team approach and cross-sectional coordination. Informal professional relationships, basic medical education and general awareness were regarded as facilitators of IPC. Identified barriers included lack of knowledge about when to start palliative care, lack of collaboration and financial structures. Recommendations for improvement included access, patient-centeredness, coordination and cooperation, financing and ICT systems. Although IPC is becoming more common, action has been uneven at different levels. IPC implementation largely remains provisional and informal due to the lack of standardised treatment pathways, legal frameworks and financial incentives to support multilevel integration. In order to make IPC more accessible, palliative care education as well as legal and financial support within national healthcare systems needs to be enhanced.

  2. Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator.

    Science.gov (United States)

    Panni, M K; Shah, S J; Chavarro, C; Rawl, M; Wojnarwsky, P K; Panni, J K

    2013-10-01

    There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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

    African Journals Online (AJOL)

    Osondu

    This study assessed management practices on ... technological methods adopted and huge ... Ethiopian Journal of Environmental Studies and Management EJESM Vol. 5 No. .... perspectives. .... specifications, cost data, programmes, plus.

  4. 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

  5. Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach.

    Science.gov (United States)

    Xie, Anping; Woods-Hill, Charlotte Z; King, Anne F; Enos-Graves, Heather; Ascenzi, Judy; Gurses, Ayse P; Klaus, Sybil A; Fackler, James C; Milstone, Aaron M

    2017-11-20

    Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. Blood culture-ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture-ordering practices, (2) ensuring that prescribing clinicians review the patient's condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture-ordering guidelines. The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Overcoming the Barriers of Distance: Using Mobile Technology to Facilitate Moderation and Best Practice in Initial Teacher Training

    Science.gov (United States)

    Leggatt, Simon

    2016-01-01

    This case study describes the development process of a model using readily-available technology to facilitate collaboration, moderation and the dissemination of best practice in initial teacher training in the UK. Students, mentors, tutors and external examiners from a number of educational institutions in a UK, higher education-led Lifelong…

  7. 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)

  8. Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review

    Directory of Open Access Journals (Sweden)

    Timothy Noblet

    2017-10-01

    Registration: PROSPERO CRD42015017212. [Noblet T, Marriott J, Graham-Clarke E, Rushton A (2017 Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. Journal of Physiotherapy 63: 221–234

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

    Directory of Open Access Journals (Sweden)

    Mathias Klein

    2016-12-01

    Full Text Available Glycerol is an abundant by-product during biodiesel production and additionally has several assets compared to sugars when used as a carbon source for growing microorganisms in the context of biotechnological applications. However, most strains of the platform production organism Saccharomyces cerevisiae grow poorly in synthetic glycerol medium. It has been hypothesized that the uptake of glycerol could be a major bottleneck for the utilization of glycerol in S. cerevisiae. This species exclusively relies on an active transport system for glycerol uptake. This work demonstrates that the expression 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 on baker's yeast. Keywords: Yeast, Saccharomyces cerevisiae, Glycerol, Transport, Glycerol facilitator, Fps1, Stl1

  11. 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.

  12. Interrogating Your Wisdom of Practice to Improve Classroom Practices

    Science.gov (United States)

    Chappell, Philip

    2017-01-01

    This article presents a heuristic for language teachers to articulate and explore their fundamental theories of and philosophical stances towards language, language learning, and language teaching. It includes tools with which teachers can interrogate those theories, weighing them up against their actual classroom practices. Through presenting…

  13. 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. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  14. Patient information, education and self-management in bronchiectasis: facilitating improvements to optimise health outcomes.

    Science.gov (United States)

    Hester, Katy L M; Newton, Julia; Rapley, Tim; De Soyza, Anthony

    2018-05-22

    Bronchiectasis is an incurable lung disease characterised by irreversible airway dilatation. It causes symptoms including chronic productive cough, dyspnoea, and recurrent respiratory infections often requiring hospital admission. Fatigue and reductions in quality of life are also reported in bronchiectasis. Patients often require multi-modal treatments that can be burdensome, leading to issues with adherence. In this article we review the provision of, and requirement for, education and information in bronchiectasis. To date, little research has been undertaken to improve self-management in bronchiectasis in comparison to other chronic conditions, such as COPD, for which there has been a wealth of recent developments. Qualitative work has begun to establish that information deficit is one of the potential barriers to self-management, and that patients feel having credible information is fundamental when learning to live with and manage bronchiectasis. Emerging research offers some insights into ways of improving treatment adherence and approaches to self-management education; highlighting ways of addressing the specific unmet information needs of patients and their families who are living with bronchiectasis. We propose non-pharmacological recommendations to optimise patient self-management and symptom recognition; with the aim of facilitating measurable improvements in health outcomes for patients with bronchiectasis.

  15. 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.

  16. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice: a stepped-wedge randomised controlled trial.

    Science.gov (United States)

    Due, Tina Drud; Thorsen, Thorkil; Kousgaard, Marius Brostrøm; Siersma, Volkert Dirk; Waldorff, Frans Boch

    2014-04-09

    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; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention. The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics. The control group was a delayed intervention group. The primary outcome was change in the number of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2 diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and reduction in number of practices with few annual chronic disease check-ups. We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the delayed intervention group. For the primary outcome, 94 and 89 practices were analysed. Almost every outcome improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention: a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification for COPD (p = 0

  17. 78 FR 18954 - Incentives To Adopt Improved Cybersecurity Practices

    Science.gov (United States)

    2013-03-28

    ... [Docket Number 130206115-3115-01] Incentives To Adopt Improved Cybersecurity Practices AGENCY: U.S... best practices and standards, once adopted, are updated in the light of changing threats and new...

  18. 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.

  19. 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

  20. How to facilitate the practical application of Quality Systems in Nuclear Medicine

    International Nuclear Information System (INIS)

    Touzet, R.E.

    2002-01-01

    Aim: Which are the reasons for non-implementation of a Quality System in most of the nuclear medicine services in Latin America, in spite of the recommendations made by international agencies and of the absolute convenience involved in guaranteeing the quality of the health-care services rendered to the population? One of the projects of the Argentine Regulatory Authority was providing an answer to this question and finding the solution to the existing situation in a progressive manner. Materials and Methods: Within a set of about 400 NM service providers and with the support of the Argentine Association of Nuclear Medicine and Biology, an investigation was made in order to learn which were the opinions of their officials and staff (interviews, surveys and discussion meetings were performed). On the basis of the results, a strategy was developed involving the design of a 'basic quality system' to be used as an intermediate stage between the 'natural quality systems' and the 'certifiable quality systems', while the general requirements of the ISO 9000-2000 Standard were applied as a structure. Once an agreement was reached on the working program, several documents were widely distributed (Explanatory Guide, Format of the Quality Manual, etc.). Also, courses and practical workshops were carried out and advice was provided by e-mail. Currently, several additional documents are being developed in order to facilitate implementation, training and quality systems evaluation. Results: Some of the reasons for the scarce certification appeared to be as follows: The cost of certification is high and specialized advisors are required. The long time required causes disappointment. There are no economic stimuli because competition is based on costs and not on quality. Medical professionals are not trained in quality management during their graduate studies. The formal certification system does not allow for intermediate stages and is highly dependent on the contracted advisor

  1. Improving the rate and quality of medicaid well child care exams in primary care practices.

    Science.gov (United States)

    Smith, Katy Duncan; Merchen, Eileen; Turner, Crystal D; Vaught, Cara; Fritz, Terrie; Mold, Jim

    2010-07-01

    Providing recommended well child care to children insured bythe Medicaid Program can be challenging. Members of the Department of Family and Preventive Medicine (DFPM) at the University of Oklahoma Health Sciences Center contracted to help practices improve the rates and quality of well child care visits within the Oklahoma Medicaid Program. Sixteen pediatric and family medicine practices in three Oklahoma counties chose to participate in this quality improvement initiative. The records of Sooner Care-insured children age 0-20 were reviewed for both rate and quality of well child care visits made during the previous twelve months. Performance feedback was provided. Practice guidelines, Sooner Care requirements, and tips from exemplary practices were provided. In two of the counties, a case manager helped practices with challenging patients. Practice Enhancement Assistants (PEAs) then helped practices implement a variety of strategies to increase visit rates and improve the quality of early and periodic screening, diagnosis, and treatment (EPSDT) visits. Information technology (IT) support was provided when needed. The average rates of visits, for all counties combined, increased. Visit rates increased more in the younger age groups (birth to two years). There was significant improvement in quality of visits. Rates and quality improved much more in some practices than in others. A combination of academic detailing, performance feedback, practice facilitation, case management, and IT support produced increases in the quality and rates of EPSDT exams.

  2. Do knowledge brokers facilitate implementation of the stroke guideline in clinical practice?

    Science.gov (United States)

    Willems, Mia; Schröder, Carin; Post, Marcel; van der Weijden, Trudy; Visser-Meily, Anne

    2013-10-23

    The implementation of clinical practice guidelines in rehabilitation practice is often troublesome and incomplete. An intervention to enhance the implementation of guidelines is the knowledge transfer program built around the activities of a knowledge broker (KB).This study investigates the use of KBs to implement guideline recommendations for intensive therapy and physical activity for patients post-stroke in 22 stroke units in hospitals and rehabilitation centers in The Netherlands. This study includes a quantitative evaluation with a non controlled pre-post intervention design and a mixed methods process evaluation. From each stroke unit, enterprising nurses and therapists will be recruited and trained as KB. The KB will work for one year on the implementation of the guideline recommendations in their team. To evaluate the effectiveness of the KB, a questionnaire will be administered to patients, health professionals and KBs at baseline (T0) and after one year (T1). Furthermore, semi structured interviews with 5 KBs will be performed at T1.The primary outcome of this implementation project will be the support health professionals give patients to exercise and be physically active, as reported by patients and health professionals themselves. The support immediately after the intervention is compared with the support at the start of the intervention.Additionally we will explore the influence of socio-demographic characteristics of health professionals and determinants identified in the Theory of Planned Behavior (intention, attitude, subjective norm and perceived behavioral control) on the change of supportive behavior of health professionals. Finally, KBs will complete a questionnaire on their own psychological and social demographic characteristics and on organizational conditions needed for health-care improvement such as time, workforce, sponsoring and support from management. With this study we will gain insight in when and why knowledge brokers seem to be

  3. Use of a facilitated discussion model for antenatal care to improve communication.

    Science.gov (United States)

    Lori, Jody R; Munro, Michelle L; Chuey, Meagan R

    2016-02-01

    Achieving health literacy is a critical step to improving health outcomes and the health of a nation. However, there is a lack of research on health literacy in low-resource countries, where maternal health outcomes are at their worst. To examine the usefulness and feasibility of providing focused antenatal care (FANC) in a group setting using picture cards to improve patient-provider communication, patient engagement, and improve health literacy. An exploratory, mixed methods design was employed to gather pilot data using the Health Literacy Skills Framework. A busy urban district hospital in the Ashanti Region of Ghana was used to gather data during 2014. A facility-driven convenience sample of midwives (n=6) aged 18 years or older, who could speak English or Twi, and had provided antenatal care at the participating hospital during the previous year prior to the start of the study participated in the study. Data were collected using pre-test and post-test surveys, completed three months after the group FANC was implemented. A semi-structured focus group was conducted with four of the participating midwives and the registered nurse providing support and supervision for the study (n=5) at the time of the post-test. Data were analyzed concurrently to gain a broad understanding of patient communication, engagement, and group FANC. There were no significant differences in the mean communication (t(df=3)=0.541, p=0.626) and engagement (t(df=3)=-0.775, p=0.495) scores between the pre- and post-test. However, the focus group revealed the following themes: (a) improved communication through the use of picture cards; (b) enhanced information sharing and peer support through the facilitated group process and; and (c) an improved understanding of patient concerns. The improved communication noted through the use of picture cards and the enhanced information sharing and peer support elicited through the group FANC undoubtedly provided patients with additional tools to invoke

  4. Facilitated Extinction Training to Improve Pharmacotherapy for Smoking Cessation: A Pilot Feasibility Trial.

    Science.gov (United States)

    Brandon, Thomas H; Unrod, Marina; Drobes, David J; Sutton, Steven K; Hawk, Larry W; Simmons, Vani N; Brandon, Karen O; Roetzheim, Richard G; Meltzer, Lauren R; Miller, Ralph R; Cahill, Shawn P

    2017-09-12

    and therapy for other disorders, to improve the extinction and generalization processes thought to underlie much of varenicline's effect. A Facilitated Extinction intervention was developed and found acceptable to smokers and feasible to implement in a research setting. The study sets the stage for a subsequent randomized controlled trial. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. 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

  6. Quality assessment and improvements in pathology practice

    NARCIS (Netherlands)

    Kuijpers, C.C.H.J.

    2016-01-01

    Every patient has the right to receive optimal quality health care. With regard to pathology practice, a small (interpretational) difference can have major impact for the patient, because prognosis and treatment selection are often based on the pathology report. Unfortunately, it is inevitable that

  7. The Facilitation of a Sustainable Power System: A Practice from Data-Driven Enhanced Boiler Control

    Directory of Open Access Journals (Sweden)

    Zhenlong Wu

    2018-04-01

    Full Text Available An increasing penetration of renewable energy may bring significant challenges to a power system due to its inherent intermittency. To achieve a sustainable future for renewable energy, a conventional power plant is required to be able to change its power output rapidly for a grid balance purpose. However, the rapid power change may result in the boiler operating in a dangerous manner. To this end, this paper aims to improve boiler control performance via a data-driven control strategy, namely Active Disturbance Rejection Control (ADRC. For practical implementation, a tuning method is developed for ADRC controller parameters to maximize its potential in controlling a boiler operating in different conditions. Based on a Monte Carlo simulation, a Probabilistic Robustness (PR index is subsequently formulated to represent the controller’s sensitivity to the varying conditions. The stability region of the ADRC controller is depicted to provide the search space in which the optimal group of parameters is searched for based on the PR index. Illustrative simulations are performed to verify the efficacy of the proposed method. Finally, the proposed method is experimentally applied to a boiler’s secondary air control system successfully. The results of the field application show that the proposed ADRC based on PR can ensure the expected control performance even though it works in a wider range of operating conditions. The field application depicts a promising future for the ADRC controller as an alternative solution in the power industry to integrate more renewable energy into the power grid.

  8. Performance improvement of professional printing systems : from theory to practice

    NARCIS (Netherlands)

    Ezzeldin Mahdy Abdelmonem, M.

    2012-01-01

    Performance Improvement of Professional Printing Systems: from theory to practice Markets demand continuously for higher quality, higher speed, and more energy-efficient professional printers. In this thesis, control strategies have been developed to improve the performance of both professional

  9. Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence.

    Science.gov (United States)

    Bosworth, Hayden B; Zullig, Leah L; Mendys, Phil; Ho, Michael; Trygstad, Troy; Granger, Christopher; Oakes, Megan M; Granger, Bradi B

    2016-03-15

    The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

  10. Measures to Improve Diagnostic Safety in Clinical Practice.

    Science.gov (United States)

    Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

    2016-10-20

    Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  11. The Role of New Information Technologies in Facilitating Professional Reflective Practice across the Supervisory Triad.

    Science.gov (United States)

    Hodder, Jacqueline; Carter, David

    This study investigated the role of new information management technologies in facilitating student teacher supervision across the supervisory triad of student teacher, cooperating teacher, and university supervisor. The study investigated how data routinely generated by teachers and stored within an Instructional Information Management System…

  12. 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

  13. 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.

  14. The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

    Science.gov (United States)

    Hughes, Roger; Margetts, Barrie

    2012-11-01

    The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

  15. Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

    Science.gov (United States)

    Hodges, Kay; Wotring, James R

    2012-04-01

    An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

  16. 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

  17. Improving doctor-patient communication in the outpatient setting using a facilitation tool: a preliminary study.

    Science.gov (United States)

    Neeman, Naama; Isaac, Thomas; Leveille, Suzanne; Dimonda, Clementina; Shin, Jacob Y; Aronson, Mark D; Freedman, Steven D

    2012-08-01

    Patients often do not fully understand medical information discussed during office visits. This can result in lack of adherence to recommended treatment plans and poorer health outcomes. We developed and implemented a program utilizing an encounter form, which provides structure to the medical interaction and facilitates bidirectional communication and informed decision-making. We conducted a prospective quality improvement intervention at a large tertiary-care academic medical center utilizing the encounter form and studied the effect on patient satisfaction, understanding and confidence in communicating with physicians. The intervention included 108 patients seen by seven physicians in five sub-specialties. Ninety-eight percent of patients were extremely satisfied (77%) or somewhat satisfied (21%) with the program. Ninety-six percent of patients reported being involved in decisions about their care and treatments as well as high levels of understanding of medical information that was discussed during visit. Sixty-nine percent of patients reported that they shared the encounter form with their families and friends. Patients' self-confidence in communicating with their doctors increased from a score of 8.1 to 8.7 post-intervention (P-value = 0.0018). When comparing pre- and post-intervention experiences, only 38% of patients felt that their problems and questions were adequately addressed by other physicians' pre-intervention, compared with 94% post-intervention. We introduced a program to enhance physician-patient communication and found that patients were highly satisfied, more informed and more actively involved in their care. This approach may be an easily generalizable approach to improving physician-patient communication at outpatient visits.

  18. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review.

    Science.gov (United States)

    Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

    2016-02-01

    Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.

  19. Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference.

    Science.gov (United States)

    Navarro-Haro, María V; López-Del-Hoyo, Yolanda; Campos, Daniel; Linehan, Marsha M; Hoffman, Hunter G; García-Palacios, Azucena; Modrego-Alarcón, Marta; Borao, Luis; García-Campayo, Javier

    2017-01-01

    Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants' attention and gives users the illusion of "being there" in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high "presence" in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to

  20. Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference.

    Directory of Open Access Journals (Sweden)

    María V Navarro-Haro

    Full Text Available Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR is a new technology that helps capture participants' attention and gives users the illusion of "being there" in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT® mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT® mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high "presence" in VR and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability

  1. Meditation experts try Virtual Reality Mindfulness: A pilot study evaluation of the feasibility and acceptability of Virtual Reality to facilitate mindfulness practice in people attending a Mindfulness conference.

    Science.gov (United States)

    Navarro-Haro, María V.; López-del-Hoyo, Yolanda; Campos, Daniel; Linehan, Marsha M.; Hoffman, Hunter G.; García-Palacios, Azucena; Modrego-Alarcón, Marta; Borao, Luis; García-Campayo, Javier

    2017-01-01

    Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants’ attention and gives users the illusion of “being there” in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high “presence” in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of

  2. Improving drug treatment in general practice

    NARCIS (Netherlands)

    Veninga, CCM; Denig, P; Zwaagstra, R; Haaijer-Ruskamp, FM

    In the international Drug Education Project, an educational program involving auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care. Individualized feedback was provided and discussed in 24 Dutch peer

  3. Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial.

    Science.gov (United States)

    Pramana, Gede; Parmanto, Bambang; Lomas, James; Lindhiem, Oliver; Kendall, Philip C; Silk, Jennifer

    2018-05-10

    Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as

  4. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

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

    2015-01-01

    is associated with a decrease in the probability of performing a C-section from 2.3 to 3.7 percentage points (7–11.6%) with no consequences for medical complications or neonatal outcomes. The impact can be explained by a reduction in the discretion of obstetric decision-making rather than by patient cream......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...

  5. An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator.

    Science.gov (United States)

    Daniel, Sylvia; Lee, Annemarie L; Switzer-McIntyre, Sharon; Evans, Cathy

    2016-01-01

    Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective. A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role. Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences. An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.

  6. Caregivers' responses to an intervention to improve young child feeding behaviors in rural Bangladesh: a mixed method study of the facilitators and barriers to change.

    Science.gov (United States)

    Affleck, William; Pelto, Gretel

    2012-08-01

    Behavior change communications regarding child feeding have met with mixed success. The present study analyzes responses of 34 Bangladeshi caregivers seven months after they received a responsive feeding intervention. The intervention communicated and demonstrated five feeding interactions: hand-washing, self-feeding, verbal responsivity, managing refusals non-forcefully, and dietary diversity. Seventeen caregivers who adopted key behaviors addressed by the intervention and 17 who did not were compared in terms of socio-demographic variables, but more importantly in terms of their recall of the messages, their reported practice, and reported facilitators and barriers. Both those who changed and those who did not reported similar facilitators and barriers to practicing the new behaviors; there was also no difference in recall or in socio-demographic variables. Key themes identified through a constant comparative analysis helped to focus on common features of the lives of caregivers that made it easy or difficult to perform the practices. Some of these were household constraints such as poverty, shortage of time in which to complete chores, and avoiding waste and messiness; others related to the child's demands. Many caregivers misinterpreted instructions about talking to one's child in response to signals, as opposed to more common forms of supervision. Facilitators such as the child's evident pleasure and the caregiver's satisfaction did not always outweigh the barriers. Recommendations for improving interventions include helping caregivers solve problems tied to barriers and including more family members in the intervention. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. A creative analysis of the role of practice development facilitators in ...

    African Journals Online (AJOL)

    Tanya Heyns

    Interventions to address challenges in the critical care environment and subsequently develop practice is currently implemented by both the public and ..... Following a natural experiment of guideline adaptation and ... A. (2012). Prioritizing.

  8. Facilitating open global data use in earthquake source modelling to improve geodetic and seismological approaches

    Science.gov (United States)

    Sudhaus, Henriette; Heimann, Sebastian; Steinberg, Andreas; Isken, Marius; Vasyura-Bathke, Hannes

    2017-04-01

    In the last few years impressive achievements have been made in improving inferences about earthquake sources by using InSAR (Interferometric Synthetic Aperture Radar) data. Several factors aided these developments. The open data basis of earthquake observations has expanded vastly with the two powerful Sentinel-1 SAR sensors up in space. Increasing computer power allows processing of large data sets for more detailed source models. Moreover, data inversion approaches for earthquake source inferences are becoming more advanced. By now data error propagation is widely implemented and the estimation of model uncertainties is a regular feature of reported optimum earthquake source models. Also, more regularly InSAR-derived surface displacements and seismological waveforms are combined, which requires finite rupture models instead of point-source approximations and layered medium models instead of homogeneous half-spaces. In other words the disciplinary differences in geodetic and seismological earthquake source modelling shrink towards common source-medium descriptions and a source near-field/far-field data point of view. We explore and facilitate the combination of InSAR-derived near-field static surface displacement maps and dynamic far-field seismological waveform data for global earthquake source inferences. We join in the community efforts with the particular goal to improve crustal earthquake source inferences in generally not well instrumented areas, where often only the global backbone observations of earthquakes are available provided by seismological broadband sensor networks and, since recently, by Sentinel-1 SAR acquisitions. We present our work on modelling standards for the combination of static and dynamic surface displacements in the source's near-field and far-field, e.g. on data and prediction error estimations as well as model uncertainty estimation. Rectangular dislocations and moment-tensor point sources are exchanged by simple planar finite

  9. In Vivo-Like Culture Conditions in a Bioreactor Facilitate Improved Tissue Quality in Corneal Storage.

    Science.gov (United States)

    Schmid, Richard; Tarau, Ioana-Sandra; Rossi, Angela; Leonhardt, Stefan; Schwarz, Thomas; Schuerlein, Sebastian; Lotz, Christian; Hansmann, Jan

    2018-01-01

    The cornea is the most-transplanted tissue worldwide. However, the availability and quality of grafts are limited due to the current methods of corneal storage. In this study, a dynamic bioreactor system is employed to enable the control of intraocular pressure and the culture at the air-liquid interface. Thereby, in vivo-like storage conditions are achieved. Different media combinations for endothelium and epithelium are tested in standard and dynamic conditions to enhance the viability of the tissue. In contrast to culture conditions used in eye banks, the combination of the bioreactor and biochrom medium 1 allows to preserve the corneal endothelium and the epithelium. Assessment of transparency, swelling, and the trans-epithelial-electrical-resistance (TEER) strengthens the impact of the in vivo-like tissue culture. For example, compared to corneas stored under static conditions, significantly lower optical densities and significantly higher TEER values were measured (p-value <0.05). Furthermore, healing of epithelial defects is enabled in the bioreactor, characterized by re-epithelialization and initiated stromal regeneration. Based on the obtained results, an easy-to-use 3D-printed bioreactor composed of only two parts was derived to translate the technology from the laboratory to the eye banks. This optimized bioreactor facilitates noninvasive microscopic monitoring. The improved storage conditions ameliorate the quality of corneal grafts and the storage time in the eye banks to increase availability and reduce re-grafting. © 2017 The Authors. Biotechnology Journal Published by Wiley-VCH Verlag GmbH & Co. KGaA.

  10. The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review

    Directory of Open Access Journals (Sweden)

    Duncan Edward AS

    2012-05-01

    Full Text Available Abstract Background Allied Health Professionals today are required, more than ever before, to demonstrate their impact. However, despite at least 20 years of expectation, many services fail to deliver routine outcome measurement in practice. This systematic review investigates what helps and hinders routine outcome measurement of allied health professionals practice. Methods A systematic review protocol was developed comprising: a defined search strategy for PsycINFO, MEDLINE and CINHAL databases and inclusion criteria and systematic procedures for data extraction and quality appraisal. Studies were included if they were published in English and investigated facilitators and/or barriers to routine outcome measurement by allied health professionals. No restrictions were placed on publication type, design, country, or year of publication. Reference lists of included publications were searched to identify additional papers. Descriptive methods were used to synthesise the findings. Results 960 papers were retrieved; 15 met the inclusion criteria. Professional groups represented were Physiotherapy, Occupational Therapy, and Speech and Language Therapy. The included literature varied in quality and design. Facilitators and barriers to routine outcome measurement exist at individual, managerial and organisational levels. Key factors affecting professionals’ use of routine outcome measurement include: professionals’ level of knowledge and confidence about using outcome measures, and the degree of organisational and peer-support professionals received with a view to promoting their work in practice. Conclusions Whilst the importance of routinely measuring outcomes within the allied health professions is well recognised, it has largely failed to be delivered in practice. Factors that influence clinicians’ ability and desire to undertake routine outcome measurement are bi-directional: they can act as either facilitators or barriers. Routine outcome

  11. Reporting to Improve Reproducibility and Facilitate Validity Assessment for Healthcare Database Studies V1.0

    NARCIS (Netherlands)

    Wang, Shirley V.; Schneeweiss, Sebastian; Berger, Marc L.; Brown, Jeffrey; de Vries, Frank; Douglas, Ian; Gagne, Joshua J.; Gini, Rosa; Klungel, Olaf; Mullins, C. Daniel; Nguyen, Michael D.; Rassen, Jeremy A.; Smeeth, Liam; Sturkenboom, Miriam C J M

    2017-01-01

    Purpose: Defining a study population and creating an analytic dataset from longitudinal healthcare databases involves many decisions. Our objective was to catalogue scientific decisions underpinning study execution that should be reported to facilitate replication and enable assessment of validity

  12. Reporting to Improve Reproducibility and Facilitate Validity Assessment for Healthcare Database Studies V1.0

    NARCIS (Netherlands)

    Wang, Shirley V.; Schneeweiss, Sebastian; Berger, Marc L.; Brown, Jeffrey; de Vries, Frank|info:eu-repo/dai/nl/303546670; Douglas, Ian; Gagne, Joshua J.; Gini, Rosa; Klungel, Olaf|info:eu-repo/dai/nl/181447649; Mullins, C. Daniel; Nguyen, Michael D.; Rassen, Jeremy A.; Smeeth, Liam; Sturkenboom, Miriam C J M

    2017-01-01

    Purpose Defining a study population and creating an analytic dataset from longitudinal healthcare databases involves many decisions. Our objective was to catalogue scientific decisions underpinning study execution that should be reported to facilitate replication and enable assessment of validity of

  13. 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.

  14. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    Science.gov (United States)

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

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

  15. Practice-level quality improvement interventions in primary care: a review of systematic reviews.

    Science.gov (United States)

    Irwin, Ryan; Stokes, Tim; Marshall, Tom

    2015-11-01

    To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews. Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care--the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting. A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions. Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions. Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality

  16. Practicing theory and theorizing practice: Using an Open Collaborative Platform to facilitate meaningful interactions between academia and industry

    DEFF Research Database (Denmark)

    Baka, Vasiliki

    2015-01-01

    The aim of this paper is to explore how a technological platform can connect multiple stakeholders towards educating open innovation ambassadors. In other words, how both academics and practitioners focusing on open innovation can ‘meet’ to constructively nurture openness in practice. The paper...

  17. 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

  18. 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.

  19. How Can Innovative Practices In HEIs Facilitate Sustainable Social And Economic Development ?

    NARCIS (Netherlands)

    Psillaki, M.; Youssef, A.B.; Filippov, S.; Ravesteijn, W.; Zvereva, T.Y.

    2010-01-01

    The paper is focused on analyzing net-based practices in Higher Education Institutions (HEIs) as a policy tool for instituting a sustainable social and economic development. The purpose of the study is to identify relationships between net-based HEIs and welfare perspective; to investigate the

  20. A Sample Practical Report to Facilitate Writing in the Scientific Style

    Science.gov (United States)

    Corradi, Hazel Ruth

    2012-01-01

    The ability to write concise and accurate scientific reports is highly valued in university level science. From reflection on marking student final year reports, it was apparent that many students have had insufficient practice at writing complete "scientific paper" style reports by that time, although some do it very well. This is a previously…

  1. Reduction of Errors during Practice Facilitates Fundamental Movement Skill Learning in Children with Intellectual Disabilities

    Science.gov (United States)

    Capio, C. M.; Poolton, J. M.; Sit, C. H. P.; Eguia, K. F.; Masters, R. S. W.

    2013-01-01

    Background: Children with intellectual disabilities (ID) have been found to have inferior motor proficiencies in fundamental movement skills (FMS). This study examined the effects of training the FMS of overhand throwing by manipulating the amount of practice errors. Methods: Participants included 39 children with ID aged 4-11 years who were…

  2. 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,…

  3. The diagnosis of autism in community pediatric settings: does advanced training facilitate practice change?

    Science.gov (United States)

    Swanson, Amy R; Warren, Zachary E; Stone, Wendy L; Vehorn, Alison C; Dohrmann, Elizabeth; Humberd, Quentin

    2014-07-01

    The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.5-year period. Trainings provided clinicians with strategies for conducting relatively brief within-practice interactive assessments following positive autism spectrum disorder screenings. Program evaluation was measured approximately 1.5 years following training through (a) clinician self-reports of practice change and (b) blind diagnostic verification of a subset of children assessed. Pediatric providers participating in the training reported significant changes in screening and consultation practices following training, with a reported 85% increase in diagnostic identification of children with autism spectrum disorder within their own practice setting. In addition, substantial agreement (86%-93%) was found between pediatrician diagnostic judgments and independent, comprehensive blinded diagnostic evaluations. Collaborative training methods that allow autism spectrum disorder identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment. © The Author(s) 2013.

  4. Information Technology Management: Social Security Administration Practices Can Be Improved

    National Research Council Canada - National Science Library

    Shaw, Clay

    2001-01-01

    To improve SSAs IT management practices, we recommend that the Acting Commissioner of Social Security direct the Chief Information Officer and the Deputy Commissioner for Systems to complete the following actions...

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

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-29

    Dec 29, 2008 ... the annual income of the PFs and NPFs, respectively. ... Key words: Adoption, improved vegetable, production practices, farmers and national fadama ..... so, fixed cost components such as depreciation, insurance, repairs,.

  6. Evidence-based care: an innovation to improve nursing practice ...

    African Journals Online (AJOL)

    Evidence-based care: an innovation to improve nursing practice globally. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... best available evidence from research findings, expert ideas from specialists in the various health ... need to be addressed to enhance utilization of the best available evidence in nursing practice.

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

    OpenAIRE

    Watt, Susan; Sword, Wendy; Krueger, Paul

    2005-01-01

    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 moth...

  8. Practice parameters facilitating adoption of advanced technologies for enhancing neuropsychological assessment paradigms.

    Science.gov (United States)

    Parsons, Thomas D; McMahan, Timothy; Kane, Robert

    2018-01-01

    Clinical neuropsychologists have long underutilized computer technologies for neuropsychological assessment. Given the rapid advances in technology (e.g. virtual reality; tablets; iPhones) and the increased accessibility in the past decade, there is an on-going need to identify optimal specifications for advanced technologies while minimizing potential sources of error. Herein, we discuss concerns raised by a joint American Academy of Clinical Neuropsychology/National Academy of Neuropsychology position paper. Moreover, we proffer parameters for the development and use of advanced technologies in neuropsychological assessments. We aim to first describe software and hardware configurations that can impact a computerized neuropsychological assessment. This is followed by a description of best practices for developers and practicing neuropsychologists to minimize error in neuropsychological assessments using advanced technologies. We also discuss the relevance of weighing potential computer error in light of possible errors associated with traditional testing. Throughout there is an emphasis on the need for developers to provide bench test results for their software's performance on various devices and minimum specifications (documented in manuals) for the hardware (e.g. computer, monitor, input devices) in the neuropsychologist's practice. Advances in computerized assessment platforms offer both opportunities and challenges. The challenges can appear daunting but are a manageable and require informed consumers who can appreciate the issues and ask pertinent questions in evaluating their options.

  9. Tablet Technology to Facilitate Improved Interaction and Communication with Students Studying Mathematics at a Distance

    Science.gov (United States)

    Galligan, Linda; Hobohm, Carola; Loch, Birgit

    2012-01-01

    Teaching and learning of mathematics is challenging when lecturer and students are separated geographically. While student engagement and interaction with the course, with other students and with the lecturer is vital to mathematics learning, it is difficult to facilitate this electronically, because of the nature of mathematics. With tablet…

  10. Evaluation of Attention Training and Metacognitive Facilitation to Improve Reading Comprehension in Aphasia

    Science.gov (United States)

    Lee, Jaime B.; Sohlberg, McKay Moore

    2013-01-01

    Purpose: This pilot study investigated the impact of direct attention training combined with metacognitive facilitation on reading comprehension in individuals with aphasia. Method: A single-subject, multiple baseline design was employed across 4 participants to evaluate potential changes in reading comprehension resulting from an 8-week…

  11. 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.

  12. Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

    Science.gov (United States)

    Houle, Sherilyn; MacKeigan, Linda

    2017-01-01

    As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing

  13. 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.

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

    Science.gov (United States)

    Johnston, Sharon; Liddy, Clare; Hogg, William; Donskov, Melissa; Russell, Grant; Gyorfi-Dyke, Elizabeth

    2010-12-13

    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. 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. 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. 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.

  15. 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.

  16. Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

    Science.gov (United States)

    Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

    2008-01-01

    The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and

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

    Science.gov (United States)

    Heckenberg, Gayle

    2008-06-01

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

  18. Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

    Science.gov (United States)

    Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

    2018-04-01

    The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

  19. What are they thinking? Facilitating clinical reasoning through longitudinal patient exposure in rural practice.

    Science.gov (United States)

    Campbell, David; Walters, Lucie; Couper, Ian; Greacen, Jane

    2017-12-01

      This article reports the findings from an international research workshop, held over 2 days in October 2014 in Bairnsdale, Australia, which brought together 19 clinician teachers and medical educators who work in rural primary care. The objectives of the workshop were to clarify and identify the key aspects of the development of clinical reasoning in students and junior doctors, particularly as a result of longitudinal immersion in rural community practice.   Delegates were asked to prepare a 55-word vignette related to their experience of teaching clinical reasoning, and these case studies formed the basis of identification of key issues, further refined via a modified Delphi process.   The workshop identified four key themes: the patient’s story, the learner’s reasoning, the context of learning, and the role of the supervisor. Exposure to undifferentiated patient presentations is increasingly common in medical education, particularly in longitudinal integrated placements.   This research explored clinicians’ perspectives of how students develop their clinical reasoning: by learning from patients, from their supervisors and by understanding the context of their clinical interactions.  .

  20. Facilitating learning through an international virtual collaborative practice: A case study.

    Science.gov (United States)

    Wihlborg, Monne; Friberg, Elizabeth E; Rose, Karen M; Eastham, Linda

    2018-02-01

    Internationalisation of higher education involving information and communication technology such as e-learning opens opportunities for innovative learning approaches across nations and cultures. Describe a case in practice of collaborative and transformative learning in relation to 'internationalisation on home grounds' with the broader learning objective of 'becoming aware and knowledgeable'. A mutually developed project established a virtual international collaborative exchange for faculty and students using a course management software (MOODLE) and open access technology (Adobe CONNECT). Two research universities in Sweden and the United States. Approximately 90 nursing students from each university per semester over several semesters. A collaborative process to develop a joint learning community to construct a virtual module and learning activity involving academics and nursing students in two countries using principles of meaning construction and negotiated learning. Developed possibilities for dealing with the challenges and finding strategies for a future higher education system that opens dialogues worldwide. Virtual international exchanges open innovative communication and learning contexts across nations and cultures. Internationalisation is so much more than students and teachers' mobility. 'Internationalisation on home grounds' (internationalisation for all) should receive more attention to support faculty and student collaboration, learning, and professional development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Creating a lab to facilitate high school student engagement in authentic paleoclimate science practices

    Science.gov (United States)

    Maloney, A.; Walsh, E.

    2012-12-01

    A solid understanding of timescales is crucial for any climate change discussion. This hands-on lab was designed as part of a dual-credit climate change course in which high school students can receive college credit. Using homemade ice cores, students have the opportunity to participate in scientific practices associated with collecting, processing, and interpreting temperature and CO2 data. Exploring millennial-scale cycles in ice core data and extending the CO2 record to the present allows students to discover timescales from an investigators perspective. The Ice Core Lab has been piloted in two high school classrooms and student engagement, and epistemological and conceptual understanding was evaluated using quantitative pre and post assessment surveys. The process of creating this lab involved a partnership between an education assessment professional, high school teachers, and University of Washington professors and graduate students in Oceanography, Earth and Space Sciences, Atmospheric Sciences and the Learning Sciences as part of the NASA Global Climate Change University of Washington in the High School program. This interdisciplinary collaboration led to the inception of the lab and was necessary to ensure that the lesson plan was pedagogically appropriate and scientifically accurate. The lab fits into a unit about natural variability and is paired with additional hands-on activities created by other graduate students that explore short-timescale temperature variations, Milankovitch cycles, isotopes, and other proxies. While the Ice Core Lab is intended to follow units that review the scientific process, global energy budget, and transport, it can be modified to fit any teaching platform.

  2. Improving safety culture in hospitals: Facilitators and barriers to implementation of Systemic Falls Investigative Method (SFIM).

    Science.gov (United States)

    Zecevic, Aleksandra A; Li, Alvin Ho-Ting; Ngo, Charity; Halligan, Michelle; Kothari, Anita

    2017-06-01

    The purpose of this study was to assess the facilitators and barriers to implementation of the Systemic Falls Investigative Method (SFIM) on selected hospital units. A cross-sectional explanatory mixed methods design was used to converge results from a standardized safety culture survey with themes that emerged from interviews and focus groups. Findings were organized by six elements of the Ottawa Model of Research Use framework. A geriatric rehabilitation unit of an acute care hospital and a neurological unit of a rehabilitation hospital were selected purposefully due to the high frequency of falls. Hospital staff who took part in: surveys (n = 39), interviews (n = 10) and focus groups (n = 12), and 38 people who were interviewed during falls investigations: fallers, family, unit staff and hospital management. Implementation of the SFIM to investigate fall occurrences. Percent of positive responses on the Modified Stanford Patient Safety Culture Survey Instrument converged with qualitative themes on facilitators and barriers for intervention implementation. Both hospital units had an overall poor safety culture which hindered intervention implementation. Facilitators were hospital accreditation, strong emphasis on patient safety, infrastructure and dedicated champions. Barriers included heavy workloads, lack of time, lack of resources and poor communication. Successful implementation of SFIM requires regulatory and organizational support, committed frontline staff and allocation of resources to identify active causes and latent contributing factors to falls. System-wide adjustments show promise for promotion of safety culture in hospitals where falls happen regularly. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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

    OpenAIRE

    Pallavi Sahay, MPT; Santosh Kr. Prasad, MSc; Shahnawaz Anwer, MPT; P.K. Lenka, PhD; Ratnesh Kumar, MS

    2014-01-01

    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). Th...

  4. 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

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

    Science.gov (United States)

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

    2015-01-01

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

  6. Performance improvement planning : developing effective billing and collection practices

    OpenAIRE

    anonymous

    2008-01-01

    Effective billing and collection systems are a critical component for ensuring the viability of a service provider. Improving billing and collection activities has an immediate impact on the revenue streams of a service provider that can, in turn, help the service provider in improving services. However, while effective billing and collection practices depend on many internal factors (including customer databases, the extent of metered and unmetered service provision, tariff and billing struc...

  7. A Pilot Feasibility Study to Improve Food Parenting Practices.

    Science.gov (United States)

    Moore, Amy M; Clair-Michaud, Mary; Melanson, Kathleen J; Tovar, Alison

    2018-03-01

    We examined the feasibility and acceptability of a novel home-based intervention to improve the food parenting practices of low-income mothers with preschool-aged children. Mother-child dyads (N = 15) were recruited from WIC in southern Rhode Island. A non-experimental, pretest-posttest design was used to assess changes in maternal food parenting practices. Dyads participated in 3 home-based sessions that included baseline measures and an evening meal video recording at session 1, a motivational interviewing (MI) intervention that included feedback on the evening meal video recording at session 2, and a satisfaction ques- tionnaire at session 3. Pretest-posttest measures included 5 subscales of the Comprehensive Feeding Practices Questionnaire. Fifteen mother-child dyads (mothers: 32.3, SD = 4.6 years, 86.7% white; children: 3.2, SD = 0.9 years, male = 73.3%, 66.7% white) completed the study. Mothers reported improvements in food parenting practices following the home-based MI intervention. Overall, 93% of mothers 'strongly agreed' that it was worth their effort to participate in the study. A home-based MI intervention may be an effective strategy for improving maternal food parenting practices in low-income populations. Most mothers found that watching themselves was informative and applicable to their own lives.

  8. A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation

    Directory of Open Access Journals (Sweden)

    Marie-Eve Lamontagne

    2016-01-01

    Full Text Available Context The Clinical Practice Improvement (CPI approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings. Method We performed a scoping review of the use of CPI methodology in rehabilitation settings. Results A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI. Conclusion Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.

  9. IMPROVING WOMEN'S LIVES Practical support for women gives ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    IMPROVING WOMEN'S LIVES Practical support for women gives communities a better future. October 26 ... Organized into small cooperatives, the women produce and market argan oil using a mix of traditional and modern methods. At the same time ... arts and craft. Technology helps Asian women balance family and work.

  10. Improving antibiotic use in daily hospital practice : The antibiotic checklist

    NARCIS (Netherlands)

    van Daalen, F.V.

    2018-01-01

    Better use of current antibiotic agents is necessary to help control antimicrobial resistance (AMR). Antibiotic stewardship programs (ASPs) are introduced to coordinate activities to measure and improve appropriate antibiotic use in daily hospital practice. This thesis shows how the introduction of

  11. 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…

  12. 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 product manufactured within 10 minutes of appointment times by 29% (from 47% to 76%; 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.

  13. What interventions can improve the mental health nursing practice environment?

    Science.gov (United States)

    Redknap, Robina; Twigg, Di; Towell, Amanda

    2016-02-01

    The nursing practice environment is an important factor for services to consider in the attraction and retention of a skilled workforce during future nursing shortages. Despite the significant number of international studies undertaken to understand the influence of the practice environment on nurse satisfaction and retention, few have been undertaken within the mental health setting. This paper reports on results from a survey conducted in a large Australian public mental health hospital to examine nurses' perceptions of their practice environment, and identifies interventions that could be implemented to improve the practice environment. The hospital is the only remaining, standalone public mental health hospital in Western Australia. © 2016 Australian College of Mental Health Nurses Inc.

  14. Using knowledge brokers to facilitate the uptake of pediatric measurement tools into clinical practice: a before-after intervention study

    Directory of Open Access Journals (Sweden)

    Cameron Dianne

    2010-11-01

    Full Text Available Abstract Background The use of measurement tools is an essential part of good evidence-based practice; however, physiotherapists (PTs are not always confident when selecting, administering, and interpreting these tools. The purpose of this study was to evaluate the impact of a multifaceted knowledge translation intervention, using PTs as knowledge brokers (KBs to facilitate the use in clinical practice of four evidence-based measurement tools designed to evaluate and understand motor function in children with cerebral palsy (CP. The KB model evaluated in this study was designed to overcome many of the barriers to research transfer identified in the literature. Methods A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months, ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months, and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored. Results PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools. Conclusions KBs

  15. Using knowledge brokers to facilitate the uptake of pediatric measurement tools into clinical practice: a before-after intervention study.

    Science.gov (United States)

    Russell, Dianne J; Rivard, Lisa M; Walter, Stephen D; Rosenbaum, Peter L; Roxborough, Lori; Cameron, Dianne; Darrah, Johanna; Bartlett, Doreen J; Hanna, Steven E; Avery, Lisa M

    2010-11-23

    The use of measurement tools is an essential part of good evidence-based practice; however, physiotherapists (PTs) are not always confident when selecting, administering, and interpreting these tools. The purpose of this study was to evaluate the impact of a multifaceted knowledge translation intervention, using PTs as knowledge brokers (KBs) to facilitate the use in clinical practice of four evidence-based measurement tools designed to evaluate and understand motor function in children with cerebral palsy (CP). The KB model evaluated in this study was designed to overcome many of the barriers to research transfer identified in the literature. A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored. PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools. KBs positively influenced PTs' self-reported knowledge and self

  16. 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.

  17. Making perceptual learning practical to improve visual functions.

    Science.gov (United States)

    Polat, Uri

    2009-10-01

    Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.

  18. Triiodothyronine facilitates weaning from extracorporeal membrane oxygenation by improved mitochondrial substrate utilization.

    Science.gov (United States)

    Files, Matthew D; Kajimoto, Masaki; O'Kelly Priddy, Colleen M; Ledee, Dolena R; Xu, Chun; Des Rosiers, Christine; Isern, Nancy; Portman, Michael A

    2014-03-20

    Extracorporeal membrane oxygenation (ECMO) provides a bridge to recovery after myocardial injury in infants and children, yet morbidity and mortality remain high. Weaning from the circuit requires adequate cardiac contractile function, which can be impaired by metabolic disturbances induced either by ischemia-reperfusion and/or by ECMO. We tested the hypothesis that although ECMO partially ameliorates metabolic abnormalities induced by ischemia-reperfusion, these abnormalities persist or recur with weaning. We also determined if thyroid hormone supplementation (triiodothyronine) during ECMO improves oxidative metabolism and cardiac function. Neonatal piglets underwent transient coronary ischemia to induce cardiac injury then were separated into 4 groups based on loading status. Piglets without coronary ischemia served as controls. We infused into the left coronary artery [2-(13)C]pyruvate and [(13)C6, (15)N]l-leucine to evaluate oxidative metabolism by gas chromatography-mass spectroscopy and nuclear magnetic resonance methods. ECMO improved survival, increased oxidative substrate contribution through pyruvate dehydrogenase, reduced succinate and fumarate accumulation, and ameliorated ATP depletion induced by ischemia. The functional and metabolic benefit of ECMO was lost with weaning, yet triiodothyronine supplementation during ECMO restored function, increased relative pyruvate dehydrogenase flux, reduced succinate and fumarate, and preserved ATP stores. Although ECMO provides metabolic rest by decreasing energy demand, metabolic impairments persist, and are exacerbated with weaning. Treating ECMO-induced thyroid depression with triiodothyronine improves substrate flux, myocardial oxidative capacity and cardiac contractile function. This translational model suggests that metabolic targeting can improve weaning.

  19. Approaching the Practice Quality Improvement Project in Interventional Radiology.

    Science.gov (United States)

    Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

    2015-12-01

    An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Godény, Sándor

    2012-02-05

    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.

  1. 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.

  2. How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

    Science.gov (United States)

    Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

    2009-09-01

    Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

  3. Experiences of leaders in the implementation of Lean in a teaching hospital--barriers and facilitators in clinical practices: a qualitative study.

    NARCIS (Netherlands)

    Aij, K.H.; Simons, F.E.; Widdershoven, G.A.; Visse, M.A.

    2013-01-01

    Objectives: To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not

  4. 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.

  5. A Computable Definition of Sepsis Facilitates Screening and Performance Improvement Tracking.

    Science.gov (United States)

    Alessi, Lauren J; Warmus, Holly R; Schaffner, Erin K; Kantawala, Sajel; Carcillo, Joseph; Rosen, Johanna; Horvat, Christopher M

    2018-03-01

    Sepsis kills almost 5,000 children annually, accounting for 16% of pediatric health care spending in the United States. We sought to identify sepsis within the Electronic Health Record (EHR) of a quaternary children's hospital to characterize disease incidence, improve recognition and response, and track performance metrics. Methods are organized in a plan-do-study-act cycle. During the "plan" phase, electronic definitions of sepsis (blood culture and antibiotic within 24 hours) and septic shock (sepsis plus vasoactive medication) were created to establish benchmark data and track progress with statistical process control. The performance of a screening tool was evaluated in the emergency department. During the "do" phase, a novel inpatient workflow is being piloted, which involves regular sepsis screening by nurses using the tool, and a regimented response to high risk patients. Screening tool use in the emergency department reduced time to antibiotics (Fig. 1). Of the 6,159 admissions, EHR definitions identified 1,433 (23.3%) between July and December 2016 with sepsis, of which 159 (11.1%) had septic shock. Hospital mortality for all sepsis patients was 2.2% and 15.7% for septic shock (Table 1). These findings approximate epidemiologic studies of sepsis and severe sepsis, which report a prevalence range of 0.45-8.2% and mortality range of 8.2-25% (Table 2). 1-5 . Implementation of a sepsis screening tool is associated with improved performance. The prevalence of sepsis conditions identified with electronic definitions approximates the epidemiologic landscape characterized by other point-prevalence and administrative studies, providing face validity to this approach, and proving useful for tracking performance improvement.

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

    International Nuclear Information System (INIS)

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

    1995-01-01

    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

  7. 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 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.

  8. 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].

  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. 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...... studies both purely descriptive and studies identifying success and failure factors, but almost no studies of how companies actually undertake improve-ments, which problems they encounter,, and how/whether they overcome these problems. Action research is proposed as a suitable method for studying...

  11. 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

  12. 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.

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

    International Nuclear Information System (INIS)

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

    2007-01-01

    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

  14. Can the identification of an idle line facilitate its removal? A comparison between a proposed guideline and clinical practice.

    Science.gov (United States)

    Kara, Areeba; Johnson, Cynthia S; Murray, Michelle; Dillon, Jill; Hui, Siu L

    2016-07-01

    There are 250,000 cases of central line-associated blood stream infections in the United States annually, some of which may be prevented by the removal of lines that are no longer needed. To test the performance of criteria to identify an idle line as a guideline to facilitate its removal. Patients with central lines on the wards were identified. Criteria for justified use were defined. If none were met, the line was considered "idle." We proposed the guideline that a line may be removed the day following the first idle day and compared actual practice with our proposed guideline. One hundred twenty-six lines in 126 patients were observed. Eighty-three (65.9%) were peripherally inserted central catheters. Twenty-seven percent (n= 34) were placed for antibiotics. Seventy-six patients had lines removed prior to discharge. In these patients, the line was in place for 522 days, of which 32.7% were idle. The most common reasons to justify the line included parenteral antibiotics and meeting systemic inflammatory response (SIRS) criteria. In 11 (14.5%) patients, the line was removed prior to the proposed guideline. Most (n = 36, 47.4%) line removals were observed to be in accordance with our guideline. In another 29 (38.2%), line removal was delayed compared to our guideline. Idle days are common. Central line days may be reduced by the consistent daily reevaluation of a line's justification using defined criteria. The practice of routine central line placement for prolonged antibiotics and the inclusion of SIRS criteria to justify the line may need to be reevaluated. Journal of Hospital Medicine 2016;11:489-493. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  15. 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].

  16. Work management practices that reduce dose and improve efficiency

    International Nuclear Information System (INIS)

    Miller, D.W.; Hulin, M.

    1998-01-01

    Work management practices at nuclear power plants can dramatically affect the outcome of annual site dose goals and outage costs. This presentation discusses global work management practices that contribute to dose reduction including work philosophy, work selection, work planning, work scheduling, worker training, work implementation and worker feedback. The presentation is based on a two-year international effort (sponsored by NEA/IAEA ISOE) to study effective work practices that reduce dose. Experts in this area believe that effective work selection and planning practices can substantially reduce occupational dose during refueling outages. For example, some plants represented in the expert group complete refueling outages in 12-18 days (Finland) with doses below 0,90 person-Sv. Other plants typically have 50-75 day outages with substantially higher site doses. The fundamental reasons for longer outages and higher occupational doses are examined. Good work management principles that have a proven track record of reducing occupational dose are summarized. Practical methods to reduce work duration and dose are explained. For example, scheduling at nuclear power plants can be improved by not only sequencing jobs on a time line but also including zone and resource-based considerations to avoid zone congestion and manpower delays. An ongoing, global, benchmarking effort is described which provides current duration and dose information for repetitive jobs to participating utilities world-wide. (author)

  17. 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

  18. A Patient Advocate to facilitate access and improve communication, care, and outcomes in adults with moderate or severe asthma: Rationale, design, and methods of a randomized controlled trial

    Science.gov (United States)

    Apter, Andrea J.; Morales, Knashawn H.; Han, Xiaoyan; Perez, Luzmercy; Huang, Jingru; Ndicu, Grace; Localio, Anna; Nardi, Alyssa; Klusaritz, Heather; Rogers, Marisa; Phillips, Alexis; Cidav, Zuleyha; Schwartz, J. Sanford

    2017-01-01

    Few interventions to improve asthma outcomes have targeted low-income minority adults. Even fewer have focused on the real-world practice where care is delivered. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, to facilitate and maintain access to chronic care for adults with moderate or severe asthma and prevalent co-morbidities recruited from clinics serving low-income urban neighborhoods. We describe the planning, design, methodology (informed by patient and provider focus groups), baseline results, and challenges of an ongoing randomized controlled trial of 312 adults of a PA intervention implemented in a variety of practices. The PA coaches, models, and assists participants with preparations for a visit with the asthma clinician; attends the visit with permission of participant and provider; and confirms participants’ understanding of what transpired at the visit. The PA facilitates scheduling, obtaining insurance coverage, overcoming patients’ unique social and administrative barriers to carrying out medical advice and transfer of information between providers and patients. PA activities are individualized, take account of comorbidities, and are generalizable to other chronic diseases. PAs are recent college graduates interested in health-related careers, research experience, working with patients, and generally have the same race/ethnicity distribution as potential participants. We test whether the PA intervention, compared to usual care, is associated with improved and sustained asthma control and other asthma outcomes (prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) relative to baseline. Mediators and moderators of the PA-asthma outcome relationship are examined along with the intervention’s cost-effectiveness. PMID:28315481

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. Electrotactile Feedback Improves Performance and Facilitates Learning in the Routine Grasping Task.

    Science.gov (United States)

    Isaković, Milica; Belić, Minja; Štrbac, Matija; Popović, Igor; Došen, Strahinja; Farina, Dario; Keller, Thierry

    2016-06-13

    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.

  4. Audit and feedback by medical students to improve the preventive care practices of general practice supervisors.

    Science.gov (United States)

    Gilkes, Lucy A; Liira, Helena; Emery, Jon

    Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.

  5. Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

    Science.gov (United States)

    Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

    2016-10-01

    Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

  6. From root to fruit – flourishing in change. Evaluation of a development programme for practice development facilitators in end-of-life care

    Directory of Open Access Journals (Sweden)

    Caroline Dickson

    2018-05-01

    Full Text Available Background: This paper outlines the structure, processes and outcomes of a 12-month development programme for nurses who were transitioning from a practice-based training role to a practice development role. The programme was part of organisational commitment to develop a person-centred culture. A new team of practice development facilitators across the UK was formed at Marie Curie, a UK-based charity supporting persons with palliative and end-of-life care needs. Aim: The overall aim of the programme was to enable practice development facilitators to engage with the theory and practice of practice development, and to develop as enablers in the delivery of person-centred practice. Method: A co-designed, multimethod evaluation of the programme, which adopted emancipatory practice development and active learning methodologies. Data collection included fourth-generation evaluation, reflective writing, participant stories and examples of practice change. Findings: The programme supported a change in focus of participants’ role from technical to emancipatory. The team identified new ways of engaging together that enabled them to embody person-centredness. By experiencing active learning, they came to a better understanding of themselves and their practice. Throughout the programme, the team experienced a range of organisational challenges that impacted on their progress. Development of facilitation skills and a strong community of practice will enhance the embeddedness and sustainability of the new role. Conclusions: Facilitators of practice development can be catalysts in the development of person-centred cultures, which are indicative of flourishing organisations. To be sustainable, initiatives such as this one need to be included in organisational strategy. A sense of wellbeing and renewed commitment to develop practice in ways that keep person-centred care at its heart can be experienced through experiencing human flourishing. Key messages:

  7. A pilot clinical study of Class III surgical patients facilitated by improved accelerated osteogenic orthodontic treatments.

    Science.gov (United States)

    Wu, JiaQi; Jiang, Jiu-Hui; Xu, Li; Liang, Cheng; Bai, YunYang; Zou, Wei

    2015-07-01

    To evaluate if the improved accelerated osteogenic orthodontics (IAOO) procedure could speed Class III surgical patients' preoperative orthodontic treatment duration and, if yes, to what extent. This study was also designed to determine whether or not an IAOO procedure affects the tooth-moving pattern during extraction space closure. The samples in this study consisted of 24 Class III surgical patients. Twelve skeletal Class III surgery patients served as an experimental group (group 1) and the others as a control group (group 2). Before treatment, the maxillary first premolars were removed. For group 1, after the maxillary dental arch was aligned and leveled (T2), IAOO procedures were performed in the maxillary alveolar bone. Except for this IAOO procedure in group 1, all 24 patients experienced similar combined orthodontic and orthognathic treatment. Study casts of the maxillary dentitions were made before orthodontic treatment (T1) and after extraction space closure (T3). All of the casts were laser scanned, and the amount of movement of the maxillary central incisor, canine, and first molar, as well as arch widths, were digitally measured and analyzed by using the three-dimensional model superimposition method. The time durations T3-T2 were significantly reduced in group 1 by 8.65 ± 2.67 months and for T3-T1 were reduced by 6.39 ± 2.00 months (P teeth movement in the sagittal, vertical, and transverse dimensions between the two groups (P > .05). The IAOO can reduce the surgical orthodontic treatment time for the skeletal Class III surgical patient by more than half a year on average. The IAOO procedures do not save anchorage.

  8. Teacher coaching supported by formative assessment for improving classroom practices.

    Science.gov (United States)

    Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M

    2018-06-01

    The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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

    Science.gov (United States)

    Maughan, Curtis; Godwin, Sandria; Chambers, Delores; Chambers, 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.

  10. Avoiding never events: Improving nasogastric intubation practice and standards

    International Nuclear Information System (INIS)

    Law, Robert L.; Pullyblank, Ann M.; Eveleigh, Mark; Slack, Nicola

    2013-01-01

    Aim: To identify and rectify weaknesses in nasogastric (NG) intubation practice in the North Bristol NHS Trust that resulted in the occurrence of a National patient Safety Agency defined “never event”. Material and methods: Root-cause analysis identified that a change in culture was required. Recommendations divided into four categories: documentation, intubation, interpretation training, and radiology. A 6 month prospective audit covering all aspects of NG intubation practice preceded implementation of the recommendations. All patients whose tubes were mis-sited formed the cohort of the study. A re-audit was undertaken 12 months after the implementation of the recommended changes. Results: Re-audit suggested significant improvements had occurred in all categories, particularly junior doctor check image interpretation errors, which in the study group were reduced from seven to one, and documentation, which has so far improved by 22%. Protocols and guidelines associated with NG tube check imaging have now been developed for radiologists and radiographers with check imaging and image interpretation being made a priority and respiratory tract intubation treated as an emergency. Conclusion: The service is still not perfect, but there is a focal awareness of patient safety associated with intubation practice, and image interpretation by junior doctors significantly improved with the introduction of the e-learning package. However, it is considered that the responsibility for developing safe practice with respect to NG tube check image interpretation ultimately lies with the department of radiology, which should take the lead on reducing the risk of never events being caused by the misinterpretation of these images

  11. Improving cost-effectiveness and facilitating participation of developing countries in international emissions trading

    International Nuclear Information System (INIS)

    Bohm, P.

    2003-01-01

    Cost-effectiveness is a crucial requirement for meaningful agreements on international climate change policy. This is also borne out in the wording of the Framework Convention of Climate Change and, in particular, the Kyoto Protocol (KP), see UNFCCC (1992) and UN (1997). However, the KP - as it stands after COP7 in Marrakech - is not fully cost-effective, although it may eventually turn out to be the only politically feasible, 'most cost-effective', first step in international climate change policy. The successor to the COP7 version of the KP may be a renegotiated protocol, if the COP7 version fails to be ratified by enough countries to enter into force, or it may be the treaty to be designed for a second commitment period. Four dimensions in which cost-effectiveness may be improved in a treaty that succeeds the KP are discussed here. They all relate to international emissions trading (IET) which is likely to be the most significant instrument for attaining cost-effective reductions in aggregate greenhouse gas (GHG) emissions. It is important for a climate treaty to be able to attract as many developing countries to IET as possible and achieve this as soon as possible. This would have to occur at essentially no cost to them. Only with developing countries onboard can the world community get full access to their low-cost options for emission reductions. A first aspect to be discussed here is related to identifying a cost-effective approach to attain that goal (Section 1). Another aspect concerns the role of the Clean Development Mechanism (CDM) in this context (Section 2). A third issue is to evaluate the consequences for cost-effectiveness of introducing a Commitment Period Reserve to limit 'overselling' (Section 3). A final one deals with the increase in flexibility that would follow from allowing not only banking but also borrowing of Assigned Amount Units (AAUs) (Section 4). While the first two issues refer directly to developing countries, the last two will be

  12. Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway.

    Science.gov (United States)

    Sommerbakk, Ragni; Haugen, Dagny Faksvåg; Tjora, Aksel; Kaasa, Stein; Hjermstad, Marianne Jensen

    2016-07-15

    Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important

  13. Operational practices of lean manufacturing: Potentiating environmental improvements

    Energy Technology Data Exchange (ETDEWEB)

    Pinto, Marcos José Alves Junior; Mendes, Juliana Veiga

    2017-07-01

    Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act), Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.

  14. Operational practices of lean manufacturing: Potentiating environmental improvements

    Directory of Open Access Journals (Sweden)

    Marcos José Alves Pinto Junior

    2017-10-01

    Full Text Available Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act, Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.

  15. Operational practices of lean manufacturing: Potentiating environmental improvements

    International Nuclear Information System (INIS)

    Pinto, Marcos José Alves Junior; Mendes, Juliana Veiga

    2017-01-01

    Purpose: The objective of this paper is to investigate how environmental improvements can be achieved through operational practices of Lean Manufacturing. Design/methodology/approach: A literature review was conducted to analyze the relationship between operational practices of Lean and reduction of environmental impact in organizational contexts. Verified theoretically, this relationship was observed in a company of the electronics industry, through an exploratory research which contemplated a mixed approach. The adopted research method consisted of a single case study, by providing greater depth and detail of the study. Utilized a research protocol, validated test pilot. The instruments for data collection were semi-structured interviews, direct observation and document analysis. The information was examined qualitatively considering the technique for content analysis. Findings: As a result of the study, it was found that there is evidence for the existence of relationship between the practices of Lean, for example, Kaizen, PDCA (plan, do, check, act), Ishikawa Diagram, Poka-Yoke, Standardized Work and Value Stream Mapping, with the reduction of environmental impacts of an organization. This reduction was observed after application of these practices that resulted in the reduction of energy consumption, water and waste generation. These results were accounted for financially, contributing to a reduction of annual costs by about US$ 20,900. Originality/value: The study presents in detail, the application of operational practices of Lean Manufacturing, with an effective view to reducing the environmental impact and cost reduction. The literature review, a detailed description of the application process and financial results are important information that contributes to the scientific studies that address traditional operating practices and the search for better environmental performance.

  16. Facilitating wider application of progesterone RIA for improving livestock production in developing countries

    International Nuclear Information System (INIS)

    Oswin Perera, B.M.B.

    2000-01-01

    Full text: Research and development programmes supported by the Joint FAO/IAEA Division on improving livestock production in developing countries have identified three major biological constraints: feeding, breeding management and diseases. Proper breeding management is important in order to achieve optimum economic benefits (through products such as milk, meat and offspring) from an animal during its lifespan. This requires early attainment of puberty, short intervals from calving to conception, high conception rates and low number of matings or artificial inseminations (Als) per conception. The use of radioimmunoassay (RIA) for measuring progesterone in milk of dairy animals or in blood of meat animals, together with recording of data on reproductive events and production parameters, is an indispensable tool that provides information both on problems in breeding management by farmers as well as deficiencies in the Al services provided to them by government, co-operative or private organizations. This allows appropriate strategies and interventions to be adopted to overcome these limitations. Progesterone RIA can also detect animals that have not conceived by Al within 21 days after mating (early non-pregnancy diagnosis or N-PD), and alert farmers to the need to have these animals closely observed for oestrus and re-inseminated at the appropriate time. In order to ensure the sustained use of RIA technology for progesterone measurement in developing Member States, the IAEA has been engaged in the development and transfer of simple, robust and cheap methods of RIA. The system currently being used is based on a direct (non-extraction) method, using a 125 I-progesterone tracer and a solid-phase separation method (antibody coated tubes). In order to ensure wider availability (and lower cost) of the two key reagents required for the assay, the IAEA has initiated a programme to assist Member States to develop the capability to produce these in selected regional or

  17. Practical recommendations for the evaluation of improvement initiatives

    Science.gov (United States)

    Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

    2018-01-01

    Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

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

    Science.gov (United States)

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

    2007-11-19

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

  19. 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.

  20. Improvements in cross-infection control in general dental practice.

    Science.gov (United States)

    Bentley, E M; Sarll, D W

    1995-07-08

    A questionnaire about cross-infection control was sent to all GDPs in five FHSAs in the North Western Region. Replies came from 312 dentists, a response rate of 74%. They worked in 185 practices, a response rate of 85%. Gloves were worn routinely by 86% of dentists and 80% of DSAs. Handpieces were autoclaved between patients in 77% of practices. Much however, remains to be improved. DSAs could be better protected if more ultrasonic cleaners were used, eye protection encouraged and heavy duty gloves were available for cleaning instruments. BDA guidelines were reported as being the most influential factor, though it would appear that the media did persuade many practitioners to use autoclavable handpieces and sterilise them after each use.

  1. 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...... packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider...... 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...

  2. Improving rapeseed production practices in the southeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, D.L.; Breve, M.A.; Raymer, P.L.; Minton, N.A.; Sumner, D.R. (Georgia Univ., Tifton, GA (USA). Georgia Coastal Plain Experiment Station)

    1990-04-01

    Oilseed rape or rapeseed is a crop which offers a potential for double-cropping in the southeastern United States. This final project report describes the results from a three year study aimed at evaluating the effect of different planting and harvesting practices on establishment and yield of three rape cultivars, and the double cropping potential of rapeseed in the southeastern United States. The project was conducted on two yield sites in Tifton, Georgia during 1986--87, 1987--88 and 1988--89. The general objective of this research is to improve the seed and biomass yield of winter rapeseed in the southeastern United States by developing appropriate agronomic practices for the region. The primary constraint is to grow rapeseed within the allowable period for double cropping with an economically desirable crop, such as peanut or soybean. Planting and harvesting are the most critical steps in this process. Therefore, the specific objectives of this research were: evaluate and improve the emergence of rapeseed by developing planting techniques that enhance the soil, water and seed regimes for winter rapeseed in the southeast, and evaluate and improve the yields of harvested rapeseed by developing techniques for determining the optimum timing of harvest and efficient methods for harvesting winter rapeseed in the southeast. 6 refs., 12 figs., 9 tabs.

  3. 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.

  4. 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.

  5. Barriers and facilitators of evidence-based practice in pediatric behavioral sleep care: qualitative analysis of the perspectives of health professionals.

    Science.gov (United States)

    Boerner, Katelynn E; Coulombe, J Aimée; Corkum, Penny

    2015-01-01

    Behavioral sleep problems are highly prevalent among young and school-aged children. Despite strong evidence for effective interventions, few children receive evidence-based care. In this study, 124 Canadian health professionals answered open-ended questions regarding barriers and facilitators of their provision of evidence-based behavioral sleep-related care, and responses were analyzed for content. Responses represented issues at an individual practice level, as well as broader systemic issues. The most frequently reported barrier and facilitator related to knowledge, training, and education. Other barriers included lack of time and institutional support, and facilitators included supportive sleep attitudes and beliefs. This study may inform the design of education programs for health professionals, and provides support for broader systems-level initiatives targeted at increasing evidence-based practice.

  6. 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.…

  7. Combining clinical practice and academic work in nursing: a qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

    NARCIS (Netherlands)

    Oostveen, C.J. van; Goedhart, N.S.; Francke, A.L.; Vermeulen, H.

    2017-01-01

    Aims and objectives: To obtain in-depth insight into the perceptions of nurse aca- demics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Background: Combining clinical practice and academic work

  8. Student Teachers' Situated Emotions: A Study of How Electronic Communication Facilitates Their Expression and Shapes Their Impact on Novice Teacher Development during Practice Placements

    Science.gov (United States)

    Gleaves, Alan; Walker, Caroline

    2010-01-01

    Research suggests that pre-service teaching students embarking on practice placements encounter affect both in a personal and a professional sense more acutely than at any other time during their professional careers. A few studies emphasise the use of electronic communications in facilitating effective peer and tutor support during these…

  9. 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

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

    DEFF Research Database (Denmark)

    Martinussen, Laila Marianne

    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...... 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......, indicating that the problem lies in the drivers’ attitudes towards safety (Article 3). 6. It is indicated that rather than viewing safety and risk as two ends of a continuum, safety and risk should be understood as two separate constructs, with different underlying motives. Therefore it is suggested...

  11. Speech pathologists' experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study.

    Science.gov (United States)

    Hadely, Kathleen A; Power, Emma; O'Halloran, Robyn

    2014-03-06

    Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists' implementation of stroke CPGs. This study aimed to describe speech pathologists' experiences and current use of guidelines, and to identify what factors influence speech pathologists' implementation of stroke CPGs. Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data. 320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline "somewhat useful" or "very useful". Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided. There are many different factors that can influence speech pathologists' implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies.

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

    Science.gov (United States)

    Ma, Qingyan; Tso, Lai Sze; Rich, Zachary C; Hall, Brian J; Beanland, Rachel; Li, Haochu; Lackey, Mellanye; Hu, Fengyu; Cai, Weiping; Doherty, Meg; Tucker, Joseph D

    2016-01-01

    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. 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. 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 health workers and inadvertent disclosure of

  13. Good practices for improved nuclear power plant performance

    International Nuclear Information System (INIS)

    1989-04-01

    This report provides an overview of operational principles, practice and improvements which have contributed to good performance of eight selected world nuclear power stations. The IAEA Power Reactor Information System (PRIS) was used to identify a population of good performers. It is recognized that there are many other good performing nuclear power stations not included in this report. Specific criteria described in the introduction were used in selecting these eight stations. The information contained in this report was obtained by the staff from IAEA, Division of Nuclear Power. This was accomplished by visits to the stations and visits to a number of utility support groups and three independent organizations which provide support to more than one utility. The information in this report is intended as an aid for operating organizations to identify possible improvement initiatives to enhance plant performance. Figs and tabs

  14. Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice.

    Science.gov (United States)

    Dumas, Denis; Torre, Dario M; Durning, Steven J

    2018-05-01

    Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.

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

    International Nuclear Information System (INIS)

    Syan, C S; Ramoutar, K

    2014-01-01

    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 and T). Empirical data were collected via a questionnaire survey which was send to 218 manufacturing firms in T and 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 and 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 and T manufacturers

  16. 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.

  17. Improving Nutrition and Physical Activity Policies and Practices in Early Care and Education in Three States, 2014-2016.

    Science.gov (United States)

    Smith, Teresa M; Blaser, Casey; Geno-Rasmussen, Cristy; Shuell, Julie; Plumlee, Catherine; Gargano, Tony; Yaroch, Amy L

    2017-08-31

    The National Early Care and Education Learning Collaboratives (ECELC) project aims to facilitate best practices in nutrition, physical activity, screen time, and breastfeeding support and infant feeding among early care and education (ECE) programs across multiple states. The project uses a train-the-trainer approach with 5, in-person learning-collaborative sessions, technical assistance, and action planning. We describe the longitudinal practice-based evaluation of the project and assess whether ECE programs evaluated (n = 104) sustained changes in policies and practices 1 year after completing the project. The number of best practices increased from pre-assessment to post-assessment (P professional development and training focused on improving best practices for environment-level child nutrition and physical activity, which is one strategy among many that are warranted for obesity prevention in young children.

  18. Practice and documentation of palliative sedation: a quality improvement initiative

    Science.gov (United States)

    McKinnon, M.; Azevedo, C.; Bush, S.H.; Lawlor, P.; Pereira, J.

    2014-01-01

    Background Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu). Methods A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards. Results Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg). Conclusions The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. PMID:24764700

  19. A conceptual-practice model for occupational therapy to facilitate return to work in breast cancer patients.

    Science.gov (United States)

    Désiron, Huguette A M; Donceel, Peter; de Rijk, Angelique; Van Hoof, Elke

    2013-12-01

    Improved therapies and early detection have significantly increased the number of breast cancers survivors, leading to increasing needs regarding return to work (RTW). Occupational therapy (OT) interventions provide successful RTW assistance for other conditions, but are not validated in breast cancer. This paper aims to identify a theoretical framework for OT intervention by questioning how OT models can be used in OT interventions in RTW of breast cancer patients; criteria to be used to select these models and adaptations that would be necessary to match the OT model(s) to breast cancer patients' needs? Using research specific criteria derived from OT literature (conceptual OT-model, multidisciplinary, referring to the International Classification of functioning (ICF), RTW in breast cancer) a search in 9 electronic databases was conducted to select articles that describe conceptual OT models. A content analysis of those models complying to at least two of the selection criteria was realised. Checking for breast cancer specific issues, results were matched with literature of care-models regarding RTW in breast cancer. From the nine models initially identified, three [Canadian Model of Occupational Performance, Model of Human Occupation (MOHO), Person-Environment-Occupation-Performance model] were selected based on the selection criteria. The MOHO had the highest compliance rate with the criteria. To enhance usability in breast cancer, some adaptations are needed. No OT model to facilitate RTW in breast cancer could be identified, indicating a need to fill this gap. Individual and societal needs of breast cancer patients can be answered by using a MOHO-based OT model, extended with indications for better treatment, work-outcomes and longitudinal process factors.

  20. Information Technology Management: Social Security Administration Practices Can Be Improved

    National Research Council Canada - National Science Library

    Shaw, Clay

    2001-01-01

    ...) develop and maintain selection criteria that include explicit cost, benefit, schedule, and risk criteria to facilitate the objective analysis, comparison, prioritization, and selection of IT investments; (3...

  1. Barriers and facilitators to the implementation of orthodontic mini-implants in clinical practice: a protocol for a systematic review and meta-analysis.

    Science.gov (United States)

    Meursinge Reynders, Reint; Ronchi, Laura; Ladu, Luisa; Di Girolamo, Nicola; de Lange, Jan; Roberts, Nia; Mickan, Sharon

    2016-02-05

    Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. Orthodontic mini implants (OMIs) have been hailed for having revolutionized orthodontics, because they provide anchorage without depending on the collaboration of patients, they have a favorable effectiveness compared with conventional anchorage devices, and they can be used for a wide scale of treatment objectives. However, surveys have shown that many orthodontists never or rarely use them. To understand the rationale behind this knowledge-to-action gap, we will conduct a systematic review that will identify and quantify potential barriers and facilitators to the implementation of OMIs in clinical practice for all potential stakeholders, i.e., patients, family members, clinicians, office staff, clinic owners, policy makers, etc. The prevalence of clinicians that do not use OMIs will be our secondary outcome. The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement was adopted as the framework for reporting this manuscript. We will apply broad-spectrum search strategies and will search MEDLINE and more than 40 other databases. We will conduct searches in the gray literature, screen reference lists, and hand-search 12 journals. All study designs, stakeholders, interventions, settings, and languages will be eligible. We will search studies that report on barriers or facilitators to the implementation of orthodontic mini implants (OMIs) in clinical practice. Implementation constructs and their prevalence among pertinent stakeholders will be our primary outcomes. All searching and data extraction procedures will be conducted by three experienced reviewers. We will also contact authors and investigators to obtain additional information on data items and unidentified studies. Risk of bias will be scored with tools designed for the specific study designs. We will assess heterogeneity, meta-biases, and the

  2. Behavioural informatics for improving water hygiene practice based on IoT environment.

    Science.gov (United States)

    Fu, Yang; Wu, Wenyan

    2018-02-01

    The development of Internet of Things (IoT) and latest Information and Communication Technologies (ICT) have changed the nature of healthcare monitoring and health behaviour intervention in many applications. Water hygiene and water conservation behaviour intervention as important influence factors to human health are gaining much attentions for improving sustained sanitation practice. Based on face-to-face delivery, typical behaviour intervention method is costly and hardly to provide all day access to personalised intervention guidance and feedbacks. In this study, we presented a behavioural information system and water use behaviour model using IoT platform. Using Expanded Theory of Planned Behaviour (ETPB) and adopted structure equation model, this study offers a solution for understanding the behaviour intervention mechanism and methodology for developing empirical model. A case study of behaviour intervention model is presented by utilising residential water conservation behaviour data collected in China. Results suggested that cultural differences have significant influences on the understanding of intervention drivers, promoting projects and increasing awareness, which could improve the behaviour intervention efficiency and further facilitate the improvement of water hygiene practice. The performance evaluation of water saving dimension is discussed as well in the paper. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. 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. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

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

    Science.gov (United States)

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

    2018-06-01

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

  5. Programme evaluation: Can it improve human resource management practice?

    Directory of Open Access Journals (Sweden)

    Johann Louw

    2012-07-01

    Full Text Available Orientation: This is the final article in the special edition on human resource (HR programmes and evaluation. Its starting point is that programme evaluation is the application of a wide range of social science research methods that provide credible information about the need, use, planning, effectiveness and cost of a programme. Research purpose: The purpose of this article is to review the other articles in this volume, and to draw out general conclusions about their contributions to knowledge in the field. Motivation for the study: If evaluations are undertaken in the HR domain in South Africa, they remain mostly unpublished, and thus cannot contribute to a knowledge base for the field. Research design, approach and method: This article provides a theory-based approach to programme evaluation. The seven articles were analysed in terms of two major functions of programme evaluation, namely to ask ‘How does a programme work?’, and ‘Does it work?‘ Main findings: Eight overarching themes are identified in the articles included in this volume. Practical/managerial implications: The evidence discussed here can be used to make better decisions, promote organisational learning, improve practice, and enhance employee wellbeing. Contribution/value-add: The main contribution of this concluding article is its argument that research and theory in this field can enhance the work of HR professionals, by providing evidence about how ‘good’ a programme is, and why it is good. This adds substantial value in a world characterised by accountability and evidence-based practice.

  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. Listening to parents to improve health visiting practice.

    Science.gov (United States)

    Morton, Alison; Hargreaves, Sharon; Taylor, Liz

    2015-05-01

    Listening to the "voice" of the service user is now widely accepted as central to the delivery of high quality healthcare. This paper presents an overview of the importance of service user engagement and personalised care in health visiting with a brief review of recent policy and research. A personalised approach to health visiting practice is recommended to improve service user experience and uptake of the health visiting service offer and this is considered most significant when engaging "hard to reach" groups. A project report on a service user experience strategy within the 0-19 service of a NHS Trust in England is presented which describes initiatives to develop a health visiting and school nursing service that listens to service users. A cyclical service user engagement model which incorporates continuous reviews and service reconfiguration is described with examples of service changes in response to expressed local needs.

  8. 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

  9. Digital mobile technology facilitates HIPAA-sensitive perioperative messaging, improves physician-patient communication, and streamlines patient care.

    Science.gov (United States)

    Gordon, Chad R; Rezzadeh, Kameron S; Li, Andrew; Vardanian, Andrew; Zelken, Jonathan; Shores, Jamie T; Sacks, Justin M; Segovia, Andres L; Jarrahy, Reza

    2015-01-01

    %). Satisfaction with the service was high: 94.2 % of users "enjoyed this software" and and 94.2 % of family/friends "felt more connected to their loved ones during surgery." 92.5 % would "recommend their loved ones sign up for this service". Ninety percent of patients who completed the survey reported "an improved hospital experience". Digital communications platforms can facilitate the immediate transfer of HIPAA-compliant data to patients and their designees. Such systems can greatly improve the level of communication between physicians, patients, and patients' families and caregivers. All types of users, including healthcare professionals, patients, and their loved ones, recorded high levels of satisfaction. Based on these observations, we conclude that mobile digital communications platforms represent a way to harness the power of social media to enhance patient care.

  10. 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

  11. 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

  12. Using Patient-Reported Information to Improve Clinical Practice.

    Science.gov (United States)

    Schlesinger, Mark; Grob, Rachel; Shaller, Dale

    2015-12-01

    To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the

  13. 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

  14. Using a standards committee to design practical procedure system improvements

    International Nuclear Information System (INIS)

    Grider, D.A.; Plung, D.

    1993-01-01

    In the post-Three Mile Island (TMI) environment, numerous reports have been issued on how to improve the quality of procedures used at government and commercial nuclear facilities. The studies tend to be long on what is wrong with existing procedures and short on practical directions on how to fix those faults. Few of these studies have been conducted by practitioners with full-time procedure-managing or procedure writing experience. None of these studies go into detail on how to improve the procedure system itself. Over the last 10 yr, various nuclear facilities within the US Department of Energy (DOE) have carried out individual programs to develop procedures that meet post-TMI standards. However, ∼2 yr ago, DOE formed a Procedures Standards Committee to advise DOE in developing a set of post-TMI guidelines that could be consistently applied throughout all DOE nuclear facilities. The committee has achieved not only its original mission by producing a series of integrated guidance documents but has also evolved a systems approach to procedures management that sets new standards for procedure quality and efficiency. As members of this committee, the authors want to describe what has made the group's approach so successful. The lessons learned may be translatable to a wide range of government and commercial industry procedure programs

  15. Errors in laboratory medicine: practical lessons to improve patient safety.

    Science.gov (United States)

    Howanitz, Peter J

    2005-10-01

    Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification

  16. Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol.

    Science.gov (United States)

    Stahmer, Aubyn C; Suhrheinrich, Jessica; Schetter, Patricia L; McGee Hassrick, Elizabeth

    2018-01-08

    This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure

  17. Improving outcomes in cancer diagnosis, prevention and control: barriers, facilitators and the need for health literacy in Ibadan Nigeria.

    Science.gov (United States)

    Adedimeji, Adebola A; Lounsbury, David; Popoola, Oluwafemi; Asuzu, Chioma; Lawal, Akinmayowa; Oladoyin, V; Crifase, Cassandra; Agalliu, Ilir; Shankar, Viswanathan; Adebiyi, Akindele

    2017-10-01

    Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system. We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk-perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis. Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts. Developing and implementing comprehensive context-relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. The verbal facilitation effect: re-reading person descriptions as a system variable to improve identification performance.

    Science.gov (United States)

    Sporer, Siegfried L; Kaminski, Kristina S; Davids, Maike C; McQuiston, Dawn

    2016-11-01

    When witnesses report a crime, police usually ask for a description of the perpetrator. Several studies suggested that verbalising faces leads to a detriment in identification performance (verbal overshadowing effect [VOE]) but the effect has been difficult to replicate. Here, we sought to reverse the VOE by inducing context reinstatement as a system variable through re-reading one's own description before an identification task. Participants (N = 208) watched a video film and were then dismissed (control group), only described the perpetrator, or described and later re-read their own descriptions before identification in either target-present or target-absent lineups after a 2-day or a 5-week delay. Identification accuracy was significantly higher after re-reading (85.0%) than in the no description control group (62.5%) irrespective of target presence. Data were internally replicated using a second target and corroborated by several small meta-analyses. Identification accuracy was related to description quality. Moreover, there was a tendency towards a verbal facilitation effect (VFE) rather than a VOE. Receiver operating characteristic (ROC) curve analyses confirm that our findings are not due to a shift in response bias but truly reflect improvement of recognition performance. Differences in the ecological validity of study paradigms are discussed.

  19. 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.

  20. Understanding Online Teacher Best Practices: A Thematic Analysis to Improve Learning

    Science.gov (United States)

    Corry, Michael; Ianacone, Robert; Stella, Julie

    2014-01-01

    The purpose of this study was to examine brick-and-mortar and online teacher best practice themes using thematic analysis and a newly developed theory-based analytic process entitled Synthesized Thematic Analysis Criteria (STAC). The STAC was developed to facilitate the meaningful thematic analysis of research based best practices of K-12…

  1. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty.

    Science.gov (United States)

    Ishii, Lisa E; Tollefson, Travis T; Basura, Gregory J; Rosenfeld, Richard M; Abramson, Peter J; Chaiet, Scott R; Davis, Kara S; Doghramji, Karl; Farrior, Edward H; Finestone, Sandra A; Ishman, Stacey L; Murphy, Robert X; Park, John G; Setzen, Michael; Strike, Deborah J; Walsh, Sandra A; Warner, Jeremy P; Nnacheta, Lorraine C

    2017-02-01

    Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice

  2. 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, Bradford Thomas

    2013-01-01

    The purpose of this study was to examine 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…

  3. Combining clinical practice and academic work in nursing: A qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

    Science.gov (United States)

    van Oostveen, Catharina J; Goedhart, Nicole S; Francke, Anneke L; Vermeulen, Hester

    2017-12-01

    To obtain in-depth insight into the perceptions of nurse academics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Combining clinical practice and academic work facilitates the use of research findings for high-quality patient care. However, nurse academics move away from the bedside because clinical academic careers for nurses have not yet been established in the Netherlands. This qualitative study was conducted in two Dutch university hospitals and their affiliated medical faculties and universities of applied sciences. Data were collected between May 2015 and August 2016. We used purposive sampling for 24 interviews. We asked 14 participants in two focus groups for their perceptions of importance, facilitators and barriers in nurses' combined clinical and academic work in education and research. We audiotaped, transcribed and thematically analysed the interviews and focus groups. Three themes related to perceived importance, facilitators and barriers: culture, leadership and infrastructure. These themes represent deficiencies in facilitating clinical academic careers for nurses. The current nursing culture emphasises direct patient care, which is perceived as an academic misfit. Leadership is lacking at all levels, resulting in the underuse of nurse academics and the absence of supporting structures for nurses who combine clinical and academic work. The present nursing culture appears to be the root cause of the dearth of academic positions and established clinical academic posts. A culture change would require a show of leadership that would promote and enable combined research, teaching and clinical practice and that would introduce clinical academic career pathways for nurses. Meanwhile, nurse academics should collaborate with established medical academics for whom combined roles are mainstream, and they should take advantage of their established infrastructure

  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. Natura 2000 appropriate assessment: Shortcomings and improvements in Finnish practice

    International Nuclear Information System (INIS)

    Soederman, Tara

    2009-01-01

    The EU Habitats Directive 92/43/EEC requires impact assessments called Appropriate Assessments (AA) for plans and projects probably having adverse effects on the sites of European ecological importance, Natura 2000 sites. Seventy-three Appropriate Assessment reports and seventy official opinions given on them by regional environmental authorities from 1997 to 2005 were reviewed. The findings of the study demonstrate typical shortcomings of ecological impact assessment: a weak information basis for assessment outcomes and lack of proper cumulative impact assessment with respect to ecological structures and processes. The quality of reporting has improved over time with respect to direct impacts on individual habitat types and species and detailed mitigation measures. Regional environment centres considered one fifth of the AA reports to be inadequate because of lacking data. In most cases the regional environment centres demanded a change of plan or project, added mitigation measures, choice of only one alternative for further planning or a new completed assessment with additional information in order to be able to evaluate the significance of the effects. The study underlines the need for iterative planning practices in which the preparation of a plan or project with alternative options goes hand in hand with the impact assessment equipped with sufficient data

  6. PNRA: Practically Improving Safety Culture within the Regulatory Body

    International Nuclear Information System (INIS)

    Bhatti, S.A.N.; Habib, M.A.

    2016-01-01

    The prevalence of a good safety culture is equally important for all kind of organizations involved in nuclear business including operating organizations, designers, regulator, etc., and this should be reflected through the processes and activities of these organizations. The need for inculcating safety culture into regulatory processes and practices is gradually increasing since the major nuclear accident of Fukushima, Japan. Accordingly, several international fora in last few years repeatedly highlighted the importance of prevalence of safety culture in regulatory bodies as well. The utilisation of concept of safety culture remained applicable in regulatory activities of PNRA in the form of core values. After the Fukushima accident, PNRA considered it important to check the extent of utilisation of safety culture concept in organizational activities and decided to conduct its “Safety Culture Self-Assessment (SCSA)” for presenting itself as role model in-order to endorse the fact that safety culture at regulatory authority plays an important role to influence safety culture at licenced facilities. Considering the complexity of cultural assessment starting from visual manifestations to the basic assumptions at the deeper level, PNRA decided to utilise IAEA emerging methodology for assessment of culture and then used modified IAEA normative framework (made it applicable for regulatory body) for assessing safety culture at a regulatory body. PNRA SCSA team utilised safety culture assessment tools (observations, focus groups, surveys, interviews and document analysis) for collecting cultural facts by including all level of personnel involved in different activities and functions in the organization. Different challenges were encountered during implementation of these tools which were tackled with the background of training on SCSA and with the help of experts during support missions arranged by IAEA. Before formally starting the SCSA process, pre-launch activities

  7. 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; and...

  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 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.

  10. Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

    Science.gov (United States)

    Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

    2010-01-01

    Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

  11. Addiction treatment staff perceptions of training as a facilitator or barrier to implementing evidence-based practices: a national qualitative research study.

    Science.gov (United States)

    D'Ippolito, Melinda; Lundgren, Lena; Amodeo, Maryann; Beltrame, Clelia; Lim, Lynn; Chassler, Deborah

    2015-01-01

    This qualitative effort examines training-related facilitators and barriers to implementing evidence-based practices (EBPs) in 285 community-based addiction treatment organizations (CBOs) nationwide that were funded by the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA/CSAT) to implement EBPs. Using qualitative interviews, the authors explored staff (N = 514) descriptions of training as a facilitator or barrier to implementation. Training-related factors were described 663 times as facilitators (by 440 staff) and 233 times as barriers (by 170 staff). Responses were coded using content analysis. Specific characteristics of the training received, such as access to expert knowledge and quality, as well as ongoing training were described as central facilitating factors to EBP implementation. Key reasons training was perceived as a barrier included the amount of training; the training did not fit current staff and/or organizational needs; the training for some EBPs was perceived to be too demanding; and the difficulty accessing training. Since government funders of addiction treatments require that CBOs implement EBPs and they provide training resources, the quality, flexibility, and accessibility of the available training needs to be promoted throughout the addiction treatment network. Only 17% of CBOs reported that they used the SAMHSA-funded ATTC (Addiction Technology Transfer Center) training centers and 42% used SAMHSA technical assistance. Hence, federally funded resources for training were not always used.

  12. Sustained transfer of knowledge to practice in long-term care: facilitators and barriers of a mental health learning initiative.

    Science.gov (United States)

    Stolee, Paul; McAiney, Carrie A; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

    2009-01-01

    This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management support, particularly designation of time for PRP activities, development of PRP teams, and supportive learning strategies were significant factors affecting sustained knowledge transfer. Continuing education that is provided and evaluated on an ongoing basis, secures management commitment, is integrated within a broader system strategy, and provides on-the-job support has the greatest potential to affect care.

  13. Fruit and Vegetable Intakes of Preschool Children Are Associated With Feeding Practices Facilitating Internalization of Extrinsic Motivation.

    Science.gov (United States)

    Shim, Jae Eun; Kim, Juhee; Lee, Yoonna

    2016-05-01

    To examine the association between feeding practices and both fruit and vegetable intakes of preschoolers. Cross-sectional; data collected from 2009 to 2010. Child care centers enrolled in the cohort of the Synergistic Theory and Research on Obesity and Nutrition Group Kids program. Three hundred and sixteen mother-child dyads were recruited in the baseline survey as primary caregivers of children aged 2-5 years. Ten aspects of maternal feeding practices were measured using a Comprehensive Feeding Practices Questionnaire. The frequency of children's fruit and vegetable consumption was estimated by mothers. Spearman's rank order correlation and linear regression analysis between parental feeding practices and both fruit and vegetable consumption were adjusted for potential confounders. Pearson's correlation coefficients among 10 parental feeding practices were calculated. Children in the study consumed fruit 1.7 ± 0.9 times per day and vegetables 1.4 ± 0.8 times per day. Feeding practices of building a healthy home food environment and involvement were positively related and those of restriction for health were negatively related to children's vegetable consumption (P < .001); moreover, encouraging balance and variety and monitoring were positively related to children's fruit consumption (P < .001). The results of this study suggest that both fruit and vegetable intakes of preschool children are more likely to increase if parents employ feeding practices that encourage child autonomy, competence, and relatedness. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  14. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

    Science.gov (United States)

    Stoneman, Alice; Atkinson, David; Davey, Maureen; Marley, Julia V

    2014-10-07

    Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Well

  15. Leveraging Employer Practices in Global Regulatory Frameworks to Improve Employment Outcomes for People with Disabilities

    Directory of Open Access Journals (Sweden)

    Matthew C. Saleh

    2018-03-01

    Full Text Available Work is an important part of life, providing both economic security and a forum to contribute one’s talents and skills to society, thereby anchoring the individual in a social role. However, access to work is not equally available to people with disabilities globally. Regulatory environments that prohibit discrimination and support vocational training and educational opportunities constitute a critical first step toward economic independence. However, they have not proven sufficient in themselves. In this article, we aim to infuse deeper consideration of employer practice and demand-side policy reforms into global policy discussions of the right to work for people with disabilities. We begin by documenting the employment and economic disparities existing for people with disabilities globally, followed by a description of the international, regional, and local regulatory contexts aiming to improve labor market outcomes for people with disabilities. Next, we examine how policies can leverage employer interests to further address inequalities. We discuss employer policies and practices demonstrated in the research to facilitate recruitment, hiring, career development, retention, and meaningful workplace inclusion. The goal of the article is to synthesize existing international literature on employment rights for people with disabilities with the employer perspective.

  16. 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. © The Author(s) 2015.

  17. Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators.

    Science.gov (United States)

    Nadler, Michelle; Bainbridge, Daryl; Tomasone, Jennifer; Cheifetz, Oren; Juergens, Rosalyn A; Sussman, Jonathan

    2017-07-01

    Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a knowledge to action gap. We sought to determine OCP's knowledge, beliefs, barriers, and facilitators to exercise discussion. A survey was administered to OCPs at the cancer center in Hamilton, Ontario. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson's chi-squared test was used to examine select associations. There were 120 respondents (61% response rate) representing a diversity of professions. Approximately, 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada's Physical Activity guidelines were significantly more likely to identify correct guidelines (p = 0.023) and to report good knowledge on how to provide exercise counseling (p = 0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial. OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.

  18. When to invest in clinical guidelines for children? A practice oriented tool to facilitate decision-making.

    Science.gov (United States)

    Schalkers, Inge; Enthoven, Clair; Bunders, Joske; Dedding, Christine

    2017-02-01

    Children are not just small adults; they need to be diagnosed and treated in the context of their rapid growth and development. However, in guideline development, children's needs and interests are still overlooked. This study aims (1) to develop a tool that could stimulate guideline developers to take children into account on a more structural basis and (2) to explore how to facilitate children's participation in the process of guideline development. The method used was a three-phase multimethod sequential design. Professionals involved in guideline development participated in interviews (n = 12), filled in a questionnaire (n = 60) and/or participated in the focus group meeting (n = 11). This study results in a comprehensive understanding of the considerations that professionals take into account when deciding whether guidelines need to apply to children specifically. This resulted in a tool that assists guideline developers to make this assessment more accurately. It takes the form of a flowchart that guides users through a series of critical questions. The flowchart reminds guideline developers to consider children as a particular patient population when prioritizing and demarcating new guideline topics. It will help to ensure that clinical guidelines address children's unique health care needs and perspectives. Facilitating children's and parents' participation in the process of guideline development is perceived as challenging; nevertheless, it should be the next step in making paediatric guidelines more child-centred and family-centred. © 2016 John Wiley & Sons, Ltd.

  19. Internet research: improving traditional community analysis before launching a practice.

    Science.gov (United States)

    Barresi, B; Scott, C

    2000-01-01

    Optometric practice management experts have always recommended that optometrists thoroughly research the communities in which they are considering practicing. Until the Internet came along, demographic research was possible but often daunting. Today, say these authors, it's becoming quite a bit easier ... and they show us how.

  20. 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"…

  1. A therapist-focused knowledge translation intervention for improving patient adherence in musculoskeletal physiotherapy practice.

    Science.gov (United States)

    Babatunde, Folarin Omoniyi; MacDermid, Joy Christine; MacIntyre, Norma

    2017-01-01

    Nonadherence to treatment remains high among patients with musculoskeletal conditions with negative impact on the treatment outcomes, use of personal and cost of care. An active knowledge translation (KT) strategy may be an effective strategy to support practice change. The purpose of this study was to deliver a brief, interactive, multifaceted and targeted KT program to improve physiotherapist knowledge and confidence in performing adherence enhancing activities related to risk, barriers, assessment and interventions. We utilised a 2-phase approach in this KT project. Phase 1 involved the development of an adherence tool kit following a synthesis of the literature and an iterative process involving 47 end-users. Clinicians treating patients with musculoskeletal conditions were recruited from two Physiotherapy and Occupational therapy national conferences in Canada. The intervention, based on the acronym SIMPLE TIPS was tested on 51 physiotherapists in phase 2. A pre- and post-repeated measures design was used in Phase 2. Graham's knowledge-to-action cycle was used as the conceptual framework. Participants completed a pre-intervention assessment, took part in a 1-h educational session and completed a post-intervention assessment. A questionnaire was used to measure knowledge of evidence-based treatment adherence barriers, interventions and measures and confidence to perform evidence-based adherence practice activities. Data was analysed using descriptive statistics (frequency and percentage), Fisher's exact test and Wilcoxon Sign-Ranked tests. Barriers and facilitators of adherence were identified under three domains (therapist, patient, health system) in phase 1. Seventy percent of the participants completed the questionnaire. Results indicated that 46.8% of respondents explored barriers including the use of behaviour change strategies and 45.7% reported that they measured adherence but none reported the use of validated outcomes. A significant improvement in

  2. Improving transfusion practice in transfusion dependent thalassaemia patients

    Directory of Open Access Journals (Sweden)

    Chathupa Wickremaarachchi

    2017-10-01

    Full Text Available The aim of this study was to improve current transfusion practice in transfusiondependent thalassaemia patients by determining whether safe transition from triplewashed red cells (TWRC to leucodepleted red cells (LDRC, increasing transfusion rates, reducing the use of frusemide and creating uniform practice across patients is possible. In patients receiving regular transfusions (50, triple-washed red blood cells were changed to LDRC, transfusion rates were increased to 5 mL/kg/h (in line with the Cooley’s Foundation guidelines to a maximum of 300 mL/h and frusemide was ceased. Medical review occurred at completion of the transfusion. Of the 20 patients on TWRC, 18 were transitioned to leucodepleted red cells (90%. Recurrent allergic reactions in 2 patients required re-institution of TWRC. 7 of the 8 patients on regular frusemide ceased this practice with no documented transfusion-related fluid overload. One patient refused. Of the eligible 50 patients, 20 patients (40% were increased to the maximum transfusion rate of 300 mLs/h; 6 (12% increased rate but refused to go to the maximum; 9 (18% refused a change in practice and 15 (30% were already at the maximum rate. There was only one documented transfusion reaction (palpitations however this patient was able to tolerate a higher transfusion rate on subsequent transfusions. Thalassemia patients on TWRC were safely transitioned to LDRC. Transfusion rates were safely increased, with a calculated reduction in day-stay bed time of 17.45 h per month. This confirms a guideline of 5 mL/kg/h for transfusion-dependant thalassaemia patients with preserved cardiac function is well tolerated and may be translated to other centres worldwide.   本研究的目的是通过确定是否有可能进行从三洗红细胞(TWRC)到去白细胞红细胞(LDRC)的安全过渡,提高输血速率,减少速尿的使用,并在患者中实施统一规则,从而改进输血依赖型地中海贫血患者中

  3. 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.

  4. 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....

  5. Practical Implications for an Effective Radiology Residency Quality Improvement Program for Milestone Assessment.

    Science.gov (United States)

    Leddy, Rebecca; Lewis, Madelene; Ackerman, Susan; Hill, Jeanne; Thacker, Paul; Matheus, Maria; Tipnis, Sameer; Gordon, Leonie

    2017-01-01

    Utilization of a radiology resident-specific quality improvement (QI) program and curriculum based on the Accreditation Council for Graduate Medical Education (ACGME) milestones can enable a program's assessment of the systems-based practice component and prepare residents for QI implementation post graduation. This article outlines the development process, curriculum, QI committee formation, and resident QI project requirements of one institution's designated radiology resident QI program. A method of mapping the curriculum to the ACGME milestones and assessment of resident competence by postgraduate year level is provided. Sample projects, challenges to success, and lessons learned are also described. Survey data of current trainees and alumni about the program reveal that the majority of residents and alumni responders valued the QI curriculum and felt comfortable with principles and understanding of QI. The most highly valued aspect of the program was the utilization of a resident education committee. The majority of alumni responders felt the residency quality curriculum improved understanding of QI, assisted with preparation for the American Board of Radiology examination, and prepared them for QI in their careers. In addition to the survey results, outcomes of resident project completion and resident scholarly activity in QI are evidence of the success of this program. It is hoped that this description of our experiences with a radiology resident QI program, in accordance with the ACGME milestones, may facilitate the development of successful QI programs in other diagnostic radiology residencies. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  6. 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

    2017-10-01

    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.

  7. 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

  8. Health Psychology Bulletin : Improving Publication Practices to Accelerate Scientific Progress

    NARCIS (Netherlands)

    Peters, Gjalt-jorn Ygram; Kok, Gerjo; Crutzen, Rik; Sanderman, Robbert

    2017-01-01

    The instrument of scientific publishing, originally a necessary tool to enable development of a global science, has evolved relatively little in response to technological advances. Current scientific publishing practices incentivize a number of harmful approaches to research. Health Psychology

  9. Best practices and strategies for improving rail energy efficiency

    Science.gov (United States)

    2014-01-28

    In support of the FRA Energy, Environment, and Engine (E3) program, this study reviews and evaluates technology development opportunities, equipment upgrades, and best practices (BPs) of international and U.S. passenger and freight rail industry segm...

  10. evidence-based care: an innovation to improve nursing practice

    African Journals Online (AJOL)

    user

    2014-10-13

    Oct 13, 2014 ... of skills for critical thinking and reflective practice as well as promotion of ... consideration of the nature of such evidence. ... nursing has a strong tradition of focusing on various .... Cost/Benefit ratio (Tanner, 1987) taking into.

  11. Improving Mathematics Teaching as Deliberate Practice through Chinese Lesson Study

    Science.gov (United States)

    Huang, Rongjin; Prince, Kyle M.; Barlow, Angela T.

    2017-01-01

    This study examined how a ninth grade teacher improved an Algebra I lesson through a lesson study approach. We used multiple data sources to investigate the improvement of the lesson towards student-centered mathematics instruction, perceived benefits of the teacher, and factors associated with the improvement of teaching. The lesson group…

  12. The History and State of Neonatal Nursing Quality Improvement Practice and Education.

    Science.gov (United States)

    Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A

    2018-03-01

    Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

  13. Facilitating out-of-home caregiving through health information technology: survey of informal caregivers' current practices, interests, and perceived barriers.

    Science.gov (United States)

    Zulman, Donna M; Piette, John D; Jenchura, Emily C; Asch, Steven M; Rosland, Ann-Marie

    2013-07-10

    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. We sought to understand caregivers' use of, interest in, and perceived barriers to health information technology for out-of-home caregiving. 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. 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. Health information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care systems can address the mismatch between caregivers' interest

  14. 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

  15. In Vitro Maturation of a Humanized Shark VNAR Domain to Improve Its Biophysical Properties to Facilitate Clinical Development

    Directory of Open Access Journals (Sweden)

    John Steven

    2017-10-01

    Full Text Available Molecular engineering to increase the percentage identity to common human immunoglobulin sequences of non-human therapeutic antibodies and scaffolds has become standard practice. This strategy is often used to reduce undesirable immunogenic responses, accelerating the clinical development of candidate domains. The first humanized shark variable domain (VNAR was reported by Kovalenko and colleagues and used the anti-human serum albumin (HSA domain, clone E06, as a model to construct a number of humanized versions including huE06v1.10. This study extends this work by using huE06v1.10 as a template to isolate domains with improved biophysical properties and reduced antigenicity. Random mutagenesis was conducted on huE06v1.10 followed by refinement of clones through an off-rate ranking-based selection on target antigen. Many of these next-generation binders retained high affinity for target, together with good species cross-reactivity. Lead domains were assessed for any tendency to dimerize, tolerance to N- and C-terminal fusions, affinity, stability, and relative antigenicity in human dendritic cell assays. Functionality of candidate clones was verified in vivo through the extension of serum half-life in a typical drug format. From these analyses the domain, BA11, exhibited negligible antigenicity, high stability and high affinity for mouse, rat, and HSA. When these attributes were combined with demonstrable functionality in a rat model of PK, the BA11 clone was established as our clinical candidate.

  16. Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology.

    Science.gov (United States)

    Ariens, Lieneke Fm; Schussler-Raymakers, Florine Ml; Frima, Cynthia; Flinterman, Annebeth; Hamminga, Eefje; Arents, Bernd Wm; Bruijnzeel-Koomen, Carla Afm; de Bruin-Weller, Marjolein S; van Os-Medendorp, Harmieke

    2017-09-05

    The number of eHealth interventions in the management of chronic diseases such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. This study aimed to assess opinions of the most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. The perspectives of health care professionals and patients towards the implementation and use of eHealth services in daily practice were assessed by using a mixed method design. A cross-sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, Web-based monitoring, and Web-based self-management training among dermatologists and dermatology nurses. The perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. Health care professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers (statements with eHealth interventions included concerns about the availability (12/99, 12%) and allocation (14/99, 14%) of resources, financial aspects (26/99, 26%), reliability, security, and confidentially of the intervention itself (29/99, 29%), and the lack of education and training (6/99, 6%). Health care professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, some important barriers were identified that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology. ©Lieneke FM Ariens, Florine ML Schussler-Raymakers, Cynthia Frima, Annebeth Flinterman, Eefje Hamminga, Bernd WM Arents, Carla AFM Bruijnzeel

  17. Opportunities for Improving Army Modeling and Simulation Development: Making Fundamental Adjustments and Borrowing Commercial Business Practices

    National Research Council Canada - National Science Library

    Lee, John

    2000-01-01

    .... This paper briefly explores project management principles, leadership theory, and commercial business practices, suggesting improvements to the Army's modeling and simulation development process...

  18. Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research.

    Science.gov (United States)

    Garbutt, Jane M; Dodd, Sherry; Walling, Emily; Lee, Amanda A; Kulka, Katharine; Lobb, Rebecca

    2018-05-07

    In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2-3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer

  19. 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.

  20. Collaborative Practice Model: Improving the Delivery of Bad News.

    Science.gov (United States)

    Bowman, Pamela N; Slusser, Kim; Allen, Deborah

    2018-02-01

    Ideal bad news delivery requires skilled communication and team support. The literature has primarily focused on patient preferences, impact on care decisions, healthcare roles, and communication styles, without addressing systematic implementation. This article describes how an interdisciplinary team, led by advanced practice nurses, developed and implemented a collaborative practice model to deliver bad news on a unit that had struggled with inconsistencies. Using evidence-based practices, the authors explored current processes, role perceptions and expectations, and perceived barriers to developing the model, which is now the standard of care and an example of interprofessional team collaboration across the healthcare system. This model for delivering bad news can be easily adapted to meet the needs of other clinical units.
.

  1. 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 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...

  2. Facilitating Community-Based Exercise for People With Stroke: Cross-Sectional e-Survey of Physical Therapist Practice and Perceived Needs.

    Science.gov (United States)

    Lau, Carrie; Chitussi, Danielle; Elliot, Sarah; Giannone, Jennifer; McMahon, Mary-Katherine; Sibley, Kathryn M; Tee, Alda; Matthews, Julie; Salbach, Nancy M

    2016-04-01

    Educating people with stroke about community-based exercise programs (CBEPs) is a recommended practice that physical therapists are well positioned to implement. The aim of this study was to evaluate the provision of education about CBEPs to people with stroke, barriers to providing education, and preferences for resources to facilitate education among physical therapists in neurological practice. A cross-sectional e-survey of physical therapists treating adults with stroke in Ontario, Canada, was conducted. A link to the questionnaire was emailed to physical therapists in a provincial stroke network, a provincial physical therapy association, and on hospital and previous research lists. Responses from 186 physical therapists were analyzed. The percentage of respondents who reported providing CBEP education was 84.4%. Only 36.6% reported typically providing education to ≥7 out of 10 patients with stroke. Physical (90.5%) and preventative (84.6%) health benefits of exercise were most frequently discussed. Therapists reported most commonly delivering education at discharge (73.7%). Most frequently cited barriers to educating patients were a perceived lack of suitable programs (53.2%) and a lack of awareness of local CBEPs (23.8%). Lists of CBEPs (94.1%) or brochures (94.1%) were considered to be facilitators. The percentage of physical therapists providing CBEP education varied across acute, rehabilitation, and public outpatient settings. The percentage of physical therapists providing education may have been overestimated if respondents who deliver CBEP education were more likely to participate and if participants answered in a socially desirable way. Even though a high proportion of physical therapists provide CBEP education, education is not consistently delivered to the majority of patients poststroke. Although a CBEP list or brochure would facilitate education regarding existing CBEPs, efforts to implement CBEPs are needed to help overcome the lack of suitable

  3. INTEGRATED PRACTICE LEARNING MODEL TO IMPROVE WAITER/S’ COMPETENCY ON HOSPITALITY STUDY PROGRAM, POLITEKNIK NEGERI BALI

    Directory of Open Access Journals (Sweden)

    I Made Darma Oka

    2017-12-01

    Full Text Available Hospitality Study Program, Politeknik Negeri Bali (PNB, hadn’t implemented integrated learning practice optimally. The aim of this research was improving the learning process method as an integrated practice learning model involving three courses (Food Production, FB Service, English for Restaurant in the same topic. This study was conducted on the forth semester of Hotel Study Program as the sample used in this research. After the random sampling was selected two classes as research samples, those were IVA class as an experiment group and IVB class as a control. Thus the samples could be determined according to the number of students in each class as many as 26 people. The application of integrated practice learning had an effect on the achievement of student competency in waiter/s occupation at Hotel Studies Program. The result of statistical test showed that there was a significant difference of competency achievement between integrated learning practices with partial practice learning students groups. It’s suggested to the management Hospitality Study Program to encourage and to facilitate the lecturers especially of core subjects to apply integrated learning practices in order to achieve the competency.

  4. Partnering through Training and Practice to Achieve Performance Improvement

    Science.gov (United States)

    Lyons, Paul R.

    2010-01-01

    This article presents a partnership effort among managers, trainers, and employees to spring to life performance improvement using the performance templates (P-T) approach. P-T represents a process model as well as a method of training leading to performance improvement. Not only does it add to our repertoire of training and performance management…

  5. Heart Failure in Zambia: Evidence for Improving Clinical Practice.

    African Journals Online (AJOL)

    Esem

    reducing mortality, but also on improving quality of life. ... Heart Failure in Zambia: Evidence for Improving ... likely to be a result of “informed guess work” with ... balance. The study reported that a high serum urea and high creatinine were ...

  6. Practical methods to improve the development of computational software

    International Nuclear Information System (INIS)

    Osborne, A. G.; Harding, D. W.; Deinert, M. R.

    2013-01-01

    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)

  7. Seven unconfirmed ideas to improve future ICU practice

    NARCIS (Netherlands)

    Marini, John J.; de Backer, Daniel; Ince, Can; Singer, Mervyn; van Haren, Frank; Westphal, Martin; Wischmeyer, Paul

    2017-01-01

    With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by

  8. 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...

  9. Improving clinical practice through simulation: A case study of ...

    African Journals Online (AJOL)

    Acquisition of knowledge and skills by nursing students before real-life practice is a familiar nursing education challenge. The use of clinical simulation in nursing education provides many opportunities for students to learn and apply theoretical principles of nursing care in a safe environment. The purpose of this study was ...

  10. Seven unconfirmed ideas to improve future ICU practice

    NARCIS (Netherlands)

    Marini, J.J. (John J.); D. de Backer (Daniel); C. Ince (Can); Singer, M. (Mervyn); F.M.P. Van Haren; M. Westphal (Manfred); Wischmeyer, P. (Paul)

    2017-01-01

    textabstractWith imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or

  11. 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

  12. 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…

  13. Under surveillance: using cameras to improve care home practice.

    Science.gov (United States)

    Pearce, Lynne

    2017-05-03

    When the owner of Bramley Court in Birmingham mooted the idea of installing surveillance cameras inside the care home, manager and nurse Ann Willey was unenthusiastic. 'It felt like Big Brother was watching you,' she says. But then she considered how cameras might reduce the risk of poor practice and the potential benefits for vulnerable residents.

  14. 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…

  15. Continuous improvement in the Netherlands: A survey-based study into the current practices of continuous improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.; Schuring, R.W.

    2004-01-01

    Continuous Improvement is a well-known and consolidated concept in literature and practice and is considered vital in today¿s business environment. In 2003 a survey, as part of the international CINet survey, has been performed in the Netherlands in order to gain insight into the current practices

  16. 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

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

    NARCIS (Netherlands)

    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.

    2016-01-01

    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

  18. Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement

    OpenAIRE

    Mazzocato, Pamela; Stenfors-Hayes, Terese; von Thiele Schwarz, Ulrica; Hasson, Henna; Nystr?m, Monica Elisabeth

    2016-01-01

    OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. METHODS: We analysed 186 structured kaizen documents containing improvement suggest...

  19. Opportunities for practical improvements in the management of plant transients

    International Nuclear Information System (INIS)

    Zebroski, E.L.

    1984-01-01

    This chapter attempts to provide some perspectives on the steps involved in analyzing, evaluating, and implementing remedies for transients and for potentially severe events. The importance of improved response and control of plant transients is stressed. The main steps involved in the attainment of improved control of plant transients are listed. Topics considered include the acquisition of plant data, sensitivity and risk analysis, the options for improvements, the managerial role, and some priorities for data, analysis, and evaluation. The ten most frequent types of transients for pressurized water reactors (PWRs) and boiling water reactors (BWRs) are listed according to frequency of occurrence. It is concluded that the two main needs of transient management are to avoid preoccupation with end-of-spectrum accidents and to improve the rate of technology transfer from best-available analysis and implementation

  20. Improvement of practical Countermeasures: Preventive medication. Post-Chernobyl action

    International Nuclear Information System (INIS)

    Gerber, G.

    1991-01-01

    The Chernobyl accident, which occurred on 26 April 1986, presented major challenges to the European Community with respect to the practical and regulatory aspects of radiation protection, public information, trade, particularly in food, and international politics. The Chernobyl accident was also a major challenge to the international scientific community which had to evaluate rapidly the radiological consequences of the accident and advise on the introduction of any countermeasures. Prior to the accident at Chernobyl, countermeasures to reduce the consequences of radioactive contamination had been conceived largely in the context of relatively small accidental releases and for application over relatively small areas. Less consideration had been given to the practical implications of applying such measures in case of a large source term and a spread over a very large area

  1. 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.

  2. Facilitating organisational development using a group-based formative assessment and benchmarking method: design and implementation of the International Family Practice Maturity Matrix.

    NARCIS (Netherlands)

    Elwyn, G.; Bekkers, M.J.; Tapp, L.; Edwards, A.; Newcombe, R.; Eriksson, T.; Braspenning, J.C.C.; Kuch, C.; Adzic, Z.O.; Ayankogbe, O.; Cvetko, T.; Veld, K. in 't; Karotsis, A.; Kersnik, J.; Lefebvre, L.; Mecini, I.; Petricek, G.; Pisco, L.; Thesen, J.; Turon, J.M.; Rossen, E. van; Grol, R.P.T.M.

    2010-01-01

    INTRODUCTION: 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

  3. The utilisation of the performances of Neil Diamond for improving the classroom practices of educators: an educational appreciation

    Directory of Open Access Journals (Sweden)

    Jannie Pretorius

    2013-12-01

    Full Text Available In this research the 5D-framework of Appreciative Inquiry is used to investigate the possibility of applying the attributes and artistic strategies of the pop singer Neil Diamond for the improvement of classroom practices of educationalists. During the attendance of the performances of Diamond in 2011 in South Africa the writers and five other educationalists have identified five broad qualities and practices of Diamond. These may have application value in a school or university classroom: passionate enthusiasm, purposeful dedication, communication and interaction with the audience, refusing to conform/creating variation as well as good planning. This is the first time that the 5D-cycle has been used to study the possible utilisation of a live performance of a popular artist to facilitate the professional development of educationalists.

  4. Limited Amount of Formula May Facilitate Breastfeeding: Randomized, Controlled Trial to Compare Standard Clinical Practice versus Limited Supplemental Feeding.

    Directory of Open Access Journals (Sweden)

    Zbyněk Straňák

    Full Text Available Breastfeeding is known to reduce infant morbidity and improve well-being. Nevertheless, breastfeeding rates remain low despite public health efforts. Our study aims to investigate the effect of controlled limited formula usage during birth hospitalisation on breastfeeding, using the primary hypothesis that early limited formula feeds in infants with early weight loss will not adversely affect the rate of exclusive or any breastfeeding as measured at discharge, 3 and 6 months of age.We randomly assigned 104 healthy term infants, 24 to 48 hours old, with ≥ 5% loss of birth weight to controlled limited formula (CLF intervention (10 ml formula by syringe after each breastfeeding, discontinued at onset of lactation or control group (standard approach, SA. Groups were compared for demographic data and breastfeeding rates at discharge, 3 months and 6 months of age (p-values adjusted for multiple testing.Fifty newborns were analysed in CLF and 50 in SA group. There were no differences in demographic data or clinical characteristics between groups. We found no evidence of difference between treatment groups in the rates of exclusive as well as any breastfeeding at discharge (p-value 0.2 and >0.99 respectively, 3 months (p-value 0.12 and 0.10 and 6 months of infants' age (p-value 0.45 and 0.34 respectively. The percentage weight loss during hospitalisation was significantly higher in the SA group (7.3% in CLF group, 8.4% in SA group, p = 0.002.The study shows that controlled limited formula use does not have an adverse effect on rates of breastfeeding in the short and long term. Larger studies are needed to confirm a possible potential in controlled limited formula use to support establishing breastfeeding and to help to improve the rates of breastfeeding overall.ISRCTN registry ISRCTN61915183.

  5. 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. © The Author(s) 2016.

  6. 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.

  7. Practitioner-informed improvements to early childhood intervention performance checklists and practice guides

    Directory of Open Access Journals (Sweden)

    Carl J. Dunst

    2017-08-01

    Full Text Available Results from four early childhood practitioner field tests of performance checklists and early intervention practice guides are reported. Findings from the first field test were used to make changes and improvements in the checklists and practice guides evaluated in the second and third field tests, and findings from the latter two field tests were used to improve the checklist and practice guide evaluated in the fourth field test. Results indicated that changes made in response to practitioners’ suggestions and feedback were associated with (1 progressive increases in the practitioners’ social validity judgments of the checklists, practice guides, and checklist-practice guide correspondence, and (2 progressive decreases in the number of practitioner suggestions and feedback for improving the early intervention materials. The field-test research demonstrates the importance of practitioner input, suggestions, and feedback for improving the usefulness of early childhood intervention practices.

  8. 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.

  9. Moving improvement research closer to practice: the Researcher-in-Residence model

    Science.gov (United States)

    Marshall, Martin; Pagel, Christina; French, Catherine; Utley, Martin; Allwood, Dominique; Fulop, Naomi; Pope, Catherine; Banks, Victoria; Goldmann, Allan

    2014-01-01

    The traditional separation of the producers of research evidence in academia from the users of that evidence in healthcare organisations has not succeeded in closing the gap between what is known about the organisation and delivery of health services and what is actually done in practice. As a consequence, there is growing interest in alternative models of knowledge creation and mobilisation, ones which emphasise collaboration, active participation of all stakeholders, and a commitment to shared learning. Such models have robust historical, philosophical and methodological foundations but have not yet been embraced by many of the people working in the health sector. This paper presents an emerging model of participation, the Researcher-in-Residence. The model positions the researcher as a core member of a delivery team, actively negotiating a body of expertise which is different from, but complementary to, the expertise of managers and clinicians. Three examples of in-residence models are presented: an anthropologist working as a member of an executive team, operational researchers working in a front-line delivery team, and a Health Services Researcher working across an integrated care organisation. Each of these examples illustrates the contribution that an embedded researcher can make to a service-based team. They also highlight a number of unanswered questions about the model, including the required level of experience of the researcher and their areas of expertise, the institutional facilitators and barriers to embedding the model, and the risk that the independence of an embedded researcher might be compromised. The Researcher-in-Residence model has the potential to engage both academics and practitioners in the promotion of evidence-informed service improvement, but further evaluation is required before the model should be routinely used in practice. PMID:24894592

  10. Use of safety management practices for improving project performance.

    Science.gov (United States)

    Cheng, Eddie W L; Kelly, Stephen; Ryan, Neal

    2015-01-01

    Although site safety has long been a key research topic in the construction field, there is a lack of literature studying safety management practices (SMPs). The current research, therefore, aims to test the effect of SMPs on project performance. An empirical study was conducted in Hong Kong and the data collected were analysed with multiple regression analysis. Results suggest that 3 of the 15 SMPs, which were 'safety committee at project/site level', 'written safety policy', and 'safety training scheme' explained the variance in project performance significantly. Discussion about the impact of these three SMPs on construction was provided. Assuring safe construction should be an integral part of a construction project plan.

  11. A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs.

    Science.gov (United States)

    Simmons, Molly M; Gabrielian, Sonya; Byrne, Thomas; McCullough, Megan B; Smith, Jeffery L; Taylor, Thom J; O'Toole, Tom P; Kane, Vincent; Yakovchenko, Vera; McInnes, D Keith; Smelson, David A

    2017-04-04

    Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation

  12. adoption of improved aquaculture practices by shrimp farmers in ...

    African Journals Online (AJOL)

    Dr.Adesope

    ABSTRACT. Crop production in the Sahel is limited by nutrients availability. The study aimed to estimate the contribution of avifauna, crop rotation and trees to soil fertility and crop production improvement. Pot experiment was carried out with soils sampled in Faidherbia albida parklands in cotton production zone of West ...

  13. adoption of improved aquaculture practices by shrimp farmers

    African Journals Online (AJOL)

    Dr.Adesope

    use of check trays and adjustment of feed accordingly (95.0%), formation of ... Key words: adoption, improved aquaculture, shrimp farmers ... Brackish water shrimp farming is getting more attention because of high profitability ..... water and pond water whereas 52.5% of farmers did not observe the actual acclimatisation.

  14. Improving health worker performance : in search of promising practices

    NARCIS (Netherlands)

    Dieleman, M.A.; Harnmeijer, JW

    2006-01-01

    Qualified and motivated human resources (HR) are essential for adequate health service provision, but HR shortages have now reached critical levels in many resource-poor settings, especially in rural areas. Strategies improving performance are essential to address shortages of the existing

  15. 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,…

  16. Improving Teacher Practice: Experimental Evidence on Individualized Teacher Coaching

    Science.gov (United States)

    Kraft, Matthew A.; Blazar, David L.

    2013-01-01

    For over a century, school systems in the U.S. have attempted to improve instructional quality by investing in the education and training of their teachers. Today, over 90% of teachers report participating in some form of professional development (PD). Practitioners have responded to critiques of PD by re-envisioning it in the form of…

  17. 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…

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

    NARCIS (Netherlands)

    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.

    2016-01-01

    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

  19. Using data to improve medical practice by measuring processes and outcomes of care.

    Science.gov (United States)

    Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

    2000-12-01

    The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not

  20. Can a Community of Practice Improve Physical Therapists' Self-Perceived Practice in Developmental Coordination Disorder?

    Science.gov (United States)

    Camden, Chantal; Rivard, Lisa M; Hurtubise, Karen; Héguy, Léa; Berbari, Jade

    2017-07-01

    Communities of practice (CoPs) are useful knowledge translation (KT) strategies, but little is known about their impact on physical therapists' self-perceived practice. The impact of a CoP on physical therapists' self-perceived practice was evaluated, and factors influencing changes in self-perceived knowledge, skills, and practice related to developmental coordination disorder (DCD) were explored. An explanatory sequential mixed-methods design was used, guided by the Theory of Reasoned Action and Theory of Planned Behavior. Physical therapists participated in a DCD physical therapist CoP, which included 2 full-day, face-to-face workshops, with access to a 5-month online forum between the workshops, and completed questionnaires at 3 time-points: before the first workshop, before accessing the online forum, and following the second workshop. Measures completed before and after the CoP included closed-ended questions providing global scores on therapists' self-perceived knowledge, skills, and practice. Physical therapists' sociodemographic characteristics, information-seeking style, use of the online forum, and behavioral change goals were also collected. Paired t-tests, ANCOVAs, and linear regression models were used to analyze the data. Forty-one physical therapists completed all questionnaires. Their self-perceived knowledge, skills, and practice change scores were significantly higher (+0.47, +1.23, and +2.61, respectively; P behavioral changes influence patient outcomes. © 2017 American Physical Therapy Association

  1. How do technical improvements change radiographers' practice – A practice theory perspective

    International Nuclear Information System (INIS)

    Lundvall, L.-L.; Abrandt-Dahlgren, M.; Wirell, S.

    2015-01-01

    Introduction: The two plane imaging techniques are gradually being replaced by multidimensional imaging. How it affects radiographers' professional practice has not been investigated. Aim: To explore how technical development affects the relations between different actors and their actions in the practice of Computer Tomography. Method: A qualitative design with data collection by open interviews (n = 8) and open observations (n = 10) of radiographers during their work with Computer Tomography. Data was first analyzed inductively resulting in seven codes. Secondly abduction was carried out by interpreting the content in the codes with a practice theory. This resulted in four themes. Result: First theme: Changed materiality makes the practical action easier. The actual image production has become practically easier. Second theme: Changed machines cause conflict between the arrangements of the work and the patients' needs. The time for the machine to carry out image production is easy to foresee, but information about the patient's individual status and needs is missing and this leads to difficulties in giving individual planned care. Third theme: Changing materiality prefigure learning. The different apparatus in use and the continuously changing methods of image production is co-constitutive of the practitioners' activities and learning. Fourth theme: Radiography is arranged for patient safety in relation to radiation doses and medical security risks. But the radiographers, who meet the patients, have to check the accuracy of the planned examination in relation to the clinical observed information about patient safety risks with the examination. - Highlights: • The arrangements of CT practice make it difficult to achieve individual planned care. • Continuously learning has become an essential part of radiographers' practice. • Radiographers' planning of each examination is important for secure patient safety

  2. 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.

  3. Improving adherence to hand hygiene practice: a multidisciplinary approach.

    OpenAIRE

    Pittet, D.

    2001-01-01

    Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate han...

  4. Improvement of Pediatric Drug Development: Regulatory and Practical Frameworks.

    Science.gov (United States)

    Tsukamoto, Katusra; Carroll, Kelly A; Onishi, Taku; Matsumaru, Naoki; Brasseur, Daniel; Nakamura, Hidefumi

    2016-03-01

    A dearth in pediatric drug development often leaves pediatricians with no alternative but to prescribe unlicensed or off-label drugs with a resultant increased risk of adverse events. We present the current status of pediatric drug development and, based on our data analysis, clarify the problems in this area. Further action is proposed to improve the drug development that has pediatric therapeutic orphan status. We analyzed all Phase II/III and Phase III trials in ClinicalTrials.gov that only included pediatric participants (Performance index, an indicator of pediatric drug development, was calculated by dividing the annual number of pediatric clinical trials by million pediatric populations acquired from Census.gov. Effects of the 2 Japanese premiums introduced in 2010, for the enhancement of pediatric drug development, were analyzed by comparing mean performance index prepremiums (2006-2009) and postpremiums (2010-2014) among Japan, the European Union, and the United States. The European Union Clinical Trials Register and published reports from the European Medicines Agency were also surveyed to investigate the Paediatric Committee effect on pediatric clinical trials in the European Union. Mean difference of the performance index in prepremiums and postpremiums between Japan and the European Union were 0.296 (P 15% after 2008. Recruitment and ethical obstacles make conducting pediatric clinical trials challenging. An improved operational framework for conducting clinical trials should mirror the ever-improving regulatory framework that incentivizes investment in pediatric clinical trials. Technological approaches, enhancements in electronic medical record systems, and community approaches that actively incorporate input from physicians, researchers, and patients could offer a sustainable solution to recruitment of pediatric study participants. The key therefore is to improve pediatric pharmacotherapy collaboration among industry, government, academia, and

  5. 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.

  6. Promoting Physicians' Self-Assessment and Quality Improvement: The ABIM Diabetes Practice Improvement Module

    Science.gov (United States)

    Holmboe, Eric S.; Meehan, Thomas P.; Lynn, Lorna; Doyle, Paula; Sherwin, Tierney; Duffy, F. Daniel

    2006-01-01

    Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and recertification must be based on an assessment of performance in practice as well as an examination of medical knowledge. Physician self-assessment of practice performance is proposed as one method that certification boards may use to evaluate competence…

  7. 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. © 2014 Society for Risk Analysis.

  8. 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.

  9. 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.

  10. 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.

  11. Constraints to adoption of improved hatchery management practices among catfish farmers in Lagos State

    Directory of Open Access Journals (Sweden)

    Oghenetejiri DIGUN-AWETO

    2017-11-01

    Full Text Available Aquaculture has shown capacities to serve as means of livelihood, improve living standards, provide employment and generate foreign exchange in many countries. Recent investment in Nigerian aquaculture has been target towards catfish farming. However, small quantity and poor quality fish seeds are one of the problems limiting production. Consequently, Lagos State government introduced improved breeding and hatchery management practices as a package to fish hatchery operators with the aim of improving fish seed quantity and quality in the state. Nevertheless, the dissemination of the package has not yielded the desired result. This study assessed the constraints to adoption of improved hatchery management practices among catfish farmers in Lagos State. With structured questionnaire, 150 catfish farmers, randomly selected from 12 local government areas spread across Lagos State were interviewed. Despite that majority of the respondents strongly agreed or agreed to the fact that improved hatchery management practices have positive impacts on breeding, hatching, and survival of fish fry, majority of them affirmed that high cost of acquisition, high technicality in using the improved management practices as well as inadequate information about the improved management practices are primary reasons for non-adoption of some of the improved practices. Some of the limitations faced by the respondents include insufficient capital, lack of technical expertise to use the methods adequately, non-availability of inputs, expensive cost of facility maintenance, poor information dissemination and insufficient technical support from the extension agents and the state government. Although the adoption of improved practices has not been total, due to these constraints, the farmers’ knowledge of the improved hatchery management practices is broad. There is a need for the state government to subsidize the improved hatchery technologies and inputs, in addition to

  12. 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.

  13. 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

  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. Motivational Interviewing: An Evidence-Based Practice for Improving Student Practice Skills

    Science.gov (United States)

    Hohman, Melinda; Pierce, Paloma; Barnett, Elizabeth

    2015-01-01

    Motivational interviewing (MI) is an evidence-based communication method to assist clients in resolving their ambivalence regarding change. With a school emphasis on evidence-based practice and learning outcomes, a social work department implemented a semester-long course on MI. The purpose of this study was to determine baseline skills and…

  16. Protein crystal growth on board Shenzhou 3: a concerted effort improves crystal diffraction quality and facilitates structure determination

    International Nuclear Information System (INIS)

    Han, Y.; Cang, H.-X.; Zhou, J.-X.; Wang, Y.-P.; Bi, R.-C.; Colelesage, J.; Delbaere, L.T.J.; Nahoum, V.; Shi, R.; Zhou, M.; Zhu, D.-W.; Lin, S.-X.

    2004-01-01

    The crystallization of 16 proteins was carried out using 60 wells on board Shenzhou 3 in 2002. Although the mission was only 7 days, careful and concerted planning at all stages made it possible to obtain crystals of improved quality compared to their ground controls for some of the proteins. Significantly improved resolutions were obtained from diffracted crystals of 4 proteins. A complete data set from a space crystal of the PEP carboxykinase yielded significantly higher resolution (1.46 A vs. 1.87 A), I/sigma (22.4 vs. 15.5), and a lower average temperature factor (29.2 A 2 vs. 42.9 A 2 ) than the best ground-based control crystal. The 3-D structure of the enzyme is well improved with significant ligand density. It has been postulated that the reduced convection and absence of macromolecule sedimentation under microgravity have advantages/benefits for protein crystal growth. Improvements in experimental design for protein crystal growth in microgravity are ongoing

  17. 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

  18. Understanding Seasonal Changes to Improve Good Practices in Livestock Management

    Directory of Open Access Journals (Sweden)

    Francesco Martelli

    2018-06-01

    Full Text Available Background and Aim: Food quality control techniques based on process control methods are increasingly adopted in livestock production systems to fulfill increasing market's expectations toward competitiveness and issues linked to One Health pillars (environment, animal, and human health. Control Charts allow monitoring and systematic investigation of sources of variability in dairy production parameters. These parameters, however, may be affected by seasonal variations that render impractical, biased or ineffective the use statistical control charts. A possible approach to this problem is to adapt seasonal adjustment methods used for the analysis of economic and demographic seasonal time series. The aim of the present work is to evaluate a seasonal decomposition technique called X-11 on milk parameters routinely collected also in small farms (fat, protein, and lactose content, solids-not-fat, freezing point, somatic cell count, total bacterial count and to test the efficacy of different seasonal removal methods to improve the effectiveness of statistical control charting.Method: Data collection was carried out for 3 years on routinely monitored bulk tank milk parameters of a small farm. Seasonality presence was statistically assessed on milk parameters and, for those parameters showing seasonality, control charts for individuals were applied on raw data, on X-11 seasonally adjusted data, and on data smoothed with a symmetric moving average filter. Correlation of seasonally influenced parameters with daily mean temperature was investigated.Results: Presence of seasonality in milk parameters was statistically assessed for fat, protein, and solids-non-fat components. The X-11 seasonally-adjusted control charts showed a reduced number of violations (false alarms with respect to non-seasonally adjusted control chart (from 5 to 1 violation for fat, from 17 to 1 violation for protein, and from 9 to none violation for solids-non-fat.. This result was

  19. Cervical cancer screening in adolescents: an evidence-based internet education program for practice improvement among advanced practice nurses.

    Science.gov (United States)

    Choma, Kim; McKeever, Amy E

    2015-02-01

    The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.

  20. Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

    Science.gov (United States)

    Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

    2018-05-25

    Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

  1. EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF IN IMPROVING SENSORIMOTOR FUNCTION IN PATIENTS WITH DIABETIC NEUROPATHY AFFECTING LOWER LIMBS

    Directory of Open Access Journals (Sweden)

    Kamaljeet Singh

    2016-06-01

    Full Text Available Background: Diabetic Mellitus is a group of metabolic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Distal Sensorimotor Polyneuropathy is the most common complication of diabetes which mainly affects the lower limbs. Most of the studies aimed at individually increasing muscle strength or sensation but not on overall performance enhancements of the diabetic lower limbs. The evidence supporting the effectiveness of PNF in diabetic neuropathic patients is scarce. Methods: 30 patients, with age between 50 to 70 years, diagnosed with Diabetic Sensorimotor Polyneuropathy (DSP were selected from the department of Medicine and department of Neurosurgery Guru Gobind Singh Medical College and Hospital. Patients were evaluated at the beginning and at the end of the intervention using Diabetic Neuropathy Examination scores. Patients received 3 sets of exercises one hour/day with 3 days/week for 3 months. Each set of exercises consists of 5 repetitions of PNF patterns (alternate day and techniques. Results: D1 & D2 patterns of PNF are effective in improving both motor and sensory functions of diabetic patients with neuropathic symptoms. Improvement in muscle strength, reflex and sensations occurred to a greater extent after the treatment of three months in these subjects. This study shows that PNF patterns were effective at enhancing sensorimotor problems of lower limbs. Conclusion: This study concluded that PNF is found to be effective in improving sensorimotor functions of diabetic neuropathic patients affecting lower limbs.

  2. Improving blood transfusion practice by regular education in the United Arab Emirates.

    Science.gov (United States)

    Sajwani, F H

    2012-07-01

    A cross-match to transfused unit ratio of less than 2.0 is frequently used to assess performance in many hospital blood banks. This brief report was initiated to evaluate the practice at a local hospital and to emphasize the importance of regular educational sessions to improve blood transfusion practice. Retrospective data on cross-match : transfused (C : T) ratio of all departments was collected and educational sessions were given to improve practice. Thereafter, a new set of data was collected and change in practice was assessed. Initial data showed total (C : T) ratio of 1.95. After medical staff education, analysis showed clinically significant improvement in blood utilization practice with a (C : T) ratio of 1.60. This brief report indicates the importance of regular physician education, the potential role of blood transfusion committee, and the need to implement clear guidelines for blood transfusion. © 2012 American Association of Blood Banks.

  3. Improving implementation of eMental health for mood disorders in routine practice : Systematic review of barriers and facilitating factors

    NARCIS (Netherlands)

    Vis, Christiaan; Mol, Mayke; Kleiboer, Annet; Bührmann, Leah; Finch, Tracy; Smit, Jan; Riper, Heleen

    2018-01-01

    BACKGROUND: Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care

  4. 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

  5. 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

  6. Improving operational performance by influencing shopfloor behavior via performance management practices

    NARCIS (Netherlands)

    de Leeuw, S.L.J.M.; van den Berg, J.P.

    2011-01-01

    It is generally believed that companies applying performance management practices outperform those that do not measure and manage their performance. Studies examining the link between performance management and performance improvement implicitly assume that performance management affects behavior of

  7. Report: EPA Needs to Improve Management Practices to Ensure a Successful Customer Technology Solutions Project

    Science.gov (United States)

    Report #10-P-0194, August 23, 2010. Although EPA indicated it could avoid spending more than $115.4 million over 8.5 years by consolidating the desktop computing environment, improved management practices are needed.

  8. Study on improving rail energy efficiency (E2) : best practices and strategies

    Science.gov (United States)

    2015-03-23

    A recent Volpe Center report [1] for the Federal Railroad Administrations (FRA) Rail Energy, Environment, and Engine (E3) Technology research and development program reviewed rail industry best practices (BPs) and strategies for improving energy e...

  9. Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement.

    Science.gov (United States)

    MacLennan, Sara J; MacLennan, Steven; Bex, Axel; Catto, James W F; De Santis, Maria; Glaser, Adam W; Ljungberg, Borje; N'Dow, James; Plass, Karin; Trapero-Bertran, Marta; Van Poppel, Hendrik; Wright, Penny; Giles, Rachel H

    2017-08-01

    Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  10. Implementation of a virtual learning from discrepancy meeting: a method to improve attendance and facilitate shared learning from radiological error

    International Nuclear Information System (INIS)

    Carlton Jones, A.L.; Roddie, M.E.

    2016-01-01

    Aim: To assess the effect on radiologist participation in learning from discrepancy meetings (LDMs) in a multisite radiology department by establishing virtual LDMs using OsiriX (Pixmeo). Materials and methods: Sets of anonymised discrepancy cases were added to an OsiriX database available for viewing on iMacs in all radiology reporting rooms. Radiologists were given a 3-week period to review the cases and send their feedback to the LDM convenor. Group learning points and consensus feedback were added to each case before it was moved to a permanent digital LDM library. Participation was recorded and compared with that from the previous 4 years of conventional LDMs. Radiologist feedback comparing the two types of LDM was collected using an anonymous online questionnaire. Results: Numbers of radiologists attending increased significantly from a mean of 12±2.9 for the conventional LDM to 32.7±7 for the virtual LDM (p<0.0001) and the percentage of radiologists achieving the UK standard of participation in at least 50% of LDMs annually rose from an average of 18% to 68%. The number of cases submitted per meeting rose significantly from an average of 11.1±3 for conventional LDMs to 15.9±5.9 for virtual LDMs (p<0.0097). Analysis of 35 returned questionnaires showed that radiologists welcomed being able to review cases at a time and place of their choosing and at their own pace. Conclusion: Introduction of virtual LDMs in a multisite radiology department improved radiologist participation in shared learning from radiological discrepancy and increased the number of submitted cases. - Highlights: • Learning from error is an important way to improve patient safety. • Consultant attendance at learning from discrepancy meetings (LDMs) was persistently poor in a large, multisite Trust. • Introduction of a ‘virtual’ LDM improved consultant participation and increased the number of cases submitted.

  11. Improving hepatitis B birth dose in rural Lao People's Democratic Republic through the use of mobile phones to facilitate communication.

    Science.gov (United States)

    Xeuatvongsa, Anonh; Datta, Siddhartha Sankar; Moturi, Edna; Wannemuehler, Kathleen; Philakong, Phanmanisone; Vongxay, Viengnakhone; Vilayvone, Vansy; Patel, Minal K

    2016-11-11

    Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic to prevent perinatal hepatitis B virus transmission in 2008; high coverage is challenging since only 38% of births occur in a health facility. Healthcare workers report being unaware of home births and thus unable to conduct timely postnatal care (PNC) home visits. A quasi-experimental pilot study was conducted wherein mobile phones and phone credits were provided to village health volunteers (VHV) and healthcare workers (HCWs) to assess whether this could improve HepB-BD administration, as well as birth notification and increase home visits. From April to September 2014, VHVs and HCWs in four selected intervention districts were trained, supervised, received outreach per diem for conducting home visits, and received mobile phones and phone credits. In three comparison districts, VHVs and HCWs were trained, supervised, and received outreach per diem for conducting home visits. A post-study survey compared HepB-BD coverage among children born during the study and children born one year before. HCWs and VHVs were interviewed about the study. Among intervention districts, 463 study children and 406 pre-study children were enrolled in the survey; in comparison districts, 347 study children and 309 pre-study children were enrolled. In both arms, there was a significant improvement in the proportion of children reportedly receiving a PNC home visit (intervention p<0.0001, comparison p=0.04). The median difference in village level HepB-BD coverage (study cohort minus pre-study cohort), was 57% (interquartile range [IQR] 32-88%, p<0.0001) in intervention districts, compared with 20% (IQR 0-50%, p<0.0001) in comparison districts. The improvement in the intervention districts was greater than in the comparison districts (p=0.0009). Our findings suggest that the provision of phones and phone credits might be one important factor for increasing coverage. However, reasons for improvement

  12. 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…

  13. 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…

  14. Leadership for School Improvement: Exploring Factors and Practices in the Process of Curriculum Change

    Science.gov (United States)

    Ho, Dora Choi Wa

    2010-01-01

    Research Findings: This article describes research into leadership practice for school improvement in Hong Kong preschools at a time when there was a move toward increased accountability. Two schools were selected for study, both of which were rated as excellent in the quality assurance inspections of the Education Bureau. Leadership practice for…

  15. Greener on the Other Side: Cultivating Community and Improvement through Sustainability Practices

    Science.gov (United States)

    Sterrett, William L.; Kensler, Lisa; McKey, Tania

    2016-01-01

    Sustainability practices that lead to greener schools are often overlooked in leadership preparation programs and in school improvement efforts. An urban middle school principal recognizes the potential to build community, foster a healthy learning environment, and redefine her school through focusing on sustainability practices in a collaborative…

  16. Improving evidence based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (BRIDGE project).

    Science.gov (United States)

    Hickman, Louise D; DiGiacomo, Michelle; Phillips, Jane; Rao, Angela; Newton, Phillip J; Jackson, Debra; Ferguson, Caleb

    2018-04-01

    The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment. To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities. Systematic review that conforms to the PRISMA statement. Master's Nursing programs that include elements of a capstone project within a university setting. MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English. Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements. There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice. Copyright © 2018. Published by Elsevier Ltd.

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

    Science.gov (United States)

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

    2014-06-01

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

  18. Consultants Group Meeting on Improvement of Codling Moth SIT to Facilitate Expansion of Field Application. Working Material

    International Nuclear Information System (INIS)

    2000-01-01

    SIT currently has only limited application in Lepidoptera control. Prospects for improvement of the technique however are good, and the species with the best immediate prospect is the codling moth (Cydia pomonella). Codling moth is the key pest of most apple and pear orchards in the world and the cause of intensive insecticide use during the whole fruiting season. As a result of increasing development of insecticide resistance in codling moth, the banning of essential insecticides, as well as public concerns about the environment and food safety, the Subprogramme continues to receive enquiries from a number of countries as to the applicability of SIT as a suppression method for this species. SIT is currently used as part of areawide codling moth control in British Columbia, Canada and in the border area with Washington State, USA. The SIT can be integrated with a number of other techniques, including mating disruption as in the trial in Washington State. The Canadian programme is co-funded by growers, local and national government. The programme is proving effective at controlling the moth in an environmental friendly way. Currently the programme is only financially attractive with government subsidy although in view of the replacement of insecticide use with SIT, growers will be able to access the rapidly growing and very lucrative market for organic fruit. A new CRP is proposed with the objective of improving the efficiency of all stages of the SIT for codling moth. This will cover reducing the cost of production, product and process quality control, genetic sexing, strain compatibility and field monitoring among others.

  19. 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.

  20. 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.

  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.

    2015-01-01

    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. PMID:25949758

  2. Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

    Science.gov (United States)

    Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

    2002-12-01

    Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

  3. Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

    Science.gov (United States)

    Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

    2002-01-01

    BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

  4. Benchmarking, benchmarks, or best practices? Applying quality improvement principles to decrease surgical turnaround time.

    Science.gov (United States)

    Mitchell, L

    1996-01-01

    The processes of benchmarking, benchmark data comparative analysis, and study of best practices are distinctly different. The study of best practices is explained with an example based on the Arthur Andersen & Co. 1992 "Study of Best Practices in Ambulatory Surgery". The results of a national best practices study in ambulatory surgery were used to provide our quality improvement team with the goal of improving the turnaround time between surgical cases. The team used a seven-step quality improvement problem-solving process to improve the surgical turnaround time. The national benchmark for turnaround times between surgical cases in 1992 was 13.5 minutes. The initial turnaround time at St. Joseph's Medical Center was 19.9 minutes. After the team implemented solutions, the time was reduced to an average of 16.3 minutes, an 18% improvement. Cost-benefit analysis showed a potential enhanced revenue of approximately $300,000, or a potential savings of $10,119. Applying quality improvement principles to benchmarking, benchmarks, or best practices can improve process performance. Understanding which form of benchmarking the institution wishes to embark on will help focus a team and use appropriate resources. Communicating with professional organizations that have experience in benchmarking will save time and money and help achieve the desired results.

  5. Reversible dual inhibitor against G9a and DNMT1 improves human iPSC derivation enhancing MET and facilitating transcription factor engagement to the genome.

    Directory of Open Access Journals (Sweden)

    Juan Roberto Rodriguez-Madoz

    Full Text Available The combination of defined factors with small molecules targeting epigenetic factors is a strategy that has been shown to enhance optimal derivation of iPSCs and could be used for disease modelling, high throughput screenings and/or regenerative medicine applications. In this study, we showed that a new first-in-class reversible dual G9a/DNMT1 inhibitor compound (CM272 improves the efficiency of human cell reprogramming and iPSC generation from primary cells of healthy donors and patient samples, using both integrative and non-integrative methods. Moreover, CM272 facilitates the generation of human iPSC with only two factors allowing the removal of the most potent oncogenic factor cMYC. Furthermore, we demonstrated that mechanistically, treatment with CM272 induces heterochromatin relaxation, facilitates the engagement of OCT4 and SOX2 transcription factors to OSKM refractory binding regions that are required for iPSC establishment, and enhances mesenchymal to epithelial transition during the early phase of cell reprogramming. Thus, the use of this new G9a/DNMT reversible dual inhibitor compound may represent an interesting alternative for improving cell reprogramming and human iPSC derivation for many different applications while providing interesting insights into reprogramming mechanisms.

  6. Reversible dual inhibitor against G9a and DNMT1 improves human iPSC derivation enhancing MET and facilitating transcription factor engagement to the genome.

    Science.gov (United States)

    Rodriguez-Madoz, Juan Roberto; San Jose-Eneriz, Edurne; Rabal, Obdulia; Zapata-Linares, Natalia; Miranda, Estibaliz; Rodriguez, Saray; Porciuncula, Angelo; Vilas-Zornoza, Amaia; Garate, Leire; Segura, Victor; Guruceaga, Elizabeth; Agirre, Xabier; Oyarzabal, Julen; Prosper, Felipe

    2017-01-01

    The combination of defined factors with small molecules targeting epigenetic factors is a strategy that has been shown to enhance optimal derivation of iPSCs and could be used for disease modelling, high throughput screenings and/or regenerative medicine applications. In this study, we showed that a new first-in-class reversible dual G9a/DNMT1 inhibitor compound (CM272) improves the efficiency of human cell reprogramming and iPSC generation from primary cells of healthy donors and patient samples, using both integrative and non-integrative methods. Moreover, CM272 facilitates the generation of human iPSC with only two factors allowing the removal of the most potent oncogenic factor cMYC. Furthermore, we demonstrated that mechanistically, treatment with CM272 induces heterochromatin relaxation, facilitates the engagement of OCT4 and SOX2 transcription factors to OSKM refractory binding regions that are required for iPSC establishment, and enhances mesenchymal to epithelial transition during the early phase of cell reprogramming. Thus, the use of this new G9a/DNMT reversible dual inhibitor compound may represent an interesting alternative for improving cell reprogramming and human iPSC derivation for many different applications while providing interesting insights into reprogramming mechanisms.

  7. Improvements of the ALICE high level trigger for LHC Run 2 to facilitate online reconstruction, QA, and calibration

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, David [Frankfurt Institute for Advanced Studies, Frankfurt (Germany); Collaboration: ALICE-Collaboration

    2016-07-01

    ALICE is one of the four major experiments at the Large Hadron Collider (LHC) at CERN. Its main goal is the study of matter under extreme pressure and temperature as produced in heavy ion collisions at LHC. The ALICE High Level Trigger (HLT) is an online compute farm of around 200 nodes that performs a real time event reconstruction of the data delivered by the ALICE detectors. The HLT employs a fast FPGA based cluster finder algorithm as well as a GPU based track reconstruction algorithm and it is designed to process the maximum data rate expected from the ALICE detectors in real time. We present new features of the HLT for LHC Run 2 that started in 2015. A new fast standalone track reconstruction algorithm for the Inner Tracking System (ITS) enables the HLT to compute and report to LHC the luminous region of the interactions in real time. We employ a new dynamically reconfigurable histogram component that allows the visualization of characteristics of the online reconstruction using the full set of events measured by the detectors. This improves our monitoring and QA capabilities. During Run 2, we plan to deploy online calibration, starting with the calibration of the TPC (Time Projection Chamber) detector's drift time. First proof of concept tests were successfully performed using data-replay on our development cluster and during the heavy ion period at the end of 2015.

  8. Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives.

    Science.gov (United States)

    Kontio, Raija; Joffe, Grigori; Putkonen, Hanna; Kuosmanen, Lauri; Hane, Kimmo; Holi, Matti; Välimäki, Maritta

    2012-01-01

    This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development. © 2011 Wiley Periodicals, Inc.

  9. 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.

  10. 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.

  11. Collaborative Practice Improvement for Childhood Obesity in Rural Clinics: The Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP)

    OpenAIRE

    Shaikh, U; Nettiksimmons, J; Joseph, JG; Tancredi, D; Romano, PS

    2014-01-01

    © 2013 by the American College of Medical Quality. This study assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. A total of 7 primary care clinics in rural California included in the Healthy Eating Active Living TeleHealth Community of Practice and 288 children seen in these clinics for well-child care participated in this prospective observational pre-post study. Cl...

  12. Examining Ratings on the VAL-ED Evaluation Instrument of Principals to Improve Instructional Leadership Practices

    Science.gov (United States)

    Babin, Erin Pevey

    2017-01-01

    The biggest challenge facing American public schools today is increasing student achievement, and this depends on the educational system's ability to improve the quality of instruction. Principals play a key role in improving the quality of instruction on their campus through the instructional leadership practices they engage in on a daily basis.…

  13. Evaluating an Art-Based Intervention to Improve Practicing Nurses' Observation, Description, and Problem Identification Skills.

    Science.gov (United States)

    Nease, Beth M; Haney, Tina S

    Astute observation, description, and problem identification skills provide the underpinning for nursing assessment, surveillance, and prevention of failure to rescue events. Art-based education has been effective in nursing schools for improving observation, description, and problem identification. The authors describe a randomized controlled pilot study testing the effectiveness of an art-based educational intervention aimed at improving these skills in practicing nurses.

  14. 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

  15. 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…

  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...

  17. 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

  18. A conceptual model of physician work intensity: guidance for evaluating policies and practices to improve health care delivery.

    Science.gov (United States)

    Horner, Ronnie D; Matthews, Gerald; Yi, Michael S

    2012-08-01

    Physician work intensity, although a major factor in determining the payment for medical services, may potentially affect patient health outcomes including quality of care and patient safety, and has implications for the redesign of medical practice to improve health care delivery. However, to date, there has been minimal research regarding the relationship between physician work intensity and either patient outcomes or the organization and management of medical practices. A theoretical model on physician work intensity will provide useful guidance to such inquiries. To describe an initial conceptual model to facilitate further investigations of physician work intensity. A conceptual model of physician work intensity is described using as its theoretical base human performance science relating to work intensity. For each of the theoretical components, we present relevant empirical evidence derived from a review of the current literature. The proposed model specifies that the level of work intensity experienced by a physician is a consequence of the physician performing the set of tasks (ie, demands) relating to a medical service. It is conceptualized that each medical service has an inherent level of intensity that is experienced by a physician as a function of factors relating to the physician, patient, and medical practice environment. The proposed conceptual model provides guidance to researchers as to the factors to consider in studies of how physician work intensity impacts patient health outcomes and how work intensity may be affected by proposed policies and approaches to health care delivery.

  19. Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

    OpenAIRE

    Clark, Catharine H; Aird, Edwin GA; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia AD; Thomas, Russell AS; Venables, Karen; Thwaites, David I

    2015-01-01

    Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK...

  20. Integrating Quality and Safety Competencies to Improve Outcomes: Application in Infusion Therapy Practice.

    Science.gov (United States)

    Sherwood, Gwen; Nickel, Barbara

    Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.

  1. 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

  2. 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.

  3. 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

  4. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

    NARCIS (Netherlands)

    Flottorp, S.A.; Oxman, A.D.; Krause, J.; Musila, N.R.; Wensing, M.; Godycki-Cwirko, M.; Baker, R.; Eccles, M.P.

    2013-01-01

    BACKGROUND: Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive,

  5. Improving outcomes for patients with type 2 diabetes using general practice networks: a quality improvement project in east London.

    Science.gov (United States)

    Hull, Sally; Chowdhury, Tahseen A; Mathur, Rohini; Robson, John

    2014-02-01

    Structured diabetes care can improve outcomes and reduce risk of complications, but improving care in a deprived, ethnically diverse area can prove challenging. This report evaluates a system change to enhance diabetes care delivery in a primary care setting. All 35 practices in one inner London Primary Care Trust were geographically grouped into eight networks of four to five practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary team developed a 'care package' for type 2 diabetes management, with financial incentives based on network achievement of targets. Monthly electronic performance dashboards enabled networks to track and improve performance. Network multidisciplinary team meetings including the diabetic specialist team supported case management and education. Key measures for improvement included the number of diabetes care plans completed, proportion of patients attending for digital retinal screen and proportions of patients achieving a number of biomedical indices (blood pressure, cholesterol, glycated haemoglobin). Between 2009 and 2012, completed care plans rose from 10% to 88%. The proportion of patients attending for digital retinal screen rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤ 140/80 mm Hg and cholesterol ≤ 4 mmol/L rose from 35.3% to 46.1%. Mean glycated haemoglobin dropped from 7.80% to 7.66% (62-60 mmol/mol). Investment of financial, organisational and education resources into primary care practice networks can achieve clinically important improvements in diabetes care in deprived, ethnically diverse communities. This success is predicated on collaborative working between practices, purposively designed high-quality information on network performance and engagement between primary and secondary care clinicians.

  6. Nursing unit leaders' influence on the long-term sustainability of evidence-based practice improvements.

    Science.gov (United States)

    Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis

    2016-04-01

    To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.

  7. MAP as a model for practice-based learning and improvement in child psychiatry training.

    Science.gov (United States)

    Kataoka, Sheryl H; Podell, Jennifer L; Zima, Bonnie T; Best, Karin; Sidhu, Shawn; Jura, Martha Bates

    2014-01-01

    Not only is there a growing literature demonstrating the positive outcomes that result from implementing evidence based treatments (EBTs) but also studies that suggest a lack of delivery of these EBTs in "usual care" practices. One way to address this deficit is to improve the quality of psychotherapy teaching for clinicians-in-training. The Accreditation Council for Graduate Medical Education (ACGME) requires all training programs to assess residents in a number of competencies including Practice-Based Learning and Improvements (PBLI). This article describes the piloting of Managing and Adapting Practice (MAP) for child psychiatry fellows, to teach them both EBT and PBLI skills. Eight child psychiatry trainees received 5 full days of MAP training and are delivering MAP in a year-long outpatient teaching clinic. In this setting, MAP is applied to the complex, multiply diagnosed psychiatric patients that present to this clinic. This article describes how MAP tools and resources assist in teaching trainees each of the eight required competency components of PBLI, including identifying deficits in expertise, setting learning goals, performing learning activities, conducting quality improvement methods in practice, incorporating formative feedback, using scientific studies to inform practice, using technology for learning, and participating in patient education. A case example illustrates the use of MAP in teaching PBLI. MAP provides a unique way to teach important quality improvement and practice-based learning skills to trainees while training them in important psychotherapy competence.

  8. Facilitating Transfers

    DEFF Research Database (Denmark)

    Kjær, Poul F.

    to specific logics of temporalisation and spatial expansion of a diverse set of social processes in relation to, for example, the economy, politics, science and the mass media. On this background, the paper will more concretely develop a conceptual framework for classifying different contextual orders...... that the essential functional and normative purpose of regulatory governance is to facilitate, stabilise and justify the transfer of condensed social components (such as economic capital and products, political decisions, legal judgements, religious beliefs and scientific knowledge) from one social contexts...

  9. Challenges and Facilitators to Promoting a Healthy Food Environment and Communicating Effectively with Parents to Improve Food Behaviors of School Children.

    Science.gov (United States)

    Luesse, Hiershenee B; Paul, Rachel; Gray, Heewon L; Koch, Pamela; Contento, Isobel; Marsick, Victoria

    2018-02-14

    Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.

  10. 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."

  11. The iSCREEN Electronic Diabetes Dashboard: A Tool to Improve Knowledge and Implementation of Pediatric Clinical Practice Guidelines.

    Science.gov (United States)

    Zahanova, Stacy; Tsouka, Alexandra; Palmert, Mark R; Mahmud, Farid H

    2017-12-01

    Clinical practice guidelines (CPG) provide evidence-based recommendations for patient care but may not be optimally applied in clinical settings. As a pilot study, we evaluated the impact of a computerized, point-of-care decision support system (CDSS) on guideline knowledge and adherence in our diabetes clinic. iSCREEN, a CDSS, integrated with a province-wide electronic health record, was designed based on the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Evaluation data were gathered by retrospective chart review and clinician questionnaire prior to and after implementation of iSCREEN. Records of patients with type 1 diabetes, 14 to 18 years of age, were assessed for appropriate screening for complications and comorbidities. To assess guideline adherence, 50 charts were reviewed at 2 time periods (25 before and 25 after launch of iSCREEN). Results revealed improved frequency of appropriate screening for diabetic nephropathy (p=0.03) and retinopathy (p=0.04), accompanied by a decrease in under- and overscreening for these outcomes. To assess guideline knowledge, 58 surveys were collected (31 prior to and 27 after the launch of iSCREEN) from care providers in the field of pediatric diabetes. There was a trend toward improved guideline knowledge in all team members (p=0.06). Implementation of a de novo CDSS was associated with improved rates of appropriate screening for diabetes-related complications. A trend toward improvement in health professionals' knowledge of the guidelines was also observed. Evaluation of this point-of-care computerized decision support tool suggests that it may facilitate diabetes care by optimizing complication screening and CPG knowledge, with the potential for broader implementation. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

  12. Handling a challenging context: experiences of facilitating evidence-based elderly care.

    Science.gov (United States)

    Nygårdh, Annette; Ahlström, Gerd; Wann-Hansson, Christine

    2016-03-01

    To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation. © 2015 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd.

  13. 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.

  14. 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.

  15. [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.

  16. Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice.

    Science.gov (United States)

    Gupta, Rajan T; Sexton, J Bryan; Milne, Judy; Frush, Donald P

    2015-01-01

    The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. Teamwork climate scores improved from a mean of 67.9 (SD, 12.8) before implementation to a mean of 87.8 (SD, 14.1) after implementation (t = -7.6; p ultrasound practice. The most notable improvements were seen in communication among team members and role clarification. We think that this model, which has been successfully implemented in many nonradiologic areas in medical care, is also applicable in imaging practice.

  17. 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.

  18. Using a Board Game About Sexual Health with Young People with Chronic Conditions in Daily Practice : A Research into Facilitating and Impeding Factors

    NARCIS (Netherlands)

    Dr. A.L. van Staa; Dr. H.A. van der Stege; Dr. S.R. Hilberink; MSc E.J.M. Bakker

    2016-01-01

    The aim of the study was to gain insight into use of a new board game (SeCZ TaLK) to facilitate discussing sexual health with adolescents with chronic conditions in healthcare and special education, and to establish impeding and facilitating factors for using the game.

  19. 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…

  20. Electro-encephalogram based brain-computer interface: improved performance by mental practice and concentration skills.

    Science.gov (United States)

    Mahmoudi, Babak; Erfanian, Abbas

    2006-11-01

    Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.

  1. Facilitating participation

    DEFF Research Database (Denmark)

    Skøtt, Bo

    2018-01-01

    the resulting need for a redefinition of library competence. In doing this, I primarily address the first two questions from Chapter 1 and how they relate to the public’s informal, leisure-time activities in a networked society. In particular, I focus on the skills of reflexive self-perception and informed...... opinion formation. Further, I point out the significance which these informal leisure-time activities have for public library staff’s cultural dissemination skills. In this way, I take on the question of the skills required for facilitating the learning of a participatory public (cf. Chapter 1......), exemplifying with the competence required of library staff. My discussion will proceed by way of a literature review. In the next section, I shall explain how and what sources were chosen and section three and four present the theoretical framework and how the applied theories are related. In the fifth section...

  2. Facilitating Transfers

    DEFF Research Database (Denmark)

    Kjær, Poul F.

    2018-01-01

    Departing from the paradox that globalisation has implied an increase, rather than a decrease, in contextual diversity, this paper re-assesses the function, normative purpose and location of Regulatory Governance Frameworks in world society. Drawing on insights from sociology of law and world...... society studies, the argument advanced is that Regulatory Governance Frameworks are oriented towards facilitating transfers of condensed social components, such as economic capital and products, legal acts, political decisions and scientific knowledge, from one legally-constituted normative order, i.......e. contextual setting, to another. Against this background, it is suggested that Regulatory Governance Frameworks can be understood as schemes which act as ‘rites of passage’ aimed at providing legal stabilisation to social processes characterised by liminality, i.e ambiguity, hybridity and in-betweenness....

  3. 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

  4. 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

    2016-01-01

    Objectives Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. Methods We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. Results 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. Conclusions There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results. PMID:27473953

  5. Current Status and Future Suggestions for Improving the Pharm. D Curriculum towards Clinical Pharmacy Practice in Pakistan

    Science.gov (United States)

    Malhi, Saima Mahmood; Ajmal, Kiran; Shamim, Sumbul; Ata, Saniya; Farooq, Salman; Sharib, Syed Muhammad; Muntaha, Sidrat-ul

    2017-01-01

    Objectives & Background: Good curriculum is reflected as the backbone for standard universities to develop competitive professionals having great potential. Pharmacy education in Pakistan has gone through the same developmental stages as in other countries, but is still striving for improvement. In the present study, we want (i) to know the opinion on whether the current pharmacy curriculum requires any improvement in order to meet the training needs of pharmacy professionals regarding clinical knowledge and pharmacy practice; and (ii) to present some humble suggestions to decision-making authorities in order to improve it with respect to patient-focused programs (PFP). Methods: The study was conducted in two sessions. In first session, a questionnaire was distributed to pharmacy students of eight public/private sector universities of Karachi (N = 354) offering Pharm. D degrees. The second session dealt with the pharmacy teachers, deans, and practicing pharmacists in health care facilities (who are in any ways also related to academia), in order to take their opinions on and suggestions for the development of a better Pharm. D curriculum (N = 135). Results: Our results showed that 75.2% of respondents agree that the Pharm. D curriculum does not meet the international standards of practice, and 88.4% of respondents support the addition of more clinical aspects than industrial ones, as Pharm. D could be both clinically and industrially oriented, according to the needs of the Pakistani people. Furthermore, 80.2% of respondents are of the view that an apprenticeship should be included in last two years, while 88.4% demand a ‘paid residency program’ to facilitate the hospital, clinical and compounding areas of pharmacy. In addition, we also received a number of verbal suggestions for improving the Pharm. D curriculum being followed in Pakistan. Discussion & Conclusions: We conclude that our Pharm. D curriculum needs additions in terms of clinical practice by

  6. [ISMP-Spain questionnaire and strategy for improving good medication practices in the Andalusian health system].

    Science.gov (United States)

    Padilla-Marín, V; Corral-Baena, S; Domínguez-Guerrero, F; Santos-Rubio, M D; Santana-López, V; Moreno-Campoy, E

    2012-01-01

    To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

  7. Practices for Improving Secondary School Climate: A Systematic Review of the Research Literature.

    Science.gov (United States)

    Voight, Adam; Nation, Maury

    2016-09-01

    School climate has received increased attention in education policy and, in response, educators are seeking strategies to improve the climates of their middle and high schools. However, there has been no comprehensive synthesis of the empirical evidence for what works in school climate improvement. This article constitutes a systematic review of programs and practices with empirical support for improving school climate. It defines school climate and provides a methodology for identifying and evaluating relevant studies. The review identified 66 studies with varying strength of evidence and nine common elements that cut across reviewed programs and practices. The review concludes with a critical appraisal of what we know about school climate improvement and what we still need to know. © Society for Community Research and Action 2016.

  8. Development and participant assessment of a practical quality improvement educational initiative for surgical residents.

    Science.gov (United States)

    Sellers, Morgan M; Hanson, Kristi; Schuller, Mary; Sherman, Karen; Kelz, Rachel R; Fryer, Jonathan; DaRosa, Debra; Bilimoria, Karl Y

    2013-06-01

    As patient-safety and quality efforts spread throughout health care, the need for physician involvement is critical, yet structured training programs during surgical residency are still uncommon. Our objective was to develop an extended quality-improvement curriculum for surgical residents that included formal didactics and structured practical experience. Surgical trainees completed an 8-hour didactic program in quality-improvement methodology at the start of PGY3. Small teams developed practical quality-improvement projects based on needs identified during clinical experience. With the assistance of the hospital's process-improvement team and surgical faculty, residents worked through their selected projects during the following year. Residents were anonymously surveyed after their participation to assess the experience. During the first 3 years of the program, 17 residents participated, with 100% survey completion. Seven quality-improvement projects were developed, with 57% completing all DMAIC (Define, Measure, Analyze, Improve, Control) phases. Initial projects involved issues of clinical efficiency and later projects increasingly focused on clinical care questions. Residents found the experience educationally important (65%) and believed they were well equipped to lead similar initiatives in the future (70%). Based on feedback, the timeline was expanded from 12 to 24 months and changed to start in PGY2. Developing an extended curriculum using both didactic sessions and applied projects to teach residents the theory and implementation of quality improvement is possible and effective. It addresses the ACGME competencies of practice-based improvement and learning and systems-based practice. Our iterative experience during the past 3 years can serve as a guide for other programs. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. 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

  10. Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke?

    Science.gov (United States)

    Graven, Christine; Brock, Kim; Hill, Keith; Joubert, Lynette

    2011-01-01

    To conduct a systematic review to explore the effectiveness of community-based rehabilitation interventions delivered by allied health professionals and/or nursing staff in reducing depression, facilitating participation and improving health-related quality of life (HRQoL) post-inpatient stroke rehabilitation. A search was conducted in the databases of MEDLINE, PEDro, CINAHL and the Cochrane Library. Publications were classified into categories based on the type of the interventions. Best evidence synthesis and meta-analysis were utilised to determine the level of evidence. Fifty-four studies were included in the review, and divided into nine broad intervention categories. Meta-analysis demonstrated significant reduction in depression with exercise interventions (n = 137; effect estimate SMD: -2.03, 95%CI: -3.22, -0.85). Community-based interventions targeting participation and leisure domains showed moderate evidence for improvement in global participation measures and HRQoL. Comprehensive rehabilitation demonstrated limited evidence for depression and participation, and strong evidence for HRQoL. There is limited to moderate evidence supporting some rehabilitation interventions in affecting the outcomes of depression, participation and HRQoL post-stroke. Heterogeneity of the studies made evidence synthesis difficult. Further consideration needs to be given to the type and timing of outcome measures selected to represent the domains of participation and HRQoL.

  11. 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

  12. A Practice Indexes for Improving Facial Movements of Brass Instrument Players

    Science.gov (United States)

    Ito, Kyoko; Hirano, Takeshi; Noto, Kazufumi; Nishida, Shogo; Ohtsuki, Tatsuyuki

    Two experimental studies have been conducted in order to propose practice indexes for the improvement of the embouchure of French horn players, two experimental studies have been conducted. In both studies, the same task was performed by advanced and amateur French horn players. The first study investigated the activity, while performing the above-mentioned task, of the 5 facial muscles (levator labii superioris, zygomaticus major, depressor anguli oris, depressor labii inferioris, and risorius muscles) on the right side of the face by surface electromyography, and the facial movement on the left side of the face by attaching two markers above each muscle and using two high-speed cameras simultaneously. The results of the study showed that it is possible for the four markers around the lower lip to practice indexes. The second study evaluated whether the above-mentioned markers are appropriate as practice indexes using a 3-D tracking system and questionnaires. The results showed that both the advanced and the amateur players assessed that the markers were suitable as practice indexes for improving the embouchure. This set of approaches could be useful for selecting practice indexes and developing scientific practice methods not only for the French horn but also for other instruments and other fields.

  13. An Investigation of the Facilitative and Inhibitory Variables Impacting Breast Health Care Practices in Low Socioeconomic Status Black Women of African-American and Caribbean Descent

    National Research Council Canada - National Science Library

    LaSorsa, Kathryn

    2001-01-01

    .... This will be accomplished in two separate waves. In the first wave, facilitators and barriers to breast cancer-screening participation among low-SES women of African-American and Caribbean descent will be determined through qualitative interview...

  14. 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