WorldWideScience

Sample records for program implementation guidelines

  1. 75 FR 48934 - Coral Reef Conservation Program Implementation Guidelines

    Science.gov (United States)

    2010-08-12

    ... National Oceanic and Atmospheric Administration RIN 0648-ZC19 Coral Reef Conservation Program... Implementation Guidelines for the Coral Reef Conservation Program. SUMMARY: This document provides NOAA's revised Grant Program Implementation Guidelines (Guidelines) for the Coral Reef Conservation Program (CRCP or...

  2. Primer: implementation of guideline-based programs for coronary care.

    Science.gov (United States)

    Eagle, Kim A; Koelling, Todd M; Montoye, Cecelia K

    2006-03-01

    The American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice program in Michigan, USA, was an initiative designed to improve the quality of cardiovascular care by bringing the American College of Cardiology/American Heart Association practice guidelines to the point of care. The program consisted of three different projects, involving a total of 33 hospitals. The program was implemented in five phases-planning, tool implementation, monitoring of tool use, remeasurement and reporting of results-by use of a collaborative model, which included a series of learning sessions for staff members that focused on the five phases. The goal was to identify the highest care priorities for patients with acute coronary syndromes and to incorporate these into the care itself. This aim was achieved with a standardized set of clinical-care tools, such as admission orders and discharge contracts; the use of such tools is associated with improvement in adherence to guidelines. Strategies were, however, tailored to each hospital by local teams. Performance was assessed by the use of tracking tools, which facilitate rapid improvement by enabling key performance indicators founded on the guidelines to be monitored. Using qualitative surveys of the project leaders, we identified an optimum timeline and correlations between hospital-specific attributes and greater or lesser success in achieving positive change. In this review, we describe our experience and identify the most useful strategies for future implementation of such a project.

  3. Impact of a multifaceted education program on implementing a pediatric palliative care guideline : a pilot study

    NARCIS (Netherlands)

    Jagt-van Kampen, Charissa Thari; Kremer, Leontien C. M.; Verhagen, A. A. Eduard; Schouten-van Meeteren, Antoinette Y. N.

    2015-01-01

    Background: A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on

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

    Science.gov (United States)

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

    2016-01-01

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

  5. NCCN Guidelines implementation in the multidisciplinary Merkel Cell Carcinoma Program at the University of Michigan.

    Science.gov (United States)

    Schwartz, Jennifer L; Wong, Sandra L; McLean, Scott A; Hayman, James A; Lao, Christopher D; Kozlow, Jeffrey H; Malloy, Kelly M; Bradford, Carol R; Frohm, Marcus L; Fullen, Douglas R; Lowe, Lori; Bichakjian, Christopher K

    2014-03-01

    Merkel cell carcinoma (MCC) is a rare malignancy of the skin, and prospective randomized clinical studies on management and treatment are very limited. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for MCC provide up-to-date, best evidence-based, and consensus-driven management pathways with the purpose of providing best care and outcomes. Multidisciplinary management with consensus treatment recommendations to individualize patient care within the framework of these guidelines is optimal. The University of Michigan multidisciplinary MCC program uses NCCN Guidelines in the management and treatment of its patients. This article discusses 4 patient presentations to highlight the implementation of the NCCN Guidelines for MCC at the University of Michigan.

  6. Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study.

    Science.gov (United States)

    Jagt-van Kampen, Charissa Thari; Kremer, Leontien C M; Verhagen, A A Eduard; Schouten-van Meeteren, Antoinette Y N

    2015-11-02

    A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline. We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning. Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning. The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be

  7. Guidelines for Implementing an Effective Language Program for Disadvantaged Mexican-Americans in the Elementary School; Guidelines for Implementing an Effective Workshop on ESOL.

    Science.gov (United States)

    Perales, Alonso M.; And Others

    A bilingual language program for Mexican American students in elementary schools and a workshop for teachers of English for Speakers of Other Languages are outlined to aid effective implementation of such activities. Guidelines include goals and objectives; administration and organization; methods, techniques, and activities; and evaluation. The…

  8. Food waste in a school nutrition program after implementation of new lunch program guidelines.

    Science.gov (United States)

    Byker, Carmen J; Farris, Alisha R; Marcenelle, Michael; Davis, George C; Serrano, Elena L

    2014-01-01

    To assess the amount of food waste by meal components according to the new National School Lunch Program guidelines among pre-kindergarten and kindergarten students. For 5 consecutive school days in 1 elementary school, the research team collected school lunch trays and separated meal components into bins relative to each food or beverage appearing on the school's daily menu. Bins were weighed in grams and converted to ounces and cups at the end of each lunch period. The researchers examined 304 meals from 1 pre-kindergarten class and 5 kindergarten classes. Of 4,988 oz of food and beverages served, 2,261 oz (45.3%) were wasted during 1 full school week, totaling 141 lb. The greatest amount of food waste was generated from vegetables, the main entree, and milk, respectively. Strategies to reduce food waste in school lunch should be researched and implemented. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  9. Implementation of curriculum guidelines for pharmacology and pharmacotherapeutics in FNP graduate programs: a national survey.

    Science.gov (United States)

    Morris, N S; Possidente, C J; Muskus, C

    2001-01-01

    Model Pharmacology and Pharmacotherapeutics Curriculum Guidelines were developed by the National Council of State Boards of Nursing and the National Organization of Nurse Practitioner Faculties and published in 1998. To date, no publication of evaluation of adoption or adherence to these guidelines is available. The purpose of this survey was to determine how family nurse practitioner programs incorporate the guidelines into their curriculum. A mailed self-report questionnaire to 193 schools yielded a 41% response rate. Eighty-five percent (n = 68) of the programs have not yet fully integrated the guidelines into their curriculum. Difficulties addressing the extensive content within a 3-credit course and the challenges of teaching students with varied clinical backgrounds and knowledge levels were frequently cited. Although further study of achievement of the guidelines is necessary, an increase in credit allocation, consideration of a conceptual approach to the topic, and use of varied teaching strategies may make achievement of the guidelines more realistic.

  10. Commercial Midstream Energy Efficiency Incentive Programs: Guidelines for Future Program Design, Implementation, and Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Milostan, Catharina [Argonne National Lab. (ANL), Argonne, IL (United States); Levin, Todd [Argonne National Lab. (ANL), Argonne, IL (United States); Muehleisen, Ralph T. [Argonne National Lab. (ANL), Argonne, IL (United States); Guzowski, Leah Bellah B. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2017-01-01

    Many electric utilities operate energy efficiency incentive programs that encourage increased dissemination and use of energy-efficient (EE) products in their service territories. The programs can be segmented into three broad categories—downstream incentive programs target product end users, midstream programs target product distributors, and upstream programs target product manufacturers. Traditional downstream programs have had difficulty engaging Small Business/Small Portfolio (SBSP) audiences, and an opportunity exists to expand Commercial Midstream Incentive Programs (CMIPs) to reach this market segment instead.

  11. Asia Oceania Guidelines for the Implementation of Programs for Cervical Cancer Prevention and Control

    Directory of Open Access Journals (Sweden)

    Hextan Y. S. Ngan

    2011-01-01

    The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed.

  12. Asia Oceania Guidelines for the Implementation of Programs for Cervical Cancer Prevention and Control

    Science.gov (United States)

    Ngan, Hextan Y. S.; Garland, Suzanne M.; Bhatla, Neerja; Pagliusi, Sonia R.; Chan, Karen K. L.; Cheung, Annie N. Y.; Chu, Tang-Yuan; Domingo, Efren J.; Qiao, You Lin; Park, Jong Sup; Tay, Eng Hseon; Supakarapongkul, Wisit

    2011-01-01

    This paper aims to provide evidence-based recommendations for health professionals, to develop a comprehensive cervical cancer program for a clinic, a community, or a country. Ensuring access to healthcare is the responsibility of all societies, and the Asia Oceania Research Organisation in Genital Infections and Neoplasia (AOGIN) is committed to working collaboratively with governments and health professionals to facilitate prevention programs, to protect girls and women from cervical cancer, a disease that globally affects 500,000 and kills nearly 300,000 women annually, just over half of whom are in the Asia Oceania region. We share the vision that a comprehensive program of vaccination, screening, and treatment should be made accessible to all girls and women in the world. The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed. PMID:21559068

  13. Asia oceania guidelines for the implementation of programs for cervical cancer prevention and control.

    Science.gov (United States)

    Ngan, Hextan Y S; Garland, Suzanne M; Bhatla, Neerja; Pagliusi, Sonia R; Chan, Karen K L; Cheung, Annie N Y; Chu, Tang-Yuan; Domingo, Efren J; Qiao, You Lin; Park, Jong Sup; Tay, Eng Hseon; Supakarapongkul, Wisit

    2011-01-01

    This paper aims to provide evidence-based recommendations for health professionals, to develop a comprehensive cervical cancer program for a clinic, a community, or a country. Ensuring access to healthcare is the responsibility of all societies, and the Asia Oceania Research Organisation in Genital Infections and Neoplasia (AOGIN) is committed to working collaboratively with governments and health professionals to facilitate prevention programs, to protect girls and women from cervical cancer, a disease that globally affects 500,000 and kills nearly 300,000 women annually, just over half of whom are in the Asia Oceania region. We share the vision that a comprehensive program of vaccination, screening, and treatment should be made accessible to all girls and women in the world. The primary purpose of these guidelines is to provide information on scientific evidence on the different modalities and approaches of cervical cancer prevention programs, for high resource and low resource settings. The secondary purpose is to provide an overview of the current situation of cervical cancer control and prevention in various Asian Oceania countries: their views of an ideal program, identified obstacles, and suggestions to overcome them are discussed.

  14. Nurses' experiences of guideline implementation

    DEFF Research Database (Denmark)

    Alanen, Seija; Välimäki, Marita; Kaila, Minna

    2009-01-01

    to local circumstances, seems to be crucial for successful implementation. CONCLUSIONS: Clinical guidelines can be promising tools in enhancing evidence-based nursing practice, as nurses see them as practical work tools in patient care and so are willing to adopt them. However, support from management......AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to be dependent on multiple context-specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation. DESIGN: Qualitative interview. METHODS: Data were generated by four focus group interviews involving nurses working in out-patient services in primary...

  15. Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study

    National Research Council Canada - National Science Library

    Jagt-van Kampen, Charissa Thari; Kremer, Leontien C. M; Verhagen, A. A. Eduard; Schouten-van Meeteren, Antoinette Y. N

    2015-01-01

    ... at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance...

  16. Guideline Implementation: Hand Hygiene.

    Science.gov (United States)

    Goldberg, Judith L

    2017-02-01

    Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  17. GOSIP implementation guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Van Norman, H.J.

    1996-07-01

    GOSIP (Government Open Systems Interconnection Profile) is a subset of ISO`s OSI protocol standards relevant to US Government operations. As a Federal Information Processing Standard (FIPS), GOSIP is required by law for all Federal agencies. Mandatory standards-based communications products are required when purchasing functionality equivalent to what is specified in GOSIP. This unprecedented requirement by the Federal government has caused considerable confusion concerning practical implementation of relatively immature and untested technologies. Many organizations already have substantial investment in one or more proprietary network architectures. This paper examines issues associated with conversion to the GOSIP system.

  18. Implementing guidelines in nursing homes

    DEFF Research Database (Denmark)

    Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte

    2016-01-01

    BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects...... of interventions to improve the implementation of guidelines in nursing homes. METHODS: A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation...... search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted...

  19. Successful implementation of a guideline program for the rational use of lipid-lowering drugs.

    Science.gov (United States)

    Stuart, M E; Handley, M A; Chamberlain, M A; Wallach, R W; Penna, P M; Stergachis, A

    1991-01-01

    Following the National Cholesterol Educational Program's (NCEP) 1988 screening and treatment recommendations, an educational and behavior-change program at Group Health Cooperative of Puget Sound (GHC) was developed to guide the use of lipid-lowering drugs within the larger context of cardiac risk reduction. The program has been successful in advancing a rational program to enhance care and manage costs of the use of lipid-lowering agents at GHC. Cost savings have been significant over the past two years. The educational design of the program includes training and ongoing education of a core group of "lipid gurus," who educate colleagues in area medical centers in a rational approach to hyperlipidemia. Patient education and patient participation in decision-making was emphasized. Program evaluation has demonstrated that physicians and patients are satisfied with the program, and inappropriate drug expenditures have been prevented. Key elements of the program include a critical review of outcome studies in the medical literature, use of information systems, algorithms and written materials organized into a well-designed, ongoing educational program, and development of a core group of physicians and pharmacists to administer the program at the clinic level.

  20. Implementation of Good Clinical Laboratory Practice (GCLP) guidelines within the External Quality Assurance Program Oversight Laboratory (EQAPOL).

    Science.gov (United States)

    Todd, Christopher A; Sanchez, Ana M; Garcia, Ambrosia; Denny, Thomas N; Sarzotti-Kelsoe, Marcella

    2014-07-01

    The EQAPOL contract was awarded to Duke University to develop and manage global proficiency testing programs for flow cytometry-, ELISpot-, and Luminex bead-based assays (cytokine analytes), as well as create a genetically diverse panel of HIV-1 viral cultures to be made available to National Institutes of Health (NIH) researchers. As a part of this contract, EQAPOL was required to operate under Good Clinical Laboratory Practices (GCLP) that are traditionally used for laboratories conducting endpoint assays for human clinical trials. EQAPOL adapted these guidelines to the management of proficiency testing programs while simultaneously incorporating aspects of ISO/IEC 17043 which are specifically designed for external proficiency management. Over the first two years of the contract, the EQAPOL Oversight Laboratories received training, developed standard operating procedures and quality management practices, implemented strict quality control procedures for equipment, reagents, and documentation, and received audits from the EQAPOL Central Quality Assurance Unit. GCLP programs, such as EQAPOL, strengthen a laboratory's ability to perform critical assays and provide quality assessments of future potential vaccines. © 2013.

  1. Implementation of a structured guideline-based program for the secondary prevention of ischemic stroke in China.

    Science.gov (United States)

    Peng, Bin; Ni, Jun; Anderson, Craig S; Zhu, Yicheng; Wang, Yongjun; Pu, Chuanqiang; Wu, Jiang; Wang, Jianming; Zhou, Lixin; Yao, Ming; He, Jia; Shan, Guangliang; Gao, Shan; Xu, Weihai; Cui, Liying

    2014-02-01

    High rates of ischemic stroke and poor adherence to secondary prevention measures are observed in the Chinese population. We used a national, multicenter, cluster-randomized controlled trial in which 47 hospitals were randomized to either a structured care program group (n=23) or a usual care group (n=24). The structured care program consisted of a specialist-administered, guideline-recommended pharmaceutical treatment and a lifestyle modification algorithm associated with written and Internet-accessed educational material for patients for the secondary prevention of ischemic stroke. The primary efficacy outcome was the proportion of patients who adhered to the recommended measures at 12-month postdischarge. This trial is registered with ClinicalTrial.gov (NCT00664846). At 12 months, 1287 (72.1%) patients in the Standard Medical Management in Secondary Prevention of Ischemic Stroke in China (SMART) group and 1430 (72%) patients in the usual care group had completed the 12-month follow-up (P=0.342). Compared with the usual care group, those in the SMART group showed higher adherence to statins (56% versus 33%; P=0.006) but no difference in adherence to antiplatelet (81% versus 75%; P=0.088), antihypertensive (67% versus 69%; P=0.661), or diabetes mellitus drugs (73% versus 67%; P=0.297). No significant difference in the composite end point (new-onset ischemic stroke, hemorrhagic stroke, acute coronary syndrome, and all-cause death) was observed (3.56% versus 3.59%; P=0.921). The implementation of a program to improve adherence to secondary ischemic stroke prevention efforts in China is feasible, but these programs had only a limited impact on adherence and no impact on 1-year outcomes. Further development of a structured program to reduce vascular events after stroke is needed. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00664846.

  2. Tangipahoa Parish Migrant Education 1982-1983 Program: Guidelines for Implementation.

    Science.gov (United States)

    Pietri, Billie J.

    The Tangipahoa Parish Migrant Education Program measures individual skill deficiencies with activities intended to reinforce and help students master or complete a particular skill. Designed to teach students to assume responsibility for the next step of achievement, skill activities and supplementary teacher materials are leveled, color coded,…

  3. Guideline Implementation: Surgical Smoke Safety.

    Science.gov (United States)

    Fencl, Jennifer L

    2017-05-01

    Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management. This article focuses on key points of the guideline to help perioperative personnel promote smoke-free work environments; evacuate surgical smoke; and develop education programs and competency verification tools, policies and procedures, and quality improvement initiatives related to controlling surgical smoke. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  4. The 2007 National Asthma Education and Prevention Program asthma guidelines: accelerating their implementation and facilitating their impact on children with asthma.

    Science.gov (United States)

    Gupta, Ruchi S; Weiss, Kevin B

    2009-03-01

    Nearly 2 decades have elapsed since the National Center for Health Statistics raised concerns regarding the trends in increasing asthma prevalence. Additional research highlighted the large racial disparities and geographic variations in asthma morbidity and mortality rates. Although there was little national consensus on the care of children with asthma at the time, there were improvements in the understanding of the mechanisms and treatment of asthma. It was in this context that the National Heart, Lung, and Blood Institute launched the National Asthma Education and Prevention Program, which convened its first panel of experts to create the national consensus clinical practice guidelines on the treatment of asthma. More than 15 years have passed since the publication of those first guidelines and, in August 2007, the National Heart, Lung, and Blood Institute released its newest updates, which are the product of the National Asthma Education and Prevention Program third expert panel. The release of the updated guidelines serves as an occasion to examine important issues regarding the dissemination and clinical implementation of National Asthma Education and Prevention Program guidelines. The goals of this report are to examine the adoption of earlier versions of the National Asthma Education and Prevention Program guidelines and to suggest opportunities for rapid adoption of the newly released guidelines.

  5. Postdoctoral program guidelines.

    Energy Technology Data Exchange (ETDEWEB)

    Teich-McGoldrick, Stephanie; Miller, Andrew W.; Sava, Dorina Florentina; Liu, Yanli; Ferreira, Summer Rhodes; Biedermann, Laura Butler; Cruz-Campa, Jose Luis; Hall, Lisa Michelle; Liu, Xiaohua H.; Ekoto, Isaac

    2012-04-01

    We, the Postdoc Professional Development Program (PD2P) leadership team, wrote these postdoc guidelines to be a starting point for communication between new postdocs, their staff mentors, and their managers. These guidelines detail expectations and responsibilities of the three parties, as well as list relevant contacts. The purpose of the Postdoc Program is to bring in talented, creative people who enrich Sandia's environment by performing innovative R&D, as well as by stimulating intellectual curiosity and learning. Postdocs are temporary employees who come to Sandia for career development and advancement reasons. In general, the postdoc term is 1 year, renewable up to five times for a total of six years. However, center practices may vary; check with your manager. At term, a postdoc may apply for a staff position at Sandia or choose to move to university, industry or another lab. It is our vision that those who leave become long-term collaborators and advocates whose relationships with Sandia have a positive effect upon our national constituency.

  6. Factors influencing hospital implementation of acute pain management practice guidelines.

    Science.gov (United States)

    Jiang, H J; Lagasse, R S; Ciccone, K; Jakubowski, M S; Kitain, E M

    2001-06-01

    To identify factors that may influence the implementation of acute pain management guidelines in hospital settings. Two questionnaire surveys. Healthcare Association of New York State, Albany, NY. The surveys were administered to 220 hospitals in New York State regarding their acute pain management practices and resources available. One survey was addressed to each hospital's chief executive officer (CEO) and the second survey was addressed to the clinical director of the Department of Anesthesiology or Acute Pain Service. The barriers and incentives to guideline implementation identified by CEOs were analyzed using factor analysis. Logistic regression was employed to determine predictors of guideline implementation by linking the CEOs' survey data with the clinical directors' report of guideline usage. According to clinical directors, only 27% of the responding hospitals were using a published pain management practice guideline. Factors predictive of guideline implementation include resource availability and belief in the benefits of using guidelines to improve quality of care or to achieve economic/legal advantages. Guideline implementation, however, does not necessarily include applying all key elements recommended by the federal Agency for Healthcare Research and Quality (formerly Agency for Health Care Policy and Research) guideline. For example, a collaborative, interdisciplinary approach to pain control was used in only 42% of the hospitals, and underutilization of nonpharmacologic therapies to control pain was widespread. Resource availability, particularly staff with expertise in pain management and existence of a formal quality assurance program to monitor pain management, was significantly predictive of compliance with key guideline elements. Resource availability significantly influences the implementation of pain management practice guidelines in hospital settings. Implementation is often incomplete because various factors affect the feasibility of

  7. Guideline Implementation: Patient Information Management.

    Science.gov (United States)

    Fencl, Jennifer L

    2016-12-01

    Clinical documentation captured in a patient's record provides health care personnel with information that can be used to guide patient care. Data collected in electronic health records can be accessed and aggregated across the health care delivery system to enhance the safety, quality, and efficacy of care. The updated AORN "Guideline for patient information management" provides guidance to perioperative personnel on documenting and managing patient information. This article focuses on key points of the guideline, which address data capture that supports the clinical workflow, incorporation of professional guidelines and standards as well as regulatory and mandatory reporting elements, use of standardized clinical terminologies, data aggregation for use in research and analytics, considerations for patient care orders, and safeguards for the patient's security and confidentiality. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  8. Total quality management implementation guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

  9. A manual for implementing residual radioactive material guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Gilbert, T.L.; Yu, C.; Yuan, Y.C.; Zielen, A.J.; Jusko, M.J.; Wallo, A. III

    1989-06-01

    This manual presents information for implementing US Department of Energy (DOE) guidelines for residual radioactive material at sites identified by the Formerly Utilized Sites Remedial Action Program (FUSRAP) and the Surplus Facilities Management Program (SFMP). It describes the analysis and models used to derive site-specific guidelines for allowable residual concentrations of radionuclides in soil and the design and use of the RESRAD computer code for calculating guideline values. It also describes procedures for implementing DOE policy for reducing residual radioactivity to levels that are as low as reasonably achievable. 36 refs., 16 figs, 22 tabs.

  10. Empowering nurses to handle the guideline implementation process: identification of implementation competencies.

    Science.gov (United States)

    Holleman, Gerda; van Tol, Marjo; Schoonhoven, Lisette; Mintjes-de Groot, Joke; van Achterberg, Theo

    2014-01-01

    Employing nurses as opinion leaders to implement guidelines may be a promising implementation activity. Until now, insight into necessary competencies of nurse opinion leaders is lacking. We studied and supported aspiring nurse opinion leaders, using a training program based on social influence and implementation theory. Twenty-one competencies were identified, of which the most important were cooperating, communicating, delegating, giving feedback, networking, and information processing. Understanding and addressing these competencies may support the implementation of evidence-based guidelines.

  11. Implementation of Get with the Guideline Acute Myocardial Infarction Program at Johns Hopkins Hospital and Its Effect on Core Measures

    Science.gov (United States)

    2007-05-25

    more zqWi buiccal dimarption ocur with non-enteric-costied aspirin formulations. ACC/AHA UAINSTEMI Guidelines t5) Clats I Antiplatelet therapy diould be...a true aspirin allerg (Level of Evidence: A). ACC/AHA LLVNSTFMI Guidelines (5) CIXXs I Antiplatelet therapy should he initiated promnptly, Aspirin ...through use of GWTG. Core measure medications include beta blockers and aspirin at arrival, smoking cessation, and the following discharge medications

  12. An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2009-07-01

    Full Text Available Abstract Background Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption. Methods The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension and institutional care (chronic ulcer, chronic heart failure topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies. Discussion Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective

  13. An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol.

    Science.gov (United States)

    Gagliardi, Anna R; Brouwers, Melissa C; Palda, Valerie A; Lemieux-Charles, Louise; Grimshaw, Jeremy M

    2009-07-02

    Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption. The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension) and institutional care (chronic ulcer, chronic heart failure) topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies. Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective outcomes reflecting the adoption of processes and

  14. Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice

    Directory of Open Access Journals (Sweden)

    Gagliardi Anna R

    2012-07-01

    Full Text Available Abstract Background Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice. Methods We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements. Results Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients. Discussion Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.

  15. Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation.

    Science.gov (United States)

    Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

    2004-01-01

    A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.

  16. ENRICH: A promising oncology nurse training program to implement ASCO clinical practice guidelines on fertility for AYA cancer patients.

    Science.gov (United States)

    Vadaparampil, Susan T; Gwede, Clement K; Meade, Cathy; Kelvin, Joanne; Reich, Richard R; Reinecke, Joyce; Bowman, Meghan; Sehovic, Ivana; Quinn, Gwendolyn P

    2016-11-01

    We describe the impact of ENRICH (Educating Nurses about Reproductive Issues in Cancer Healthcare), a web-based communication-skill-building curriculum for oncology nurses regarding AYA fertility and other reproductive health issues. Participants completed an 8-week course that incorporated didactic content, case studies, and interactive learning. Each learner completed a pre- and post-test assessing knowledge and a 6-month follow-up survey assessing learner behaviors and institutional changes. Out of 77 participants, the majority (72%) scored higher on the post-test. Fifty-four participants completed the follow-up survey: 41% reviewed current institutional practices, 20% formed a committee, and 37% gathered patient materials or financial resources (22%). Participants also reported new policies (30%), in-service education (37%), new patient education materials (26%), a patient navigator role (28%), and workplace collaborations with reproductive specialists (46%). ENRICH improved nurses' knowledge and involvement in activities addressing fertility needs of oncology patients. Our study provides a readily accessible model to prepare oncology nurses to integrate American Society of Clinical Oncology guidelines and improve Quality Oncology Practice Initiative measures related to fertility. Nurses will be better prepared to discuss important survivorship issues related to fertility and reproductive health, leading to improved quality of life outcomes for AYAs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Hypertension management initiative: qualitative results from implementing clinical practice guidelines in primary care through a facilitated practice program.

    Science.gov (United States)

    Tobe, Sheldon W; Moy Lum-Kwong, Margaret; Von Sychowski, Shirley; Kandukur, Kishan

    2013-05-01

    The goal of the Hypertension Management Initiative (HMI) is to improve the management and control of hypertension by both primary care providers and patients. The HMI was in effect in 11 primary care sites across the province of Ontario, Canada. This was a qualitative study. Focus groups and a lobby survey were completed with a total of 199 of the 3934 patients enrolled in the study. Interviews with 41 participating health care providers from all sites were performed. A qualitative description approach was used to give a rich description of each informant's experiences. Patients expressed motivation and engagement in their own health care and became more knowledgeable about hypertension and how to manage it with their health care providers. Most reported satisfaction with the discipline of regular appointments and ongoing monitoring and counseling of the program including identifying and working on goals for their modifiable risk factors. Their health care providers felt the HMI program had a positive impact on the treatment and management of hypertension and also that it improved the functioning of the interprofessional team. The HMI helped to improve patient self-empowerment and self-management and also improved physicians' and nurses' confidence in diagnosing accurately and in hypertension management. Physician buy-in is key to maintaining clinical hypertension management. Interprofessional collaboration was improved for physicians and nurses but less so for pharmacists. Greater confidence among the nurses to manage hypertension more independently reduced demands on physician time. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  18. Implementing the Exercise Guidelines for Cancer Survivors

    Science.gov (United States)

    Wolin, Kathleen Y.; Schwartz, Anna L.; Matthews, Charles E.; Courneya, Kerry S.; Schmitz, Kathryn H.

    2013-01-01

    In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life (QOL), and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice, and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community. PMID:22579268

  19. Guideline Implementation: Prevention of Retained Surgical Items.

    Science.gov (United States)

    Fencl, Jennifer L

    2016-07-01

    A surgical item unintentionally retained in a patient after an operative or other invasive procedure is a serious, preventable medical error with the potential to cause the patient great harm. Perioperative RNs play a key role in preventing retained surgical items (RSIs). The updated AORN "Guideline for prevention of retained surgical items" provides guidance for implementing a consistent, multidisciplinary approach to RSI prevention; accounting for surgical items; preventing retention of device fragments; reconciling count discrepancies; and using adjunct technologies to supplement manual count procedures. This article focuses on key points of the guideline to help perioperative personnel provide optimal care during a procedure. Key points addressed include taking responsibility for RSI prevention as a team; minimizing distractions, noise, and interruptions during counts; using consistent counting methods; reconciling discrepancies; and participating in performance-improvement activities. Perioperative RNs should review the complete guideline for additional information and for guidance in writing and updating policies and procedures. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  20. Implementation of Aerobic Programs.

    Science.gov (United States)

    American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD).

    This information is intended for health professionals interested in implementing aerobic exercise programs in public schools, institutions of higher learning, and business and industry workplaces. The papers are divided into three general sections. The introductory section presents a basis for adhering to a health fitness lifestyle, using…

  1. The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA: a knowledge translation (KT randomized controlled trial (RCT: Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs

    Directory of Open Access Journals (Sweden)

    Brosseau Lucie

    2012-10-01

    Full Text Available Abstract Background The implementation of evidence based clinical practice guidelines on self-management interventions to patients with chronic diseases is a complex process. A multifaceted strategy may offer an effective knowledge translation (KT intervention to promote knowledge uptake and improve adherence in an effective walking program based on the Ottawa Panel Evidence Based Clinical Practice Guidelines among individuals with moderate osteoarthritis (OA. Methods A single-blind, randomized control trial was conducted. Patients with mild to moderate (OA of the knee (n=222 were randomized to one of three KT groups: 1 Walking and Behavioural intervention (WB (18 males, 57 females which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking for OA; 2 Walking intervention (W (24 males, 57 females wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet; 3 Self-directed control (C (32 males, 52 females wherein participants only received the educational pamphlet. One-way analyses of variance were used to test for differences in quality of life, adherence, confidence, and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period. Results Short-term program adherence was greater in WB compared to C (p 0.05 was observed for long-term adherence (6 to 12 months, and total adherence between the three groups. The three knowledge translation strategies demonstrated equivalent long-term results for the implementation of a walking program for older individuals with moderate OA. Lower dropout rates as well as higher retention rates were observed for WB at 12 and 18 months. Conclusion The additional knowledge translation behavioural component facilitated the implementation of clinical practice guidelines

  2. Acceptance and perceived barriers of implementing a guideline for managing low back in general practice

    Directory of Open Access Journals (Sweden)

    Pfingsten Michael

    2008-02-01

    Full Text Available Abstract Background Implementation of guidelines in clinical practice is difficult. In 2003, the German College of General Practitioners and Family Physicians (DEGAM released an evidence-based guideline for the management of low back pain (LBP in primary care. The objective of this study is to explore the acceptance of guideline content and perceived barriers to implementation. Methods Seventy-two general practitioners (GPs participating in quality circles within the framework of an educational intervention study for guideline implementation evaluated the LBP-guideline and its practicability with a standardised questionnaire. In addition, statements of group discussions were recorded using the metaplan technique and were incorporated in the discussion. Results Most GPs agree with the guideline content but believe that guideline stipulations are not congruent with patient wishes. Non-adherence to the guideline and contradictory information for patients by other professionals (e.g., GPs, orthopaedic surgeons, physiotherapists are important barriers to guideline adherence. Almost half of the GPs have no access to recommended multimodal pain programs for patients with chronic LBP. Conclusion Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system. Trial registration BMBF Grant Nr. 01EM0113. FORIS (database for research projects in social science Reg #: 20040116 25.

  3. A structured record to implement the national Guidelines for ...

    African Journals Online (AJOL)

    Background. Guidelines to improve standards of care for hypertension and diabetes were disseminated by the National Department of Health in 1996 but have generally not been implemented by health professionals in local primary care. A strategy for the adoption and implementation of the Guidelines was developed in ...

  4. Instructional Program Review Guidelines, Spring 2001.

    Science.gov (United States)

    Peralta Community Coll. System, Oakland, CA. Office of Educational Services.

    This document presents guidelines for program review at Peralta Community College District's (PCCD) (California) institutions. The primary objective of the program review process is to assure that PCCD's educational programs reflect student needs and encourage student success. The review process consists of five stages: (1) a discipline self-study…

  5. Cancer cachexia: global awareness and guideline implementation on the web.

    Science.gov (United States)

    Mauri, Davide; Tsiara, Anna; Valachis, Antonis; Kalopita, Konstantina; Tsali, Lampriani; Tolis, Panagiotis; Polyzos, Nikolaos P

    2013-06-01

    Cancer cachexia is a common associate of cancer and has a negative impact on patients' survival. Nonetheless, cancer cachexia assessment and management are frequently less than satisfactory in daily practice. To scrutinise global cancer cachexia awareness and relative web guideline implementation among oncology societies. Systematical identification of scientific and policymaker oncology societies and their guideline implementation on cancer cachexia. Assessment of the general level of awareness on cancer cachexia and evaluation of intercontinental and national variations on guideline implementation. 144,000 web pages were scrutinised, and 275 oncology societies identified covering a large array of oncology setting (educational/clinical/research/policymaker); 71 were international (African, American, Asian, European, Oceania and Intercontinental), 110 belonged to the top 10 countries with the highest development index and 94 pertained to 10 countries with a long lasting tradition in medical oncology (not included in the top 10 high developed countries). Overall, only 10/275 web sites provided guidelines; six of them (2.2%) provided guidelines for physicians and four (0.7%) for patients. Half of the guidelines (4/10) were outdated. All guidelines for physicians reported references, while only one of the recommendations for patients reported references to support its sentences. Cancer cachexia global awareness appears extremely low; guideline implementation on the web was inconsistent for any category analysed (nation vs continent vs international vs society type vs physician vs patient oriented) and for updating.

  6. A guideline for green economy implementation in the agriculture sector

    CSIR Research Space (South Africa)

    Musvoto, Constansia D

    2017-08-01

    Full Text Available The CSIR has developed a guideline for implementing green economy projects in the agriculture sector. The guideline is available for use by agricultural practitioners; and is a tool for translating the principles of a green economy into tangible...

  7. How GPs implement clinical guidelines in everyday clinical practice

    DEFF Research Database (Denmark)

    Videbæk Le, Jette; Hansen, Helle P; Riisgaard, Helle

    2015-01-01

    . Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. RESULTS: Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective......BACKGROUND: Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood....... OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form...

  8. Implementing diabetes care guidelines in long term care.

    Science.gov (United States)

    Hager, Kathy K; Loprinzi, Paul; Stone, Dennis

    2013-11-01

    The objectives of this article are to (1) describe the outcomes of a diabetes care program in a long term care facility dedicated to diabetes excellence and (2) compare the relevant outcome variables of research published between 2007 and 2012 with the results found in the studied facility. Three-year retrospective chart review of the facility's residents with comparison to extant literature. A total of 224 resident charts within the studied facility were reviewed. Residents with a diagnosis of diabetes, or who were on diabetes medications, or whose fasting blood sugars exceeded 126 mg/dL on 2 occasions, and whose length of stay exceeded 6 months, were tracked for adherence to diabetes guidelines (n = 48). Participant outcomes from relevant studies in the literature were compared to these 48 participants' outcomes. All levels of staff in the studied facility were educated in general diabetes care. A nurse practitioner was contracted to provide medical care for all diabetic residents (with primary care provider approval). A scorecard for adherence to diabetes guidelines was completed by the nurse practitioner. Over a 3-year period following the education program and scorecard implementation, a chart review of all residents was completed by a consulting diabetes educator/nurse practitioner/nurse faculty member and 6 undergraduate nursing students. In general, the nursing home in the present study compared favorably with other relevant studies, demonstrating lower A1C levels, tracking blood sugars more regularly, monitoring blood pressure and lipids more regularly, having a greater percentage of patients on lipid-lowering medications among those in need, more appropriate use of sliding scale insulin, greater adherence to recommendations regarding diet, and had more patients who fit criteria on preventive anticoagulation. The results for the studied facility were very similar, often better, when compared with the most current nursing home literature. Areas of weakness

  9. Hypertension guideline implementation: experiences of Finnish primary care nurses

    DEFF Research Database (Denmark)

    Alanen, Seija; Ijäs, Jarja; Kaila, Minna

    2008-01-01

    RATIONALE, AIMS AND OBJECTIVES: Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses. METHOD: We assessed the style of implementation and adoption of the national...... Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers...

  10. Enhanced implementation of low back pain guidelines in general practice

    DEFF Research Database (Denmark)

    Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming

    2013-01-01

    BACKGROUND: Evidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs....... The aim of this study is to evaluate whether a complex, multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy. METHODS/DESIGN: In a two-armed cluster randomised trial, 100...... visits, stratification tools, and quality reports on low back pain treatment. Primary outcome is referral to secondary care. Secondary outcomes are pain, physical function, health-related quality of life, patient satisfaction with care and treatment outcome, employment status, and sick leave. Primary...

  11. Rational pharmacotherapy and clinical practice guidelines - Theories and perspectives on implementing pharmacotherapeutic treatment guidelines

    NARCIS (Netherlands)

    Fijn, R; Brouwers, JRBJ; Timmer, JW; de Jong-van den Berg, LTW

    Several theories behind implementing clinical guidelines have been described within the literature. At first sight, these may seem different. However, there are similarities and eventually they are rather complementary than mutually exclusive. This article integrates several theoretical views on

  12. Implementing guidelines: Proposed definitions of neuropsychology services in pediatric oncology.

    Science.gov (United States)

    Baum, Katherine T; Powell, Stephanie K; Jacobson, Lisa A; Gragert, Marsha N; Janzen, Laura A; Paltin, Iris; Rey-Casserly, Celiane M; Wilkening, Greta N

    2017-08-01

    Several organizations have published guidelines for the neuropsychological care of survivors of childhood cancer. However, there is limited consensus in how these guidelines are applied. The model of neuropsychology service delivery is further complicated by the variable terminology used to describe recommended services. In an important first step to translate published guidelines into clinical practice, this paper proposes definitions for specific neuropsychological processes and services, with the goal of facilitating consistency across sites to foster future clinical program development and to clarify clinical practice guidelines. © 2017 Wiley Periodicals, Inc.

  13. Pleural drainage and pleurodesis: implementation of guidelines in four hospitals

    NARCIS (Netherlands)

    Burgers, J. A.; Kunst, P. W. A.; Koolen, M. G. J.; Willems, L. N. A.; Burgers, J. S.; van den Heuvel, M.

    2008-01-01

    The aim of the present study was to evaluate the implementation of the 2003 Dutch guideline on the diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis. All patients with malignant pleural effusion who had a

  14. Pleural drainage and pleurodesis: implementation of guidelines in four hospitals.

    NARCIS (Netherlands)

    Burgers, J.A.; Kunst, P.W.; Koolen, M.G.; Willems, L.N.; Burgers, J.S.

    2008-01-01

    The aim of the present study was to evaluate the implementation of the 2003 Dutch guideline on the diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis. All patients with malignant pleural effusion who had a

  15. A practical approach to implementing new CDC GBS guidelines.

    Science.gov (United States)

    Hill, Shawna M; Bridges, Margie A; Knudsen, Alexis L; Vezeau, Toni M

    2013-01-01

    Group beta streptococcus (GBS) is a well-documented pathogen causing serious maternal and fetal morbidity and mortality. The CDC guidelines for managing clients who test positive for GBS in pregnancy were revised and published in 2010. However, CDC and extant literature provide limited guidance on implementation strategies for these new recommendations. Although several algorithms are included in the CDC (2010) document, none combine the maternal risk factors for practical and consistent implementation from pregnancy to newborn. In response to confusion upon initial education of these guidelines, we developed an algorithm for maternal intrapartum management. In addition, we clarified the CDC (2010) newborn algorithm in response to provider request. Without altering the recommendations, both algorithms provide clarification of the CDC (2010) guidelines. The nursing process provides an organizational structure for the discussion of our efforts to translate the complex guidelines into practice. This article could provide other facilities with tools for dealing with specific aspects of the complex clinical management of perinatal GBS.

  16. Guidelines for Implementing Change: A Case Study

    Science.gov (United States)

    Masekela, Belinda; Nienaber, Rita

    To attain and sustain a competitive advantage organizations are continually faced with the need to change their structures, processes and technologies. Converting to new technology and implementing a new information management system in an organization results in inevitable changes in organizational procedures impacting on the people involved. A major problem encountered during this process is resistance to change, which may contribute to total failure of this system. Change management is the process that can be used to negate this impact and assist employees in transitioning to a new way of doing things.

  17. A case of standardization? Implementing health promotion guidelines in Denmark

    DEFF Research Database (Denmark)

    Rod, Morten Hulvej; Høybye, Mette Terp

    2016-01-01

    policies and interventions and were structured according to risk factors such as alcohol, smoking and physical activity. This article examines the process of implementation of the new Danish health promotion guidelines. The article is based on qualitative interviews and participant observation, focusing...... and standardization. It remains an open question whether or not the guidelines lead to more standardized policies and interventions, but we suggest that the guidelines promote a risk factor oriented approach as the dominant frame for knowledge, reasoning, decision making and priority setting in health promotion. We...

  18. Managing Air Quality - Program Implementation

    Science.gov (United States)

    Describes elements for the set of activities to ensure that control strategies are put into effect and that air quality goals and standards are fulfilled, permitting programs, and additional resources related to implementation under the Clean Air Act.

  19. Implementing Practice Guidelines: A Workshop on Guidelines Dissemination and Implementation with a Focus on Asthma and COPD

    Directory of Open Access Journals (Sweden)

    Louis-Philippe Boulet

    2006-01-01

    Full Text Available The present supplement summarizes the proceedings of the symposium “Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD”, which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue, the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients’ associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals.

  20. A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice

    DEFF Research Database (Denmark)

    Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming

    2016-01-01

    BACKGROUND: Guidelines are often slowly adapted into clinical practice. However, actively supporting healthcare professionals in evidence-based treatment may speed up guideline implementation. Danish low back pain (LBP) guidelines focus on primary care treatment of LBP, to reduce referrals from......IS including outreach visits, quality reports, and the STarT Back Tool for subgrouping patients with LBP. Both groups were offered the usual dissemination of guidelines, guideline-concordant structuring of the medical record, and a new referral opportunity for patients with psycho-social problems...

  1. Clinical guideline implementation strategies for common mental health disorders.

    Science.gov (United States)

    Moreno, Eliana María; Moriana, Juan Antonio

    2016-01-01

    There has been a considerable proliferation of clinical guidelines recently, but their practical application is low, and organisations do not always implement their own ones. The aim of this study is to analyse and describe key elements of strategies and resources designed by the National Institute for Health and Care Excellence for the implementation of guidelines for common mental health disorders in adults, which are some of the most prevalent worldwide. A systematic review was performed following PRISMA model. Resources, tools and implementation materials where included and categorised considering type, objectives, target and scope. A total of 212 elements were analysed, of which 33.5 and 24.5% are related to the implementation of generalized anxiety and depression guidelines, respectively. Applied tools designed to estimate costs and assess the feasibility of the setting up at local level are the most frequent type of resource. The study highlights the important variety of available materials, classified into 3 main strategies: tools targeting the professionals (30.6%), structural (26.4%), and organizational (24%). Developing guidelines is not enough; it is also necessary to promote their implementation in order to encourage their application. The resources and strategies described in this study may be potentially applicable to other contexts, and helpful to public health managers and professionals in the design of programmes and in the process of informed decision making to help increase access to efficient treatments. Copyright © 2015. Published by Elsevier España.

  2. The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers

    Directory of Open Access Journals (Sweden)

    Adesuwa Olomu

    2016-12-01

    Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases.

  3. Large program implementation on minicomputers

    CERN Document Server

    Fonti, L

    1980-01-01

    A method is described to fit a very large program (usually executed on very big mainframes, like a CDC 7600 or IBM 370/168) on a 16-bit minicomputer with memory management support. The method outlined is fully general, even if references are made to a specific example: the implementation of the CERN program HYDRA on a PDP 11/70. (2 refs).

  4. School nutrition guidelines: overview of the implementation and evaluation.

    Science.gov (United States)

    Gregorič, Matej; Pograjc, Larisa; Pavlovec, Alenka; Simčič, Marjan; Gabrijelčič Blenkuš, Mojca

    2015-06-01

    To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems. The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation). Slovenian primary schools. A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation. The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements. The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

  5. Effectiveness and efficiency of guideline dissemination and implementation strategies.

    NARCIS (Netherlands)

    Grimshaw, J.; Thomas, R.; MacLennan, G.; Fraser, C.; Ramsay, C.R.; Vale, L.; Whitty, P.; Eccles, M.P.; Matowe, L.; Shirran, L.; Wensing, M.J.P.; Dijkstra, R.F.; Donaldson, C.

    2004-01-01

    OBJECTIVES: To undertake a systematic review of the effectiveness and costs of different guideline development, dissemination and implementation strategies. To estimate the resource implications of these strategies. To develop a framework for deciding when it is efficient to develop and introduce

  6. Designing, Developing, and Implementing Diversity Training: Guidelines for Practitioners.

    Science.gov (United States)

    Kincaid, Tanna M.; Horner, Erin R.

    1997-01-01

    Discusses diversity in the workplace and offers guidelines for practitioners in designing, developing, and implementing diversity training. Highlights include linking the diversity initiative to the organization's mission, cultural climate assessments, reviewing policies and procedures, needs assessment, learner analysis, establishing objectives,…

  7. Overactive Bladder and Continence Guidelines: implementation, inaction or frustration?

    NARCIS (Netherlands)

    Wagg, A.; Cardozo, L.; Chapple, C.; Diaz, D.C.; Ridder, D. de; Espuna-Pons, M.; Haab, F.; Kelleher, C.; Kolbl, H.; Milsom, I.; Kerrebroeck, P. van; Vierhout, M.E.; Kirby, M.

    2008-01-01

    Guidelines for the management of continence and overactive bladder are generally available across Europe. For a majority of countries, these have been adopted by professional societies in either urology or gynaecology for local use. There has, however, been little monitoring of formal implementation

  8. Implementation of locally adapted guidelines on type 2 diabetes

    NARCIS (Netherlands)

    van Bruggen, Rykel; Gorter, Kees J.; Stolk, Roland P.; Verhoeven, Rob P.; Rutten, Guy E. H. M.

    2008-01-01

    Objective. To assess the effects of a facilitator enhanced multifaceted intervention to implement a locally adapted guideline on the shared care for people with type 2 diabetes. Methods. During 1 year a cluster-randomized trial was performed in 30 general practices. In the intervention group, nurse

  9. Guidelines for Identification. Educational Programs for Gifted and Talented Children.

    Science.gov (United States)

    Drons, Michael T.

    This publication provides Maine school administrative unit personnel with guidelines to implement procedures for identifying gifted and talented children. Legislative requirements are presented on the left-hand pages and suggested guidelines for implementing the requirements are on the right-hand pages. Requirements and guidelines are organized…

  10. Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline

    Directory of Open Access Journals (Sweden)

    Brouwers Melissa C

    2011-09-01

    Full Text Available Abstract Background Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and colorectal cancers? Methods A guideline panel was established as part of Cancer Care Ontario's Program in Evidence-based Care, and a systematic review of the published literature was conducted. It yielded three foundational systematic reviews and an existing guidance document. We conducted updates of these reviews and searched the literature published between 2004 and 2010. A draft guideline was written that went through two rounds of review. Revisions were made resulting in a final set of guideline recommendations. Results Sixty-six new studies reflecting 74 comparisons met eligibility criteria. They were generally of poor to moderate quality. Using these and the foundational documents, the panel developed a draft guideline. The draft report was well received in the two rounds of review with mean quality scores above four (on a five-point scale for each of the items. For most of the interventions considered, there was insufficient evidence to support or refute their effectiveness. However, client reminders, reduction of structural barriers, and provision of provider assessment and feedback were recommended interventions to increase screening for at least two of three cancer sites studied. The final guidelines also provide advice on how the recommendations can be used and future areas for research. Conclusion Using established guideline development methodologies and the AGREE II as our methodological

  11. Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline.

    Science.gov (United States)

    Brouwers, Melissa C; De Vito, Carol; Bahirathan, Lavannya; Carol, Angela; Carroll, June C; Cotterchio, Michelle; Dobbins, Maureen; Lent, Barbara; Levitt, Cheryl; Lewis, Nancy; McGregor, S Elizabeth; Paszat, Lawrence; Rand, Carol; Wathen, Nadine

    2011-09-29

    Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and colorectal cancers? A guideline panel was established as part of Cancer Care Ontario's Program in Evidence-based Care, and a systematic review of the published literature was conducted. It yielded three foundational systematic reviews and an existing guidance document. We conducted updates of these reviews and searched the literature published between 2004 and 2010. A draft guideline was written that went through two rounds of review. Revisions were made resulting in a final set of guideline recommendations. Sixty-six new studies reflecting 74 comparisons met eligibility criteria. They were generally of poor to moderate quality. Using these and the foundational documents, the panel developed a draft guideline. The draft report was well received in the two rounds of review with mean quality scores above four (on a five-point scale) for each of the items. For most of the interventions considered, there was insufficient evidence to support or refute their effectiveness. However, client reminders, reduction of structural barriers, and provision of provider assessment and feedback were recommended interventions to increase screening for at least two of three cancer sites studied. The final guidelines also provide advice on how the recommendations can be used and future areas for research. Using established guideline development methodologies and the AGREE II as our methodological frameworks, we developed an implementation guideline to advise on

  12. Factors influencing the implementation of the guideline triage in emergency departments: a qualitative study.

    NARCIS (Netherlands)

    Janssen, M.A.M.; Achterberg, T. van; Adriaansen, M.J.M.; Kampshoff, C.S.; Schalk, D.M.; Mintjes-de Groot, A.J.

    2012-01-01

    AIMS AND OBJECTIVES: The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.

  13. Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study

    NARCIS (Netherlands)

    Janssen, M.A.P.; van Achterberg, T.; Adriaansen, M.J.M.; Kampshoff, C.S.; Schalk, D.M.J.; Mintjes-de Groot, A.J.

    2012-01-01

    Aims and objectives. The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.

  14. Implementation of nutritional guidelines in a university hospital monitored by repeated point prevalence surveys

    OpenAIRE

    Tangvik, Randi Julie; Guttormsen, Anne Berit; Tell, Grethe Seppola; Ranhoff, Anette Hylen

    2012-01-01

    Background/Objectives: Malnutrition is present in 20–50% of hospitalized patients, and nutritional care is a challenge. The aim was to evaluate whether the implementation of a nutritional strategy would influence nutritional care performance in a university hospital.Subjects/Methods: This was a prospective quality improvement program implementing guidelines for nutritional care, with the aim of improving nutritional practice. The Nutrition Risk Screening (NRS) 2002 was used. Point pr...

  15. Development, Validation, and Implementation of a Clinic Nurse Staffing Guideline.

    Science.gov (United States)

    Deeken, Debra Jean; Wakefield, Douglas; Kite, Cora; Linebaugh, Jeanette; Mitchell, Blair; Parkinson, Deidre; Misra, Madhukar

    2017-10-01

    Ensuring that the level of nurse staffing used to care for patients is appropriate to the setting and service intensity is essential for high-quality and cost-effective care. This article describes the development, validation, and implementation of the clinic technical skills permission list developed specifically to guide nurse staffing decisions in physician clinics of an academic medical center. Results and lessons learned in using this staffing guideline are presented.

  16. Implementation of anaphylaxis management guidelines: a register-based study.

    Directory of Open Access Journals (Sweden)

    Linus Grabenhenrich

    Full Text Available BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

  17. Design and implementation of speed humps: supplement to national guidelines for traffic calming

    CSIR Research Space (South Africa)

    Emslie, I

    1997-03-01

    Full Text Available This report presents guidelines to assist local authorities and traffic engineers with a uniform approach to the implementation of speed humps. It is recommended that these guidelines be read in conjunction with The National Guidelines for Traffic...

  18. Effectiveness of the implementation of guidelines for anxiety disorders in specialized mental health care

    NARCIS (Netherlands)

    Dijk, M.K. van; Oosterbaan, D.B.; Verbraak, M.J.P.M.; Hoogendoorn, A.W.; Penninx, B.W.J.H.; Balkom, A.J.L.M. van

    2015-01-01

    Objective To examine the effect of implementing anxiety disorders guidelines on guideline adherence and patient outcomes in specialized mental health care. Method A treatment setting in which guidelines were implemented (intervention condition) was compared with one in which guidelines were only

  19. Effectiveness of the implementation of guidelines for anxiety disorders in specialized mental health care

    NARCIS (Netherlands)

    Dijk, M.K. van; Oosterbaan, D.B.; Verbraak, M.J.; Hoogendoorn, A.W.; Penninx, B.W.; Balkom, A.J. van

    2015-01-01

    OBJECTIVE: To examine the effect of implementing anxiety disorders guidelines on guideline adherence and patient outcomes in specialized mental health care. METHOD: A treatment setting in which guidelines were implemented (intervention condition) was compared with one in which guidelines were only

  20. Isolated systems with wind power. An implementation guideline

    Energy Technology Data Exchange (ETDEWEB)

    Clausen, N.E.; Bindner, H.; Frandsen, S.; Hansen, J.C.; Hansen, L.H.; Lundsager, P.

    2001-06-01

    The overall objective of this research project is to study the development of methods and guidelines rather than 'universal solutions' for the use of wind energy in isolated communities. So far most studies of isolated systems with wind power have been case-oriented and it has proven difficult to extend results from one project to another, not least due to the strong individuality that has characterised such systems in design and implementation. In the present report a unified and generally applicable approach is attempted in order to support a fair assessment of the technical and economical feasibility of isolated power supply systems with wind energy. General guidelines and checklists on which facts and data are needed to carry out a project feasibility analysis are presented as well as guidelines how to carry out the project feasibility study and the environmental analysis. The report outlines the results of the project as a set of proposed guidelines to be applied when developing a project containing an application of wind in an isolated power system. It is the author's hope that this will facilitate the development of projects and enhance electrification of small rural communities in developing countries. (au)

  1. From guidelines to action: implementation opportunities and realities

    Directory of Open Access Journals (Sweden)

    Wafaa El-Sadr

    2014-11-01

    Full Text Available The past decade has seen notable progress in confronting the HIV epidemic. By the end of 2013, almost 13 million persons living with HIV had access to antiretroviral therapy (ART in low- and middle-income countries (LMIC. In addition, progress has also been achieved in terms of HIV prevention with 26 LMIC achieving a 50% decrease in number of new infections including 15 countries in sub-Saharan Africa. New research findings also offer new efficacious prevention interventions that offer new opportunities for further mitigation of new HIV infections. Such progress has inspired ambitious pronouncements such as achieving “The End of AIDS” or “An AIDS Free Generation.” This progress has also motivated the development of new guidelines aimed to achieving these goals. Implementation of guideline recommendations, however, requires translation of these guidelines into actionable steps and then their successful delivery within established health services. The opportunities offered by new guidelines frequently meet the realities of the frailties of the health system. Achieving current ambitious global targets must confront the specific deficits in the health system that inhibit access and acceptability of programmes as well as hinder achievement of high quality or desired coverage.

  2. Overcoming the obstacles of implementing infection prevention and control guidelines.

    Science.gov (United States)

    Birgand, G; Johansson, A; Szilagyi, E; Lucet, J-C

    2015-12-01

    Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  3. Use of theory to plan or evaluate guideline implementation among physicians: A scoping review

    NARCIS (Netherlands)

    Liang, L.; Bernhardsson, S.; Vernooij, R.W.M.; Armstrong, M.J.; Bussières, A.; Brouwers, M.C.; Gagliardi, A.R.; Alhabib, S.; Fleuren, M.; Fortino, M.; Mazza, D.; O'Rourke, N.; Willson, M.

    2017-01-01

    Background: Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This

  4. Improving the use of research evidence in guideline development: 15. Disseminating and implementing guidelines

    Directory of Open Access Journals (Sweden)

    Oxman Andrew D

    2006-12-01

    Full Text Available Abstract Background The World Health Organization (WHO, like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 15th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives In this review we address strategies for the implementation of recommendations in health care. Methods We examined overviews of systematic reviews of interventions to improve health care delivery and health care systems prepared by the Cochrane Effective Practice and Organisation of Care (EPOC group. We also conducted searches using PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. Key questions and answers What should WHO do to disseminate and facilitate the uptake of recommendations? • WHO should choose strategies to implement their guidelines from among those which have been evaluated positively in the published literature on implementation research • Because the evidence base is weak and modest to moderate effects, at best, can be anticipated, WHO should promote rigorous evaluations of implementation strategies. What should be done at headquarters, by regional offices and in countries? • Adaptation and implementation of WHO guidelines should be done locally, at the national or sub-national level. • WHO headquarters and regional offices should support the development and evaluation of implementation strategies by local authorities.

  5. Towards local implementation of Dutch health policy guidelines: a concept-mapping approach.

    Science.gov (United States)

    Kuunders, Theo J M; van Bon-Martens, Marja J H; van de Goor, Ien A M; Paulussen, Theo G W M; van Oers, Hans A M

    2017-02-22

    To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful implementation of the guideline were identified. Differences and similarities in perceptions of these characteristics between RHSs and developers were explored. Separate concept mapping procedures were executed in two RHSs, one with representatives from partner local health organizations and municipalities, the second with RHS members only. A third map was conducted with the developers of the guideline. All mapping procedures followed the same design of generating statements up to interpretation of results with participants. Concept mapping, as a practical implementation tool, will be discussed in the context of international research literature on guideline implementation in public health. Guideline developers consider implementation successful when substantive components (health issues) of the guidelines, content are visible in local policy practice. RHSs, local organizations and municipalities view the implementation process itself within and between organizations as more relevant, and state that usability of the guideline for municipal policy and commitment by officials and municipal managers are critical targets for successful implementation. Between the RHSs, differences in implementation targets were smaller than between RHSs and guideline developers. For successful implementation, RHSs tend to focus on process targets while developers focus more on the thematic contents of the guideline. Implications of these different orientations for implementation strategies are dealt with in the discussion. © The Author 2017. Published by Oxford University Press.

  6. [Evaluation of tools for the implementation of clinical practice guidelines on sexually transmitted infections].

    Science.gov (United States)

    Moreno, Jaime Hernán Rodríguez; Romero Vergara, Antonio José; De Moya, Danilo De Jesús De Alba; Jaramillo Rojas, Hernán Javier; Díaz Rojas, Claudia Milena; Ciapponi, Agustín

    2017-05-25

    Determine the acceptability, perceived usefulness, and adoption of implementation tools and technical assistance provided by the Health Technology Assessment Institute (IETS) in hospitals in two regions of Colombia. Assistance was provided for implementation of clinical practice guidelines (CPGs) in 24 hospitals (17 in Antioquia and seven in Cundinamarca) in areas with high prevalence of sexually transmitted infections, and for use of the implementation tools. Health professionals were given surveys and medical specialists were interviewed. Overall, 86% of respondents are familiar with the GPGs, 86% with the tracer recommendations, 79% with the interactive flow charts, and 82% with the evidence sheets, while 41% never used the implementation tools. Of the respondents who used the tools, 55% did so on their work computer, while 24% used their personal telephone. The most useful tools were the evidence sheets and flow charts (98%) and the tracer recommendations (92%). The least useful were the budgetary impact tools (81%). The implementation tools and technical assistance provided in hospitals in two regions of Colombia are perceived as useful and acceptable, although the degree of implementation is low. The findings of this research will help the different actors, such as the Ministry of Health and Social Protection, the IETS, and the Administrative Department of Science, Technology and Innovation (Colciencias), among others, improve their programs for the implementation of clinical practice guidelines.

  7. Implementing an Information Security Program

    Energy Technology Data Exchange (ETDEWEB)

    Glantz, Clifford S.; Lenaeus, Joseph D.; Landine, Guy P.; O' Neil, Lori Ross; Leitch, Rosalyn; Johnson, Christopher; Lewis, John G.; Rodger, Robert M.

    2017-11-01

    The threats to information security have dramatically increased with the proliferation of information systems and the internet. Chemical, biological, radiological, nuclear, and explosives (CBRNe) facilities need to address these threats in order to protect themselves from the loss of intellectual property, theft of valuable or hazardous materials, and sabotage. Project 19 of the European Union CBRN Risk Mitigation Centres of Excellence Initiative is designed to help CBRN security managers, information technology/cybersecurity managers, and other decision-makers deal with these threats through the application of cost-effective information security programs. Project 19 has developed three guidance documents that are publically available to cover information security best practices, planning for an information security management system, and implementing security controls for information security.

  8. Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial

    NARCIS (Netherlands)

    Engers, AJ; Wensing, M.; van Tulder, M.; Timmermans, A.; Oostendorp, R.A.B.; Koes, B.W.; Grol, R.P.T.M.

    2005-01-01

    STUDY DESIGN.: Cluster randomized controlled trial for a multifaceted implementation strategy. OBJECTIVES.: To assess the effectiveness of tailored interventions (multifaceted implementation strategy) to implement the Dutch low back pain guideline for general practitioners with regard to adherence

  9. Development of an implementation strategy for physiotherapy guidelines on low back pain.

    NARCIS (Netherlands)

    Bekkering, G.E.; Engers, A.J.; Wensing, M.J.P.; Hendriks, H.J.M.; Tulder, M.W. van; Oostendorp, R.A.B.; Bouter, L.M.

    2003-01-01

    In the Netherlands, clinical practice physiotherapy guidelines are mainly implemented by using passive implementation strategies. It is well known that these strategies are not effective in establishing changes in behaviour of health care professionals. Therefore, a new implementation strategy was

  10. Acute coronary syndromes: considerations for improved acceptance and implementation of management guidelines.

    NARCIS (Netherlands)

    Werf, F. van de; Ardissino, D.; Bueno, H.; Collet, J.P.; Gershlick, A.; Kolh, P.; Kristensen, S.D.; Silber, S.; Verheugt, F.W.; Wojakowski, W.

    2012-01-01

    The management of acute coronary syndrome in Europe is covered by various European Society of Cardiology guidelines, which although valuable, are complex and may not always provide clear guidance in everyday clinical practice. Consequently, implementation of the guideline recommendations is

  11. Implementing an Applied Science Program

    Science.gov (United States)

    Rickman, Doug; Presson, Joan

    2007-01-01

    The work implied in the NASA Applied Science Program requires a delicate balancing act for the those doing it. At the implementation level there are multiple tensions intrinsic to the program. For example each application of an existing product to a decision support process requires deep knowledge about the data and deep knowledge about the decision making process. It is highly probable no one person has this range of knowledge. Otherwise the decision making process would already be using the data. Therefore, a team is required. But building a team usually requires time, especially across agencies. Yet the program mandates efforts of relatively short duration. Further, those who know the data are scientists, which makes them essential to the program. But scientists are evaluated on their publication record. Anything which diverts a scientist from the research for his next publication is an anathema to him and potential death to their career. Trying to get another agency to use NASA data does not strike most scientists as material inherently suitable for publication. Also, NASA wishes to rapidly implement often substantial changes to another agency's process. For many reasons, such as budget and program constraints, speed is important. But the owner of a decision making process is tightly constrained, usually by law, regulation, organization and custom. Changes when made are slow, cautious, even hesitant, and always done according a process specific to the situation. To manage this work MSFC must balance these and other tensions. Some things we have relatively little control over, such as budget. These we try to handle by structural techniques. For example by insisting all of our people work on multiple projects simultaneously we inherently have diversification of funding for all of our people. In many cases we explicitly use some elements of tension to be productive. For example the need for the scientists to constantly publish is motivation to keep tasks short and

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

    Science.gov (United States)

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

    2016-01-01

    To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPC_E) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPC_E, and develop a monitoring and evaluation system for the key recommendations. The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. the conclusions and final adjustments were discussed with the GPC_E leaders. The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor

  13. Towards guideline implementation for integrated local health policies : Evaluation of an experimental implementation strategy in regional health services

    NARCIS (Netherlands)

    Kuunders, T.J.M.; Cloin, J.C.M.; van Bon, M.J.H.; Paulussen, T.G.W.M.; van Oers, J.A.M.; van de Goor, L.A.M.

    2017-01-01

    To enhance implementation of a Guideline for integrated local health policy, a draft implementation strategy (DIS) was developed. It was hypothesized that the DIS would be feasible and effective to enhance the use of a Guideline for integrated local health policy. To examine its feasibility and

  14. A framework of the desirable features of guideline implementation tools (GItools): Delphi survey and assessment of GItools

    NARCIS (Netherlands)

    Gagliardi, A.R.; Brouwers, M.C.; Bhattacharyya, O.K.; Wees, P.J. van der

    2014-01-01

    BACKGROUND: Guidelines are the foundation for healthcare planning, delivery and quality improvement but are not consistently implemented. Few guidelines are accompanied by guideline implementation tools (GItools). Users have requested GItools, and developers have requested guidance on how to develop

  15. Standards and Guidelines for Commuter Student Programs and Services.

    Science.gov (United States)

    NASPA Journal, 1986

    1986-01-01

    In describing standards and guidelines for commuter student programs and services, an analysis is provided of the mission, the program, multicultural programs and services, leadership and management, organization and administration, human resources, funding, facilities, legal responsibilities, equal opportunity, access and affirmative action,…

  16. 76 FR 16724 - Child Nutrition Programs-Income Eligibility Guidelines

    Science.gov (United States)

    2011-03-25

    ...; ] DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child Nutrition Programs--Income Eligibility Guidelines..., Supervisory Program Analyst, School Programs Section, Child Nutrition Division, Food and Nutrition Service...)), and sections 3(a)(6) and 4(e)(1)(A) of the Child Nutrition Act of 1966 (42 U.S.C. 1772(a)(6) and 1773...

  17. Memoranda about Implementation of the Cancer Guidelines and Accompanying Supplemental Guidance - Science Policy Council Cancer Guidelines Implementation Workgroup Communication I and II

    Science.gov (United States)

    Memoranda from the Chair of EPA's Science Policy Council to the Science Policy Council and the Science Policy Council Steering Committee regarding Implementation of the Cancer Guidelines and Accompanying Supplemental Guidance.

  18. Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up

    Directory of Open Access Journals (Sweden)

    Janszky Imre

    2010-01-01

    Full Text Available Abstract Background The gap between evidence-based guidelines for clinical care and their use in medical settings is well recognized and widespread. Only a few implementation studies of psychiatric guidelines have been carried out, and there is a lack of studies on their long-term effects. The aim of this study was to measure compliance to clinical guidelines for treatment of patients with depression and patients with suicidal behaviours, two years after an actively supported implementation. Methods Six psychiatric clinics in Stockholm, Sweden, participated in an implementation of the guidelines. The guidelines were actively implemented at four of them, and the other two only received the guidelines and served as controls. The implementation activities included local implementation teams, seminars, regular feedback, and academic outreach visits. Compliance to guidelines was measured using quality indicators derived from the guidelines. At baseline, measurements of quality indicators, part of the guidelines, were abstracted from medical records in order to analyze the gap between clinical guidelines and current practice. On the basis of this, a series of seminars was conducted to introduce the guidelines according to local needs. Local multidisciplinary teams were established to monitor the process. Data collection took place after 6, 12, and 24 months and a total of 2,165 patient records were included in the study. Results The documentation of the quality indicators improved from baseline in the four clinics with an active implementation, whereas there were no changes, or a decline, in the two control clinics. The increase was recorded at six months, and persisted over 12 and 24 months. Conclusions Compliance to the guidelines increased after active implementation and was sustained over the two-year follow-up. These results indicate that active local implementation of clinical guidelines involving clinicians can change behaviour and maintain

  19. Implementing clinical guidelines in psychiatry: a qualitative study of perceived facilitators and barriers

    Directory of Open Access Journals (Sweden)

    Wistedt Anna

    2010-01-01

    Full Text Available Abstract Background Translating scientific evidence into daily practice is complex. Clinical guidelines can improve health care delivery, but there are a number of challenges in guideline adoption and implementation. Factors influencing the effective implementation of guidelines remain poorly understood. Understanding of barriers and facilitators is important for development of effective implementation strategies. The aim of this study was to determine perceived facilitators and barriers to guideline implementation and clinical compliance to guidelines for depression in psychiatric care. Methods This qualitative study was conducted at two psychiatric clinics in Stockholm, Sweden. The implementation activities at one of the clinics included local implementation teams, seminars, regular feedback and academic detailing. The other clinic served as a control and only received guidelines by post. Data were collected from three focus groups and 28 individual, semi-structured interviews. Content analysis was used to identify themes emerging from the interview data. Results The identified barriers to, and facilitators of, the implementation of guidelines could be classified into three major categories: (1 organizational resources, (2 health care professionals' individual characteristics and (3 perception of guidelines and implementation strategies. The practitioners in the implementation team and at control clinics differed in three main areas: (1 concerns about control over professional practice, (2 beliefs about evidence-based practice and (3 suspicions about financial motives for guideline introduction. Conclusions Identifying the barriers to, and facilitators of, the adoption of recommendations is an important way of achieving efficient implementation strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals actively participate in an ongoing implementation process and identify

  20. Social network analysis for program implementation.

    Science.gov (United States)

    Valente, Thomas W; Palinkas, Lawrence A; Czaja, Sara; Chu, Kar-Hai; Brown, C Hendricks

    2015-01-01

    This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

  1. [Guideline implementation study on asthma: Results of a pragmatic implementation approach].

    Science.gov (United States)

    Redaèlli, Marcus; Vollmar, Horst Christian; Simic, Dusan; Maly-Schürer, Cornelia; Löscher, Susanne; Koneczny, Nikolaus

    2015-01-01

    Knowledge transfer from theory to practice in healthcare systems poses a challenge worldwide. Typical examples include national disease management guidelines. The present study contributes towards improving implementation strategies for an asthma guideline. A guideline implementation strategy was examined in a four-armed, non-randomised, controlled intervention study with an additional control group. The study participants were general practitioners and paediatricians recruited from primary care quality circles. All study participants attended an interactive seminar on the evidence-based recommendations for patients with asthma. In addition, the participants were asked to choose among the following options: no further intervention, additional e-learning, training of their practice nurses, or e-learning and training of their practice nurses. The success of the intervention was measured by questionnaire (and the success rate expressed as a percentage). About one third of all participants (n=313) opted for the combination of an interactive seminar and a training of practice nurses; two third preferred the classic way of continuing medical education with an interactive seminar without a further intervention. Just 10 % of the physicians participated in e-learning. Independently of their choice for continuing medical education, all participants demonstrated an increase in knowledge about asthma and an improvement in the management of asthma. The physicians exhibited an average increase in both categories of about 10 % of the percentage values, compared to an increase of about 28 % among the practice nurses without continuing medical education. The physicians' free choice of the educative modules might be an integral part of successful implementation strategies. However, this will require a change of focus from general continuing medical education packages to a more individualised culture of continuing professional development in Germany. Copyright © 2015. Published by

  2. Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis.

    Science.gov (United States)

    Miao, Melissa; Power, Emma; O'Halloran, Robyn

    2015-01-01

    Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care

  3. Examining Guidelines for School-Based Breakfast Programs in Canada: A Systematic Review of the Grey Literature.

    Science.gov (United States)

    Godin, Katelyn M; Kirkpatrick, Sharon I; Hanning, Rhona M; Stapleton, Jackie; Leatherdale, Scott T

    2017-06-01

    School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet it is unclear what is available in Canada. A systematic review was conducted to identify and compare Canadian guidelines related to breakfast programs. Data sources included grey literature databases, customized search engines, targeted websites, and content expert consultations. Eligible guidelines met the following criteria: government and nongovernment sources at the federal and provincial/territorial levels, current version, and intended for program coordinators. Recommendations for program delivery were extracted, categorized, and mapped onto the 4 environments outlined in the ANGELO framework, and they were classified as "common" or "inconsistent" across guidelines. Fifteen sets of guidelines were included. No guidelines were available from federal or territorial governments and 4 provincial governments. There were few references to peer-reviewed literature within the guidelines and despite many common recommendations for program delivery, conflicting recommendations were also identified. Potential barriers to program participation, including a lack of consideration of allergies and other dietary restrictions, were identified. Future research should identify how guidelines are implemented and evaluate what effect their implementation has on program delivery and student outcomes.

  4. School Administrator's Guide to Implementing Language Programming

    Science.gov (United States)

    Alberta Education, 2007

    2007-01-01

    The "School Administrator's Guide to Implementing Language Programming" serves as a starting point to plan for and implement language programming. It provides a general overview; suggests practical strategies for working with students, parents, teachers and the surrounding community; and includes details on areas to address in selecting…

  5. The relative influence of secondary versus primary prevention using the national cholesterol education program adult treatment panel II guidelines

    NARCIS (Netherlands)

    Goldman, L; Coxson, P; Hunink, MGM; Goldman, PA; Tosteson, ANA; Mittleman, M; Williams, L; Weinstein, MC

    OBJECTIVES This study was undertaken to project the population-wide effect of full implementation of the Adult Treatment Panel (ATP) II guidelines of the National Cholesterol Education Program (NCEP). BACKGROUND The ATP II has proposed guidelines for cholesterol reduction, but the long-term

  6. Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: barriers, facilitators and keys to success.

    Science.gov (United States)

    Jilcott Pitts, S B; Graham, J; Mojica, A; Stewart, L; Walter, M; Schille, C; McGinty, J; Pearsall, M; Whitt, O; Mihas, P; Bradley, A; Simon, C

    2016-12-01

    Healthy foodservice guidelines are being implemented in worksites and healthcare facilities to increase access to healthy foods by employees and public populations. However, little is known about the barriers to and facilitators of implementation. The present study aimed to examine barriers to and facilitators of implementation of healthy foodservice guidelines in federal worksite and hospital cafeterias. Using a mixed-methods approach, including a quantitative survey followed by a qualitative, in-depth interview, we examined: (i) barriers to and facilitators of implementation; (ii) behavioural design strategies used to promote healthier foods and beverages; and (iii) how implementation of healthy foodservice guidelines influenced costs and profitability. We used a purposive sample of five hospital and four federal worksite foodservice operators who recently implemented one of two foodservice guidelines: the United States Department of Health and Human Services/General Services Administration Health and Sustainability Guidelines ('Guidelines') in federal worksites or the Partnership for a Healthier America Hospital Healthier Food Initiative ('Initiative') in hospitals. Descriptive statistics were used to analyse quantitative survey data. Qualitative data were analysed using a deductive approach. Implementation facilitators included leadership support, adequate vendor selections and having dietitians assist with implementation. Implementation barriers included inadequate selections from vendors, customer complaints and additional expertise required for menu labelling. Behavioural design strategies used most frequently included icons denoting healthier options, marketing using social media and placement of healthier options in prime locations. Lessons learned can guide subsequent steps for future healthy foodservice guideline implementation in similar settings. © 2016 The British Dietetic Association Ltd.

  7. Critical update on CoBRA guideline implementation

    OpenAIRE

    Bravo Elena

    2016-01-01

    CoBRA is a Reporting Guideline for the Standardized Citation Of BioResources in scientific journal Articles published on February 2015 in BMC Medicine. This presentation is an update of the CoBRA guideline and it has been presented in Vienna Sept. 16 at the Europe Biobank Week.

  8. Developing and implementing health and sustainability guidelines for institutional food service.

    Science.gov (United States)

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H; Bowden, Brian

    2012-05-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.

  9. 77 FR 17004 - Child Nutrition Programs-Income Eligibility Guidelines

    Science.gov (United States)

    2012-03-23

    ... Food and Nutrition Service Child Nutrition Programs--Income Eligibility Guidelines AGENCY: Food and..., School Programs Section, Child Nutrition Division, Food and Nutrition Service (FNS), USDA, Alexandria... 3(a)(6) and 4(e)(1)(A) of the Child Nutrition Act of 1966 (42 U.S.C. 1772(a)(6) and 1773(e)(1)(A...

  10. 78 FR 17628 - Child Nutrition Programs; Income Eligibility Guidelines

    Science.gov (United States)

    2013-03-22

    ... Food and Nutrition Service Child Nutrition Programs; Income Eligibility Guidelines AGENCY: Food and..., School Programs Section, Child Nutrition Division, Food and Nutrition Service (FNS), USDA, Alexandria... 3(a)(6) and 4(e)(1)(A) of the Child Nutrition Act of 1966 (42 U.S.C. 1772(a)(6) and 1773(e)(1)(A...

  11. EPA LABORATORIES IMPLEMENT EMS PROGRAM

    Science.gov (United States)

    This paper highlights the breadth and magnitude of carrying out an effective Environmental Management System (EMS) program at the U.S. EPA's research and development laboratories. Federal research laboratories have unique operating challenges compared to more centralized industr...

  12. Introducing the Canadian Thoracic Society Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation

    Directory of Open Access Journals (Sweden)

    Samir Gupta

    2013-01-01

    Full Text Available The Canadian Thoracic Society (CTS is leveraging its strengths in guideline production to enable respiratory guideline implementation in Canada. The authors describe the new CTS Framework for Guideline Dissemination and Implementation, with Concurrent Evaluation, which has three spheres of action: guideline production, implementation infrastructure and knowledge translation (KT methodological support. The Canadian Institutes of Health Research ‘Knowledge-to-Action’ process was adopted as the model of choice for conceptualizing KT interventions. Within the framework, new evidence for formatting guideline recommendations to enhance the intrinsic implementability of future guidelines were applied. Clinical assemblies will consider implementability early in the guideline production cycle when selecting clinical questions, and new practice guidelines will include a section dedicated to KT. The framework describes the development of a web-based repository and communication forum to inventory existing KT resources and to facilitate collaboration and communication among implementation stakeholders through an online discussion board. A national forum for presentation and peer-review of proposed KT projects is described. The framework outlines expert methodological support for KT planning, development and evaluation including a practical guide for implementers and a novel ‘Clinical Assembly – KT Action Team’, and in-kind logistical support and assistance in securing peer-reviewed funding.

  13. Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

    DEFF Research Database (Denmark)

    Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J

    2007-01-01

    OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...

  14. Implementing a centralized institutional peer tutoring program.

    Science.gov (United States)

    Gaughf, Natalie White; Foster, Penni Smith

    2016-01-01

    Peer tutoring has been found to be beneficial to both students and peer tutors in health sciences education programs. This article describes the implementation of a centralized, institutional peer tutoring program at the University of Mississippi Medical Center, an academic health science center in the U.S. The Program: This multispecialty peer tutoring program paired students experiencing academic difficulties with peer tutors who showed prior academic success, professionalism and effective communication skills. The program allowed students and peer tutors to coordinate their own tutoring services. Evaluations by both students and peer tutors showed satisfaction with the program. Recommendations for developing and implementing an effective peer tutoring program are presented, including utilization of an online system, consistent program policy with high professionalism expectations, funding, program evaluation and data tracking.

  15. The Veterans Choice Program (VCP): Program Implementation

    Science.gov (United States)

    2017-01-05

    to VACAA and challenges encountered during implantation of the law. Table 1 provides major highlights pertaining to the Veterans Choice Program (VCP...outpatient medical, surgical, and mental healthcare; pharmaceuticals; pregnancy and delivery services; dental care; and durable medical equipment, and

  16. When implementation fails: the case of a nursing guideline for fall prevention.

    Science.gov (United States)

    van der Helm, Jelle; Goossens, Astrid; Bossuyt, Patrick

    2006-03-01

    Implementing guidelines can be very difficult. No magic bullet or step-by-step implementation plan is available, neither is any single implementation strategy superior. At the Academic Medical Center (AMC) in Amsterdam, a nursing guideline was developed in 1993 on prevention of patient falls. Falls decreased by 30% on six wards, yet an effort to implement the guideline into daily practice throughout the hospital failed. A renewed effort was made to implement the guideline in two wards (neurology and internal medicine) in 1999. IMPLEMENTING THE GUIDELINE: Preparations were made for implementation in the two wards. Barriers to change were identified and solutions were translated into day-to-day activities in the wards. The intervention period covered 18 months (January 2000-June 2001). A mix of implementation strategies was used, including a local consensus process, educational activities, and active support and feedback to management and staff. In the internal medicine ward, the target incidence of 6% was met for four of the 18 months in the intervention period. In the neurology ward, the incidence target of 11% was met in five months. Barriers to change and enabling factors may only become apparent during the implementation process itself. A strongly perceived need to change daily practice, a simple guideline, the hospital board's support, an understanding of local barriers, monitoring of outcomes, a locally tailored multifaceted implementation strategy, and voluntarily cooperating nurses are no guarantees for success.

  17. Isolated systems with wind power. An implementation guideline

    DEFF Research Database (Denmark)

    Clausen, Niels-Erik; Bindner, Henrik W.; Frandsen, Sten Tronæs

    2001-01-01

    The overall objective of this research project is to study the development of methods and guidelines rather than "universal solutions" for the use of wind energy in isolated communities. So far most studies of isolated systems with wind power have beencase-oriented and it has proven difficult...... feasibility of isolated power supply systems with wind energy. General guidelines and checklists on which facts and data are needed to carry out a projectfeasibility analysis are presented as well as guidelines how to carry out the project feasibility study and the environmental analysis. The report outlines...... the results of the project as a set of proposed guidelines to be applied when developing a projectcontaining an application of wind in an isolated power system. It is the author's hope that this will facilitate the development of projects and enhance electrification of small rural communities in developing...

  18. Number and type of guideline implementation tools varies by guideline, clinical condition, country of origin, and type of developer organization: content analysis of guidelines

    Directory of Open Access Journals (Sweden)

    Laurel Liang

    2017-11-01

    Full Text Available Abstract Background Guideline implementation tools (GI tools can improve clinician behavior and patient outcomes. Analyses of guidelines published before 2010 found that many did not offer GI tools. Since 2010 standards, frameworks and instructions for GI tools have emerged. This study analyzed the number and types of GI tools offered by guidelines published in 2010 or later. Methods Content analysis and a published GI tool framework were used to categorize GI tools by condition, country, and type of organization. English-language guidelines on arthritis, asthma, colorectal cancer, depression, diabetes, heart failure, and stroke management were identified in the National Guideline Clearinghouse. Screening and data extraction were in triplicate. Findings were reported with summary statistics. Results Eighty-five (67.5% of 126 eligible guidelines published between 2010 and 2017 offered one or more of a total of 464 GI tools. The mean number of GI tools per guideline was 5.5 (median 4.0, range 1 to 28 and increased over time. The majority of GI tools were for clinicians (239, 51.5%, few were for patients (113, 24.4%, and fewer still were to support implementation (66, 14.3% or evaluation (46, 9.9%. Most clinician GI tools were guideline summaries (116, 48.5%, and most patient GI tools were condition-specific information (92, 81.4%. Government agencies (patient 23.5%, clinician 28.9%, implementation 24.1%, evaluation 23.5% and developers in the UK (patient 18.5%, clinician 25.2%, implementation 27.2%, evaluation 29.1% were more likely to generate guidelines that offered all four types of GI tools. Professional societies were more likely to generate guidelines that included clinician GI tools. Conclusions Many guidelines do not include any GI tools, or a variety of GI tools for different stakeholders that may be more likely to prompt guideline uptake (point-of-care forms or checklists for clinicians, decision-making or self-management tools for

  19. Number and type of guideline implementation tools varies by guideline, clinical condition, country of origin, and type of developer organization: content analysis of guidelines.

    Science.gov (United States)

    Liang, Laurel; Abi Safi, Jhoni; Gagliardi, Anna R

    2017-11-15

    Guideline implementation tools (GI tools) can improve clinician behavior and patient outcomes. Analyses of guidelines published before 2010 found that many did not offer GI tools. Since 2010 standards, frameworks and instructions for GI tools have emerged. This study analyzed the number and types of GI tools offered by guidelines published in 2010 or later. Content analysis and a published GI tool framework were used to categorize GI tools by condition, country, and type of organization. English-language guidelines on arthritis, asthma, colorectal cancer, depression, diabetes, heart failure, and stroke management were identified in the National Guideline Clearinghouse. Screening and data extraction were in triplicate. Findings were reported with summary statistics. Eighty-five (67.5%) of 126 eligible guidelines published between 2010 and 2017 offered one or more of a total of 464 GI tools. The mean number of GI tools per guideline was 5.5 (median 4.0, range 1 to 28) and increased over time. The majority of GI tools were for clinicians (239, 51.5%), few were for patients (113, 24.4%), and fewer still were to support implementation (66, 14.3%) or evaluation (46, 9.9%). Most clinician GI tools were guideline summaries (116, 48.5%), and most patient GI tools were condition-specific information (92, 81.4%). Government agencies (patient 23.5%, clinician 28.9%, implementation 24.1%, evaluation 23.5%) and developers in the UK (patient 18.5%, clinician 25.2%, implementation 27.2%, evaluation 29.1%) were more likely to generate guidelines that offered all four types of GI tools. Professional societies were more likely to generate guidelines that included clinician GI tools. Many guidelines do not include any GI tools, or a variety of GI tools for different stakeholders that may be more likely to prompt guideline uptake (point-of-care forms or checklists for clinicians, decision-making or self-management tools for patients, implementation and evaluation tools for managers and

  20. Operational Earthquake Forecasting: Proposed Guidelines for Implementation (Invited)

    Science.gov (United States)

    Jordan, T. H.

    2010-12-01

    The goal of operational earthquake forecasting (OEF) is to provide the public with authoritative information about how seismic hazards are changing with time. During periods of high seismic activity, short-term earthquake forecasts based on empirical statistical models can attain nominal probability gains in excess of 100 relative to the long-term forecasts used in probabilistic seismic hazard analysis (PSHA). Prospective experiments are underway by the Collaboratory for the Study of Earthquake Predictability (CSEP) to evaluate the reliability and skill of these seismicity-based forecasts in a variety of tectonic environments. How such information should be used for civil protection is by no means clear, because even with hundredfold increases, the probabilities of large earthquakes typically remain small, rarely exceeding a few percent over forecasting intervals of days or weeks. Civil protection agencies have been understandably cautious in implementing formal procedures for OEF in this sort of “low-probability environment.” Nevertheless, the need to move more quickly towards OEF has been underscored by recent experiences, such as the 2009 L’Aquila earthquake sequence and other seismic crises in which an anxious public has been confused by informal, inconsistent earthquake forecasts. Whether scientists like it or not, rising public expectations for real-time information, accelerated by the use of social media, will require civil protection agencies to develop sources of authoritative information about the short-term earthquake probabilities. In this presentation, I will discuss guidelines for the implementation of OEF informed by my experience on the California Earthquake Prediction Evaluation Council, convened by CalEMA, and the International Commission on Earthquake Forecasting, convened by the Italian government following the L’Aquila disaster. (a) Public sources of information on short-term probabilities should be authoritative, scientific, open, and

  1. Regional Traffic Incident Management Programs : implementation guide

    Science.gov (United States)

    2000-11-01

    The purpose of this document is to assist organizations and their leaders in implementing and sustaining regional traffic incident management programs, both by examining some successful models, and by considering some of the lessons learned by early ...

  2. Organizational factors that support the implementation of a nursing best practice guideline.

    Science.gov (United States)

    Marchionni, Caroline; Ritchie, Judith

    2008-04-01

    The context of the healthcare setting may play a crucial role in influencing the implementation of best practice guidelines in nursing. Further study is required to understand these organizational factors. Two variables, organizational culture and leadership, are thought to influence the adoption of best practice guidelines. A discussion of organizational factors that influence best practice guideline adoption is presented. A small pilot study is provided as an example of methods for further research. A quantitative survey of nursing staff was conducted. Results from the pilot study reveal variability in best practice guideline implementation despite the presence of a culture of organizational learning and transformational leadership. There is beginning evidence in the literature that culture and leadership are key elements influencing guideline implementation. In this pilot work on two inpatient units where a nursing best practice guideline was implemented, a supportive organizational culture and key people leading change were present. Implications for further studies are offered. Nursing leaders interested in promoting the use of best practice guidelines must pay attention to the organizational context in which nursing care occurs. A supportive culture where learning is valued coupled with transformational leadership may be key factors in the implementation and the sustainability of best practice guidelines.

  3. Clinical practice guideline implementation strategy patterns in Veterans Affairs primary care clinics.

    Science.gov (United States)

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

    2007-02-01

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

  4. The adaptation and implementation of guidelines for responsible media reporting on suicide in Slovenia

    Science.gov (United States)

    Tančič Grum, Alenka; Poštuvan, Vita; Podlesek, Anja; De Leo, Diego

    2017-01-01

    Abstract Introduction The existing literature provides evidence of the link between media reporting and suicide in terms of either preventive or provocative effects. Hence, working with media representatives on responsible reporting on suicide is of great importance. Until recently in Slovenia, there has been an obvious lack of communication between media representatives and suicidologists. The aims of the present study were twofold; firstly, to introduce the adaptation and dissemination of intervention on responsible media reporting, and secondly, to evaluate the effectiveness of the implemented intervention on suicide reporting. Methods We used a pre-post research design. Newspaper articles were retrieved over two 12-month periods: the baseline period and the follow-up period. In between, we had a year of implementation of our intervention program (launching and disseminating the Guidelines via workshops). Each retrieved article was rated qualitatively with respect to its adherence to the Guidelines. Results The comparison of baseline and follow-up periods revealed some significant differences. Reporting in the follow-up period was less sensationalistic, there was less reporting about specific cases of suicides and more about causes of suicide and pathways out of mental distress. Furthermore, in the follow-up period, there was a significant improvement related to headlines of media articles. Contact information about where to seek help was more often included in the articles. Conclusion The findings are promising, but working with the media needs to be continuous and ongoing if sustainable results are to be achieved. PMID:28289461

  5. Research on elaboration of the evaluation guidelines for activities implemented jointly; Kyodo jisshi katsudo hyoka guide line sakutei chosa

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    Elaboration of the evaluation guidelines for activities implemented jointly (AIJ) was researched to prevent the earth from warming. AIJ is the means to globally promote countermeasures against global warming cost-effectively by optimally combining every country`s technology, know-how and fund. AIJ was established in the 1st Conference of the Parties (COPI) of the United Nations Framework Convention on Climate Change in March, 1995. The pilot phase of AIJ is first carried out by voluntary workers jointly with developing countries under the agreement of the parties. The current situation of activities is reported in COPI as materials for evaluation of AIJ. To promote AIJ, elaboration of the evaluation guidelines for AIJ Japan program is also necessary for Japan. This research arranged the contents of the evaluation guidelines and the method of classifying projects for AIJ Japan program, and carried out some case studies of promising projects to reduce greenhouse gas emission for future proposal. 3 figs., 31 tabs.

  6. Formulation: Implementing Successful Public Montessori Programs.

    Science.gov (United States)

    Epstein, Paul

    1994-01-01

    Draws on the experiences of the OEkos Foundation for Education in implementing successful Montessori programs in 12 public school districts to present essential elements and key decisions needed for establishing such programs. Includes a schematic for the Decision Tree developed by the foundation. (ETB)

  7. Could accreditation bodies facilitate the implementation of medical guidelines in laboratories?

    Science.gov (United States)

    Aakre, Kristin M; Oosterhuis, Wytze P; Misra, Shivani; Langlois, Michel R; Joseph, Watine; Twomey, Patrick J; Barth, Julian H

    2017-05-01

    Several studies have shown that recommendations related to how laboratory testing should be performed and results interpreted are limited in medical guidelines and that the uptake and implementation of the recommendations that are available need improvement. The EFLM/UEMS Working Group on Guidelines conducted a survey amongst the national societies for clinical chemistry in Europe regarding development of laboratory-related guidelines. The results showed that most countries have guidelines that are specifically related to laboratory testing; however, not all countries have a formal procedure for accepting such guidelines and few countries have guideline committees. Based on this, the EFLM/UEMS Working Group on Guidelines conclude that there is still room for improvement regarding these processes in Europe and raise the question if the accreditation bodies could be a facilitator for an improvement.

  8. How GPs implement clinical guidelines in everyday clinical practice--a qualitative interview study.

    Science.gov (United States)

    Le, Jette V; Hansen, Helle P; Riisgaard, Helle; Lykkegaard, Jesper; Nexøe, Jørgen; Bro, Flemming; Søndergaard, Jens

    2015-12-01

    Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood. To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form. Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective implementation activities and organized their everyday practice to support these activities. In other practices GPs discussed guidelines collectively but left the application up to the individual GP whilst others again saw no need for discussion or collective activities depending entirely on the individual GP's decision on whether and how to manage implementation. Approaches to implementation of clinical guidelines vary substantially between practices. Supporting activities should take this into account. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Preadmission programs: development, implementation and evaluation.

    Science.gov (United States)

    O'Meara, K; McAuliffe, M J; Motherway, D; Dunleavy, M J

    1983-01-01

    Preparation of children for hospitalization is utilized to mitigate the stresses which may accompany the experience. Preadmission programs provide preparation for the patient and family on a prehospital basis. The authors describe the development of family-centered, developmentally based programs which foster continuity and consistency in a large, pediatric tertiary care setting. Implementation and evaluation of the programs which contribute to quality patient care are discussed.

  10. 78 FR 17679 - Implementation of the Updated American Veterinary Medical Association Guidelines for the...

    Science.gov (United States)

    2013-03-22

    ... the American Veterinary Medical Association (AVMA) Guidelines for the Euthanasia of Animals: 2013... HUMAN SERVICES National Institutes of Health Implementation of the Updated American Veterinary Medical Association Guidelines for the Euthanasia of Animals: 2013 Edition SUMMARY: The National Institutes of Health...

  11. RELAP5-3D Developer Guidelines and Programming Practices

    Energy Technology Data Exchange (ETDEWEB)

    Dr. George L Mesina

    2014-03-01

    Our ultimate goal is to create and maintain RELAP5-3D as the best software tool available to analyze nuclear power plants. This begins with writing excellent programming and requires thorough testing. This document covers development of RELAP5-3D software, the behavior of the RELAP5-3D program that must be maintained, and code testing. RELAP5-3D must perform in a manner consistent with previous code versions with backward compatibility for the sake of the users. Thus file operations, code termination, input and output must remain consistent in form and content while adding appropriate new files, input and output as new features are developed. As computer hardware, operating systems, and other software change, RELAP5-3D must adapt and maintain performance. The code must be thoroughly tested to ensure that it continues to perform robustly on the supported platforms. The coding must be written in a consistent manner that makes the program easy to read to reduce the time and cost of development, maintenance and error resolution. The programming guidelines presented her are intended to institutionalize a consistent way of writing FORTRAN code for the RELAP5-3D computer program that will minimize errors and rework. A common format and organization of program units creates a unifying look and feel to the code. This in turn increases readability and reduces time required for maintenance, development and debugging. It also aids new programmers in reading and understanding the program. Therefore, when undertaking development of the RELAP5-3D computer program, the programmer must write computer code that follows these guidelines. This set of programming guidelines creates a framework of good programming practices, such as initialization, structured programming, and vector-friendly coding. It sets out formatting rules for lines of code, such as indentation, capitalization, spacing, etc. It creates limits on program units, such as subprograms, functions, and modules. It

  12. Guideline implementation in clinical practice: Use of statistical process control charts as visual feedback devices

    Directory of Open Access Journals (Sweden)

    Fahad A Al-Hussein

    2009-01-01

    Conclusions: A process of audits in the context of statistical process control is necessary for any improvement in the implementation of guidelines in primary care. Statistical process control charts are an effective means of visual feedback to the care providers.

  13. Operational Earthquake Forecasting: State of Knowledge and Guidelines for Implementation.

    OpenAIRE

    Koshun Yamaoka; Gerassimos Papadopoulos; Gennady Sobolev; Warner Marzocchi; Ian Main; Raul Madariaga; Paolo Gasparini; Yun-Tai Chen; Jordan, Thomas H.; Jochen Zschau

    2011-01-01

    Following the 2009 L'Aquila earthquake, the Dipartimento della Protezione Civile Italiana (DPC), appointed an International Commission on Earthquake Forecasting for Civil Protection (ICEF) to report on the current state of knowledge of short-term prediction and forecasting of tectonic earthquakes and indicate guidelines for utilization of possible forerunners of large earthquakes to drive civil protection actions, including the use of probabilistic seismic hazard analysis in the wake of a lar...

  14. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

    OpenAIRE

    Smith Patricia M; Sellick Scott M; Spadoni Michelle M

    2012-01-01

    Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by n...

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

    Science.gov (United States)

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

    2015-04-24

    Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

  16. The relationship between organizational culture and implementation of clinical practice guidelines: a narrative review.

    Science.gov (United States)

    Dodek, Peter; Cahill, Naomi E; Heyland, Daren K

    2010-01-01

    The context in which critical care providers work has been shown to be associated with adherence to recommendations of clinical practice guidelines (CPGs). Consideration of contextual factors such as organizational culture may therefore be important when implementing guidelines. Organizational culture has been defined simply as "how things are around here" and encompasses leadership, communication, teamwork, conflict resolution, and other domains. This narrative review highlights the results of recent quantitative and qualitative studies, including studies on adherence to nutrition guidelines in the critical care setting, which demonstrate that elements of organizational culture, such as leadership support, interprofessional collaboration, and shared beliefs about the utility of guidelines, influence adherence to guideline recommendations. Outside nutrition therapy, there is emerging evidence that strategies focusing on organizational change (eg, revision of professional roles, interdisciplinary teams, integrated care delivery, computer systems, and continuous quality improvement) can favorably influence professional performance and patient outcomes. Consequently, future interventions aimed at implementing nutrition guidelines should aim to measure and take into account organizational culture, in addition to considering the characteristics of the patient, provider, and guideline. Further high quality, multimethod studies are required to improve our understanding of how culture influences guideline implementation, and which organizational change strategies might be most effective in optimizing nutrition therapy.

  17. Implementation of a clinical dementia guideline. A controlled study on the effect of a multifaceted strategy

    DEFF Research Database (Denmark)

    Waldorff, Frans Boch; Almind, Gert; Mäkelä, Marjukka

    2003-01-01

    OBJECTIVE: To assess the impact of a multifaceted implementation strategy aiming to improve GP adherence to a clinical guideline on dementia. DESIGN: Controlled before and after study using data records from regional laboratories. The guideline was mailed to all GPs. The multifaceted implementation...... strategy was planned with local GPs, and consisted of seminars, outreach visits, reminders and continuing medical education (CME) small group training. SETTING: Primary health care. SUBJECTS: 535 GP practices with 727 physicians in Denmark. MAIN OUTCOME MEASURES: The diffusion and use of the guideline...... was subsequently verified by a questionnaire to the practices. RESULTS: Of the GPs who read the guideline, 88% found it applicable in primary care. No increase in the adherence to guideline recommendations was observed regarding the use of laboratory tests or cognitive tests in the diagnostic evaluation...

  18. Incorporation of Pharmacogenomics into Routine Clinical Practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline Development Process

    Science.gov (United States)

    Caudle, Kelly E.; Klein, Teri E.; Hoffman, James M.; Müller, Daniel J.; Whirl-Carrillo, Michelle; Gong, Li; McDonagh, Ellen M.; Sangkuhl, Katrin; Thorn, Caroline F.; Schwab, Matthias; Agúndez, José A.G.; Freimuth, Robert R.; Huser, Vojtech; Lee, Ming Ta Michael; Iwuchukwu, Otito F.; Crews, Kristine R.; Scott, Stuart A.; Wadelius, Mia; Swen, Jesse J.; Tyndale, Rachel F.; Stein, C. Michael; Roden, Dan; Relling, Mary V.; Williams, Marc S.; Johnson, Samuel G.

    2014-01-01

    The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy. CPIC has focused initially on well-known examples of pharmacogenomic associations that have been implemented in selected clinical settings, publishing nine to date. Each CPIC guideline adheres to a standardized format and includes a standard system for grading levels of evidence linking genotypes to phenotypes and assigning a level of strength to each prescribing recommendation. CPIC guidelines contain the necessary information to help clinicians translate patient-specific diplotypes for each gene into clinical phenotypes or drug dosing groups. This paper reviews the development process of the CPIC guidelines and compares this process to the Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines. PMID:24479687

  19. Tips for managing chronic pain. Implementing the latest guidelines.

    Science.gov (United States)

    Marcus, Dawn A

    2003-04-01

    Recently revised guidelines from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) call for an increased awareness of the impact of chronic pain and recommend that physicians assess and treat pain complaints seriously. Although significant and persistent chronic pain is a common reason for primary care visits, the incidence of psychologic distress and personality disorder in patients with chronic pain often makes this population a difficult one for physicians and staff to treat. This discussion offers practical tips for managing patients with chronic pain and reducing staff burnout. The author also dispels various myths about chronic pain and focuses on the effective management of its comorbidities.

  20. Implementing practice guidelines for anxiety disorders in secondary mental health care: a case study

    Directory of Open Access Journals (Sweden)

    van Dijk Maarten K

    2012-09-01

    Full Text Available Abstract Background Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment of anxiety disorders. An important question was whether it is feasible to implement these guidelines because implementing practice guidelines is often difficult. Although several implementation interventions have proven effective, there seems to be no ready-made strategy that works in all circumstances. Case description The Dutch multidisciplinary guidelines for anxiety disorders were implemented in a community mental health care centre, located in the east of the Netherlands. The centre provides secondary outpatient care. The unit within the centre that specializes in the treatment of anxiety disorders has 16 team members with diverse professional backgrounds. Important steps in the process of implementing the guidelines were analysing the care provided before start of the implementation to determine the goals for improvement, and analysing the context and target group for implementation. Based on these analyses, a tailor-made multifaceted implementation strategy was developed that combined the reorganization of the care process, the development of instruction materials, the organization of educational meetings and the use of continuous quality circles to improve adherence to guidelines. Discussion and evaluation Significant improvements in adherence rates were made in the aspect of care that was targeted for change. An increase was found in the number of patients being provided with recommended forms of psychotherapeutic treatment, ranging from 43% to 54% (p  Conclusion The case study presented here shows that the implementation of practice guidelines for anxiety disorders in mental health care is feasible. Based on the results of our study, the

  1. Multifaceted guideline implementation strategies improve early identification and management of osteoporosis.

    Science.gov (United States)

    Kimber, Cheryl M; Grimmer-Somers, Karen A

    2009-08-01

    Osteoporosis contributes significantly to fractures, subsequent disability and premature mortality in Australia. Better detection and management of osteoporosis will reduce unnecessary health expenditure. To evaluate, in one large tertiary metropolitan hospital, the orthopaedic health care team's approach to osteoporosis guideline implementation to improve early identification and management of osteoporosis. This paper describes the implementation of multifaceted strategies to improve health-promoting behaviours and the uptake of osteoporosis guidelines by staff in the orthopaedic outpatient clinic at one metropolitan hospital, reflecting organisational and individual commitment to embedding guideline recommendations into routine practice. Implementation strategies were aimed at the requirements and perspectives of different stakeholder groups. Five audit datasets were compared: 62 patient records in two baseline audits, and three post-implementation audits of 31 patient records, collected over the following 3-month periods (August 2006 to April 2007). All audits used the same criteria to assess compliance with clinical guidelines, and outcomes of implementation strategies. There was consistent improvement in compliance with osteoporosis guidelines over the audit periods. Comparing baseline and immediate post-implementation data, there was a significant improvement (P < 0.05) in the percentage of patients with likely fragility fractures who were identified with an osteoporotic fracture. The percentage of patients who had a likely fragility fracture, with whom staff communicated about their problems and how to deal with them, increased consistently over all post-implementation audit periods. For patients with established osteoporosis who presented with fragility fractures, there was sustained improvement over the audit periods in the percentage provided with guideline-based care. This study highlights that appropriate and targeted intervention strategies can be

  2. Use of theory to plan or evaluate guideline implementation among physicians: a scoping review.

    Science.gov (United States)

    Liang, Laurel; Bernhardsson, Susanne; Vernooij, Robin W M; Armstrong, Melissa J; Bussières, André; Brouwers, Melissa C; Gagliardi, Anna R

    2017-02-27

    Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians. A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in duplicate. Study characteristics and details about theory use were analyzed. A total of 1244 published reports were identified, 891 were unique, and 716 were excluded based on title and abstract. Among 175 full-text articles, 89 planned or evaluated guideline implementation targeted to physicians; 42 (47.2%) were based on theory and included. The number of studies using theory increased yearly and represented a wide array of countries, guideline topics and types of physicians. The Theory of Planned Behavior (38.1%) and the Theoretical Domains Framework (23.8%) were used most frequently. Many studies rationalized choice of theory (83.3%), most often by stating that the theory described implementation or its determinants, but most failed to explicitly link barriers with theoretical constructs. The majority of studies used theory to inform surveys or interviews that identified barriers of guideline use as a preliminary step in implementation planning (76.2%). All studies that evaluated interventions reported positive impact on reported physician or patient outcomes. While the use of theory to design or evaluate interventions appears to be increasing over time, this review found that one half of guideline implementation studies were based on theory and many of those provided

  3. The EDUCATE Study: a continuing education exemplar for Clinical Practice Guideline Implementation.

    Science.gov (United States)

    Friedman, Lyssa; Engelking, Constance; Wickham, Rita; Harvey, Catherine; Read, Martha; Whitlock, Kimberly Bardel

    2009-04-01

    Cancer care is evolving from a solo practitioner care delivery system based on tradition and anecdotal experience to a multidisciplinary, collaborative, science-driven paradigm. Evidence-based practice facilitates optimal care quality for patients with cancer and is effected for medical and nursing practitioners through clinical practice guideline implementation. Clinician education based on principles of adult learning is one method of implementing clinical practice guidelines in clinical practice. However, research demonstrates that conventional static methods of education do little to change behavior; instead, effective education incorporates interactive formats, provides feedback, and includes reminder and reinforcement strategies. The EDUCATE (Educating Clinicians to Achieve Treatment Guideline Effectiveness) Study offers one model for clinical practice guideline implementation using educational methods. A faculty of nurse educators, together with practice champions, carried out an intensive educational intervention comprised of multiple teaching/learning activities during a 12-month period in community oncology practices throughout the United States. In addition to an overview of clinical practice guidelines and educational methods that can be used for implementation of clinical practice guidelines, the obstacles faced and lessons learned through the EDUCATE Study are presented, along with recommendations for implementation in the practice setting.

  4. Role of the National Cholesterol Education Program Adult treatment panel III guidelines in managing dyslipidemia.

    Science.gov (United States)

    Talbert, Robert L

    2003-07-01

    Using recently updated guidelines to evaluate and manage lipid disorders is discussed. Coronary heart disease (CHD) is a costly chronic condition associated with significant morbidity and mortality. Epidemiologic data further indicate that dyslipidemia and associated conditions, which may lead to CHD, are grossly undertreated. In 2001, the third National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) released updated guidelines for the evaluation and treatment of lipid disorders. Significant changes to the updated guidelines include designation of a CHD risk equivalent category identifying patients who require aggressive management, recommendation of Framingham-based CHD risk assessment in patients with multiple risk factors, revised target levels for several of the lipids and lipoproteins, and criteria for the identification of patients with the metabolic syndrome. Low-density lipoprotein cholesterol (LDL-C) continues to be the primary target of therapy. In addition, non-high-density lipoprotein cholesterol (HDL-C) is now defined as a secondary treatment target in patients with hypertriglyceridemia. Increased emphasis is placed on the metabolic syndrome, low HDL-C levels, and the presence of multiple and emerging risk factors in guiding the intensity of therapy. The NCEP ATP III guidelines acknowledge challenges in implementing and maintaining patient adherence to both lifestyle changes and pharmacotherapy regimens and provide strategies for increasing treatment success. Implementation of these new guidelines will likely enhance identification, management, and treatment success rates among patients at risk for CHD in the United States.

  5. 14 CFR 1214.505 - Program implementation.

    Science.gov (United States)

    2010-01-01

    ... identify positions/duties subject to this regulation and will identify all civil service and contractor... Administrators) before implementation. 5 See footnote 1 to § 1214.502(e). (2) A management review process to... of this part) pursuant to international agreements also require certification under this program...

  6. Awareness and implementation of tobacco dependence treatment guidelines in Arizona: Healthcare Systems Survey 2000

    Directory of Open Access Journals (Sweden)

    Menke J Michael

    2008-12-01

    Full Text Available Abstract Background This paper presents findings from the Tobacco Control in Arizona Healthcare Systems Survey, conducted in 2000. The purpose of the survey was to assess the status of Arizona healthcare systems' awareness and implementation of tobacco cessation and prevention measures. Methods The 20-item survey was developed by The University of Arizona HealthCare Partnership in collaboration with the Arizona Department of Health Services Bureau of Tobacco Education and Prevention. It was mailed to representatives of Arizona's 40 healthcare systems, including commercial and Medicare managed care organizations, "managed Medicaid" organizations, Veterans Affairs Health Care Systems, and Indian Health Service Medical Centers. Thirty-three healthcare systems (83% completed the survey. Results The majority of healthcare systems reported awareness of at least one tobacco cessation and prevention clinical practice guideline, but only one third reported full guideline implementation. While a majority covered some form of behavioral therapy, less than half reported covering tobacco treatment medications. "Managed Medicaid" organizations administered through the Arizona Health Care Cost Containment System were significantly less likely to offer coverage for behavioral therapy and less likely to cover pharmacotherapy than were their non-Medicaid counterparts in managed care, Veterans Affairs Health Care Systems and Indian Health Service Medical Centers. Conclusion Arizona healthcare system coverage for tobacco cessation in the year 2000 was comparable to national survey findings of the same year. The findings that only 10% of "Managed Medicaid" organizations covered tobacco treatment medication and were significantly less likely to cover behavioral therapy were important given the nearly double smoking prevalence among Medicaid patients. Throughout the years of the program, the strategic plan of the Arizona Department of Health Services Bureau of Tobacco

  7. Barriers to implementing the group B streptococcal prevention guidelines.

    Science.gov (United States)

    Cárdenas, Vicky; Davis, Robert L; Hasselquist, Mary Beth; Zavitkovsky, Ann; Schuchat, Anne

    2002-12-01

    Group B streptococcal disease is the leading cause of neonatal sepsis in the United States. We assessed predictors of compliance with the consensus guidelines for perinatal group B streptococcus disease prevention at two Group Health Cooperative hospitals. A descriptive and cohort analysis was conducted of failure to comply with the screening-based approach to group B streptococcus prevention among singleton birth pregnancies in two Group Health Cooperative hospitals, September 1, 1996 to December 31, 1997. We studied determinants of failure to screen pregnant women for group B streptococcus at 35 to 37 weeks' gestation and failure to deliver intrapartum antibiotic prophylaxis to Group B streptococcus-positive women. Nearly 28 percent of 1969 women delivering at two Group Health Cooperative hospitals were not screened appropriately for group B streptococcus. Women who were not screened properly were more likely to be in their teens. A short length of hospital stay before delivery was the strongest predictor of the lack of administration of intrapartum antibiotic prophylaxis to infected multiparas at delivery. Group B streptococcus-positive women without pregnancy complications were less likely to receive intrapartum antibiotic prophylaxis than infected women with complications. The findings of this study suggest that to improve group B streptococcus disease prevention, screening efforts should focus on teenage women, and intrapartum antibiotic prophylaxis delivery efforts should be aimed at low-risk women with precipitous labor.

  8. Studying the implementation of public programs

    Energy Technology Data Exchange (ETDEWEB)

    Yin, R.K.

    1980-02-01

    This report describes and critically assesses approaches that have been employed to study the implementation of public programs. Implementation is defined as the process by which new policies and/or practices are installed in organizations. The report was produced because of the increased interest among researchers and policy makers alike in the linkages between policy and outcome. The study of implementation has barely begun, and it was recognized that methodological issues of a particularly complex nature arise because of certain unique characteristics of the implementation processes: (1) they involve a series of decisions that occur over a long period of time, with no clear beginning or end points; (2) their outcomes have direct or indirect implications that are too complex for single-factor theories; (3) they involve a large number of participants; and (4) they involve situations that are rather unique in terms of agency context, historical moment in time, and other key elements. The approach employed in the report was to examine the methods that have been used in a number of exemplary studies of implementation. These studies are commonly cited in publications and informally in research circles. Descriptive material from each study was used to address three questions: (1) How is evidence collected in studies of implementation; (2) How is evidence analyzed; (3) What are the reasons for believing the conclusions from such studies. The report concludes with recomendations for the conduct of future studies of implementation.

  9. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle.

    Science.gov (United States)

    Álvarez Lerma, F; Sánchez García, M; Lorente, L; Gordo, F; Añón, J M; Álvarez, J; Palomar, M; García, R; Arias, S; Vázquez-Calatayud, M; Jam, R

    2014-05-01

    "Zero-VAP" is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. An initiative of the Spanish Societies of Intensive Care Medicine and of Intensive Care Nurses, the project is supported by the Spanish Ministry of Health, and participation is voluntary. In addition to guidelines for VAP prevention, the "Zero-VAP" Project incorporates an integral patient safety program and continuous online validation of the application of the bundle. For the latter, VAP episodes and participation indices are entered into the web-based Spanish ICU Infection Surveillance Program "ENVIN-HELICS" database, which provides continuous information about local, regional and national VAP incidence rates. Implementation of the guidelines aims at the reduction of VAP to less than 9 episodes per 1000 days of mechanical ventilation. A total of 35 preventive measures were initially selected. A task force of experts used the Grading of Recommendations, Assessment, Development and Evaluation Working Group methodology to generate a list of 7 basic "mandatory" recommendations (education and training in airway management, strict hand hygiene for airway management, cuff pressure control, oral hygiene with chlorhexidine, semi-recumbent positioning, promoting measures that safely avoid or reduce time on ventilator, and discouraging scheduled changes of ventilator circuits, humidifiers and endotracheal tubes) and 3 additional "highly recommended" measures (selective decontamination of the digestive tract, aspiration of subglottic secretions, and a short course of iv antibiotic). We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the

  10. Awareness and Implementation of the 2014 ESPGHAN/NASPGHAN Guideline for Childhood Functional Constipation.

    Science.gov (United States)

    Koppen, Ilan J N; Vriesman, M H; Tabbers, M M; Di Lorenzo, C; Benninga, M A

    2017-10-17

    To assess if physicians approach children with functional constipation according to the 2014 ESPGHAN/NASPGHAN guideline. We invited pediatricians and pediatric gastroenterologists in the Netherlands and the U.S. to participate in this anonymous survey using a self-developed questionnaire containing 19 multiple-choice questions concerning evaluation and treatment of children with constipation. We included 328 physicians (67% from the U.S., 34% from the Netherlands). The majority of U.S. responders (53%) worked in primary care whereas all Dutch responders worked in a hospital. In total, 31% of responders were not familiar with the guideline, (38% U.S. responders vs. 16% Dutch responders, p constipation. Nonetheless, therapeutic decisions correlated fairly well with recommendations from the guideline, especially for children ≥1 year. Guideline awareness and adherence remain to be improved. Future studies should focus on exploring strategies to improve guideline implementation through the development of digital learning tools.

  11. Challenges for the implementation of World Health Organization guidelines for acute stress, PTSD, and bereavement: a qualitative study in Uganda.

    Science.gov (United States)

    Kane, Jeremy C; Adaku, Alex; Nakku, Juliet; Odokonyero, Raymond; Okello, James; Musisi, Seggane; Augustinavicius, Jura; Greene, M Claire; Alderman, Steve; Tol, Wietse A

    2016-03-15

    In 2013, the World Health Organization (WHO) published new guidelines for the management of conditions specifically related to stress, including symptoms of acute stress, bereavement, and post-traumatic stress disorder (PTSD). It is important to evaluate potential challenges for the implementation of these guidelines in low-resource settings, however, there is a dearth of research in this area. The current qualitative study aimed to assess perspectives on the feasibility and acceptability of the new guidelines in four clinics that provide mental health services in post-conflict northern Uganda. In-depth interviews were conducted with 19 mental health-care providers and program developers in northern Uganda to address three major research objectives: (1) describe the current standard practices and guidelines used for treating conditions related to stress in Uganda; (2) identify barriers and challenges associated with implementing the new WHO guidelines; and (3) identify and describe potential strategies for overcoming these barriers and challenges. An emergent thematic analysis was used to develop a coding scheme for the transcribed interviews. Practices for managing conditions related to stress included group psychological interventions, psychoeducation, and medication for clients with severe signs and symptoms. Several themes were identified from the interviews on barriers to guideline implementation. These included (1) a lack of trained and qualified mental health professionals to deliver WHO-recommended psychological interventions; (2) a perception that psychological interventions developed in high-income countries would not be culturally adaptable in Uganda; and (3) reluctance about blanket statements regarding medication for the management of acute stress symptoms and PTSD. Identified strategies for overcoming these barriers included (1) training and capacity building for current mental health staff; (2) a stepped care approach to mental health services; and

  12. Intervention mapping for the development of a strategy to implement the insurance medicine guidelines for depression.

    Science.gov (United States)

    Zwerver, Feico; Schellart, Antonius J M; Anema, Johannes R; Rammeloo, Kathelijne C; van der Beek, Allard J

    2011-01-05

    This article describes the development of a strategy to implement the insurance medicine guidelines for depression. Use of the guidelines is intended to result in more transparent and uniform assessment of claimants with depressive symptoms. The implementation strategy was developed using the Intervention Mapping (IM) method for alignment with insurance-medical practice. The ASE behavioural explanation model (Attitude, Social Influence and Self-Efficacy) was used as theoretical basis for the development work. A literature study of implementation strategies and interviews with insurance physicians were performed to develop instruments for use with the guideline. These instruments were designed to match the needs and the working circumstances of insurance physicians. Performance indicators to measure the quality of the assessment and the adherence to the guidelines were defined with input from insurance physicians. This study resulted in the development of a training course to teach insurance physicians how to apply the guidelines for depression, using the aforementioned instruments. The efficacy of this training course will be evaluated in a Randomized Controlled Trial. The use of IM made it possible to develop guideline support instruments tailored to insurance medical practice.

  13. Intervention mapping for the development of a strategy to implement the insurance medicine guidelines for depression

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2011-01-01

    Full Text Available Abstract Background This article describes the development of a strategy to implement the insurance medicine guidelines for depression. Use of the guidelines is intended to result in more transparent and uniform assessment of claimants with depressive symptoms. Methods The implementation strategy was developed using the Intervention Mapping (IM method for alignment with insurance-medical practice. The ASE behavioural explanation model (Attitude, Social Influence and Self-Efficacy was used as theoretical basis for the development work. A literature study of implementation strategies and interviews with insurance physicians were performed to develop instruments for use with the guideline. These instruments were designed to match the needs and the working circumstances of insurance physicians. Performance indicators to measure the quality of the assessment and the adherence to the guidelines were defined with input from insurance physicians. Results This study resulted in the development of a training course to teach insurance physicians how to apply the guidelines for depression, using the aforementioned instruments. The efficacy of this training course will be evaluated in a Randomized Controlled Trial. Conclusions The use of IM made it possible to develop guideline support instruments tailored to insurance medical practice.

  14. Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline

    NARCIS (Netherlands)

    Wees, P.J. van der; Zagers, C.A.; Die, S.E. de; Hendriks, E.J.; Nijhuis-Van der Sanden, M.W.G.; Bie, R.A. de

    2013-01-01

    BACKGROUND: Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation

  15. Responsive feeding: implications for policy and program implementation.

    Science.gov (United States)

    Engle, Patrice L; Pelto, Gretel H

    2011-03-01

    In this article, we examine responsive feeding as a nutrition intervention, with an emphasis on the development and incorporation of responsive feeding into policies and programs over the last 2 decades and recommendations for increasing the effectiveness of responsive feeding interventions. A review of policy documents from international agencies and high-income countries reveals that responsive feeding has been incorporated into nutrition policies. Official guidelines from international agencies, nongovernmental organizations, and professional organizations often include best practice recommendations for responsive feeding. Four potential explanations are offered for the rapid development of policies related to responsive feeding that have occurred despite the relatively recent recognition that responsive feeding plays a critical role in child nutrition and growth and the paucity of effectiveness trials to determine strategies to promote responsive feeding. Looking to the future, 3 issues related to program implementation are highlighted: 1) improving intervention specificity relative to responsive feeding; 2) developing protocols that facilitate efficient adaptation of generic guidelines to national contexts and local conditions; and 3) development of program support materials, including training, monitoring, and operational evaluation.

  16. Responsive Feeding: Implications for Policy and Program Implementation12

    Science.gov (United States)

    Engle, Patrice L.; Pelto, Gretel H.

    2011-01-01

    In this article, we examine responsive feeding as a nutrition intervention, with an emphasis on the development and incorporation of responsive feeding into policies and programs over the last 2 decades and recommendations for increasing the effectiveness of responsive feeding interventions. A review of policy documents from international agencies and high-income countries reveals that responsive feeding has been incorporated into nutrition policies. Official guidelines from international agencies, nongovernmental organizations, and professional organizations often include best practice recommendations for responsive feeding. Four potential explanations are offered for the rapid development of policies related to responsive feeding that have occurred despite the relatively recent recognition that responsive feeding plays a critical role in child nutrition and growth and the paucity of effectiveness trials to determine strategies to promote responsive feeding. Looking to the future, 3 issues related to program implementation are highlighted: 1) improving intervention specificity relative to responsive feeding; 2) developing protocols that facilitate efficient adaptation of generic guidelines to national contexts and local conditions; and 3) development of program support materials, including training, monitoring, and operational evaluation. PMID:21270361

  17. Guidelines for the implementation of an open source information system

    Energy Technology Data Exchange (ETDEWEB)

    Doak, J.; Howell, J.A.

    1995-08-01

    This work was initially performed for the International Atomic Energy Agency (IAEA) to help with the Open Source Task of the 93 + 2 Initiative; however, the information should be of interest to anyone working with open sources. The authors cover all aspects of an open source information system (OSIS) including, for example, identifying relevant sources, understanding copyright issues, and making information available to analysts. They foresee this document as a reference point that implementors of a system could augment for their particular needs. The primary organization of this document focuses on specific aspects, or components, of an OSIS; they describe each component and often make specific recommendations for its implementation. This document also contains a section discussing the process of collecting open source data and a section containing miscellaneous information. The appendix contains a listing of various providers, producers, and databases that the authors have come across in their research.

  18. RAY TRACING IMPLEMENTATION IN JAVA PROGRAMMING LANGUAGE

    Directory of Open Access Journals (Sweden)

    Aybars UĞUR

    2002-01-01

    Full Text Available In this paper realism in computer graphics and components providing realism are discussed at first. It is mentioned about illumination models, surface rendering methods and light sources for this aim. After that, ray tracing which is a technique for creating two dimensional image of a three-dimensional virtual environment is explained briefly. A simple ray tracing algorithm was given. "SahneIzle" which is a ray tracing program implemented in Java programming language which can be used on the internet is introduced. As a result, importance of network-centric ray tracing software is discussed.

  19. Implementation of a shared care guideline on the lumbosacral radicular syndrome : effects on unnecessary referrals, waiting time and costs

    OpenAIRE

    Fleuren, M.A.H.; Dusseldorp, E.; M. E. van den Akker-van Marle; Van den Bergh-Verhappen, S.; Wildschut, J.; H. Vlek; Wijkel, D.

    2009-01-01

    Purpose To determine the effects of the implementation of the LRS-guideline in two regions in The Netherlands with regard to reduction of unnecessary referrals and duration of total diagnostic procedure. The effects were related to the cost of implementing the guideline. Theory The guideline Although in The Netherlands GPs, physiotherapists and neurologists share the same guidelines regarding the conservative treatment of LRS, adherence turns out to be difficult. The main reasons are that pat...

  20. The implementation of the counterintelligence assistant program.

    OpenAIRE

    Kloster, Martin Gilbert

    1981-01-01

    Approved for public release; distribution is unlimited The implementation of a new program within the Army's Military Intelligence Branch, the enlisted Counterintelligence career management field, is described. The creation of the duty position Counterintelligence Assistant represents a major change to the field through the introduction of an entry skill level which did not previously exist. This change was primarily a result of a chronic shortage of personnel which fo...

  1. Implementing guidelines on reporting research using animals (ARRIVE etc.): new requirements for publication in BJP

    Science.gov (United States)

    McGrath, John C; Lilley, Elliot

    2015-01-01

    The ARRIVE guidelines have been implemented in BJP for 4 years with the aim of increasing transparency in reporting experiments involving animals. BJP has assessed our success in implementing them and concluded that we could do better. This editorial discusses the issues and explains how we are changing our requirements for authors to report their findings in experiments involving animals. This is one of a series of editorials discussing updates to the BJP Instructions to Authors Video To view the video on the ARRIVE guidelines, visit: https://www.youtube.com/watch?v=DYXoUAnhoPM PMID:25964986

  2. The role of physical structures in implementing the Norwegian guidelines for healthy school meals.

    Science.gov (United States)

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2010-01-01

    Drawing on a multiple case design, this study examines the role of physical structures in the implementation of national guidelines for healthy school meals at three Norwegian schools. Findings suggest that the degree of implementation of the guidelines was influenced by types of consumer product, facilities in buildings and regulation of access to neighbourhood facilities. Further, lack of adequate canteen facilities influenced the selection of food on offer, food safety and capacity. Students seeking an alternative to the traditional packed lunch were generally forced to eat their lunch away from the school.

  3. Effects of the implementation of a breastfeeding best practice guideline in a Canadian public health agency.

    Science.gov (United States)

    Rempel, Lynn A; McCleary, Lynn

    2012-10-01

    Several strategies were used to implement a breastfeeding best practice guideline (BPG) in a Canadian public health agency. Nurses surveyed before and 1 year after implementation reported increased BPG-related knowledge and stronger beliefs regarding breastfeeding duration beyond 1 year. Telephone surveys also were conducted with mothers; 90 before BPG implementation and another cohort of 141 mothers following implementation. Post-implementation mothers were more knowledgeable about sources of breastfeeding help, obtained more help from public health nurses, and reported more breastfeeding-related discussion with healthcare providers. Compared to the pre-implementation cohort, mothers in the post-implementation cohort who were still breastfeeding at 6 months intended to continue breastfeeding longer. Implementing a breastfeeding BPG can affect breastfeeding-related experiences at a population level. Copyright © 2012 Wiley Periodicals, Inc.

  4. Pressure Safety Program Implementation at ORNL

    Energy Technology Data Exchange (ETDEWEB)

    Lower, Mark [ORNL; Etheridge, Tom [ORNL; Oland, C. Barry [XCEL Engineering, Inc.

    2013-01-01

    The Oak Ridge National Laboratory (ORNL) is a US Department of Energy (DOE) facility that is managed by UT-Battelle, LLC. In February 2006, DOE promulgated worker safety and health regulations to govern contractor activities at DOE sites. These regulations, which are provided in 10 CFR 851, Worker Safety and Health Program, establish requirements for worker safety and health program that reduce or prevent occupational injuries, illnesses, and accidental losses by providing DOE contractors and their workers with safe and healthful workplaces at DOE sites. The regulations state that contractors must achieve compliance no later than May 25, 2007. According to 10 CFR 851, Subpart C, Specific Program Requirements, contractors must have a structured approach to their worker safety and health programs that at a minimum includes provisions for pressure safety. In implementing the structured approach for pressure safety, contractors must establish safety policies and procedures to ensure that pressure systems are designed, fabricated, tested, inspected, maintained, repaired, and operated by trained, qualified personnel in accordance with applicable sound engineering principles. In addition, contractors must ensure that all pressure vessels, boilers, air receivers, and supporting piping systems conform to (1) applicable American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code (2004) Sections I through XII, including applicable code cases; (2) applicable ASME B31 piping codes; and (3) the strictest applicable state and local codes. When national consensus codes are not applicable because of pressure range, vessel geometry, use of special materials, etc., contractors must implement measures to provide equivalent protection and ensure a level of safety greater than or equal to the level of protection afforded by the ASME or applicable state or local codes. This report documents the work performed to address legacy pressure vessel deficiencies and comply

  5. Integrated Financial Management Information Systems: Guidelines for effective implementation by the public sector of South Africa

    Directory of Open Access Journals (Sweden)

    Christoffel J. Hendriks

    2012-12-01

    Full Text Available Background: Integrated Financial Management Information Systems (IFMIS can improve public sector management by providing real-time financial information to managers in order to enhance their decision-making capabilities. The South African Public Service is currently busy with the implementation of an IFMIS. However, the implementation of such a project has proved to be a very demanding undertaking and has not been met with resounding success.Objectives: The research was conducted in order to identify the challenges and risks that are involved in the implementation of the IFMIS in South Africa. After identification of the challenges and risks, solutions or guidelines were developed that may make the implementation more successful.Method: The methodology that was used is that of a literature study where theories were explored and used to solve a research problem. Based on the theoretical research, solutions and guidelines were developed to solve challenges and risks experienced.Results: The results indicated that there are a number of challenges involved with the implementation of an IFMIS. A set of best practice guidelines was developed that may make the implementation more successful.Conclusion: The sheer size and complexity of an IFMIS poses significant challenges and a number of risks to the implementation process. There are, however, critical success factors or best practices that can be used for the project to succeed. It is recommended that these best practices be used by the South African Public Service.

  6. A Review and Critique of "Guiding Questions: Guidelines for Leadership Education Programs"

    Science.gov (United States)

    Sowcik, Matthew

    2012-01-01

    The International Leadership Association's "Guiding Questions: Guidelines for Leadership Education Programs" (Ritch & Mengel, 2009) provides a framework to attend to leadership program development, redesign, evaluation, organized program review, questions concerning academic legitimacy and developing common program benchmarks. This article…

  7. Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

    Science.gov (United States)

    Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

    2012-03-09

    A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

  8. Programs for the Emotionally Disturbed: A Handbook of Guidelines and Evaluative Data on Five Instructional Models. 1974-1975.

    Science.gov (United States)

    Alachua County Schools, Gainesville, FL.

    Presented are guidelines and evaluative data on five instructional models implemented between 1972 and 1975 to educate emotionally disturbed students in Alachua County Schools (Florida). General information includes the philosphy of the program; a definition and list of characteristics of emotionally disturbed students; and an outline of…

  9. Describing Illinois Music Programs Using the Whole School Effectiveness Guidelines Survey for Music Education: A Statewide Investigation

    Science.gov (United States)

    Ciorba, Charles R.; McLay, Melanie

    2010-01-01

    The purpose of this study was to describe Illinois music educators' self-perceptions regarding the demographics, logistics, function, and implementation of their classroom operations using the Whole School Effectiveness Guidelines Survey for Music Programs. The survey was administered to K-12 music educators (N = 1,251) throughout the state of…

  10. The National Cholesterol Education Program Adult Treatment Panel III guidelines.

    Science.gov (United States)

    Lipsy, Robert J

    2003-01-01

    Coronary heart disease (CHD) persists as a major cause of morbidity and mortality in the United States, with more than 40% of all deaths each year directly attributed to the disease. Dyslipidemia is recognized as a major risk factor for the development and progression of CHD, with clinical trials clearly demonstrating the public health and economic benefits of favorable cholesterol modification. As a result of this evidence, the National Cholesterol Education Program (NCEP) has developed guidelines for the detection, evaluation, and treatment of high blood cholesterol in adults. The most recent of the NCEP recommendations, the Adult Treatment Panel III (ATP III) guidelines, were released in May 2001 and build on the earlier editions and reiterate the importance of low-density lipoprotein cholesterol (LDL-C) reduction to modify CHD risk. New features of the guidelines include the identification of CHD risk equivalents; lower treatment target goals; an emphasis on conditions conferring a higher risk for CHD, such as the metabolic syndrome; and a scoring system for calculating CHD risk. The ATP III emphasis on risk assessment will result in a substantial increase in the number of patients considered at risk for CHD and will expand the number eligible for lifestyle and drug intervention.

  11. Anxiety Management in Primary Care: Implementing the National Institute of Clinical Excellence Guidelines.

    Science.gov (United States)

    Conn, Monica K; Shafer, Sheree; Cline, Thomas

    2017-04-01

    More than 40 million Americans suffer from anxiety disorders, ranking them as one of the most common mental health disorders in America. The purpose of this pilot study was to educate providers on the National Institute Clinical Excellence (NICE) anxiety guidelines and monitor providers' perceived competence in managing anxiety. Results showed perceived competence increased significantly pre-intervention to immediately post-intervention (p=0.001), and data revealed the scores did not change significantly immediately post-to six-weeks post (p=0.170). Providers who implemented the guidelines into practice had significantly higher scores (p=0.026) than those who did not implement the guidelines. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Revision and Implementation of "Clinical Guideline for Tuberculosis and HIV in Prisons", Great Tehran Prison, Iran.

    Science.gov (United States)

    Farhoudi, Behnam; SeyedAlinaghi, SeyedAhmad; Mohraz, Minoo; Golrokhy, Raheleh; Farnia, Marzieh; Shahbazi, Mohammad; Alasvand, Ramin; Ebrahimi, Bahman; Esfehani, Jafar; Tashakoriyan, Mehrzad

    2017-05-17

    To evaluate the feasibility of the revised "Clinical Guideline for HIV and TB" in the Great Tehran Prison during October 2013 to June 2014. The guideline includes all aspects of HIV/TB diagnosis based on active case finding (ACF), treatment and care services. Before the implementation, a focus group discussion was conducted, and attended by experts on jail diseases. The objective was to identify defects and limitations of the guideline. After the discussion, the guideline was revised. The Great Tehran Prison contains three separate units. All prisoners are taken first to "reception and identification unit (quarantine)" and then send to two housing units according to their legal status. An HIV ACF strategy was employed in the quarantine, and two units through a voluntary provider-initiated HIV testing. Three staffs of the triangular clinic trained the prisoners about common routes of HIV transmission and the symptoms of TB in the units. In the quarantine, all prisoners were examined for HIV-risk factors and symptoms of TB, and offered HIV testing. In unit one, healthcare staff continued the ACF process, while in unit two, the trained prisoners were assigned as the healthcare communicators to proceed the strategy. When the test result was positive, then the process of care, treatment and follow ups were initiated. Also, the use of directly observed therapy (DOTs) for antiretroviral therapy (ART) and TB was initiated. There was a follow up for released prisoner to refer them to care and treatment services outside the prison. The guideline was implemented in the prison successfully. Regarding feasibility of the guideline, the investigators suggest that the guideline to be implemented in other prisons across the country. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  13. 75 FR 76478 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

    Science.gov (United States)

    2010-12-08

    ... HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing Programs AGENCY: Substance Abuse... Department of Health and Human Services (HHS) Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory Guidelines) which took effect on October 1, 2010 address the role and qualifications of...

  14. [The German program for disease management guidelines. Background, methods, and development process].

    Science.gov (United States)

    Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika; Sänger, Sylvia; Heymans, Lothar; Thole, Henning; Trapp, Henrike; Lorenz, Wilfried; Selbmann, Hans-Konrad; Encke, Albrecht

    2006-10-15

    The Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 by the German Medical Association (umbrella organization of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF; umbrella organization of more than 150 professional societies) and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The program provides a conceptual basis for disease management, focusing on high-priority health-care topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organized by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the German DM-CPG Program is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health-care provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year, DM-CPGs have been published for asthma, chronic obstructive pulmonary disease, type 2 diabetes, and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for health-care providers. The article describes background, methods, and tools of the DM-CPG Program, and is the first of a publication series dealing with innovative recommendations and aspects of the program.

  15. Improving manual oxygen titration in preterm infants by training and guideline implementation

    NARCIS (Netherlands)

    van Zanten, Henriëtte A; Pauws, Steffen C; Beks, Evelien C; Stenson, Ben J; Lopriore, Enrico; Te Pas, Arjan B

    To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the

  16. Challenges to implementing the food-based dietary guidelines in the ...

    African Journals Online (AJOL)

    Objectives: The South African food-based dietary guidelines (FBDG) were developed and implemented to promote healthy lifestyles in the .... dietary habits in the primary school curriculum, feasibility of and barriers to .... 'They stress, because of all the administration and the burden from Head Office and the pressure I put on.

  17. Web-Based Social Work Courses: Guidelines for Developing and Implementing an Online Environment

    Science.gov (United States)

    Dawson, Beverly Araujo; Fenster, Judy

    2015-01-01

    Although web-based courses in schools of social work have proliferated over the past decade, the literature contains few guidelines on steps that schools can take to develop such courses. Using Knowles's framework, which delineates tasks and themes involved in implementing e-learning in social work education, this article describes the cultivation…

  18. Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec.

    Science.gov (United States)

    Chaillet, Nils; Dubé, Eric; Dugas, Marylène; Francoeur, Diane; Dubé, Johanne; Gagnon, Sonia; Poitras, Lucie; Dumont, Alexandre

    2007-10-01

    To investigate obstetricians perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians solutions for implementing these guidelines in practice. This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups. The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients motivations. Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices.

  19. A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial.

    Science.gov (United States)

    Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming; Maindal, Helle Terkildsen; Petersen, Karin Dam; Bendtsen, Mette Dahl; Jensen, Martin Bach

    2016-10-21

    Guidelines are often slowly adapted into clinical practice. However, actively supporting healthcare professionals in evidence-based treatment may speed up guideline implementation. Danish low back pain (LBP) guidelines focus on primary care treatment of LBP, to reduce referrals from primary care to secondary care. The primary aim of this project was to reduce secondary care referral within 12 weeks by a multifaceted implementation strategy (MuIS). In a cluster randomised design, 189 general practices from the North Denmark Region were invited to participate. Practices were randomised (1:1) and stratified by practice size to MuIS (28 practices) or a passive implementation strategy (PaIS; 32 practices). Included were patients with LBP aged 18 to 65 years who were able to complete questionnaires, had no serious underlying pathology, and were not pregnant. We developed a MuIS including outreach visits, quality reports, and the STarT Back Tool for subgrouping patients with LBP. Both groups were offered the usual dissemination of guidelines, guideline-concordant structuring of the medical record, and a new referral opportunity for patients with psycho-social problems. In an intention-to-treat analysis, the primary and secondary outcomes pertained to the patient, and a cost-effectiveness analysis was performed from a healthcare sector perspective. Patients and the assessment of outcomes were blinded. Practices and caregivers delivering the interventions were not blinded. Between January 2013 and July 2014, 60 practices were included, of which 54 practices (28 MuIS, 26 PaIS) included 1101 patients (539 MuIS, 562 PaIS). Follow-up data for the primary outcome were available on 100 % of these patients. Twenty-seven patients (5.0 %) in the MuIS group were referred to secondary care vs. 59 patients (10.5 %) in the PaIS group. The adjusted odds ratio (AOR) was 0.52 [95 % CI 0.30 to 0.90; p = 0.020]. The MuIS was cost-saving £-93.20 (£406.51 vs. £499.71 per patient

  20. AES ALGORITHM IMPLEMENTATION IN PROGRAMMING LANGUAGES

    Directory of Open Access Journals (Sweden)

    Luminiţa DEFTA

    2010-12-01

    Full Text Available Information encryption represents the usage of an algorithm to convert an unknown message into an encrypted one. It is used to protect the data against unauthorized access. Protected data can be stored on a media device or can be transmitted through the network. In this paper we describe a concrete implementation of the AES algorithm in the Java programming language (available from Java Development Kit 6 libraries and C (using the OpenSSL library. AES (Advanced Encryption Standard is an asymmetric key encryption algorithm formally adopted by the U.S. government and was elected after a long process of standardization.

  1. Determinants of implementation of maternal health guidelines in Kosovo: mixed methods study.

    Science.gov (United States)

    Straus, Sharon E; Moore, Julia E; Uka, Sami; Marquez, Christine; Gülmezoglu, A Metin

    2013-09-09

    One of the challenges to implementing clinical practice guidelines is the need to adapt guidelines to the local context and identify barriers to their uptake. Several models of framework are available to consider for use in guideline adaptation. We completed a multiphase study to explore the implementation of maternal health guidelines in Kosovo, focusing on determinants of uptake and methods to contextualize for local use. The study involved a survey, individual interviews, focus groups, and a consensus meeting with relevant stakeholders, including clinicians (obstetricians, midwives), managers, researchers, and policy makers from the national Ministry of Health and the World Health Organization office in Pristina, Kosovo. Participants identified several important barriers to implementation. First, lack of communication between clinicians and ministry representatives was seen as leading to duplication of effort in creating or adapting guidelines, as well as substantial mistrust between clinicians and policy makers. Second, there was a lack of communication across clinical groups that provide obstetric care and a lack of integration across the entire healthcare system, including rural and urban centers. This fragmentation was thought to have directly resulted from the war in 1998 - 1999. Third, the conflict substantially and adversely affected the healthcare infrastructure in Kosovo, which has resulted in an inability to monitor quality of care across the country. Furthermore, the impact on infrastructure has affected the ability to access required medications consistently and to smoothly transfer patients from rural to urban centers. Another issue raised during this project was the appropriateness of including guideline recommendations perceived to be 'aspirational'. Implementing clinical practice guidelines in low- and middle-income countries (LMICs) requires consideration of several specific barriers. Particularly pertinent to this study were the effects of

  2. Implementing evidence-based guidelines for managing depression in elderly patients: a Norwegian perspective.

    Science.gov (United States)

    Aakhus, E; Flottorp, S A; Oxman, A D

    2012-09-01

    Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called 'Tailored Implementation for Chronic Diseases' (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.

  3. [Pedagogical Project for the Graduate Nursing Program at UFAL: adaptations to curricular guidelines].

    Science.gov (United States)

    dos Santos, Regina Maria; Brandão, Francisco da Silva; Valverde, Rosimar Camilo; Trezza, Maria Cristina Soares Figueiredo

    2003-01-01

    This is an analysis of the adaptation of the Pedagogical Political Project of the Nursing Graduate Program at Alagoas Federal University (PPP/Enf/UFAL) to new Brazilian curriculum guidelines, evidencing convergence points and some points that need to be approached, taking into account that the present project was established prior to the existence of the current curricular guidelines. Our analysis shows that the main difficulties presented by the newly implemented curriculum lie in the ones inherent to the process of changing conceptions on the educational process in Nursing and in the work conditions imposed by the current situation of the Brazilian Public University System. It calls for a review on strategies and contents related to the basis of research and expansion in Nursing Sciences, as well as the search for alternatives to integration with domain areas from Humanistic and Health Sciences.

  4. Evaluation of the dissemination and implementation of a nutritional guideline for pressure ulcer care.

    Science.gov (United States)

    Meijers, J M M; Schols, J M G A; Jackson, P A; Langer, G; Clark, M; Halfens, R J G

    2007-05-01

    In 2004 the European Pressure Ulcer Advisory Panel nutritional working group developed a nutritional guideline for pressure ulcer prevention and treatment. This study investigated the degree to which the guideline was disseminated and implemented in clinical practice. A cross-sectional study was undertaken in health-care organisations in The Netherlands, Germany and the UK. A printed, standardised questionnaire which followed Rogers' model of the innovation-decision process was developed, translated and distributed to 1087 health-care organisations. The response rate was 33% (n = 363). Sixty-one per cent of respondents knew of the guideline. Twenty-five per cent had applied it to their clinical practice and used it for nutritional screening. The main barrier to the provision of nutritional support appeared to be lack of knowledge and skills. One year after its dissemination, more than half of respondents knew of the guideline, with one in four applying it to their practice. The guideline was better disseminated and implemented in The Netherlands and UK than in Germany, where only 4% of participants had used it.

  5. A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

    Directory of Open Access Journals (Sweden)

    Reisinger Heather

    2009-09-01

    Full Text Available Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy, computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the

  6. A before-after implementation trial of smoking cessation guidelines in hospitalized veterans.

    Science.gov (United States)

    Katz, David; Vander Weg, Mark; Fu, Steve; Prochazka, Allan; Grant, Kathleen; Buchanan, Lynne; Tinkelman, David; Reisinger, Heather Schacht; Brooks, John; Hillis, Stephen L; Joseph, Anne; Titler, Marita

    2009-09-10

    Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Pre-post study design in four VA hospitals. Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the

  7. Implementation of a pharmacist career ladder program.

    Science.gov (United States)

    Heavner, Mojdeh S; Tichy, Eric M; Yazdi, Marina

    2016-10-01

    The implementation and outcomes of a pharmacist career ladder program (PCLP) at a tertiary care, academic medical center are described. A PCLP was developed at Yale-New Haven Hospital to guide career development, motivate staff to perform beyond their daily tasks and responsibilities, and recognize and retain high performers through professional advancement. The PCLP advancement criteria include specific requirements for excellence in five categories: level of training and experience, pharmacy practice, drug information, education and scholarship, and leadership. The PCLP is designed with four distinct tiers: clinical pharmacist, clinical pharmacist II, clinical pharmacy specialist, and clinical pharmacy specialist II. The specific criteria are increasingly challenging to achieve when moving up the ladder. Pharmacists may apply voluntarily each year for advancement. A PCLP review committee consisting of pharmacist peers and managers meets annually to discuss and vote on career advancement decisions. Since PCLP implementation, we have observed an increasing success rate for advancement (50% in 2013, 85% in 2014, and 100% in 2015) and a considerable increase in pharmacist participation in clinical and process improvement projects, as well as intervention and medication-use variance documentation. The implementation of a PCLP at a tertiary care, academic medical center provided an opportunity for frontline pharmacists to advance professionally and increased their participation and leadership in clinical and process improvement projects and drug-use policy and medication safety initiatives; the program also increased the number of pharmacists with specialty board certification and peer-reviewed publications. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Do guidelines on first impression make sense? Implementation of a chest pain guideline in primary care: a systematic evaluation of acceptance and feasibility

    Directory of Open Access Journals (Sweden)

    Kramer Lena

    2011-11-01

    Full Text Available Abstract Background Most guidelines concentrate on investigations, treatment, and monitoring instead of patient history and clinical examination. We developed a guideline that dealt with the different aetiologies of chest pain by emphasizing the patient's history and physical signs. The objective of this study was to evaluate the guideline's acceptance and feasibility in the context of a practice test. Methods The evaluation study was nested in a diagnostic cross-sectional study with 56 General Practitioners (GPs and 862 consecutively recruited patients with chest pain. The evaluation of the guideline was conducted in a mixed method design on a sub-sample of 17 GPs and 282 patients. Physicians' evaluation of the guideline was assessed via standardized questionnaires and case record forms. Additionally, practice nursing staff and selected patients were asked for their evaluation of specific guideline modules. Quantitative data was analyzed descriptively for frequencies, means, and standard deviations. In addition, two focus groups with a total of 10 GPs were held to gain further insights in the guideline implementation process. The data analysis and interpretation followed the standards of the qualitative content analysis. Results The overall evaluation of the GPs participating in the evaluation study regarding the recommendations made in the chest pain guideline was positive. A total of 14 GPs were convinced that there was a need for this kind of guideline and perceived the guideline recommendations as useful. While the long version was partially criticized for a perceived lack of clarity, the short version of the chest pain guideline and the heart score were especially appreciated by the GPs. However, change of clinical behaviour as consequence of the guideline was inconsistent. While on a concrete patient related level, GPs indicated to have behaved as the guideline recommended, the feedback on a more general level was heterogeneous. Several

  9. Major Differences in Implementation Strategies of the European Resuscitation Council Guidelines 2015 in Danish Hospitals - A Nationwide Study

    DEFF Research Database (Denmark)

    Stærk, Mathilde; Glerup Lauridsen, Kasper; Mygind-Klausen, Troels

    2016-01-01

    Introduction: Implementation of guidelines into clinical practice is important to provide quality of care. Implementation of clinical guidelines is known to be poor. This study aimed to investigate awareness, expected time frame and strategy for implementation of the European Resuscitation Council...... (ERC) Guidelines 2015 in Danish hospitals.Methods: All public, somatic hospitals with a cardiac arrest team in Denmark were included. A questionnaire was sent to hospital resuscitation committees one week after guideline publication. The questionnaire included questions on awareness of ERC Guidelines...... 2015 and time frame and strategy for implementation.Results: In total, 41 hospitals replied (response rate: 87%) between October 22nd and December 22nd 2015. Overall, 37% of hospital resuscitation committees were unaware of the content of the guidelines. The majority of hospitals (80%) expected...

  10. Adopting and implementing nutrition guidelines in recreational facilities: tensions between public health and corporate profitability.

    Science.gov (United States)

    Olstad, Dana Lee; Raine, Kim D; McCargar, Linda J

    2013-05-01

    Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities. In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis. Food services in recreational facilities. Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters). Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete. Public-private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

  11. [Medico-economic assessment of two methods for implementing thyroid testing guidelines].

    Science.gov (United States)

    Saillour-Glénisson, F; Michel, P; Daucourt, V

    2005-09-01

    To compare independent and combined effectiveness and cost-effectiveness of two implementation interventions of guidelines for ordering thyroid function tests. The two implementation interventions were a Memorandum Pocket Card (MPC) and a Test Request Form (TRF). Intervention groups were wards. The study used an experimental 2*2 factorial design with matching hospitals according to size and activity and wards according to pre-intervention appropriateness for test ordering. Four ward groups were established: the dual intervention group, the order form group, the pocket card group and the control group. Physicians in all groups received guidelines and were invited to a local information meeting. The main outcome measure of effectiveness was the Guideline Conformity Rate (GCR). The cost-effectiveness ratio was the cost difference between the tested intervention and the control intervention upon effectiveness difference between the tested intervention and the control intervention. Six hospitals participated in the study (two middle-sized hospitals, two small-sized hospitals and two psychiatric hospitals). A total of 1412 orders for thyroid function tests were collected. GCR was 78% in the dual intervention group, 83% in the order form group, 73% in the pocket card group and 62% in the control group. The interaction between TRF and MPC was not significant (B=-0.70, p=0.21). Compared to simple information, TRF was effective in increasing GCR (OR=2.65, 95% Confidence Interval [CI]: 1.52-4.62), unlike MPC (OR=1.28, CI: 0.75-2.19). TRF was the less expensive and the most effective intervention. Using a robust design, our study shows a greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines. The development of clinical practice improvement projects through the second procedure of accreditation in France is a good opportunity to develop a guidelines implementation research project.

  12. Barriers in the implementation of the Resuscitation Guidelines: European survey of defibrillation techniques.

    Science.gov (United States)

    Krawczyk, Paweł; Kononowicz, Andrzej A; Andres, Janusz

    2016-03-11

    The European Resuscitation Council (ERC) Guidelines recommend providing chest compressions during defibrillator charging and using adhesive pads for defibrillation to increase the effectiveness of resuscitation. However, the most common defibrillation technique in each European country is unknown, as are the potential barriers in implementation of the guidelines. The aim of this study was to assess the techniques of defibrillation procedures performed by professional European healthcare providers and to estimate how frequently adhesive pads are used. We sent an online questionnaire to the ERC National Representatives that contained 12 questions regarding the techniques of defibrillation and monitoring heart rhythm during cardiac arrest. We also evaluated the frequency and indications of manual paddles use. We collected questionnaires from 27 out of 33 invited ERC member countries. The response rate was 82%. Seventeen (17/27; 63%) declared the use of adhesive pads. The leading cause for not using adhesive pads was economic reason (9/17; 53%). Some respondents declared resistance to using adhesive pads by healthcare providers or tradition connected with manual paddles use. We found three leading techniques of defibrillation with manual paddles: Charging paddles keeping them on the defibrillator during chest compressions being delivered (9/21; 43%), Charging paddles keeping them on the patient chest during chest compressions being delivered (6/21; 29 %), Charging paddles on the patient chest without chest compressions (5/21; 24%). Respondents from 11 countries declared the use of gel or electrode pastes during defibrillation with manual paddles. This study collected preliminary data showing how defibrillation is performed in Europe. It revealed the recommeded techniques underuse and identyfied barriers in the Resuscitation Guidelines implementation. The survey should be open to a wider group of respondents. in each country in future. There are limitations and barriers

  13. Implementation of low-fat, low-sugar, and portion-controlled nutrition guidelines in competitive food venues of Maine public high schools.

    Science.gov (United States)

    Whatley Blum, Janet E; Davee, Anne-Marie; Devore, Rachel L; Beaudoin, Christina M; Jenkins, Paul L; Kaley, Lori A; Wigand, Debra A

    2007-12-01

    The prevalence of childhood "overweight" and "at risk for overweight" has become a major public health concern. School food environments can affect key nutritional risk factors, especially in high schools where foods of poor nutrient value are pervasive in à la carte and vending programs. This study examines à la carte and vending programs in Maine public high schools at baseline and following implementation of low-fat (defined as itemsschools implemented LFLS guidelines and 3 made no changes to à la carte and vending programs for a period of 1 school year. Findings revealed no significant change in food and beverage offerings in control schools. Whereas, in intervention schools, the proportion of items meeting the LFLS nutrient criteria increased from 32.8% to 81.8% in à la carte items, increased from 22.5% to 84.0% in snack vending, and increased from 48.0% to 98.9% in beverage vending from baseline to follow-up. However, these increases were mitigated when LFLS portion size criteria were applied. These findings demonstrate the successful implementation of LFLS guidelines similar to recommendations recently proposed by numerous organizations. School food service personnel were identified as key stakeholders in the successful implementation of the LFLS guidelines. Furthermore, these findings emphasize an important role the food and beverage industry will have in providing foods and beverages that meet proposed nutrient and portion guidelines.

  14. Perceptions of national guidelines and their (non) implementation in mental healthcare: a deductive and inductive content analysis.

    OpenAIRE

    Sandström, Boel; Willman, Ania; Svensson, Bengt; Borglin, Gunilla

    2015-01-01

    Background National guidelines are being produced at an increasing rate, and politicians and managers are expected to promote these guidelines and their implementation in clinical work. However, research seldom deals with how decision-makers can perceive these guidelines or their challenges in a cultural context. Therefore, the aim of this study was twofold: to investigate how well Promoting Action on Research Implementation in Health Services (PARIHS) reflected the empirical reality of menta...

  15. Gavi HPV Programs: Application to Implementation

    Directory of Open Access Journals (Sweden)

    Celina M. Hanson

    2015-05-01

    Full Text Available Developing countries disproportionately suffer from the burden of cervical cancer yet lack the resources to establish systematic screening programs that have resulted in significant reductions in morbidity and mortality in developed countries. Human Papillomavirus (HPV vaccination provides an opportunity for primary prevention of cervical cancer in low-resource settings through vaccine provision by Gavi The Vaccine Alliance. In addition to the traditional national introduction, countries can apply for a demonstration program to help them make informed decisions for subsequent national introduction. This article summarizes information from approved Gavi HPV demonstration program proposals and preliminary implementation findings. After two rounds of applications, 23 countries have been approved targeting approximately 400,000 girls for vaccination. All countries are proposing primarily school-based strategies with mixed strategies to locate and vaccinate girls not enrolled in school. Experiences to date include: Reaching marginalized girls has been challenging; Strong coordination with the education sector is key and overall acceptance has been high. Initial coverage reports are encouraging but will have to be confirmed in population based coverage surveys that will take place later this year. Experiences from these countries are consistent with existing literature describing other HPV vaccine pilots in low-income settings.

  16. Gavi HPV Programs: Application to Implementation.

    Science.gov (United States)

    Hanson, Celina M; Eckert, Linda; Bloem, Paul; Cernuschi, Tania

    2015-05-20

    Developing countries disproportionately suffer from the burden of cervical cancer yet lack the resources to establish systematic screening programs that have resulted in significant reductions in morbidity and mortality in developed countries. Human Papillomavirus (HPV) vaccination provides an opportunity for primary prevention of cervical cancer in low-resource settings through vaccine provision by Gavi The Vaccine Alliance. In addition to the traditional national introduction, countries can apply for a demonstration program to help them make informed decisions for subsequent national introduction. This article summarizes information from approved Gavi HPV demonstration program proposals and preliminary implementation findings. After two rounds of applications, 23 countries have been approved targeting approximately 400,000 girls for vaccination. All countries are proposing primarily school-based strategies with mixed strategies to locate and vaccinate girls not enrolled in school. Experiences to date include: Reaching marginalized girls has been challenging; Strong coordination with the education sector is key and overall acceptance has been high. Initial coverage reports are encouraging but will have to be confirmed in population based coverage surveys that will take place later this year. Experiences from these countries are consistent with existing literature describing other HPV vaccine pilots in low-income settings.

  17. How the CATCH eat smart program helps implement the USDA regulations in school cafeterias.

    Science.gov (United States)

    Hoelscher, Deanna M; Mitchell, Paul; Dwyer, Johanna; Elder, John; Clesi, Ann; Snyder, Patricia

    2003-08-01

    This article describes the implementation of the U.S. Department of Agriculture's National School Lunch Program (NSLP) standards in school lunch menus in 56 intervention and 20 control schools from the Child and Adolescent Trial for Cardiovascular Health (CATCH) 5 years after the main trial, compared with 12 schools previously unexposed to CATCH. School food service personnel completed questionnaires to assess CATCH guideline implementation, demographic data, behavioral constructs, training, program material use, and participation in competing programs. Five days of menus and recipes were collected from school cafeteria staff, averaged, and compared to USDA School Meal Initiative (SMI) standards. Significant differences between intervention and unexposed schools were found for training and knowledge of CATCH and in mean percentage energy from fat and carbohydrates. Intervention schools most closely met USDA SMI recommendations for fat. Thus, the CATCH Eat Smart Program assisted school cafeterias in meeting USDA guidelines 5 years postimplementation.

  18. Teachers' perspective on barriers to implementing physical activity curriculum guidelines for school children in Toronto.

    Science.gov (United States)

    Dwyer, John J M; Allison, Kenneth R; Barrera, Maru; Hansen, Barbara; Goldenberg, Ellie; Boutilier, Marie A

    2003-01-01

    Teachers in Ontario are expected to implement the physical activity guidelines in the health and physical education (HPE) curriculum document that was introduced in 1998. This study examined Toronto teachers' perspective on barriers to implementing these guidelines. Forty-five teachers from five Toronto elementary schools in which generalist classroom teachers provide physical education classes participated in focus groups. An experienced moderator facilitated each session. Themes were inductively generated from the data. Participants reported that children were not engaged in moderate or vigorous physical activity daily and for the expected duration. Participants identified three categories of barriers to implementing the curriculum guidelines: lower priority for HPE, lack of performance measures for physical activity, and lack of sufficient infrastructure. First, they reported that the new curriculum expectations for other subjects were demanding, which left little time to focus on physical education. They felt that resource support for the HPE curriculum was not sufficient and that physical education specialists were necessary but unavailable to implement the curriculum. Second, participants felt accountable to both government and parents for high student performance on standardized tests in subjects deemed to be of higher priority. Third, participants reported inadequate facilities and equipment, use of portables for classrooms, cancelling physical education to have events in the gymnasium, and unavailability of teachers to supervise off-school physical activity. The study suggests that participating teachers perceive physical education to be a low priority in the educational system, making it difficult for them to meet the HPE curriculum expectations.

  19. Implementing tobacco use treatment guidelines in community health centers in Vietnam.

    Science.gov (United States)

    Shelley, Donna; VanDevanter, Nancy; Cleland, Charles C; Nguyen, Linh; Nguyen, Nam

    2015-10-09

    Vietnam has a smoking prevalence that is the second highest among Southeast Asian countries (SEACs). According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Yet, largely due to a lack of research on strategies for implementing WHO-endorsed treatment guidelines in primary care settings, services to treat tobacco dependence are not readily available to smokers in low middle-income countries (LMICs) like Vietnam. The objective of this study is to conduct a cluster randomized controlled trial that compares the effectiveness of two system-level strategies for implementing evidence-based guidelines for the treatment of tobacco use in 26 public community health centers (CHCs) in Vietnam. The current study will use a cluster-randomized design and multiple data sources (patient exit interviews, provider and village health worker (VHW) surveys, and semi-structured provider/VHW interviews) to study the process of adapting and implementing clinical practice guidelines in Vietnam and theory-driven mechanisms hypothesized to explain the comparative effectiveness of the two strategies for implementation. CHCs will be randomly assigned to either of the following: (1) training plus clinical reminder system (TC) or (2) TC + referral to a VHW (TCR) for three in person counseling sessions. The primary outcome is provider adherence to tobacco use treatment guidelines. The secondary outcome is 6-month biochemically verified smoking abstinence. The proposed implementation strategies draw on evidence-based approaches and a growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We hypothesize that the value of these implementation strategies is additive and that incorporating a referral resource that allows providers to delegate the task of offering counseling (TCR

  20. Have renal dietitians successfully implemented evidence-based guidelines into practice? A survey of dietitians across Australia and New Zealand.

    Science.gov (United States)

    Hall-McMahon, Emma J; Campbell, Katrina L

    2012-11-01

    Successful implementation of evidence-based practice (EBP) guidelines has been shown to improve the nutrition status of dialysis patients. This study aimed to establish use of EBP guidelines and implementation of key recommendations for nutrition assessment of dialysis patients, as well as to identify barriers and enablers associated with EBP guideline adherence. A survey of nutrition assessment practices and barriers to implementation of EBP guidelines was developed and piloted. The survey measured implementation of guidelines regarding frequency of nutrition assessment and use of the subjective global assessment (SGA) to diagnose malnutrition. Barriers to guideline implementation were measured using agreement with statements rated on a Likert scale. Data were summarized as counts and percentages and analyzed using chi-squared tests of association, with P nutrition assessment of dialysis patients (n = 36 of 65) and use of the SGA (n = 43 of 65), respectively. Barriers related to time, skills/self-efficacy, and an inefficient referral system were related to lower rates of guideline implementation. These findings indicate an evidence-practice gap in the nutritional management of dialysis patients. A standardized approach to EBP guideline implementation including structured 6-monthly nutrition assessment of dialysis patients and group training for use of the SGA tool may assist in closing this evidence-practice gap. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  1. Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: a qualitative study

    Science.gov (United States)

    Peters-Klimm, Frank; Natanzon, Iris; Müller-Tasch, Thomas; Ludt, Sabine; Nikendei, Christoph; Lossnitzer, Nicole; Szecsenyi, Joachim; Herzog, Wolfgang; Jünger, Jana

    2012-01-01

    Objectives: A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice. The implementation of heart failure (HF) CPGs represents a challenge in general practice. As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care. Methods: We conducted a modified focus group with elements of a workshop of three hours duration. Thirteen GPs collected and discussed together and parallel in smaller groups barriers of guideline implementation. Afterwards they performed a needs assessment for a tailored CME curriculum for chronic HF. The content of the discussions was analysed qualitatively according to Mayring and categorised thematically. Results: Barriers of guideline adherence were found in the following areas: doctor: procedural knowledge (knowledge gaps), communicative and organisational skills (e.g. time management) and attitude (dissatisfaction with time-money-relation). Patients: individual case-related problems (multimorbidity, psychiatric comorbidity, expectations and beliefs). Doctor and patient: Adherence and barriers of communication. Main measures for improvement of care concerned the areas of the identified barriers of guideline adherence with the focus on application-oriented training of the abovementioned procedural knowledge and skills, but also the supply of tools (like patient information leaflets) and patient education. Conclusion: For a CME-curriculum for HF tailored to the needs of GPs, a comprehensive educational approach seems necessary. It should be broad-based and include elements of knowledge and skills to be addressed and trained case-related. Additional elements should include support in the implementation of organisational processes in the practice and patient education. PMID:22737201

  2. The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Outcomes and Metrics of Pharmacogenetic Implementations Across Diverse Healthcare Systems.

    Science.gov (United States)

    Luzum, J A; Pakyz, R E; Elsey, A R; Haidar, C E; Peterson, J F; Whirl-Carrillo, M; Handelman, S K; Palmer, K; Pulley, J M; Beller, M; Schildcrout, J S; Field, J R; Weitzel, K W; Cooper-DeHoff, R M; Cavallari, L H; O'Donnell, P H; Altman, R B; Pereira, N; Ratain, M J; Roden, D M; Embi, P J; Sadee, W; Klein, T E; Johnson, J A; Relling, M V; Wang, L; Weinshilboum, R M; Shuldiner, A R; Freimuth, R R

    2017-09-01

    Numerous pharmacogenetic clinical guidelines and recommendations have been published, but barriers have hindered the clinical implementation of pharmacogenetics. The Translational Pharmacogenetics Program (TPP) of the National Institutes of Health (NIH) Pharmacogenomics Research Network was established in 2011 to catalog and contribute to the development of pharmacogenetic implementations at eight US healthcare systems, with the goal to disseminate real-world solutions for the barriers to clinical pharmacogenetic implementation. The TPP collected and normalized pharmacogenetic implementation metrics through June 2015, including gene-drug pairs implemented, interpretations of alleles and diplotypes, numbers of tests performed and actionable results, and workflow diagrams. TPP participant institutions developed diverse solutions to overcome many barriers, but the use of Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines provided some consistency among the institutions. The TPP also collected some pharmacogenetic implementation outcomes (scientific, educational, financial, and informatics), which may inform healthcare systems seeking to implement their own pharmacogenetic testing programs. © 2017, The American Society for Clinical Pharmacology and Therapeutics.

  3. An Interdisciplinary Approach to Implementing a Best Practice Guideline in Public Health.

    Science.gov (United States)

    Prowd, Lisa; Leach, Denna; Lynn, Hazel; Tao, May

    2017-12-01

    This article describes how one Ontario Public Health Unit implemented a best practice guideline throughout the organization and across disciplines to achieve best practice outcomes in the delivery of client-centered care. Integration of evidence-informed practice presents challenges for both implementation and sustainability. Applying a best practice guideline in the public health setting can add to the challenge. To address this, a variety of interventions were applied: building an interdisciplinary team, adapting a Registered Nurses' Association of Ontario Best Practice Guideline to reflect public health practice for nursing and other disciplines, developing a working definition of "client," engaging staff in knowledge translation, developing policy to support practice change, and incorporating client-centered care principles into daily practice. Outcomes indicate that nursing best practice guidelines, specific to client-centered care, can be successfully adapted and applied in public health practice. Considerations include the varied definitions of a "client," the various roles of public health professionals, and engagement of both internal and external clients. Moreover, interdisciplinary staff can apply the principles of client-centered care when working with clients and when engaging in education-, practice-, and policy-level initiatives to support evidence-informed practice.

  4. Oncologist's knowledge and implementation of guidelines for breakthrough cancer pain in Spain: CONOCE study.

    Science.gov (United States)

    López López, R; Camps Herrero, C; Khosravi-Shahi, P; Guillem Porta, V; Carrato Mena, A; Garcia-Foncillas, J; Cruz Hernández, J J; Gascón Vilaplana, P; Antón Torres, A; Diaz-Rubio, E; Feyjoo Saus, M; Aranda Aguilar, E

    2017-10-03

    Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline. A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines. Despite oncologist's clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.

  5. Implementation of the national tuberculosis guidelines on culture and drug sensitivity testing in Guatemala, 2013.

    Science.gov (United States)

    Samayoa-Peláez, Maritza; Ayala, Nancy; Yadon, Zaida E; Heldal, Einar

    2016-01-01

    Objective To assess whether the National Tuberculosis Program (NTP) guidelines for culture and drug sensitivity testing (DST) in Guatemala were successfully implemented, particularly in cases of smear-negative pulmonary tuberculosis (TB) or previously treated TB, by documenting notification rates by department (geographic area), disease type and category, and culture and DST results. Methods This was a cross-sectional, operational research study that merged and linked all patients registered by the NTP and the National Reference Laboratory in 2013, eliminating duplicates. The proportions with culture (for new smear negative pulmonary cases) and culture combined with DST (for previously treated patients) were estimated and analyzed by department. Data were analyzed using EpiData Analysis version 2.2. Results There were 3 074 patients registered with TB (all forms), for a case notification rate of 20/100 000 population. Of these, 2 842 had new TB, of which 2 167 (76%) were smear-positive pulmonary TB (PTB), 385 (14%) were smear-negative PTB, and 290 (10%) were extrapulmonary TB. There were 232 (8%) previously treated cases. Case notification rates (all forms) varied by department from 2-68 per 100 000 population, with the highest rates seen in the southwest and northeast part of Guatemala. Of new TB patients, 136 had a culture performed and 55 had DST of which the results were 33 fully sensitive, 9 monoresistant, 3 polyresistant, and 10 multidrug resistant TB (MDR-TB). Only 21 (5%) of new smear-negative PTB patients had cultures. Of 232 previously treated patients, 54 (23%) had a culture and 47 (20%) had DST, of which 29 were fully sensitive, 7 monoresistant, 2 polyresistant, and 9 MDR-TB. Of 22 departments (including the capital), culture and DST was performed in new smear-negative PTB in 7 departments (32%) and in previously treated TB in 13 departments (59%). Conclusions Despite national guidelines, only 5% of smear-negative PTB cases had a culture and only 20% of

  6. Treating Conjugal Violence in Prison Settings: Guidelines for Program Implementation.

    Science.gov (United States)

    Rondeau, Gilles; Brochu, Serge; Lemire, Guy; Brodeur, Normand; Schneeberger, Pascal

    1997-01-01

    Examines ways to change prisoners' violent urges. Suggests that consciousness-raising strategies be used to motivate incarcerated men to change, whereas coercion might be used with those clients who are most at risk of committing acts of family violence. Summarizes the characteristics of violent men and incarcerated populations. (RJM)

  7. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay.

    Science.gov (United States)

    Souza Possa, S; Braga Amador, C; Meira Costa, A; Takahama Sakamoto, E; Seiko Kondo, C; Maida Vasconcellos, A L; Moran de Brito, C M; Pereira Yamaguti, W

    2014-01-01

    The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS) in reducing the incidence of atelectasis and length of hospital stay in the postoperative period. A "before and after" study design with historical control was used. The "before" period included consecutive patients who underwent UAS before guideline implementation (intervention). The "after" period included consecutive patients after guideline implementation. Patients in the pre-intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post-intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization). There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post-intervention period. No patient who adhered totally to the guideline in the post-intervention period developed atelectasis. Individuals in the post-intervention period presented a shorter length of hospital stay (9.2±4.1 days) compared to patients in the pre-intervention period (12.1±8.3 days) (p<0.05). The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  8. Guideline for implementing Co-generation based on biomass waste from Thai industries

    Energy Technology Data Exchange (ETDEWEB)

    Lybaek, R.

    2005-07-01

    Due to the large-scale industrial development in Thailand the consumption of energy - primarily based on fossil fuels - has increased enormously, even though the economic growth has slowed down since the economic crisis in 1997. It is, therefore, important to reduce the environmental impact of this energy consumption, which can be achieved by energy conservation, higher efficiency in the production of energy, or by the use of different kinds of renewable energy. This thesis seeks to develop new strategies for the use of waste heat as a part of the industrial process heat, which can be supplied to industries by a district-heating network. By substituting process heat - produced by electricity or by boilers using fossil fuel in individual industries - with process heat, produced by a co-generation plant - using the industries own biomass waste as fuel - process heat can be supplied to industries participating in a small scale district heating network. Thus, an Industrial Materials Network can be created, which is environmentally as well as economically beneficial for both industry and society. On the basis of a case study of the industrial area, Navanakorn Industrial Promotion Zone in Thailand, such initiatives for efficient materials and energy uses have been conducted and proved successful, and industries - as well as local and national governmental agencies, NGOs and branch organizations etc. - have shown interest in supporting the implementation of such scheme. In this thesis, a Guideline for large-scale implementation of Industrial Materials Network in Thailand was developed. By following a series of actions, the Guideline defines the initiatives that must be taken in order to ensure correct implementation. Chronologically, the emphasis of the Guideline is on pointing to relevant stakeholders who can pursue the implementation, and then appropriate areas and types of industries for Industrial Materials Network implementation. Thereafter, guidance for the

  9. Guidelines for Implementing Advanced Distribution Management Systems-Requirements for DMS Integration with DERMS and Microgrids

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jianhui [Argonne National Lab. (ANL), Argonne, IL (United States); Chen, Chen [Argonne National Lab. (ANL), Argonne, IL (United States); Lu, Xiaonan [Argonne National Lab. (ANL), Argonne, IL (United States)

    2015-08-01

    This guideline focuses on the integration of DMS with DERMS and microgrids connected to the distribution grid by defining generic and fundamental design and implementation principles and strategies. It starts by addressing the current status, objectives, and core functionalities of each system, and then discusses the new challenges and the common principles of DMS design and implementation for integration with DERMS and microgrids to realize enhanced grid operation reliability and quality power delivery to consumers while also achieving the maximum energy economics from the DER and microgrid connections.

  10. Guideline Implementation: Energy-Generating Devices, Part 2-Lasers.

    Science.gov (United States)

    Burlingame, Byron L

    2017-04-01

    Lasers have been used in the OR for many years and are essential tools in many different types of procedures. However, laser beams that come into contact with unintended targets directly or via reflection can cause injury to patients or personnel or pose other hazards, such as fires. The new AORN "Guideline for safe use of energy-generating devices" provides guidance on the use of all energy-generating devices in the OR. This article focuses on key points of the guideline that address the safe use of lasers. These include the components of the laser safety program, the responsibilities of the personnel in roles specific to use of a laser, laser safety measures, and documentation of laser use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  11. Implementation of practice guidelines for antifungal therapy in a surgical intensive care unit and its impact on use and costs.

    Science.gov (United States)

    Swoboda, Stefanie; Lichtenstern, Christoph; Ober, Michael Christoff; Taylor, Lenka Alexandra; Störzinger, Dominic; Michel, André; Brobeil, Angelika; Mieth, Markus; Hofer, Stefan; Sonntag, Hans-Günther; Hoppe-Tichy, Torsten; Weigand, Markus Alexander

    2009-01-01

    Considering the complexity of diagnosis, high costs of therapy and high morbidity and mortality of systemic fungal infections, antifungal therapy of intensive care patients should follow clearly defined guidelines. We outline the impact of a standardised practice of antifungal treatment in an interdisciplinary surgical intensive care unit of a university hospital. Therapy was intended to be optimised by implementation of standardised practice guidelines supported by the clinical pharmacist. Costs for antifungal agents during a period of 18 months before and after implementation of the practice guidelines were compared, respectively. The intervention was associated with a significant decrease in use of antifungal agents. Analysis of data revealed a reduction in costs by 50%. This could substantially be attributed to the implementation of the practice guidelines. The implementation of standardised practice guidelines for antifungal therapy in intensive care units decreased the use of selected antifungal agents and resulted in substantial reduction in expenditure on antifungal agents. Copyright 2009 S. Karger AG, Basel.

  12. A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Allan Riis

    2016-10-01

    Full Text Available Abstract Background Guidelines are often slowly adapted into clinical practice. However, actively supporting healthcare professionals in evidence-based treatment may speed up guideline implementation. Danish low back pain (LBP guidelines focus on primary care treatment of LBP, to reduce referrals from primary care to secondary care. The primary aim of this project was to reduce secondary care referral within 12 weeks by a multifaceted implementation strategy (MuIS. Methods In a cluster randomised design, 189 general practices from the North Denmark Region were invited to participate. Practices were randomised (1:1 and stratified by practice size to MuIS (28 practices or a passive implementation strategy (PaIS; 32 practices. Included were patients with LBP aged 18 to 65 years who were able to complete questionnaires, had no serious underlying pathology, and were not pregnant. We developed a MuIS including outreach visits, quality reports, and the STarT Back Tool for subgrouping patients with LBP. Both groups were offered the usual dissemination of guidelines, guideline-concordant structuring of the medical record, and a new referral opportunity for patients with psycho-social problems. In an intention-to-treat analysis, the primary and secondary outcomes pertained to the patient, and a cost-effectiveness analysis was performed from a healthcare sector perspective. Patients and the assessment of outcomes were blinded. Practices and caregivers delivering the interventions were not blinded. Results Between January 2013 and July 2014, 60 practices were included, of which 54 practices (28 MuIS, 26 PaIS included 1101 patients (539 MuIS, 562 PaIS. Follow-up data for the primary outcome were available on 100 % of these patients. Twenty-seven patients (5.0 % in the MuIS group were referred to secondary care vs. 59 patients (10.5 % in the PaIS group. The adjusted odds ratio (AOR was 0.52 [95 % CI 0.30 to 0.90; p = 0.020]. The MuIS was cost

  13. Implementation of Developmental Screening Guidelines for Children with Congenital Heart Disease.

    Science.gov (United States)

    Knutson, Stacie; Kelleman, Michael S; Kochilas, Lazaros

    2016-09-01

    To assess awareness and implementation among pediatric primary care providers of the 2012 American Heart Association (AHA) guidelines for the evaluation and management of developmental abnormalities in children with congenital heart disease (CHD). We hypothesized that children with CHD are not being provided neurodevelopmental screening and support according to the AHA guidelines. An online survey was administered to licensed pediatric primary care providers in Minnesota (pediatricians = 530, family physicians = 1469) to evaluate awareness of the AHA guidelines, current screening practices, and barriers to implementation of these guidelines. A total of 326 providers (17% of 1911 successful e-mails) responded to the survey, which included 148 pediatricians (29% of 518 successful e-mails) and 178 family physicians (13% of 1393 successful e-mails). Overall, 202 providers (62%) reported caring for children with CHD. Among those caring for children with CHD, the most commonly reported reasons for neurodevelopmental referral were nonspecific to CHD. Presence of risks specific to children with CHD, such as history of cyanotic heart disease or open heart surgery as an infant, accounted for only 25% and 22% of the referrals, respectively. Only 21% of providers were aware of the guidelines, and only 7% received guidance from a pediatric cardiologist regarding neurodevelopmental screening in children with CHD. There is need for further education of primary care providers on the developmental risks associated with CHD as well as increased involvement by the pediatric cardiology community to enhance the developmental outcomes of children with CHD. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2007-03-01

    Full Text Available Abstract Background Evaluations of interventions to improve implementation of guidelines have failed to produce a clear pattern of results favouring a particular method. While implementation depends on clinicians and managers changing a variety of behaviours, psychological theories of behaviour and behaviour change are seldom used to try to understand difficulties in implementation or to develop interventions to overcome them. Objectives This study applied psychological theory to examine explanations for difficulties in implementation. It used a theoretical framework derived from an interdisciplinary consensus exercise to code interviews across 11 theoretical domains. The focus of the study was a National Institute for Health and Clinical Excellence's Schizophrenia guideline recommendation that family intervention should be offered to the families of people with schizophrenia. Methods Participants were recruited from community mental health teams from three United Kingdom National Health Service (NHS Trusts; 20 members (social workers, nurses, team managers, psychologists, and psychiatrists participated. Semi-structured interviews were audio-taped and transcribed. Interview questions were based on the theoretical domains and addressed respondents' knowledge, attitudes and opinions regarding the guideline. Two researchers independently coded the transcript segments from each interview that were related to each theoretical domain. A score of 1 indicated that the transcript segments relating to the domain did not appear to contain description of difficulties in implementation of the family therapy guidelines; similarly a score of 0.5 indicated possible difficulties and a score of 0 indicated definite difficulties. Results Coding respondents' answers to questions related to the three domains 'beliefs about consequences,' 'social/professional role and identity,' and 'motivation' produced the three highest total scores indicating that factors relating

  15. The classwide peer tutoring program: implementation factors moderating students' achievement.

    Science.gov (United States)

    Greenwood, C R; Terry, B; Arreaga-Mayer, C; Finney, R

    1992-01-01

    We conducted a study designed to assess implementation of the classwide peer tutoring program and the relationship between implementation variation and student outcome. A clinical replication design was used. Five volunteer elementary teachers were trained to implement the program; their implementation was monitored for 19 consecutive weeks during 1 school year. Overall, the results indicated that specific variations in program implementation were associated with students' responses to treatment. It was also demonstrated that different teachers' applications of the program produced differential levels of student outcome. Implementation factors related to lower spelling achievement were (a) reduced opportunities to receive program sessions, (b) reduced probabilities of students' participation in program opportunities, (c) too many students assigned unchallenging spelling words, and (d) reduced rates of daily point earning reflecting lower levels of spelling practice during tutoring sessions. The implications of these findings and methods of preventing these implementation problems are discussed in the context of quality assurance and social validity.

  16. The Identification, Implementation, and Evaluation of Critical User Interface Design Features of Computer-Assisted Instruction Programs in Mathematics for Students with Learning Disabilities

    Science.gov (United States)

    Seo, You-Jin; Woo, Honguk

    2010-01-01

    Critical user interface design features of computer-assisted instruction programs in mathematics for students with learning disabilities and corresponding implementation guidelines were identified in this study. Based on the identified features and guidelines, a multimedia computer-assisted instruction program, "Math Explorer", which delivers…

  17. Sustaining the implementation of an evidence-based guideline for bronchiolitis.

    Science.gov (United States)

    Perlstein, P H; Kotagal, U R; Schoettker, P J; Atherton, H D; Farrell, M K; Gerhardt, W E; Alfaro, M P

    2000-10-01

    To describe the changes occurring over a 3-year period after implementation of an evidence-based clinical practice guideline for the care of infants with bronchiolitis. Before and after study. Children's Hospital Medical Center, Cincinnati, Ohio. Infants 1 year or younger admitted to the hospital with a first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997. Data on all patients discharged from the hospital with bronchiolitis, from January 15 through March 27, in 1997, 1998, and 1999, were stratified by year and compared with data on similar patients discharged from the hospital in the same periods in the years 1993 through 1996. Patient volumes, length of stay for admissions, and use of specific laboratory and therapeutic resources ancillary to bed occupancy. After implementation of the guideline, admissions decreased 30% and mean length of stay decreased 17% (P<.001). Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients (P<.001); 14% fewer chest x-ray films were ordered (P<.001). There were significant reductions in the use of all respiratory therapies, with a 17% decrease in the use of at least 1 beta(2)-agonist inhalation therapy (P<.001). In addition, 28% fewer repeated inhalations were administered (P<.001); mean costs for all resources ancillary to bed occupancy fell 41% (P<.001); and mean costs for respiratory care services fell 72% (P<.001). An evidence-based clinical practice guideline for the care of patients encountered in major pediatric care facility has been successfully sustained beyond the initial year of its introduction to practitioners in southwest Ohio.

  18. An observational study of the effectiveness of practice guideline implementation strategies examined according to physicians' cognitive styles

    Directory of Open Access Journals (Sweden)

    Kowalski Christine P

    2007-12-01

    Full Text Available Abstract Background Reviews of guideline implementation recommend matching strategies to the specific setting, but provide little specific guidance about how to do so. We hypothesized that the highest level of guideline-concordant care would be achieved where implementation strategies fit well with physicians' cognitive styles. Methods We conducted an observational study of the implementation of guidelines for hypertension management among patients with diabetes at 43 Veterans' Health Administration medical center primary care clinics. Clinic leaders provided information about all implementation strategies employed at their sites. Guidelines implementation strategies were classified as education, motivation/incentive, or barrier reduction using a pre-specified system. Physician's cognitive styles were measured on three scales: evidence vs. experience as the basis of knowledge, sensitivity to pragmatic concerns, and conformity to local practices. Doctors' decisions were designated guideline-concordant if the patient's blood pressure was within goal range, or if the blood pressure was out of range and a dose change or medication change was initiated, or if the patient was already using medications from three classes. Results The final sample included 163 physicians and 1,174 patients. All of the participating sites used one or more educational approaches to implement the guidelines. Over 90% of the sites also provided group or individual feedback on physician performance on the guidelines, and over 75% implemented some type of reminder system. A minority of sites used monetary incentives, penalties, or barrier reduction. The only type of intervention that was associated with increased guideline-concordant care in a logistic model was barrier reduction (p Conclusion Guidelines implementation strategies that were designed to reduce physician time pressure and task complexity were the only ones that improved performance. Education may have been

  19. Community pharmacists' involvement in smoking cessation: familiarity and implementation of the National smoking cessation guideline in Finland

    Directory of Open Access Journals (Sweden)

    Sandström Patrick

    2010-07-01

    Full Text Available Abstract Background Guidelines on smoking cessation (SC emphasize healthcare cooperation and community pharmacists' involvement. This study explored the familiarity and implementation of the National SC Guideline in Finnish community pharmacies, factors relating to Guideline familiarity, implementation and provision of SC services. Methods A nationwide mail survey was sent to a systematic, sample of community pharmacy owners and staff pharmacists (total n = 2291. Response rate was 54% (n = 1190. Factors related to the SC Guideline familiarity were assessed by bivariate and multivariate analysis. Results Almost half (47% of the respondents (n = 1190 were familiar with the SC Guideline and familiarity enhanced Guideline implementation. The familiarity was associated with the respondents' perceptions of their personal SC skills and knowledge (OR 3.8; of customers' value of counseling on nicotine replacement therapy (NRT (OR 3.3; and regular use of a pocket card supporting SC counseling (OR 3.0. Pharmacists' workplaces' characteristics, such as size and geographical location were not associated with familiarity. In addition to recommending NRT, the pharmacists familiar with the Guideline used more frequently other Guideline-based SC methods, such as recommended non-pharmacological SC aids, compared to unfamiliar respondents. Conclusions SC Guideline familiarity and implementation is crucial for community pharmacists' involvement in SC actions in addition to selling NRT products. Pharmacists can constitute a potential public health resource in SC easily accessible throughout the country.

  20. A Review Of Nutritional Guidelines And Menu Compositions For School Feeding Programs In 12 Countries.

    Directory of Open Access Journals (Sweden)

    Ruzky eAliyar

    2015-08-01

    Full Text Available Study objectives: To analyze the nutritional guidelines and menu compositions of school meal provision in various different countries.Background: School feeding is the provision of food on-site or to take home, which aims to increase school enrolment, attendance and retention, and exist as a social safety net for households with very low income. Home-grown school feeding (HGSF, additionally, aims to stimulate local economies by providing a source of income for local smallholder farmers. Methods: Literature searches using the Ovid MEDLINE databases, gathered information from in-country stakeholders, and accessed the programme websites of various countries. Nutrient composition of these menus was calculated from nutritional guidelines and menu compositions using a nutrition linear programming tool (NUTVAL.Country comparisons: School feeding aims differ between countries of each income group. The implementation, delivery of service and nutritional content of foods also differ considerably between countries and income groups. In high-income countries, guidelines and standards have been recommended in an attempt to combat rising levels of overweight and obesity, and to model healthier lifestyle habits. In low-income countries there is a gap in terms of guidance on nutrition standards and menu composition.Conclusions: Provision of evidence-based guidance on nutrition standards to middle and low income countries who have recently established or are planning to establish school feeding has the potential to greatly enhance and improve the quality of service and improve the life of millions of children worldwide.

  1. The Use of Systematic Reviews and Reporting Guidelines to Advance the Implementation of the 3Rs

    Science.gov (United States)

    Avey, Marc T; Fenwick, Nicole; Griffin, Gilly

    2015-01-01

    In 1959, Russell and Burch published The Principles of Humane Experimental Technique, which included concrete advice on factors that they considered would govern progress in the implementation of these principles (enunciated as the 3Rs [Replacement, Reduction, and Refinement in animal-based studies]). One challenge to the implementation of the 3Rs was identified as information retrieval. Here, we further explore this challenge—the need for ‘research on research’—and the role that systematic reviews and reporting guidelines can play in implementation of the 3Rs. First, we examine the 2-fold nature of the challenge of information retrieval: 1) the identification of relevant publications spread throughout a large population of nonrelevant publications and 2) the incomplete reporting of relevant details within those publications. Second, we evaluate how systematic reviews and reporting guidelines can be used generally to address this challenge. Third, we assess the explicit reporting of the 3Rs in a cohort of preclinical animal systematic reviews. Our results show that Reduction methods are the most commonly reported by authors of systematic reviews but that, in general, reporting on how findings relate to the 3Rs is limited at best. Although systematic reviews are excellent tools for resolving the challenge of information retrieval, their utility for making progress in implementation of the 3Rs may be limited unless authors improve their reporting of these principles. PMID:25836961

  2. Implementation of surveillance of invasive mosquitoes in Belgium according to the ECDC guidelines.

    Science.gov (United States)

    Deblauwe, Isra; Sohier, Charlotte; Schaffner, Francis; Rakotoarivony, Laurence Marrama; Coosemans, Marc

    2014-04-26

    In 2012, the new guidelines for the surveillance of IMS in Europe, produced by the European Centre for Disease Prevention and Control (ECDC), were tested in Belgium. This study aimed at (1) testing the usefulness and applicability in the field of the ECDC guidelines for the surveillance of IMS in Europe and (2) surveying IMS throughout Belgium. First, the scenarios, which Belgium is facing, were identified according to the ECDC guidelines. Second, the surveillance strategy and the methods were identified based on the guidelines and adjusted to the Belgium context. Two areas colonised by IMS and 20 potential points of entry (PoE) were selected. Mosquito Magnet Liberty Plus (CO2-baited) traps (23) and oviposition traps (147) were set-up, and larval sampling was performed monthly or bi-monthly from July till October 2012. Finally, the costs and workload of the surveillance activities were compared to the estimates provided by the ECDC guidelines. Surveillance at 20 potential PoE (complying with scenario 1) revealed that no new IMS were established in Belgium. Surveillance at two sites colonised by IMS (scenario 2) indicated that although control measures have drastically reduced the Ae. j. japonicus population this species is still present. Furthermore, Ae. koreicus is permanently established. For both scenarios, the problems encountered are discussed and recommendations are given. In addition, the actual workload was lower than the estimated workload, while the actual costs were higher than the estimated ones. The ECDC guidelines are helpful, applicable and efficient to implement surveillance of IMS in Belgium. Recommendations were customised to the local context (political demands, salary and investment costs, and existing expertise). The workload and costs related to the preparatory phase (i.e., planning, contacts with the PoE, writing a protocol) were found to be missing in the cost evaluation suggested in the guidelines. Updates on the occurrence of IMS in

  3. Guideline implementation in clinical practice: use of statistical process control charts as visual feedback devices.

    Science.gov (United States)

    Al-Hussein, Fahad A

    2009-01-01

    To use statistical control charts in a series of audits to improve the acceptance and consistant use of guidelines, and reduce the variations in prescription processing in primary health care. A series of audits were done at the main satellite of King Saud Housing Family and Community Medicine Center, National Guard Health Affairs, Riyadh, where three general practitioners and six pharmacists provide outpatient care to about 3000 residents. Audits were carried out every fortnight to calculate the proportion of prescriptions that did not conform to the given guidelines of prescribing and dispensing. Simple random samples of thirty were chosen from a sampling frame of all prescriptions given in the two previous weeks. Thirty six audits were carried out from September 2004 to February 2006. P-charts were constructed around a parametric specification of non-conformities not exceeding 25%. Of the 1081 prescriptions, the most frequent non-conformity was failure to write generic names (35.5%), followed by the failure to record patient's weight (16.4%), pharmacist's name (14.3%), duration of therapy (9.1%), and the use of inappropriate abbreviations (6.0%). Initially, 100% of prescriptions did not conform to the guidelines, but within a period of three months, this came down to 40%. A process of audits in the context of statistical process control is necessary for any improvement in the implementation of guidelines in primary care. Statistical process control charts are an effective means of visual feedback to the care providers.

  4. Mandatory Special Education Plan for the Administration and Implementation of Public School Programs for the Hearing Impaired.

    Science.gov (United States)

    Indiana State Dept. of Public Instruction, Indianapolis. Div. of Special Education.

    Intended for public school administrators, teachers, and speech and hearing clinicians, the document contains guidelines for setting up programs to implement the statewide mandatory special education plan for hearing impaired children in Indiana. Outlined are procedures to follow in comprehensive programing for the following categories of the…

  5. Barriers to implementation of the FUSE program.

    Science.gov (United States)

    Nguyen, Brian M; Fitzpatrick, Emilie; Jones, Daniel B

    2018-01-01

    The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed The Fundamental Use of Surgical Energy (FUSE) Program to promote safe use of energy devices in the operating room and endoscopy suite. Utilization of the program has been slower than anticipated. This study aims to determine the barriers to implementing FUSE. An anonymous survey was distributed to a surgery department at an academic teaching hospital (n = 256). Participants indicated their level of training. Answers were measured using a 5-point Likert scale. There were 94 (36.7%) respondents to the survey from September 7 to 20, 2016. Fifteen surveys were incomplete, leaving 79 responses for analysis. Most respondents were at the faculty level (45/79, 57.0%). The majority had heard of FUSE (62/79, 78.5%), but only 19 had completed the certification (19/62, 32.3%). There was no difference in the completion rate between faculty and trainees (26.7 vs. 20.6%, OR 1.4, 95% CI 0.49-4.06, p = 0.53). The most common reasons for not taking the exam were lack of time to study (26/43, 60.5%) and lack of time to take the exam (28/43, 62.1%); however, cost was not a barrier (12/43, 27.9%). The majority identified a personal learning gap regarding the safe use of surgical energy (30/43, 69.7%). Of the 19 FUSE-certified respondents, reasons cited for completing the exam included wanting to prevent adverse events to patients and in the operating room (17/19, 89.5% and 17/19, 89.5%), and the belief that the course would make them a safer surgeon (16/19, 84.2%). FUSE teaches the proper use of radiofrequency energy, how to prevent unnecessary injury, and promotes safe practice. Close to three out of every four surgeons self-identified a personal knowledge gap regarding the safe use of surgical energy. Time restraints were cited most commonly as the barrier to starting and completing FUSE. Integrating the FUSE program into resident educational conferences, faculty grand rounds, or national

  6. 36 CFR 230.21 - Implementation of the program.

    Science.gov (United States)

    2010-07-01

    ... STATE AND PRIVATE FORESTRY ASSISTANCE Urban and Community Forestry Assistance Program § 230.21 Implementation of the program. (a) The Urban and Community Forestry Assistance Program is implemented through the... Service, under the authority of the Cooperative Forestry Assistance Act of 1978 and through the Urban and...

  7. Epilepsy care guidelines for low- and middle- income countries: From WHO mental health GAP to national programs

    Directory of Open Access Journals (Sweden)

    Katchanov Juri

    2012-09-01

    Full Text Available Abstract In 2011, the World Health Organization's (WHO mental health Gap Action Programme (mhGAP released evidence-based epilepsy-care guidelines for use in low and middle income countries (LAMICs. From a geographical, sociocultural, and political perspective, LAMICs represent a heterogenous group with significant differences in the epidemiology, etiology, and perceptions of epilepsy. Successful implementation of the guidelines requires local adaptation for use within individual countries. For effective implementation and sustainability, the sense of ownership and empowerment must be transferred from the global health authorities to the local people. Sociocultural and financial barriers that impede the implementation of the guidelines should be identified and ameliorated. Impact assessment and program revisions should be planned and a budget allocated to them. If effectively implemented, as intended, at the primary-care level, the mhGAP guidelines have the potential to facilitate a substantial reduction in the epilepsy treatment gap and improve the quality of epilepsy care in resource-limited settings.

  8. Manual for implementing residual radioactive material guidelines using RESRAD, Version 5.0

    Energy Technology Data Exchange (ETDEWEB)

    Yu, C.; Zielen, A.J.; Cheng, J.J. [and others

    1993-09-01

    This manual presents information for implementing US Department of Energy (DOE) guidelines for residual radioactive material. It describes the analysis and models used to derive site-specific guidelines for allowable residual concentrations of radionuclides in soil and the design and use of the RESRAD computer code for calculating doses, risks, and guideline values. It also describes procedures for implementing DOE policy for reducing residual radioactivity to levels that are as low as reasonably achievable. Two new pathways, radon inhalation and soil ingestion, have been added to RESRAD. Twenty-seven new radionuclides have also been added, and the cutoff half-life for associated radionuclides has been reduced to six months. Other major improvements to the RESRAD code include the ability to run sensitivity analyses, the addition of graphical output, user-specified dose factors, updated databases, an improved groundwater transport model, optional input of a groundwater concentration and a solubility constant, special models for tritium and carbon-14, calculation of cancer incidence risk, and the use of a mouse with menus.

  9. Implementation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy.

    Science.gov (United States)

    Dulko, Dorothy; Hertz, Elisheva; Julien, Jerelyn; Beck, Susan; Mooney, Kathi

    2010-01-01

    Despite the availability of clinical practice guidelines (CPGs) for cancer pain, consistent integration of these principles into practice has not been achieved. The optimal method for implementing CPGs and the impact of guidelines on healthcare outcomes remain uncertain. This study evaluated the effect of an audit and feedback (A/F) intervention on nurse practitioner (NP) implementation of cancer pain CPGs and on hospitalized patients' self-report of pain and satisfaction with pain relief. Eight NPs and two groups of 96 patients were the sources of data. Eligible patients in both groups completed the Brief Pain Inventory-Short Form (BPI-SF) within 24 h of admission and every 48 h until discharge. During A/F, NPs received weekly feedback on pain scores and guideline adherence. Nurse practitioner adherence to CPGs increased during A/F. Pain intensity did not significantly differ between groups. Intervention group patients reported significantly less overall pain interference (p pain relief increased from 68.4% to 95.1% during A/F (p pain severity underscores the need to consider symptom clusters when studying pain.

  10. Implementing nutritional guidelines - the effect of systematic training for nurse nutrition practitioners

    DEFF Research Database (Denmark)

    Pedersen, Preben Ulrich; Tewes, Marianne; Bjerrum, Merete

    2012-01-01

    Introduction: Approximately 40% of patients admitted to hospitals are undernourished. Implementing nutritional guidelines might reduce the incidence of malnutrition, and it requires education and training for the hospital staff. Aim: It was hypothesised that a training programme focussing...... the effect of the training programme for nurses. The training was conducted in five modules over 1 year and combined nutritional issues with issues on implementation and theories of planned changes. The programme was based on experimental leaning theories and the steps of look think and act. The effect...... of appropriate food choices from the menu increased suggesting that the nutritional intake of the patients had improved. Conclusion: Our findings suggest that s strategy based on the principles of experimental learning theory and the phases in the look, think and act model facilitated the implementation...

  11. Program home visit Costa Rica's health system: guidelines for improvement

    Directory of Open Access Journals (Sweden)

    Katherine Solís Cordero

    2015-07-01

    Full Text Available Introduction. Home visit is the main strategy of primary care by bringing health services to the homes and workplaces of people, which allows knowing the needs of the population firsthand. Thus, home visit by the ATAP represents the first contact of the individual, family and community with the health system, with significant benefits both individually and collectively. This research responds to the need to identify the elements that the home visiting program needs to improve modify or replace in order to maximize the provision of this service.Method. It is a qualitative, observational analytic study. Data were collected through documentary research, key informant interviews and focus group. The analysis was performed from the grounded theory.Results. The main results showed the existence of elements at the level of the health system, home visiting program and the figure of the ATAP that should be reviewed, modified or replaced to the home visit, thus it has bigger and better results for the population and the health system.Conclusion. The Home Visiting Program is strength of the Costa Rican health system to address health inequities. However, it is imperative to make decisions and implementation of actions that promote the improvement and increased results of the home visit at a family and community level.

  12. Guidelines for the implementation of cooperative education in South African teaching and learning organisations in higher education / Marius Lourens Wessels

    OpenAIRE

    Wessels, Marius Lourens

    2007-01-01

    This study focuses on the compilation of guidelines for the implementation of cooperative education in teaching and learning organisations, in the Gauteng region in South Africa. Since no or limited guidelines exist in cooperative education in such organisations, it was intended to determine the present position or status of cooperative education in such organisations with the concomitant development of a conceptual framework and guidelines that could act as directive in higher...

  13. Development and implementation of guidelines for quality assurance in breast cancer screening: The European experience.

    Directory of Open Access Journals (Sweden)

    Lawrence von Karsa

    2013-05-01

    Full Text Available In Europe, as in many other regions of the world, breast cancer is a major cause of suffering and death. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. Comprehensive quality assurance guidelines for breast cancer screening based on mammography have been developed in the Europe Against Cancer programme with the aim of maximising screening benefits while minimising adverse effects, such as unnecessary examination or treatment resulting from false-positive screening tests. The present report provides an overview of the European experience in developing and implementing quality assurance guidelines for breast cancer screening. It highlights implications relevant to those regions of the world in which the burden of breast cancer in the coming years will make population-based screening an option for cancer control.

  14. Falling on stony ground? A qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care.

    Science.gov (United States)

    Rashidian, Arash; Eccles, Martin P; Russell, Ian

    2008-02-01

    We aimed to explore key themes for the implementation of guidelines' prescribing recommendations. We interviewed a purposeful sample of 25 participants in British primary care in late 2000 and early 2001. Thirteen were academics in primary care and 12 were non-academic GPs. We asked about implementation of guidelines for five conditions (asthma, coronary heart disease prevention, depression, epilepsy, menorrhagia) ensuring variation in complexity, role of prescribing in patient management, GP role in prescribing and GP awareness of guidelines. We used the Theory of Planned Behaviour to design the study and the framework method for the analysis. Seven themes explain implementation of prescribing recommendations in primary care: credibility of content, credibility of source, presentation, influential people, organisational factors, disease characteristics, and dissemination strategy. Change in recommendations may hinder implementation. This is important since the development of evidence-based guidelines requires change in recommendations. Practitioners do not have a universal view or a common understanding of valid 'evidence'. Credibility is improved if national bodies develop primary care guidelines with less input from secondary care and industry, and with simple and systematic presentation. Dissemination should target GPs' perceived needs, improve ownership and get things right in the first implementation attempt. Enforcement strategies should not be used routinely. GPs were critical of guidelines' development, relevance and implementation. Guidelines should be clear about changes they propose. Future studies should quantify the relationship between evidence base of recommendations and implementation, and between change in recommendations and implementation. Small but important costs and side effects of implementing guidelines should be measured in evaluative studies.

  15. The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial.

    Science.gov (United States)

    Törmä, Johanna; Winblad, Ulrika; Saletti, Anja; Cederholm, Tommy

    2017-08-29

    Suboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. To compare two different implementation strategies, external facilitation (EF) and educational outreach visits (EOVs), when introducing nutritional guidelines in nursing homes (NHs), and study the impact on staff performance. A quasi-experimental study with baseline and follow-up measurements. The primary outcome was staff performance as a function of mealtime ambience and food service routines. The EF strategy was a 1-year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one-three-hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy. © 2017 Nordic College of Caring Science.

  16. Developing a computer delivered, theory based intervention for guideline implementation in general practice

    Directory of Open Access Journals (Sweden)

    Ashworth Mark

    2010-11-01

    Full Text Available Abstract Background Non-adherence to clinical guidelines has been identified as a consistent finding in general practice. The purpose of this study was to develop theory-informed, computer-delivered interventions to promote the implementation of guidelines in general practice. Specifically, our aim was to develop computer-delivered prompts to promote guideline adherence for antibiotic prescribing in respiratory tract infections (RTIs, and adherence to recommendations for secondary stroke prevention. Methods A qualitative design was used involving 33 face-to-face interviews with general practitioners (GPs. The prompts used in the interventions were initially developed using aspects of social cognitive theory, drawing on nationally recommended standards for clinical content. The prompts were then presented to GPs during interviews, and iteratively modified and refined based on interview feedback. Inductive thematic analysis was employed to identify responses to the prompts and factors involved in the decision to use them. Results GPs reported being more likely to use the prompts if they were perceived as offering support and choice, but less likely to use them if they were perceived as being a method of enforcement. Attitudes towards using the prompts were also related to anticipated patient outcomes, individual prescriber differences, accessibility and presentation of prompts and acceptability of guidelines. Comments on the prompts were largely positive after modifying them based on participant feedback. Conclusions Acceptability and satisfaction with computer-delivered prompts to follow guidelines may be increased by working with practitioners to ensure that the prompts will be perceived as valuable tools that can support GPs' practice.

  17. Food Safety Programs Based on HACCP Principles in School Nutrition Programs: Implementation Status and Factors Related to Implementation

    Science.gov (United States)

    Stinson, Wendy Bounds; Carr, Deborah; Nettles, Mary Frances; Johnson, James T.

    2011-01-01

    Purpose/Objectives: The objectives of this study were to assess the extent to which school nutrition (SN) programs have implemented food safety programs based on Hazard Analysis and Critical Control Point (HACCP) principles, as well as factors, barriers, and practices related to implementation of these programs. Methods: An online survey was…

  18. Asthma and Chronic Obstructive Pulmonary Disease Guideline Implementation: Lessons Learned on Recruitment of Primary Care Physicians to a Knowledge Translation Study

    Directory of Open Access Journals (Sweden)

    Louis-Philippe Boulet

    2013-01-01

    Full Text Available BACKGROUND: Implementation of current clinical practice guidelines in asthma and chronic obstructive pulmonary disease (COPD is suboptimal. New implementation strategies should be developed and evaluated.

  19. Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.

    Science.gov (United States)

    Vest, Bonnie M; York, Trevor R M; Sand, Jessica; Fox, Chester H; Kahn, Linda S

    2015-01-01

    Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. © Copyright 2015 by the American Board of Family Medicine.

  20. Identifying and Intervening in Child Maltreatment and Implementing Related National Guidelines by Public Health Nurses in Finland and Japan

    OpenAIRE

    Kayoko Suzuki; Eija Paavilainen; Mika Helminen; Aune Flinck; Natsuko Hiroyama; Taiko Hirose; Noriko Okubo; Motoko Okamitsu

    2017-01-01

    Aim. This study aimed to investigate how public health nurses identify, intervene in, and implement the guidelines on child maltreatment in Finland and Japan and to compare the data between the two countries. Method. This study employed a cross-sectional design. Public health nurses' knowledge and skills with respect to child maltreatment prevention were assessed using a questionnaire consisting of three categories: identification, intervention, and implementation of guidelines. Public health...

  1. The implementation of European Association of Urology guidelines in the management of acute epididymo-orchitis.

    Science.gov (United States)

    Garthwaite, Mary A E; Johnson, G; Lloyd, S; Eardley, I

    2007-11-01

    Acute epididymo-orchitis is a common and increasing problem. This retrospective study reviewed whether the European Association of Urology guidelines for the management of acute epididymo-orchitis, which form the basis of this Trust's present inter-departmental guidelines, are being effectively implemented. Case notes of 53 patients attending the emergency department with acute epididymo-orchitis over a 6-month period were reviewed retrospectively. The hospital results' database was used to confirm the diagnostic tests requested on patients at the time of their initial presentation. Of the study cohort, 26 patients were aged 35 years. The results demonstrated that a sexual history was documented in only 43.4% of cases. A mid-stream urine sample was sent for routine culture in 54.7% of cases whilst urine for the Chlamydia polymerase chain reaction (PCR) test was obtained in 17% and a urethral swab performed in 5.6%. Antibiotics were prescribed in 81% of cases. Of these patients, 46.5% received ciprofloxacin alone (mean age, 52 years; range, 18-87 years), 25.5% received doxycycline alone (mean age, 30 years; range, 18-45 years) and 21% received both ciprofloxacin and doxycycline (mean age, 33 years; range 18-49 years). In 26.4% of cases, verbal advice to attend a genito-urinary medicine clinic was given, whilst a formal telephone referral was made in only one case. Formal urological follow-up was arranged for only three out of 11 patients aged > 50 years. Although a joint emergency department/urology clinical protocol for the investigation and treatment of acute epididymo-orchitis already exists within the Trust, our current management conforms to this in only a minority of cases. Many different strategies can be employed in the implementation of clinical practice guidelines and all are associated with variable degrees of success. The regular movement of junior staff through each department necessitates that the distribution of management protocols and guidelines

  2. WHO Environmental Noise Guidelines for the European Region - What is new? 4. Implementation of guidelines and implications for practice

    NARCIS (Netherlands)

    Brink, M.; Babisch, W.; Belojevic, G.; Heroux, M.E.; Janssen, S.; Lercher, P.; Paviotti, M.; Pershagen, G.; Persson Waye, K.; Preis, A.; Stansfeld, S.; Van Den Berg, M.; Verbeek, J.

    2016-01-01

    WHO Environmental Noise Guidelines focus on the WHO European Region and provide guidance to its Member States that is compatible with the noise indicators used in the EU Environmental Noise Directive. The Guidelines aim to serve as a reference for several target audiences, such as decision makers

  3. Implementing Intervention Movement Programs for Kindergarten Children

    Science.gov (United States)

    Deli, Eleni; Bakle, Iliana; Zachopoulou, Evridiki

    2006-01-01

    The reported study aimed to identify the effects of two 10-week intervention programs on fundamental locomotor skill performance in kindergarten children. Seventy-five children with mean age 5.4 plus or minus 0.5 years participated. Experimental Group A followed a movement program, experimental Group B followed a music and movement program, and…

  4. Improving children's nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities

    Directory of Open Access Journals (Sweden)

    Downs Shauna M

    2011-06-01

    Full Text Available Abstract Background Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. Methods A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151 with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. Results One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11% of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. Conclusions If fully adopted and implemented, the ANGCY

  5. Implementing a Hybrid Graduate Program: Lessons Learned One Year Later

    Directory of Open Access Journals (Sweden)

    Ronda Sturgill

    2016-06-01

    Full Text Available Development of any graduate program is an extensive and timely process. Once the development phase is complete the program continues into the implementation phase. The implementation phase of a hybrid delivered program can present with many challenges. The purpose of this paper is to describe the implementation and challenges of delivering a hybrid graduate program. This is a follow-up paper to "Developing a Hybrid Graduate Program," [4]. This follow-up will provide information from both a faculty and graduate student perspective. Challenges of implementation, lessons learned, and future program delivery recommendations will also be presented.[4] R. Sturgill, J. Wilson, and J.C. Andersen, "Developing a Hybrid Graduate Program," Journal of Systemics, Cybernetics, and Informatics, Vol. 12, No. 7, 2014, pp. 22-24.

  6. Medicare program; Medicare depreciation, useful life guidelines--HCFA. Final rule.

    Science.gov (United States)

    1983-08-18

    These final rules amend Medicare regulations to clarify which useful life guidelines may be used by providers of health care services to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize the Departmental useful life guidelines or, if none have been published by the Department, either the American Hospital Association (AHA) useful life guidelines of 1973 of IRS guidelines. We are eliminating the reference to IRS guidelines because these are now outdated for Medicare purposes since they have been rendered obsolete either by the IRS or by statutory change. We are also deleting the specific reference to the 1973 AHA guidelines since these guidelines are updated by the AHA periodically. In addition, we are clarifying that certain tax legislation on accelerated depreciation, passed by Congress, does not apply to the Medicare program.

  7. 46 CFR 16.205 - Implementation of chemical testing programs.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Implementation of chemical testing programs. 16.205 Section 16.205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY MERCHANT MARINE OFFICERS AND SEAMEN CHEMICAL TESTING Required Chemical Testing § 16.205 Implementation of chemical testing programs. (a) When a...

  8. 78 FR 48159 - Preliminary 2012 Effluent Guidelines Program Plan and 2011 Annual Effluent Guidelines Review Report

    Science.gov (United States)

    2013-08-07

    ... captured and included as part of the comment that is placed in the public docket and made available on the... delist from the effluent guidelines plan the rulemaking for the Coalbed Methane Extraction subcategory... Regenerated Cellulose Manufacturers (previously categorized as Plastics Molding and Forming (40 CFR Part 463...

  9. Barriers to implementing evidence-based clinical guidelines: A survey of early adopters

    Science.gov (United States)

    Spallek, Heiko; Song, Mei; Polk, Deborah E; Bekhuis, Tanja; Frantsve-Hawley, Julie; Aravamudhan, Krishna

    2010-01-01

    Objective The purpose of this study is to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. Method This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results The most common barriers to implementation are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems have to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. Conclusions Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists’ fears need to be addressed. PMID:21093800

  10. Child Protection Program Implementations in Sport Management

    National Research Council Canada - National Science Library

    Özgün PARASIZ; Mustafa Yaşar ŞAHİN; Akın ÇELİK

    2015-01-01

    ... of the most important social responsibilites of states in this day and age. In the fight against this problem, especially developed countries promote chi ld protection policies and implement them in every sport field children take active part...

  11. Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study

    Directory of Open Access Journals (Sweden)

    Helin-Salmivaara Arja

    2011-08-01

    Full Text Available Abstract Background Antihypertensive drug choices and treatment levels are not in accordance with the existing guidelines. We aimed to assess the impact of a guideline implementation intervention on antihypertensive drug prescribing. Methods In this controlled before and after study, the effects of a multifaceted (education, audit and feedback, local care pathway quality programme was evaluated. The intervention was carried out in a health centre between 2002 and 2003. From each health care unit (n = 31, a doctor-nurse pair was trained to act as peer facilitators in the intervention. All antihypertensive drugs prescribed by 25 facilitator general practitioners (intervention GPs and 53 control GPs were retrieved from the nationwide Prescription Register for three-month periods in 2001 and 2003. The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes. Results In all subgroups, the use of multiple concurrent medications increased. For intervention patients with hypertension only, the odds ratio (OR was 1.12 (95% CI 0.99, 1.25; p = 0.06 and for controls 1.13 (1.05, 1.21; p = 0.002. We observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups. The use of agents acting on the renin-angiotensin-aldosterone system increased in all subgroups (hypertension only intervention patients OR 1.19 (1.06, 1.34; p = 0.004 and controls OR 1.24 (1.15, 1.34; p Conclusions A multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.

  12. Evidence-based guideline implementation in low and middle income countries: lessons for mental health care.

    Science.gov (United States)

    Docherty, Mary; Shaw, Kate; Goulding, Lucy; Parke, Hannah; Eassom, Erica; Ali, Farnoosh; Thornicroft, Graham

    2017-01-01

    There is a significant treatment gap in provision of effective treatment for people with mental disorders globally. In some Low and Middle Income Countries (LMICs) this gap is 90% or more in terms of untreated cases. Clinical practice guidelines (CPGs) are one tool to improve health care provision. The aim of this review is to examine studies of the effectiveness of evidence-based CPG implementation across physical and mental health care, to inform mental healthcare provision in low and middle income countries (LMICs), and to identify transferable lessons from other non-communicable diseases to mental health. A systematic literature review employing narrative synthesis and utilising the tools developed by the Cochrane Effective Practice and Organisation of Care (EPOC) group was conducted. Experimental studies of CPG implementation relating to non-communicable diseases, including mental disorders, in LMICs were retrieved and synthesised. Few (six) studies were identified. Four cluster randomised controlled trials (RCTs) related to the introduction of CPGs for non-communicable diseases in physical health; one cluster-RCT included CPGs for both a non-communicable disease in physical health and mental health, and one uncontrolled before and after study described the introduction of a CPG for mental health. All of the included studies adopted multi-faceted CPG implementation strategies and used education as part of this strategy. Components of the multi-faceted strategies were sometimes poorly described. Results of the studies included generally show statistically significant improvement on some, but not all, outcomes. Evidence for the effectiveness of interventions to improve uptake of, and compliance with, evidence-based CPGs in LMICs for mental disorders and for other non-communicable diseases is at present limited. The sparse literature does, however, suggest that multifaceted CPG implementation strategies that involve an educational component may be an effective

  13. Mentoring program design and implementation in new medical schools

    Directory of Open Access Journals (Sweden)

    Alice Fornari

    2014-06-01

    Full Text Available Purpose: Mentoring is considered a valuable component of undergraduate medical education with a variety of programs at established medical schools. This study presents how new medical schools have set up mentoring programs as they have developed their curricula. Methods: Administrators from 14 US medical schools established since 2006 were surveyed regarding the structure and implementation of their mentoring programs. Results: The majority of new medical schools had mentoring programs that varied in structure and implementation. Although the programs were viewed as valuable at each institution, challenges when creating and implementing mentoring programs in new medical schools included time constraints for faculty and students, and lack of financial and professional incentives for faculty. Conclusions: Similar to established medical schools, there was little uniformity among mentoring programs at new medical schools, likely reflecting differences in curriculum and program goals. Outcome measures are needed to determine whether a best practice for mentoring can be established.

  14. Mentoring program design and implementation in new medical schools

    Science.gov (United States)

    Fornari, Alice; Murray, Thomas S.; Menzin, Andrew W.; Woo, Vivian A.; Clifton, Maurice; Lombardi, Marion; Shelov, Steven

    2014-01-01

    Purpose Mentoring is considered a valuable component of undergraduate medical education with a variety of programs at established medical schools. This study presents how new medical schools have set up mentoring programs as they have developed their curricula. Methods Administrators from 14 US medical schools established since 2006 were surveyed regarding the structure and implementation of their mentoring programs. Results The majority of new medical schools had mentoring programs that varied in structure and implementation. Although the programs were viewed as valuable at each institution, challenges when creating and implementing mentoring programs in new medical schools included time constraints for faculty and students, and lack of financial and professional incentives for faculty. Conclusions Similar to established medical schools, there was little uniformity among mentoring programs at new medical schools, likely reflecting differences in curriculum and program goals. Outcome measures are needed to determine whether a best practice for mentoring can be established. PMID:24962112

  15. Mentoring program design and implementation in new medical schools.

    Science.gov (United States)

    Fornari, Alice; Murray, Thomas S; Menzin, Andrew W; Woo, Vivian A; Clifton, Maurice; Lombardi, Marion; Shelov, Steven

    2014-01-01

    Mentoring is considered a valuable component of undergraduate medical education with a variety of programs at established medical schools. This study presents how new medical schools have set up mentoring programs as they have developed their curricula. Administrators from 14 US medical schools established since 2006 were surveyed regarding the structure and implementation of their mentoring programs. The majority of new medical schools had mentoring programs that varied in structure and implementation. Although the programs were viewed as valuable at each institution, challenges when creating and implementing mentoring programs in new medical schools included time constraints for faculty and students, and lack of financial and professional incentives for faculty. Similar to established medical schools, there was little uniformity among mentoring programs at new medical schools, likely reflecting differences in curriculum and program goals. Outcome measures are needed to determine whether a best practice for mentoring can be established.

  16. Implementing an overdose education and naloxone distribution program in a health system.

    Science.gov (United States)

    Devries, Jennifer; Rafie, Sally; Polston, Gregory

    To design and implement a health system-wide program increasing provision of take-home naloxone in patients at risk for opioid overdose, with the downstream aim of reducing fatalities. The program includes health care professional education and guidelines, development, and dissemination of patient education materials, electronic health record changes to promote naloxone prescriptions, and availability of naloxone in pharmacies. Academic health system, San Diego, California. University of California, San Diego Health (UCSDH), offers both inpatient and outpatient primary care and specialty services with 563 beds spanning 2 hospitals and 6 pharmacies. UCSDH is part of the University of California health system, and it serves as the county's safety net hospital. In January 2016, a multisite academic health system initiated a system-wide overdose education and naloxone distribution program to prevent opioid overdose and opioid overdose-related deaths. An interdisciplinary, interdepartmental team came together to develop and implement the program. To strengthen institutional support, naloxone prescribing guidelines were developed and approved for the health system. Education on naloxone for physicians, pharmacists, and nurses was provided through departmental trainings, bulletins, and e-mail notifications. Alerts in the electronic health record and preset naloxone orders facilitated co-prescribing of naloxone with opioid prescriptions. Electronic health record reports captured naloxone prescriptions ordered. Summary reports on the electronic health record measured naloxone reminder alerts and response rates. Since the start of the program, the health system has trained 252 physicians, pharmacists, and nurses in overdose education and take-home naloxone. There has been an increase in the number of prescriptions for naloxone from a baseline of 4.5 per month to an average of 46 per month during the 3 months following full implementation of the program including

  17. Implementing a Multidisciplinary Program for Developing Learning,

    Science.gov (United States)

    Mc Goldrick, Niamh B.; Marzec, Bartosz; Scully, P. Noelle; Draper, Sylvia M.

    2013-01-01

    Since 2002, a multidisciplinary program has been used to encourage science students to build on their chemical knowledge and to appreciate how it applies to the world around them. The program is interactive and instills a new set of core learning skills that are often underrepresented in undergraduate curricula, namely, cooperative learning,…

  18. On implementation of an endodontic program.

    Science.gov (United States)

    Koch, Margaretha

    2013-01-01

    It is widely accepted that the uptake of research findings by practitioners is unpredictable, yet until they are adopted, advances in technology and clinical research cannot improve health outcomes in patients. Despite extensive research there is limited knowledge of the processes by which changes occur and ways of measuring the effectiveness of change of practice. The overall aim of this thesis was to investigate aspects of an educational intervention in clinical endodontic routines and new instrumentation techniques in a Swedish County Public Dental Service. Special reference was made to the establishment of changed behaviour in practice, the process of change, and the clinical effects. Although a high level of competence in root canal treatment procedures is required in general dental practice, a number of Swedish studies have revealed inadequate root-fillings quality and associated periapical inflammation in general populations. It is suggested that the adoption of the nickel-titanium rotary instrumentation (NiTiR) technique would improve the cleaning and shaping of root canals and the quality of the root-filling. However, there is limited knowledge of the effectiveness of the technique when applied in general dental practice. In two of four consecutive studies, the subjects were employees of a county Public Dental Service. The aim was to investigate the rate of adoption of clinical routines and the NiTiR technique: the output, and the qualitative meaning of successful change in clinical practice. In the other two studies the aim was to investigate treatment effect and the cost-effectiveness of root canal treatment in a general population: the outcome. Four hundred employees (dentists, dental assistants, administrative assistants and clinical managers) of a Swedish County Public Dental Service were mandatorily enrolled in an educational and training program over two years. Change of practice was investigated in a post-education survey. The NiTiR technique was

  19. FEEDING GUIDELINES FOR INFANTS AND TODDLERS (START HEALTHY PROGRAM

    Directory of Open Access Journals (Sweden)

    Nancy Butte

    2007-01-01

    Full Text Available The dietary guidelines for americans contains recommendations on diets and healthy lifestyles but it does not deal with specificities of the diet and feeding breast and small infants (to 2 years. However, parents and carecgivers need practical recommendations on feeding infants and toddlers that are necessary to ensure a normal growth and to create the basis for forming healthy food habits, which apart from other benefits might help prevent the development of obesity and other diseases in both childhood and adulthood. The feeding guidelines for infants and toddlers is aimed at providing parents and carecgivers with practical information on feeding breast and small infants. It is intendced for adding and broadening recommendations worked out by other expert groups and organizations. The article provides a substantiation of the guidelines. The methodology, results and a complete reference list used to work out the recommendations are presented in another document.Key words: infants, nutrition.

  20. Implementation research for 'evidence-based' guideline development by dietitians : a pilot study to test an instrument

    NARCIS (Netherlands)

    Wammes, BM; Blom, CA; Koelen, M; De Groot, SDW; Remijnse-Meester, WTA; van Staveren, WA

    Aim To improve the quality of dietetic care, dietitians in the University Medical Center Utrecht (UMCU) are encouraged to develop and implement 'evidence-based' guidelines. The aim of this pilot study was to develop and test a questionnaire for implementation research to monitor the process of

  1. Implementation research for evidence-based guideline development by dietians: a pilot study to test an instrument

    NARCIS (Netherlands)

    Wammes, B.M.; Blom, C.A.; Koelen, M.A.; Groot, de S.D.W.; Remijnse-Meester, W.T.A.; Staveren, van W.A.

    2002-01-01

    Aim To improve the quality of dietetic care, dietitians in the University Medical Center Utrecht (UMCU) are encouraged to develop and implement 'evidence-based' guidelines. The aim of this pilot study was to develop and test a questionnaire for implementation research to monitor the process of

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

    Directory of Open Access Journals (Sweden)

    Taba Pille

    2012-12-01

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

  3. The virtual asthma guideline e-learning program: learning effectiveness and user satisfaction.

    Science.gov (United States)

    Kang, Sung-Yoon; Kim, Sae-Hoon; Kwon, Yong-Eun; Kim, Tae-Bum; Park, Hye-Kyung; Park, Heung-Woo; Chang, Yoon-Seok; Jee, Young-Koo; Moon, Hee-Bom; Min, Kyung-Up; Cho, Sang-Heon

    2017-07-21

    Effective educational tools are important for increasing adherence to asthma guidelines and clinical improvement of asthma patients. We developed a computer-based interactive education program for asthma guideline named the Virtual Learning Center for Asthma Management (VLCAM). We evaluated the usefulness of program in terms of its effects on user awareness of asthma guideline and level of satisfaction. Physicians-in-training at tertiary hospitals in Korea were enrolled in a cross-sectional questionnaire survey. The e-learning program on asthma guideline was conducted over a 2-week period. We investigated changes in the awareness of asthma guideline using 35-item self-administered questionnaire aiming at assessing physicians' knowledge, attitude, and practice. Satisfaction with the program was scored on 4-point Likert scales. A total of 158 physicians-in-training at six tertiary hospitals completed the survey. Compared with baseline, the overall awareness obtained from the scores of knowledge, attitude, and practice was improved significantly. Participants were satisfied with the VLCAM program in the following aspects: helpfulness, convenience, motivation, effectiveness, physicians' confidence, improvement of asthma management, and willingness to recommend. All items in user satisfaction questionnaires received high scores over 3 points. Moreover, the problem-based learning with a virtual patient received the highest user satisfaction among all parts of the program. Our computer-based e-learning program is useful for improving awareness of asthma management. It could improve adherence to asthma guidelines and enhance the quality of asthma care.

  4. Guidelines for a graph-theoretic implementation of structural equation modeling

    Science.gov (United States)

    Grace, James B.; Schoolmaster, Donald R.; Guntenspergen, Glenn R.; Little, Amanda M.; Mitchell, Brian R.; Miller, Kathryn M.; Schweiger, E. William

    2012-01-01

    Structural equation modeling (SEM) is increasingly being chosen by researchers as a framework for gaining scientific insights from the quantitative analyses of data. New ideas and methods emerging from the study of causality, influences from the field of graphical modeling, and advances in statistics are expanding the rigor, capability, and even purpose of SEM. Guidelines for implementing the expanded capabilities of SEM are currently lacking. In this paper we describe new developments in SEM that we believe constitute a third-generation of the methodology. Most characteristic of this new approach is the generalization of the structural equation model as a causal graph. In this generalization, analyses are based on graph theoretic principles rather than analyses of matrices. Also, new devices such as metamodels and causal diagrams, as well as an increased emphasis on queries and probabilistic reasoning, are now included. Estimation under a graph theory framework permits the use of Bayesian or likelihood methods. The guidelines presented start from a declaration of the goals of the analysis. We then discuss how theory frames the modeling process, requirements for causal interpretation, model specification choices, selection of estimation method, model evaluation options, and use of queries, both to summarize retrospective results and for prospective analyses. The illustrative example presented involves monitoring data from wetlands on Mount Desert Island, home of Acadia National Park. Our presentation walks through the decision process involved in developing and evaluating models, as well as drawing inferences from the resulting prediction equations. In addition to evaluating hypotheses about the connections between human activities and biotic responses, we illustrate how the structural equation (SE) model can be queried to understand how interventions might take advantage of an environmental threshold to limit Typha invasions. The guidelines presented provide for

  5. Challenges of implementing national guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus colonization or infection in acute care hospitals in the Republic of Ireland.

    LENUS (Irish Health Repository)

    Fitzpatrick, Fidelma

    2009-03-01

    Of the 49 acute care hospitals in Ireland that responded to the survey questionnaire drafted by the Infection Control Subcommittee of the Health Protection Surveillance Centre\\'s Strategy for the Control of Antimicrobial Resistance in Ireland, 43 reported barriers to the full implementation of national guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus infection; these barriers included poor infrastructure (42 hospitals), inadequate laboratory resources (40 hospitals), inadequate staffing (39 hospitals), and inadequate numbers of isolation rooms and beds (40 hospitals). Four of the hospitals did not have an educational program on hand hygiene, and only 17 had an antibiotic stewardship program.

  6. Implementation of the American College of Cardiology/American Heart Association 2008 Guidelines for the Management of Adults With Congenital Heart Disease.

    Science.gov (United States)

    Goossens, Eva; Fernandes, Susan M; Landzberg, Michael J; Moons, Philip

    2015-08-01

    Although different guidelines on adult congenital heart disease (ACHD) care advocate for lifetime cardiac follow-up, a critical appraisal of the guideline implementation is lacking. We investigated the implementation of the American College of Cardiology/American Heart Association 2008 guidelines for ACHD follow-up by investigating the type of health care professional, care setting, and frequency of outpatient visits in young adults with CHD. Furthermore, correlates for care in line with the recommendations or untraceability were investigated. A cross-sectional observational study was conducted, including 306 patients with CHD who had a documented outpatient visit at pediatric cardiology before age 18 years. In all, 210 patients (68.6%) were in cardiac follow-up; 20 (6.5%) withdrew from follow-up and 76 (24.9%) were untraceable. Overall, 198 patients were followed up in tertiary care, 1/4 (n = 52) of which were seen at a formalized ACHD care program and 3/4 (n = 146) remained at pediatric cardiology. Of those followed in formalized ACHD and pediatric cardiology care, the recommended frequency was implemented in 94.2% and 89%, respectively (p = 0.412). No predictors for the implementation of the guidelines were identified. Risk factors for becoming untraceable were none or lower number of heart surgeries, health insurance issues, and nonwhite ethnicity. In conclusion, a significant number of adults continue to be cared for by pediatric cardiologists, indicating that transfer to adult-oriented care was not standard practice. Frequency of follow-up for most patients was in line with the ACC/AHA 2008 guidelines. A considerable proportion of young adults were untraceable in the system, which makes them vulnerable for discontinuation of care. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory.

    Science.gov (United States)

    Bamford, Claire; Heaven, Ben; May, Carl; Moynihan, Paula

    2012-10-30

    Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation. We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring). The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT

  8. Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory

    Directory of Open Access Journals (Sweden)

    Bamford Claire

    2012-10-01

    Full Text Available Abstract Background Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT to understand the barriers and facilitators to implementing the guidelines and inform future implementation. Methods We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Results Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence, and as a result, relatively few staff invested in the guidelines (cognitive participation. Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action. Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring. Conclusions The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to

  9. Implementation of an Evidence Based Guideline for Assessment and Documentation of the Civil Commitment Process.

    Science.gov (United States)

    Perrigo, Tabitha L; Williams, Kimberly A

    2016-11-01

    The purpose of this quality improvement project was to implement an evidence-based practice guideline for assessment and documentation of the civil commitment process. Participants included six civil commitment examiners who conduct court ordered psychiatric evaluations at two crisis intervention centers in rural area of southeaster state. Data collection was conducted utilizing a chart audit tool both pre and post intervention of 100 civil commitment evaluations. The intervention included the development of an evidenced based form for documentation of civil commitment evaluations and a one on one educational training session was conducted for each participant. Descriptive statistics (t test) was utilized to analyze the data collected. The project demonstrated a significant increase as 25.5 % of evaluations contained the America Psychiatric Association's recommended 11 domains of assessment prior to implementation compared to 65.6 % (p value = 0.018) post implementation. Moreover, participants with family practice training showed an increase in commitment rates from 60 to 77.3 % (p value = 0.066). Whereas, psychiatric trained participants showed a decrease from 83.75 to 77.66 % (p value = 0.38). Demonstrating that court ordered evaluations guided by a standardized form based on evidence affected examiners recommendations for commitments.

  10. Randomized Controlled Trials in Music Therapy: Guidelines for Design and Implementation.

    Science.gov (United States)

    Bradt, Joke

    2012-01-01

    Evidence from randomized controlled trials (RCTs) plays a powerful role in today's healthcare industry. At the same time, it is important that multiple types of evidence contribute to music therapy's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence-based practice. Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate, RCTs can contribute important knowledge to our field. Therefore, it is important that music therapists are prepared to design trials that meet current methodological standards and, equally important, are able to respond appropriately to those design aspects that may not be feasible in music therapy research. To provide practical guidelines to music therapy researchers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence. This article reviews key design aspects of RCTs and discusses how to best implement these standards in music therapy trials. A systematic presentation of basic randomization methods, allocation concealment strategies, issues related to blinding in music therapy trials and strategies for implementation, the use of treatment manuals, types of control groups, outcome selection, and sample size computation is provided. Despite the challenges of meeting all key design demands typical of an RCT, it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits.

  11. The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007-2016

    DEFF Research Database (Denmark)

    Jensen, Maj-Britt; Laenkholm, Anne-Vibeke; Offersen, Birgitte V

    2018-01-01

    guidelines for the management of early breast cancer. By use of the clinical DBCG database we analyze the effectiveness of the implementation of guideline revisions in Denmark. METHODS: From the DBCG guidelines we extracted modifications introduced in 2007-2016 and selected examples regarding surgery......, radiotherapy (RT) and systemic treatment. We assessed introduction of modifications from release on the DBCG webpage to change in clinical practice using the DBCG clinical database. RESULTS: Over a 10-year period data from 48,772 patients newly diagnosed with malignant breast tumors were entered into DBCG......'s clinical database and 42,197 of these patients were diagnosed with an invasive carcinoma following breast conserving surgery (BCS) or mastectomy. More than twenty modifications were introduced in the guidelines. Implementations, based on prospectively collected data, varied widely; exemplified with around...

  12. Measure Guideline: Implementing a Plenum Truss for a Compact Air Distribution System

    Energy Technology Data Exchange (ETDEWEB)

    Burdick, A. [IBACOS, Inc., Pittsburgh, PA (United States)

    2013-10-01

    This Measure Guideline presents the steps to implement a compact duct system inside an attic bulkhead (plenum truss) of a one-story, slab-on-grade home. In a compact duct design, ductwork runs are reduced in length to yield a smaller and more compact duct system. Less energy will be lost through ductwork if the ducts are contained within the thermal enclosure of the house. These measures are intended for the production builder working to meet the 2012 International Energy Conservation Code (IECC) requirements and keep the ductwork within the thermal enclosure of the house. This measure of bringing the heating, ventilation and air conditioning (HVAC) equipment and ductwork within the thermal enclosure of the house is appropriate for the builder wishing to avoid cathedralizing the insulation in the attic space (i.e., locating it at the underside of the roof deck rather than along the attic floor) or adding dropped soffits.

  13. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Fonseca Andrade

    2016-01-01

    Full Text Available Objective to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. Method systematic review on literature based on data from CINAHL(r, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r, Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. Results studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. Conclusion the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice.

  14. Implementing a Community-Oriented Policing Program.

    Science.gov (United States)

    Sumner, Dave

    2002-01-01

    Describes a successful community-oriented policing program at the University of South Alabama which has cut crime rates while not requiring extra funding. Discusses the reorganization of the police department, efforts targeting children, university services started by the deputy chief, and other new crime prevention and training initiatives. (EV)

  15. Abstract Machines for Programming Language Implementation

    NARCIS (Netherlands)

    Diehl, Stephan; Hartel, Pieter H.; Sestoft, Peter

    We present an extensive, annotated bibliography of the abstract machines designed for each of the main programming paradigms (imperative, object oriented, functional, logic and concurrent). We conclude that whilst a large number of efficient abstract machines have been designed for particular

  16. Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East.

    Science.gov (United States)

    Babiker, Amir; Amer, Yasser S; Osman, Mohamed E; Al-Eyadhy, Ayman; Fatani, Solafa; Mohamed, Sarar; Alnemri, Abdulrahman; Titi, Maher A; Shaikh, Farheen; Alswat, Khalid A; Wahabi, Hayfaa A; Al-Ansary, Lubna A

    2017-12-29

    Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase. The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan. In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions. © 2018 John Wiley & Sons, Ltd.

  17. The Development and Implementation of a Staff Development Program for Uncertified Teachers in the Field of Early Childhood Education.

    Science.gov (United States)

    Hill, Bettye Jane

    This practicum report describes the development and implementation of an inservice program for four teachers who, in order to meet Federal integration guidelines, were given kindergarten assignments for which they were not certified. Comparison of test scores of disadvantaged kindergarten children taught by trained and untrained teachers revealed…

  18. Implementation contexts of a Tuberculosis Control Program in Brazilian prisons

    Directory of Open Access Journals (Sweden)

    Luisa Gonçalves Dutra de Oliveira

    2015-01-01

    Full Text Available OBJECTIVE To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects.METHODS A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons.RESULTS The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases.CONCLUSIONS The implementation degree and its contexts – external and political-organizational dimensions – simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons.

  19. Implementation contexts of a Tuberculosis Control Program in Brazilian prisons.

    Science.gov (United States)

    de Oliveira, Luisa Gonçalves Dutra; Natal, Sonia; Camacho, Luiz Antonio Bastos

    2015-01-01

    OBJECTIVE To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects.METHODS A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons.RESULTS The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases.CONCLUSIONS The implementation degree and its contexts - external and political-organizational dimensions - simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons.

  20. The CSSP implementation plan for space plasma physics programs

    Science.gov (United States)

    Baker, D. N.; Williams, D. J.

    1985-12-01

    The Committee on Solar and Space Physics (CSSP) has provided NASA with guidance in the areas of solar, heliospheric, magnetospheric, and upper atmospheric research. The budgetary situation confronted by NASA has called for a prioritized plane for the implementation of solar and space plasma physics programs. CSSP has developed the following recommendations: (1) continue implementation of both the Upper Atmosphere Research Satellite and Solar Optical Telescope programs; (2) initiate the International Solar Terrestrial Physics program; (3) plan for later major free-flying missions and carry out the technology development they require; (4) launch an average of one solar and space physics Explorer per yr beginning in 1990; (5) enhance current Shuttle/Spacelab programs; (6) develop facility-class instrumentation; (7) augment the solar terrestrial theory program by FY 1990; (8) support a compute modeling program; (9) strengthen the research and analysis program; and (10) maintain a stable suborbital program for flexible science objectives in upper atmosphere and space plasma physics.

  1. CSSP implementation plan for space plasma physics programs

    Energy Technology Data Exchange (ETDEWEB)

    Baker, D.N.; Williams, D.J.

    1985-12-01

    The Committee on Solar and Space Physics (CSSP) has provided NASA with guidance in the areas of solar, heliospheric, magnetospheric, and upper atmospheric research. The budgetary sitation confronted by NASA has called for a prioritized plane for the implementation of solar and space plasma physics programs. CSSP has developed the following recommendations: (1) continue implementation of both the Upper Atmosphere Research Satellite and Solar Optical Telescope programs; (2) initiate the International Solar Terrestrial Physics program; (3) plan for later major free-flying missions and carry out the technology development they require; (4) launch an average of one solar and space physics Explorer per yr beginning in 1990; (5) enhance current Shuttle/Spacelab programs; (6) develop facility-class instrumentation; (7) augment the solar terrestrial theory program by FY 1990; (8) support a compute modeling program; (9) strengthen the research and analysis program; and (10) maintain a stable suborbital program for flexible science objectives in upper atmosphere and space plasma physics.

  2. FEEDING GUIDELINES FOR INFANTS AND TODDLERS (START HEALTHY PROGRAM)

    OpenAIRE

    Nancy Butte; Kathleen Cobb; Joanna Dwyer; Laura Graney; William Heird; Caryl Richard

    2007-01-01

    The dietary guidelines for americans contains recommendations on diets and healthy lifestyles but it does not deal with specificities of the diet and feeding breast and small infants (to 2 years). However, parents and carecgivers need practical recommendations on feeding infants and toddlers that are necessary to ensure a normal growth and to create the basis for forming healthy food habits, which apart from other benefits might help prevent the development of obesity and other diseases in bo...

  3. Design Patterns : Implementation in video game programming

    OpenAIRE

    Le Van, Cuong

    2016-01-01

    The goal of this thesis was to develop Last Planets, a social mobile game for iOS devices. The game development theory and the design patterns are portrayed in the first part of this study. The second part presents how such theories are put into practice during the development of Last Planets. The completion of the project resulted in the launch of Last Planets during spring 2016. Multiple design patterns were chosen to be implemented within the code base. Patterns such as Observer, Strat...

  4. From the EBM pyramid to the Greek temple: a new conceptual approach to Guidelines as implementation tools in mental health.

    Science.gov (United States)

    Salvador-Carulla, L; Lukersmith, S; Sullivan, W

    2017-04-01

    Guideline methods to develop recommendations dedicate most effort around organising discovery and corroboration knowledge following the evidence-based medicine (EBM) framework. Guidelines typically use a single dimension of information, and generally discard contextual evidence and formal expert knowledge and consumer's experiences in the process. In recognition of the limitations of guidelines in complex cases, complex interventions and systems research, there has been significant effort to develop new tools, guides, resources and structures to use alongside EBM methods of guideline development. In addition to these advances, a new framework based on the philosophy of science is required. Guidelines should be defined as implementation decision support tools for improving the decision-making process in real-world practice and not only as a procedure to optimise the knowledge base of scientific discovery and corroboration. A shift from the model of the EBM pyramid of corroboration of evidence to the use of broader multi-domain perspective graphically depicted as 'Greek temple' could be considered. This model takes into account the different stages of scientific knowledge (discovery, corroboration and implementation), the sources of knowledge relevant to guideline development (experimental, observational, contextual, expert-based and experiential); their underlying inference mechanisms (deduction, induction, abduction, means-end inferences) and a more precise definition of evidence and related terms. The applicability of this broader approach is presented for the development of the Canadian Consensus Guidelines for the Primary Care of People with Developmental Disabilities.

  5. Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

    Science.gov (United States)

    Hoyme, Derek B; Atkins, Dianne L

    2017-02-01

    To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study

    Directory of Open Access Journals (Sweden)

    Mazza Danielle

    2013-01-01

    Full Text Available Abstract Background Despite strong evidence of the benefits of preconception interventions for improving pregnancy outcomes, the delivery and uptake of preconception care and periconceptional folate supplementation remain low. General practitioners play a central role in the delivery of preconception care. Understanding general practitioners’ perceptions of the barriers and enablers to implementing preconception care allows for more appropriate targeting of quality improvement interventions. Consequently, the aim of this study was to examine the barriers and enablers to the delivery and uptake of preconception care guidelines from general practitioners’ perspective using theoretical domains related to behaviour change. Methods We conducted a qualitative study using focus groups consisting of 22 general practitioners who were recruited from three regional general practice support organisations. Questions were based on the theoretical domain framework, which describes 12 domains related to behaviour change. General practitioners’ responses were classified into predefined themes using a deductive process of thematic analysis. Results Beliefs about capabilities, motivations and goals, environmental context and resources, and memory, attention and decision making were the key domains identified in the barrier analysis. Some of the perceived barriers identified by general practitioners were time constraints, the lack of women presenting at the preconception stage, the numerous competing preventive priorities within the general practice setting, issues relating to the cost of and access to preconception care, and the lack of resources for assisting in the delivery of preconception care guidelines. Perceived enablers identified by general practitioners included the availability of preconception care checklists and patient brochures, handouts, and waiting room posters outlining the benefits and availability of preconception care consultations

  7. Concurrent implementation of quality improvement programs.

    Science.gov (United States)

    Nyström, Monica Elisabeth; Garvare, Rickard; Westerlund, Anna; Weinehall, Lars

    2014-01-01

    Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches. Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members. Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances. This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.

  8. Impact of the implementation of electronic guidelines for cardiovascular prevention in primary care: study protocol

    Directory of Open Access Journals (Sweden)

    Eva Comin

    2013-03-01

    Full Text Available Background The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs. This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension.Methods Eligible study participants are those aged 35–74 years assigned to family practitioners (FPs of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1 a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2 a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1 suspected and confirmed diagnoses, (2 control of clinical variables, (3 requests for tests and (4 proportions of patients with adequate drug prescriptions.Results This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013.Conclusion This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.

  9. Implementation issues in Inductive Logic Programming

    OpenAIRE

    Kolter, Robert

    2017-01-01

    We propose several algorithms for efficient Testing of logical Implication in the case of ground objects. Because the problem of Testing a set of propositional formulas for (un)satisfiability is \\(NP\\)-complete there's strong evidence that there exist examples for which every algorithm which solves the problem of testing for (un)satisfiability has a runtime that is exponential in the length of the input. So will have our algorithms. We will therefore point out classes of logic programs for wh...

  10. Developing an Implementation Guideline to International Standard School for Schools under Secondary Educational Service Area Office 25

    Directory of Open Access Journals (Sweden)

    Worawut Poltree

    2017-09-01

    Full Text Available The objectives of developing an implementation guideline to international standard school for schools under secondary educational service area office 25 were ; 1 to study present and problem an implementation guideline to international standard school for schools under secondary educational service area office 25 and 2 to develop an implementation guideline to international standard school for schools under secondary educational service area office 25. There were 68 samples ; administrators, deputy administrators, head of quality management systems, and academic teachers by purposive sampling. The tools used to collect the data were the five level scale questionnaire and structured interviews. Data were analyzed using mean, standard deviation, and descriptive analysis. The researcher set the research by 2 phase. The first phase educated present and problem an implementation guideline to international standard school for schools under secondary educational service area office 25. The research was assessed feasibility of developing an implementation guideline to international standard school for schools under secondary educational service area office 25 by 5 experts. The research results were: 1. The present and problem an implementation guideline to international standard school for schools under secondary educational service area office 25 found that the overall present were at the high level and each one was at the high level. The overall problem were at the low and each one was at the moderate 2 aspects ; The leadership and the focus on personnel. Then it was at the low level. 2. Developing an implementation guideline to international standard school for schools under secondary educational service area office 25 found that 1 the leadership had set with the vision, values, performance of the school’s senior leadership, including good governance of the school, implementation of the ethics law, and responsibility for the community, 2 strategic

  11. Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions.

    Science.gov (United States)

    Lind, S; Wallin, L; Brytting, T; Fürst, C J; Sandberg, J

    2017-11-01

    In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Implementing ACCM critical care guidelines for septic shock management in a Cuban pediatric intensive care unit.

    Science.gov (United States)

    Cartaya, José M; Rovira, Luis E; Segredo, Yamilet; Alvarez, Idalys; Acevedo, Yoandra; Moya, Ariel

    2014-01-01

    INTRODUCTION Sepsis is the most common direct cause of death worldwide and septic shock the syndrome's most serious complication. In 2002, the pediatric intensive care unit of the José Luis Miranda Pediatric University Hospital in Santa Clara (Villa Clara Province), Cuba, began implementing the recently published guidelines of the American College of Critical Care Medicine (ACCM) for management of pediatric and neonatal septic shock, observing a drop in case fatality from 34.6% to 19% between the years 2003 and 2007. ACCM updated these Guidelines in 2007. OBJECTIVE Describe experiences with the use of the 2007 ACCM updated Guidelines and discuss their possible impact in reducing case fatality. METHODS Between 2008 and 2010, a study was conducted of 280 children and adolescents, from newborns through 18 years, admitted to the pediatric intensive care unit with a diagnosis of septic shock. The diagnostic and therapeutic criteria used were those recommended in the ACCM's 2007 updated Guidelines. The dependent variable was case fatality. Independent variables were age, sex, comorbidity or prior chronic disease, origin and course of sepsis, hemodynamic state, blood glucose level, hyperglycemia, organ dysfunction, volume of fluid therapy administered, use of mechanical ventilation and therapeutic response. RESULTS In the 3-year period, 28-day case fatality was 11.1% (31/280). A total of 45 patients had comorbidities, with 14 deaths and a case fatality rate of 31.1% vs. 7.2% (17/235) in previously healthy patients. Cold shock with a hemodynamic state of low cardiac output and high systemic vascular resistance predominated (68.9%), with low cardiac output and low systemic vascular resistance the least common type (12.5%), but the one with highest case fatality (34.4%). Hyperglycemia was present in 39.6% of patients, with 15.3% case fatality; case fatality was higher (25.6%) when hyperglycemia was in the 10-15.9 mmol/L range. Fluid therapy of 40-100 mL/kg was administered

  13. Self-assessment program implementation plan. Revision A

    Energy Technology Data Exchange (ETDEWEB)

    Quets, A.L.

    1991-10-23

    This implementation plan identifies and describes the tasks that must be completed in order to successfully implement a Self-Assessment (SA) Program. The purpose of the Self-Assessment Program is to comply with applicable Department of Energy (DOE) directives and orders, Federal, State, and local regulations, operate the Pinellas Plant according to best management practices, and achieve excellence in all operating areas. The Self-Assessment Program will be applied to the Pinellas Plant facility which includes buildings, grounds, equipment, operations, and activities under the control of line management. Furthermore, all applicable disciplines under environmental protection, safety, health and management will be covered by the program. The Self-Assessment Program has been designed to accomplish the following tasks: define the scope of the Self-Assessment Program; assign organizational roles and responsibilities; address EH and S functional elements and management issues; develop a Self-Assessment program charter and policy; identify all applicable EH and S codes, regulations and standards; develop self-assessment procedures and instructions; generate a Self-Assessment Manual; develop a master schedule for facility appraisals and audits; design checklists and report formats for recording appraisal data; implement an assessment tracking and reporting system; implement a root cause analysis and corrective action system; implement a trend analysis and lessons learned system; and establish a formal training program.

  14. Implementing a Dynamic Street-Children's Program: Successes and ...

    African Journals Online (AJOL)

    Implementing a Dynamic Street-Children's Program: Successes and Challenges. ... the influence that early childhood dynamics of parentchild, parent-parent and ... they can influence the child's behaviour in both positive and negative ways.

  15. Sustained Implementation Support Scale: Validation of a Measure of Program Characteristics and Workplace Functioning for Sustained Program Implementation.

    Science.gov (United States)

    Hodge, Lauren M; Turner, Karen M T; Sanders, Matthew R; Filus, Ania

    2017-07-01

    An evaluation measure of enablers and inhibitors to sustained evidence-based program (EBP) implementation may provide a useful tool to enhance organizations' capacity. This paper outlines preliminary validation of such a measure. An expert informant and consumer feedback approach was used to tailor constructs from two existing measures assessing key domains associated with sustained implementation. Validity and reliability were evaluated for an inventory composed of five subscales: Program benefits, Program burden, Workplace support, Workplace cohesion, and Leadership style. Exploratory and confirmatory factor analysis with a sample of 593 Triple P-Positive Parenting Program-practitioners led to a 28-item scale with good reliability and good convergent, discriminant, and predictive validity. Practitioners sustaining implementation at least 3 years post-training were more likely to have supervision/peer support, reported higher levels of program benefit, workplace support, and positive leadership style, and lower program burden compared to practitioners who were non-sustainers.

  16. Implementation and Effectiveness of the Response to Intervention (RTI) Program

    Science.gov (United States)

    Hite, Jessica Elaine; McGahey, James Todd

    2015-01-01

    The purpose of this research study was to determine whether or not student test scores on the Georgia Criterion-Referenced Competency Test (CRCT) were positively impacted by the implementation of the Response to Intervention (RTI) program. This paper will review the implementation and effectiveness of the RTI method.

  17. Implementing Interpersonal Psychotherapy in a Psychiatry Residency Training Program

    Science.gov (United States)

    Lichtmacher, Jonathan; Eisendrath, Stuart J.; Haller, Ellen

    2006-01-01

    Objective: Interpersonal psychotherapy (IPT) for depression is a brief, well researched treatment for acute major depression. This article describes the implementation of IPT as an evidence-based treatment for depression in a psychiatry residency program. Method: The authors tracked the implementation process over 5 years as interpersonal…

  18. The Network Form of Implementing Educational Programs: Differences and Typology

    Science.gov (United States)

    Sobolev, Alexandr Borisovich

    2016-01-01

    The article describes peculiarities of implementation and major differences in network educational programs, currently introduced in Russia. It presents a general typology of models and forms for implementing interaction between educational institutions of Russia, including teacher institutes and federal universities, as well as a typology of…

  19. Interprofessional development and implementation of a pharmacist professional advancement and recognition program.

    Science.gov (United States)

    Hager, David; Chmielewski, Eric; Porter, Andrea L; Brzozowski, Sarah; Rough, Steve S; Trapskin, Philip J

    2017-11-15

    The interprofessional development, implementation, and outcomes of a pharmacist professional advancement and recognition program (PARP) at an academic medical center are described. Limitations of the legacy advancement program, in combination with low rates of employee engagement in peer recognition and professional development, at the UW Health department of pharmacy led to the creation of a task force comprising pharmacists from all practice areas to develop a new pharmacist PARP. Senior leadership within the organization expanded the scope of the project to include an interprofessional work group tasked to develop guidelines and core principles that other professional staff could use to reduce variation across advancement and recognition programs. Key program design elements included a triennial review of performance against advancement standards and the use of peer review to supplement advancement decisions. The primary objective was to meaningfully improve pharmacists' engagement as measured through employee engagement surveys. Secondary outcomes of interest included the results of pharmacist and management satisfaction surveys and the program's impact on the volume and mix of pharmacist professional development activities. Of the 126 eligible pharmacists, 93 participated in the new program. The majority of pharmacists was satisfied with the program. For pharmacists who were advanced as part of the program, meaningful increases in employee engagement scores were observed, and a mean of 95 hours of professional development and quality-improvement activities was documented. Implementation of a PARP helped increase pharmacist engagement through participation in quality-improvement and professional development activities. The program also led to the creation of organizationwide interprofessional guidelines for advancement programs within various healthcare disciplines. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  20. Systematic review of the cost-effectiveness of implementing guidelines on low back pain management in primary care

    DEFF Research Database (Denmark)

    Jensen, Cathrine Elgaard; Jensen, Martin Bach; Riis, Allan

    2016-01-01

    comparing implementation strategies, (2) the guideline must concern treatment of low back pain in primary care and (3) the economic evaluation should contain primary data on cost and cost-effectiveness. RESULTS: The title and abstract were assessed for 308 studies; of these, three studies were found......OBJECTIVE: The primary aim is to identify, summarise and quality assess the available literature on the cost-effectiveness of implementing low back pain guidelines in primary care. The secondary aim is to assess the transferability of the results to determine whether the identified studies can...

  1. Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation.

    Science.gov (United States)

    Damschroder, Laura J; Reardon, Caitlin M; Sperber, Nina; Robinson, Claire H; Fickel, Jacqueline J; Oddone, Eugene Z

    2017-06-01

    The Telephone Lifestyle Coaching (TLC) program provided telephone-based coaching for six lifestyle behaviors to 5321 Veterans at 24 Veterans Health Administration (VHA) medical facilities. The purpose of the study was to conduct an evaluation of the TLC program to identify factors associated with successful implementation. A mixed-methods study design was used. Quantitative measures of organizational readiness for implementation and facility complexity were used to purposively select a subset of facilities for in-depth evaluation. Context assessments were conducted using interview transcripts. The Consolidated Framework for Implementation Research (CFIR) was used to guide qualitative data collection and analysis. Factors most strongly correlated with referral rates included having a skilled implementation leader who used effective multi-component strategies to engage primary care clinicians as well as general clinic structures that supported implementation. Evaluation findings pointed to recommendations for local and national leaders to help anticipate and mitigate potential barriers to successful implementation.

  2. EPA`s program for risk assessment guidelines: Quantification issues

    Energy Technology Data Exchange (ETDEWEB)

    Dourson, M.L. [Environmental Protection Agency, Washington, DC (United States)

    1990-12-31

    The quantitative procedures associated with noncancer risk assessment include reference dose (RfD), benchmark dose, and severity modeling. The RfD, which is part of the EPA risk assessment guidelines, is an estimation of a level that is likely to be without any health risk to sensitive individuals. The RfD requires two major judgments: the first is choice of a critical effect(s) and its No Observed Adverse Effect Level (NOAEL); the second judgment is choice of an uncertainty factor. This paper discusses major assumptions and limitations of the RfD model.

  3. Implementing sustainable development programs in Chicago

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, H.

    1994-12-31

    Achieving sustainable development requires a revision of the present view of the nature of the city as an environment, and its relation to a larger ecosystem of which it is an essential part. The environmental health of a wilderness area is inextricably related to the environmental, and economic, health of the great urban centers. The vitality of dense metropolitan areas, where population and economic activities are concentrated, is key to the preservation of productive farm lands, wildlife habitat, and open spaces. The social and economic crisis which grips many metropolitan centers, with attendant flight of industry and development to the so-called {open_quotes}greenfields,{close_quotes} fundamentally spreads a broader crisis to our common ecosystem. This crisis is marked by the obliteration of habitat necessary for biodiversity, loss of fertile farm land, and the contamination of air, water and land, as an unescapable effect of the sprawl created by flight from the urban centers. The removal of false conceptual distinctions between the city and nature, distinctions that are unfortunately at the heart of so much of American environmental philosophy, is key to the concept of `sustainable development.` This article sets forth how the City of Chicago is implementing this understanding of the nature of the urban environment, in pursuit of sustainable development within the city.

  4. [Considerations on the development of nutrition-related guidelines by the World Health Organization and their implementation].

    Science.gov (United States)

    Zamora, Gerardo; Meneses, Daniela; De-Regil, Luz Maria; Neufeld, Lynnette; Peña-Rosas, Juan Pablo; Sinisterra, Odalis Teresa

    2015-03-01

    The World Health Organization (WHO) follows a complex and rigorous process to develop global guidelines. With regard to nutrition-related guidelines, the joint participation of national authorities from Member States and their partners, including those of the social economy, is key to strengthening the process of evidence-informed guideline development and the subsequent implementation as part of national public health strategies. WHO puts forward a series of tools that can assist national authorities on health and social development in the elaboration of evidence-informed policies, considering their pertinence, relevance and implementability. This adoption and adaptation process must consider equity in order to avoid widening existing inequities. WHO global nutrition guidelines contribute to the effective implementation of nutrition interventions in Member States. Two experiences of implementation, one in Panama and one in Peru, exemplify this process. The paper ends by suggesting a deeper understanding and utilization of implementation research during programmes to identify what factors ensure effective interventions, appropriate scale up strategies and greater health equity.

  5. Implementation of Early Diagnosis and Intervention Guidelines for Cerebral Palsy in a High-Risk Infant Follow-Up Clinic.

    Science.gov (United States)

    Byrne, Rachel; Noritz, Garey; Maitre, Nathalie L

    2017-11-01

    Cerebral palsy is the most common physical disability in childhood, and is mostly diagnosed after age 2 years. Delays in diagnosis can have negative long-term consequences for children and parents. New guidelines for early cerebral palsy diagnosis and intervention were recently published, after systematic review of the evidence by international multidisciplinary experts aiming to decrease age at diagnosis. The current study tested the feasibility of implementing these guidelines in an American clinical setting. We designed a stepwise implementation process in a neonatal intensive care follow-up clinic. Efficacy was tested by comparing 10-month pre- and post-implementation periods. Clinic visit types, cerebral palsy diagnosis, provider competencies and perspectives, and balancing measures were analyzed. Changes to infrastructure, assessments, scheduling algorithms, documentation and supports in diagnosis or counseling were successfully implemented. Number of three- to four-month screening visits increased (255 to 499, P cerebral palsy care guidelines for infants under age 2 years. We demonstrated for the first time in a US clinical setting the feasibility of implementation of international early diagnosis and treatment guidelines for cerebral palsy. This process is adaptable to other settings and underscores the necessity of future research on cerebral palsy treatments in infancy. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Responsive Feeding: Implications for Policy and Program Implementation12

    OpenAIRE

    Engle, Patrice L.; Pelto, Gretel H.

    2011-01-01

    In this article, we examine responsive feeding as a nutrition intervention, with an emphasis on the development and incorporation of responsive feeding into policies and programs over the last 2 decades and recommendations for increasing the effectiveness of responsive feeding interventions. A review of policy documents from international agencies and high-income countries reveals that responsive feeding has been incorporated into nutrition policies. Official guidelines from international age...

  7. A unit-level perspective on the long-term sustainability of a nursing best practice guidelines program: An embedded multiple case study.

    Science.gov (United States)

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

    2016-01-01

    Best practice guidelines are a tool for narrowing research-to-practice gaps and improving care outcomes. There is some empirical understanding of guideline implementation in nursing settings, yet there has been almost no consideration of the longer-term sustainability of guideline-based practice improvements. Many healthcare innovations are not sustained, underscoring the need for knowledge about how to promote their survival. To understand how a nursing best practice guidelines program was sustained on acute healthcare center nursing units. We undertook a qualitative descriptive case study of an organization-wide nursing best practice guidelines program with four embedded nursing unit subcases. The setting was a large, tertiary/quaternary urban health center in Canada. The nursing department initiated a program to enhance patient safety through the implementation of three guidelines: falls prevention, pressure ulcer prevention, and pain management. We selected four inpatient unit subcases that had differing levels of program sustainability at an average of almost seven years post initial program implementation. Data sources included 39 key informant interviews with nursing leaders/administrators and frontline nurses; site visits; and program-related documents. Data collection and content analysis were guided by a framework for the sustainability of healthcare innovations. Program sustainability was characterized by three elements: benefits, routinization, and development. Seven key factors most accounted for the differences in the level of program sustainability between subcases. These factors were: perceptions of advantages, collaboration, accountability, staffing, linked levels of leadership, attributes of formal unit leadership, and leaders' use of sustainability activities. Some prominent relationships between characteristics and factors explained long-term program sustainability. Of primary importance was the extent to which unit leaders used sustainability

  8. A distributed implementation of a mode switching control program

    DEFF Research Database (Denmark)

    Holdgaard, Michael; Eriksen, Thomas Juul; Ravn, Anders P.

    1995-01-01

    A distributed implementation of a mode switched control program for a robot is described. The design of the control program is given by a set of real-time automatons. One of them plans a schedule for switching between a fixed set of control functions, another dispatches the control functions...

  9. Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare services: A systematic review.

    Science.gov (United States)

    Seward, Kirsty; Finch, Meghan; Yoong, Sze Lin; Wyse, Rebecca; Jones, Jannah; Grady, Alice; Wiggers, John; Nathan, Nicole; Conte, Kathleen; Wolfenden, Luke

    2017-12-01

    Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994-2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was 'environmental context and resources'. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Guidelines for Self-Study and External Evaluation of Undergraduate Physics Programs

    Science.gov (United States)

    American Association of Physics Teachers (NJ1), 2005

    2005-01-01

    Influenced by the project entitled "Strategic Programs for Innovations in Undergraduate Physics", this document is intended to guide a physics department in initial, or mid-stream evaluation of a program of undergraduate physics education. The original Guidelines were developed by the American Association of Physics Teachers (AAPT) in 1986. The…

  11. Barriers to implementation of an organized geriatric fracture program.

    Science.gov (United States)

    Kates, Stephen L; O'Malley, Natasha; Friedman, Susan M; Mendelson, Daniel A

    2012-03-01

    There has been a recent increase in interest in implementing organized geriatric fracture programs for care of older adults with fragility fractures in order to improve both the quality and costs of care. Because such programs are relatively new, there are no standardized methods for implementation and no published descriptions of barriers to implementation. An online survey tool was sent to 185 surgeons and physicians practicing in the United States, who are involved with geriatric fracture care. Sixty-eight responses were received and evaluated. Barriers identified included lack of medical and surgical leadership, need for a clinical case manager, lack of anesthesia department support, lack of hospital administration support, operating room time availability, and difficulty with cardiac clearance for surgery. Other issues important to implementation included quality improvement, cost reductions, cost to the hospital, infection prevention, readmission prevention, and dealing with competing interest groups and competing projects mandated by the government. Physicians and surgeons felt that a site visit to a functioning program was most important when considering implementing a hip fracture program. This study provides useful insights into barriers to implementing an organized hip fracture program. The authors offer suggestions on ways to mitigate or overcome these barriers.

  12. Improving prenatal HIV screening with tailored educational interventions: an approach to guideline implementation.

    Science.gov (United States)

    Prairie, B A; Foster, T

    2010-12-01

    A healthy, uncomplicated pregnancy undergoes approximately 13 tests performed over an average of 12.5 prenatal visits. Published rates of compliance with routine prenatal testing are generally >90%, with lower rates for newer tests or those that require additional inputs prior to ordering. New CDC guidelines for prenatal HIV testing highlight the importance of prenatal testing and motivated the authors to explore our routine prenatal testing performance. The authors found the conceptual framework of simple/complicated/complex problems in healthcare helpful in understanding the rates for tests and for developing interventions. The setting for this work was a single, rural, academic tertiary care centre. Baseline rates of four routine prenatal tests (HBsAg, 1 h GTT, GBS, HIV) were determined by analysing 12 months of data from a web-based delivery registry. All rates were >90% except HIV, which was 79.2%. Process mapping and discussions with ordering providers were performed to plan the improvement intervention. Targeted educational interventions specific to each ordering provider type were followed by audit and feedback. HIV testing rates were monitored and analysed monthly using process control charts. The HIV testing rate increased significantly from 79.2% to 94.2%. Rates greater than 90% were maintained for 10 of 11 months reported. Targeted educational interventions combined with audit and feedback can increase rates of routine testing successfully in an outpatient setting. These interventions can be used to improve implementation and compliance with new guidelines when informed by an understanding of local context and processes coupled with an appropriate conceptual framework.

  13. How to implement clinical guidelines to optimise familial hypercholesterolaemia diagnosis and treatment.

    Science.gov (United States)

    Farnier, Michel; Civeira, Fernando; Descamps, Olivier

    2017-04-01

    Familial hypercholesterolaemia (FH) is a genetic disorder associated with significantly elevated plasma low-density lipoprotein cholesterol (LDL-C) and premature coronary heart disease (CHD). Optimal management of FH relies on early identification and treatment with statins alone or in combination with other lipid-lowering therapies. A lack of awareness of FH and its manifestations among primary care physicians and specialists has led to many individuals being misdiagnosed in the early stages of the disease, further increasing the risk of CHD and requiring much more intensive lipid-lowering strategies. Therefore, implementing clinical guidelines to optimise the diagnosis and treatment of FH is essential. A working group of clinical experts managing FH patients in their daily practice collaborated in order to provide healthcare professionals with a practical evidence-based guide to streamline early diagnosis and treatment of FH. Following thorough evaluation of available data and clinical guidelines, the expert working group provided recommendations on how to detect patients with a suspicion of FH; criteria for clinical and genetic diagnoses of FH; how to assess atherosclerosis in primary care and identify patients at the highest risk; follow-up approaches for patients' families; the most optimal treatment combinations; and when to start lipid-lowering therapy in children with FH. The expert working group placed great importance on an individualised approach in the management of FH and highlighted the unmet need for both improved education and communication with the laboratory for physicians when LDL-C levels are significantly elevated. Screening high-risk individuals, or cascade screening, is the most cost-effective way of identifying FH cases and initiating adequate statin therapy alone or in combination with other lipid-lowering therapies. In the case of severe FH, where plasma LDL-C levels remain high following maximum-tolerated statin and ezetimibe treatment

  14. Documentation of Calculation Program and Guideline for Optimal Window Design

    DEFF Research Database (Denmark)

    Vanhoutteghem, Lies; Svendsen, Svend

    . A user-friendly calculation program based on simple input data has recently been developed to assist engineers and architects during the process of selecting suitable windows for residential building design. The program is organised in four steps, which together represent an analysis of how windows...... in a specific building design perform with regard to energy consumption, thermal indoor environment, and cost. The analyses in the steps gradually increase in level of detail and support the design decisions throughout the design process. This document presents work done to validate the program and demonstrates...

  15. Translating Theory Into Practice: Implementing a Program of Assessment.

    Science.gov (United States)

    Hauer, Karen E; O'Sullivan, Patricia S; Fitzhenry, Kristen; Boscardin, Christy

    2018-03-01

    A program of assessment addresses challenges in learner assessment using a centrally planned, coordinated approach that emphasizes assessment for learning. This report describes the steps taken to implement a program of assessment framework within a medical school. A literature review on best practices in assessment highlighted six principles that guided implementation of the program of assessment in 2016-2017: (1) a centrally coordinated plan for assessment aligns with and supports a curricular vision; (2) multiple assessment tools used longitudinally generate multiple data points; (3) learners require ready access to information-rich feedback to promote reflection and informed self-assessment; (4) mentoring is essential to facilitate effective data use for reflection and learning planning; (5) the program of assessment fosters self-regulated learning behaviors; and (6) expert groups make summative decisions about grades and readiness for advancement. Implementation incorporated stakeholder engagement, use of multiple assessment tools, design of a coaching program, and creation of a learner performance dashboard. The assessment team monitors adherence to principles defining the program of assessment and gathers and responds to regular feedback from key stakeholders, including faculty, staff, and students. Next steps include systematically collecting evidence for validity of individual assessments and the program overall. Iterative review of student performance data informs curricular improvements. The program of assessment also highlights technology needs that will be addressed with information technology experts. The outcome ultimately will entail showing evidence of validity that the program produces physicians who engage in lifelong learning and provide high-quality patient care.

  16. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge.

    Science.gov (United States)

    Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena

    2014-01-01

    Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Multi-site implementation of health education programs for Latinas.

    Science.gov (United States)

    Sudarsan, Nora R; Jandorf, Lina; Erwin, Deborah O

    2011-04-01

    US Latinas are more likely to be diagnosed with late stage breast cancer and have nearly double the incidence of cervical cancer. A culturally customized educational program (Esperanza y Vida) was established in three locations to increase cancer awareness and screening. Educational programs (N = 159) were conducted, with participants randomized to either a breast and cervical (intervention) or diabetes (control) program. Variations in key factors, including gender, program location sites, language utilized, time/day of programs, and data collection method were detected, uncovering unique distributions across locations. Esperanza y Vida was successful in recruiting participants to health programs in three locations, each with a unique Latino population. Program site differences demonstrated educational and screening interventions can be implemented in multiple locations, with program variations reflecting local characteristics. These findings can be applied to outreach efforts to effectively increase participation and enhance screening practices and benefits in other regions.

  18. Implementing a clinical practice guideline for the treatment of bronchiolitis in a high-risk Hispanic pediatric population.

    Science.gov (United States)

    Zamora-Flores, Dora; Busen, Nancy H; Smout, Randall; Velasquez, Otto

    2015-01-01

    Bronchiolitis is the leading cause of hospitalization among infants and young children. Because of its frequency, a clinical practice guideline for bronchiolitis was implemented in this population in an effort to decrease costs and the number of diagnostic evaluations performed and medications used without increasing length of stay or transfers to the pediatric intensive care unit. A retrospective chart review of 322 pediatric admissions to a rural community hospital was conducted (169 before guideline implementation and 153 after guideline implementation), and data were categorically stratified into three groups for comparison purposes. Descriptive statistics were used to analyze the data, with a p value bronchiolitis. Statistically significant decreases in cost per day and decreases in use of antibiotics and chest radiographs were achieved without increasing length of stay or pediatric intensive care unit transfers. This project demonstrated feasibility in implementing an evidence-based clinical practice guideline in a rural hospital to improve patient outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  19. Successful implementation of guidelines for encouraging the use of beta blockers in patients after acute myocardial infarction.

    Science.gov (United States)

    Sarasin, F P; Maschiangelo, M L; Schaller, M D; Héliot, C; Mischler, S; Gaspoz, J M

    1999-05-01

    To assess whether implementation of guidelines increases the prescription of drugs, particularly beta blockers, recommended for secondary prevention after acute myocardial infarction. Prescription patterns among 355 patients discharged from a public teaching hospital after recovery from myocardial infarction were prospectively monitored in a before-after trial. The implementation strategies included educational interventions (large group meetings), placement of guidelines in patients' records, and bimonthly general reminders sent to physicians. Beta blockers were prescribed in 93 (38%) of 243 survivors of acute myocardial infarction before guideline implementation (12-month control period), as compared with 71 (63%) of 112 patients (P digoxin (OR = 0.2; 95% CI, 0.05 to 0.8; P = 0.02) or calcium antagonists (OR = 0.06; 95% CI, 0.01 to 0.3; P = 0.001). When appropriately developed and implemented by local experts, literature-based guidelines may be effective in modifying use of recommended drugs for secondary prevention of coronary artery disease, such as prescription of beta blockers.

  20. Evaluation of PROforma as a language for implementing medical guidelines in a practical context

    Directory of Open Access Journals (Sweden)

    Earle Kenneth

    2006-04-01

    Full Text Available Abstract Background PROforma is one of several languages that allow clinical guidelines to be expressed in a computer-interpretable manner. How these languages should be compared, and what requirements they should meet, are questions that are being actively addressed by a community of interested researchers. Methods We have developed a system to allow hypertensive patients to be monitored and assessed without visiting their GPs (except in the most urgent cases. Blood pressure measurements are performed at the patients' pharmacies and a web-based system, created using PROforma, makes recommendations for continued monitoring, and/or changes in medication. The recommendations and measurements are transmitted electronically to a practitioner with authority to issue and change prescriptions. We evaluated the use of PROforma during the knowledge acquisition, analysis, design and implementation of this system. The analysis focuses on the logical adequacy, heuristic power, notational convenience, and explanation support provided by the PROforma language. Results PROforma proved adequate as a language for the implementation of the clinical reasoning required by this project. However a lack of notational convenience led us to use UML activity diagrams, rather than PROforma process descriptions, to create the models that were used during the knowledge acquisition and analysis phases of the project. These UML diagrams were translated into PROforma during the implementation of the project. Conclusion The experience accumulated during this study highlighted the importance of structure preserving design, that is to say that the models used in the design and implementation of a knowledge-based system should be structurally similar to those created during knowledge acquisition and analysis. Ideally the same language should be used for all of these models. This means that great importance has to be attached to the notational convenience of these languages, by

  1. Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales.

    Science.gov (United States)

    Morriss, Richard

    2015-09-30

    Bipolar disorder is a common long-term mental health condition characterised by episodes of mania or hypomania and depression resulting in disability, early death, and high health and society costs. Public money funds the National Institute of Healthcare and Clinical Excellence (NICE) to produce clinical guidelines by systematically identifying the most up to date research evidence and costing its main recommendations for healthcare organisations and professionals to follow in England and Wales. Most governments, including those of England and Wales, need to improve healthcare but at reduced cost. There is evidence, particularly in bipolar disorder, that systematically following clinical guidelines achieves these outcomes. NICE clinical guidelines, including those regarding bipolar disorder, remain variably implemented. They give clinicians and patients a non-prescriptive basis for deciding their care. Despite the passing of the Health and Social Care Act in 2012 in England requiring all healthcare organisations to consider NICE clinical guidelines in commissioning, delivering, and inspecting healthcare services, healthcare organisations in the National Health Service may ignore them with little accountability and few consequences. There is no mechanism to ensure that healthcare professionals know or consider them. Barriers to their implementation include the lack of political and professional leadership, the complexity of the organisation of care and policy, mistrust of some processes and recommendations of clinical guidelines, and a lack of a clear implementation model, strategy, responsibility, or accountability. Mitigation to these barriers is presented herein. The variability, safety, and quality of healthcare might be improved and its cost reduced if the implementation of NICE clinical guidelines, such as those for bipolar disorder, were made the minimum starting point for clinical decision-making and mandatory responsibilities of all healthcare organisations

  2. Radiological guidelines for application to DOE's Formerly Utilized Sites Remedial Action Program. [FUSRAP sites

    Energy Technology Data Exchange (ETDEWEB)

    1983-03-01

    The US Department of Energy has implemented a program to evaluate and, where necessary, take action to protect the public from contamination at sites that were used in the past to process and/or store radioactive materials for the former US Army Corps of Engineers Manhattan Engineer District or the US Atomic Energy Commission. The program is identified as the Formerly Utilized Sites Remedial Action Program (FUSRAP). This document describes methods considered appropriate for the evaluation of health effects that might possible be caused by radioactive contamination at FUSRAP sites. This assessment methodology is applied to a typical site for the purposeof deriving guidelines for the cleanup of contaminated soil. Additional guidance is provided for planning site-specific remedial action that is consistent with the overall objectives of FUSRAP.

  3. Implementation of antiretroviral therapy guidelines for under-five children in Tanzania: translating recommendations into practice

    Directory of Open Access Journals (Sweden)

    Harriet Nuwagaba-Biribonwoha

    2015-12-01

    Full Text Available Introduction: Paediatric antiretroviral therapy (ART guidelines have been updated several times in recent years. We assessed implementation of ART guidelines among under-five children to inform the transition to universal paediatric ART in Tanzania. Methods: We conducted a retrospective cohort analysis of infants (0 to 11 months and children (12 to 59 months enrolled between 2010 and 2012 using routinely collected data. Infants and children were initiated on ART according to the 2008 World Health Organization (WHO recommendations/2009 Tanzania guidelines (universal ART for infants. Cumulative ART initiation incidence and correlates of ART initiation were examined using competing risk methods accounting for attrition (death or loss to follow-up. Kaplan-Meier methods and Cox regression models were used to examine attrition on ART and its correlates. Results: A total of 1679 children were enrolled at 69 clinics: 469 (28% infants and 1210 (74% children. Infant cumulative ART initiation incidence was 59.6, 71.3 and 78.0% at one, three and six months of follow-up. Infants were more likely to start ART if enrolled in 2012 [adjusted sub-hazard ratio (AsHR=2.2, 95% confidence interval (CI: 1.7 to 2.8] or 2011 (AsHR=1.8, 95% CI: 1.4 to 2.3 compared to 2010; they were more likely to start ART from prevention of mother-to-child HIV transmission (AsHR=1.6, 95% CI: 1.3 to 2.1 and inpatient wards (AsHR=1.5, 95% CI: 1.2 to 2.0 versus being enrolled from voluntary counselling and testing centres. Attrition at 12 months on ART was 33.9% and was more likely among infants with WHO Stage 4 [adjusted hazard ratio (AHR=3.1. 95% CI: 1.8 to 5.2] and severe malnutrition (AHR=1.4, 95% CI: 1.0 to 1.9.Among 599 children eligible for ART at enrolment, cumulative ART initiation incidence was 51.8, 68.6 and 76.1% at one, three, and six months. Children were more likely to start ART if enrolled in 2012 (AsHR=1.8, 95% CI: 1.4 to 2.3 or 2011 (AsHR=1.5, 95% CI: 1.2 to 1.8 compared

  4. Implementing Guidelines: The Cost and Clinical Impact of Anticoagulants in the UK Atrial Fibrillation Population.

    Science.gov (United States)

    Shields, Gemma E; Bates, Alexander E; Chapman, Ann-Marie

    2015-10-01

    Updated treatment guidelines for atrial fibrillation (AF) have been released by the National Institute for Health and Care Excellence (NICE) in the UK, and highlight a current shortfall in the prescription of anticoagulants to patients with AF for stroke prevention. To design a budget impact model as a planning tool for UK Clinical Commissioning Groups (CCGs) looking to budget for greater use of anticoagulants in the AF population. An Excel® model was developed to estimate the five-year impact of gradually treating all eligible patients with AF who are currently not being prescribed anticoagulants, both in terms of the effect on key clinical outcomes (strokes, major bleeds and mortality) and the associated financial impact. For a population of 251,693 (average CCG size) with an estimated 2626 prevalent patients and an additional 546 incident cases annually, the model estimated that increasing the proportion of the eligible AF patient population receiving anticoagulation by a fraction would require an additional budget of GBP139,961 in Year 1 to treat an additional 314 patients. This would rise to GBP1,004,900 in Year 5 to treat an additional 2242 patients, with all eligible patients treated by this year. The price year was 2014. Over the 5-year timeframe, this could lead to the prevention of 24 strokes and 29 deaths, with an increase of 31 major bleeds. The clinical benefits of appropriate anticoagulation are widely recognised; however, full implementation can be difficult and costly. Therefore, the development of models can support the planning process by facilitating discussion among stakeholders on how best they can reach full implementation. The model is flexible and can be adapted to suit different payers.

  5. Barriers to implementation of opioid overdose prevention programs in Ohio.

    Science.gov (United States)

    Winstanley, Erin L; Clark, Angela; Feinberg, Judith; Wilder, Christine M

    2016-01-01

    Nationally, overdose fatalities have reached epidemic proportions. Ohio has one of the highest overdose death rates in the country, as well as high rates of prescription opioid trafficking. A cross-sectional self-report survey of opioid overdose prevention programs (OOPPs) in Ohio was conducted between August and October 2014 to characterize programs and ascertain barriers to successful implementation. A 91% response rate was achieved with 18 programs participating in the study. The first Ohio OOPP opened in August 2012, a second program opened in 2013, and the remaining programs began in 2014. All of the programs distribute nasal naloxone and provide overdose prevention education, and 89% (n = 16) provide overdose kits for free. Six OOPPs are funded by the Ohio Department of Health, 3 programs are funded by a local health foundation, and several other public and private funding sources were reported. The OOPPs have funding to distribute a combined total of 8,670 overdose kits and had distributed 1998 kits by October 2014. The OOPPs reported 149 overdose reversals. Fifteen programs (83%) reported implementation barriers that were categorized as stigma-, cost-, staffing-, legal, regulatory, and client-related problems. Legislative changes aimed at removing some of the obstacles to distribution and lay administration of naloxone have recently been enacted in Ohio. OOPPs have rapidly expanded in Ohio during the past 3 years. Although recent legislative changes have addressed some of the reported implementation barriers, stigma and the cost of naloxone remain significant problems.

  6. Setting Priorities in Global Child Health Research Investments: Guidelines for Implementation of the CHNRI Method

    Science.gov (United States)

    Rudan, Igor; Gibson, Jennifer L.; Ameratunga, Shanthi; El Arifeen, Shams; Bhutta, Zulfiqar A.; Black, Maureen; Black, Robert E.; Brown, Kenneth H.; Campbell, Harry; Carneiro, Ilona; Chan, Kit Yee; Chandramohan, Daniel; Chopra, Mickey; Cousens, Simon; Darmstadt, Gary L.; Gardner, Julie Meeks; Hess, Sonja Y.; Hyder, Adnan A.; Kapiriri, Lydia; Kosek, Margaret; Lanata, Claudio F.; Lansang, Mary Ann; Lawn, Joy; Tomlinson, Mark; Tsai, Alexander C.; Webster, Jayne

    2008-01-01

    This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global. PMID:19090596

  7. Human and organizational factors in implementing a security program for dams and powerhouses

    Energy Technology Data Exchange (ETDEWEB)

    Cattanach, D.; Stanley, P. [BC Hydro, Burnaby, BC (Canada)

    2009-07-01

    This paper discussed issues related to the implementation of a security program for dams and powerhouses owned by BC Hydro. The program was developed as a result of increased threats and acts of theft and vandalism involving the utility's assets. A system-wide security risk assessment was conducted before the development of a multi-year program designed to reduce security risk. The security program included policy and guideline development, implementation, monitoring, and response components. A security perimeter was defined for dam facilities in order to control access, detect, and assess unauthorized entries. Emergency response plans were also reviewed. The study demonstrated that organizational, human, and technical factors play a significant role in security breaches at generation sites. The program included a homes for gnomes program, in which a garden gnome was left at a critical asset as an indicator that the site had been successfully penetrated by personnel unknown to the site. The program is intended to ensure that generation facilities will benefit from safer and more secure working environments. 6 figs.

  8. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

    Directory of Open Access Journals (Sweden)

    Smith Patricia M

    2012-04-01

    Full Text Available Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269 via mail to the researchers. Results Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent Conclusions The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

  9. The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice.

    Science.gov (United States)

    Breimaier, Helga E; Heckemann, Birgit; Halfens, Ruud J G; Lohrmann, Christa

    2015-01-01

    Implementing clinical practice guidelines (CPGs) in healthcare settings is a complex intervention involving both independent and interdependent components. Although the Consolidated Framework for Implementation Research (CFIR) has never been evaluated in a practical context, it appeared to be a suitable theoretical framework to guide an implementation process. The aim of this study was to evaluate the comprehensiveness, applicability and usefulness of the CFIR in the implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian university teaching hospital setting. The evaluation of the CFIR was based on (1) team-meeting minutes, (2) the main investigator's research diary, containing a record of a before-and-after, mixed-methods study design embedded in a participatory action research (PAR) approach for guideline implementation, and (3) an analysis of qualitative and quantitative data collected from graduate and assistant nurses in two Austrian university teaching hospital departments. The CFIR was used to organise data per and across time point(s) and assess their influence on the implementation process, resulting in implementation and service outcomes. Overall, the CFIR could be demonstrated to be a comprehensive framework for the implementation of a guideline into a hospital-based nursing practice. However, the CFIR did not account for some crucial factors during the planning phase of an implementation process, such as consideration of stakeholder aims and wishes/needs when implementing an innovation, pre-established measures related to the intended innovation and pre-established strategies for implementing an innovation. For the CFIR constructs reflecting & evaluating and engaging, a more specific definition is recommended. The framework and its supplements could easily be used by researchers, and their scope was appropriate for the complexity of a prospective CPG-implementation project. The CFIR facilitated qualitative data

  10. An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study.

    Science.gov (United States)

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

    2015-12-03

    Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. Although there have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the 'staying power' of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was sustained over a long-term period in an acute healthcare centre. We conducted a qualitative descriptive case study to examine the program's sustainability at the nursing department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada. The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following program initiation through 14 key informant interviews, document reviews, and observations. We developed a framework for the sustainability of healthcare innovations to guide data collection and content analysis. Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization, and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing program sustainability and characteristics of program sustainability accounted for how the program had been sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership actions and both institutionalization and development; and a

  11. Development, implementation and management of a drug testing program in the workplace

    Energy Technology Data Exchange (ETDEWEB)

    Burtis, C.A.

    1990-01-01

    To combat the rising use of drugs in the workplace many American companies have implemented drug testing programs and are testing employees and job applicants for use of illegal drugs. In addition, on September 15, 1986, Executive Order No.12564 was issued by President Reagan, which requires all federal agencies to develop programs and policies, one of the goals of which is to achieve a drug-free federal workplace. Included in this Executive Order is the requirement that federal agencies implement drug testing has become a prevalent practice as a means to detect and deter drug use in the workplace. Before a drug testing program is implemented, it is imperative that policies and procedures are developed that (1) ensure the accuracy of test results, (2) protect the validity and integrity of the specimen, (3) guarantee due process, and (4) maintain confidentiality. To make certain that these prerequisites were met in the government drug testing programs, the US Department of Health and Human Services (HHS) was directed to develop technical and scientific guidelines for conducting such programs. 15 refs., 1 fig., 2 tabs.

  12. Regulatory standards and other guidelines for goundwater monitoring programs

    Energy Technology Data Exchange (ETDEWEB)

    Keller, J.F.; Schmidt, A.J.; Selby, K.B.

    1989-07-01

    This report has been prepared to provide information on regulatory programs relevant to a groundwater monitoring program. The information provides a framework within which planners and decisions makers can systematically consider the maze of specific requirements and guidance as they develop a groundwater strategy for the Hanford Site. Although this report discusses legislation and regulations as they pertain to groundwater monitoring activities, it is not intended as a legal opinion. Rather, it is provided as a guide to the relationships among the various regulatory programs related to groundwater. Federal and state environmental pollution control statutes and regulations that have been reviewed in this document include the Resource Conservation and Recovery Act (RCRA); Washington's Hazardous Waste Management Act; Washington's Solid Waste Management Act; the Comprehensive Environmental Response, Liability, and Compensation Act (CERCLA); the Superfund Amendments and Reauthorization Act (SARA); the Safe Drinking Water Act (SDWA); and the Clean Water Act (CWA). The implications and details of these regulations as they may apply to Hanford are discussed. The information contained within this report can be used to develop the Hanford Site's groundwater quality protection programs, assess regulatory compliance, and characterize the Hanford Site for potential remediation and corrective actions. 5 refs., 14 tabs.

  13. Program Evaluation for School Improvement: Guidelines for School Administrators.

    Science.gov (United States)

    Gillies, Warna D.

    1995-01-01

    Fourth-generation program evaluation is a collaborative, responsive approach that attaches great importance to the claims, concerns, and issues set forth by various stakeholders. This model stresses value pluralism and has several community-involvement phases: planning, data collection, results, final evaluation report, and follow-up. (20…

  14. Guidelines on the use of molecular genetics in reintroduction programs

    Science.gov (United States)

    Michael K. Schwartz

    2005-01-01

    The use of molecular genetics can play a key role in reintroduction efforts. Prior to the introduction of any individuals, molecular genetics can be used to identify the most appropriate source population for the reintroduction, ensure that no relic populations exist in the reintroduction area, and guide captive breeding programs. The use of molecular genetics post-...

  15. Empowering Learners: Guidelines for School Library Media Programs

    Science.gov (United States)

    American Association of School Librarians (NJ3), 2009

    2009-01-01

    As we approach the second decade of the twenty-first century, school library media programs continue to undergo momentous changes that have heightened the importance of technology and evidence-based learning. The focus has moved from the library as a confined place to one with fluid boundaries that is layered by diverse needs and influenced by an…

  16. Design Guidelines for Graduate Program Social Media Use

    Science.gov (United States)

    Rosenberg, Joshua M.; Terry, Colin A.; Bell, John; Hiltz, Virginia; Russo, Tracy E.

    2016-01-01

    Social media provides a promising platform for members of informal and formal educational communities to build community, collaborate, and support institutional goals such as student recruitment. Despite burgeoning research on the educational uses of social media, we are not aware of any to guide graduate program social media use. In order to…

  17. Effectiveness of supporting intensive care units on implementing the guideline 'End-of-life care in the intensive care unit, nursing care': a cluster randomized controlled trial

    NARCIS (Netherlands)

    Noome, M.; Dijkstra, B.M.; Leeuwen, E. van; Vloet, L.C.M.

    2017-01-01

    AIM: The aim of this study was to examine the effectiveness of supporting intensive care units on implementing the guidelines. BACKGROUND: Quality of care can be achieved through evidence-based practice. Guidelines can facilitate evidence-based practice, such as the guidelines 'End-of-life care in

  18. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

    Directory of Open Access Journals (Sweden)

    Ploeg Jenny

    2008-02-01

    Full Text Available Abstract Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. Methods A naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD, foot complications in diabetes, smoking cessation and venous leg ulcers. Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review. Process and patient outcomes were assessed by chart audit (n = 681 pre-implementation, 592 post-implementation. Outcomes were also assessed for four of six topics by in-hospital/home interviews (n = 261 pre-implementation, 232 post-implementation and follow-up telephone interviews (n = 152 pre, 121 post. Interviews were conducted with 83/95 (87% CRN's, nurses and administrators to describe recommendations selected, strategies used and participants' perceived facilitators and barriers to guideline implementation. Results While statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%, diabetes foot care (83% and venous leg ulcers (60%. Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack

  19. Perceptions of national guidelines and their (non) implementation in mental healthcare: a deductive and inductive content analysis.

    Science.gov (United States)

    Sandström, Boel; Willman, Ania; Svensson, Bengt; Borglin, Gunilla

    2015-04-01

    National guidelines are being produced at an increasing rate, and politicians and managers are expected to promote these guidelines and their implementation in clinical work. However, research seldom deals with how decision-makers can perceive these guidelines or their challenges in a cultural context. Therefore, the aim of this study was twofold: to investigate how well Promoting Action on Research Implementation in Health Services (PARIHS) reflected the empirical reality of mental healthcare and to gain an extended understanding of the perceptions of decision-makers operating within this context, in regard to the implementation of evidence-based guidelines. The study took place in the southeast of Sweden and employed a qualitative design. The data were collected through 23 interviews with politicians and managers working either in the county council or in the municipalities. The transcribed text was analysed iteratively and in two distinct phases, first deductively and second inductively by means of qualitative content analysis. Our deductive analysis showed that the text strongly reflected two out of three categorisation matrices, i.e. evidence and context representing the PARIHS framework. However, the key element of facilitation was poorly mirrored in the text. Results from the inductive analysis can be seen in light of the main category sitting on the fence; thus, the informants' perceptions reflected ambivalence and contradiction. This was illustrated by conflicting views and differences in culture and ideology, a feeling of security in tradition, a certain amount of resistance to change and a lack of role clarity and clear directions. Together, our two analyses provide a rich description of an organisational culture that is highly unlikely to facilitate the implementation of the national guidelines, together with a distrust of the source behind such guidelines, which stands in stark contrast to the high confidence in the knowledge of experienced people in

  20. Implementation and outcomes of a comprehensive worksite health promotion program.

    Science.gov (United States)

    Renaud, Lise; Kishchuk, Natalie; Juneau, Martin; Nigam, Anil; Téreault, Karine; Leblanc, Marie-Claude

    2008-01-01

    This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p = 0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful. This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of

  1. Program management aid for redundancy selection and operational guidelines

    Science.gov (United States)

    Hodge, P. W.; Davis, W. L.; Frumkin, B.

    1972-01-01

    Although this criterion was developed specifically for use on the shuttle program, it has application to many other multi-missions programs (i.e. aircraft or mechanisms). The methodology employed is directly applicable even if the tools (nomographs and equations) are for mission peculiar cases. The redundancy selection criterion was developed to insure that both the design and operational cost impacts (life cycle costs) were considered in the selection of the quantity of operational redundancy. These tools were developed as aids in expediting the decision process and not intended as the automatic decision maker. This approach to redundancy selection is unique in that it enables a pseudo systems analysis to be performed on an equipment basis without waiting for all designs to be hardened.

  2. Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

    Science.gov (United States)

    Brady, Teresa J; Murphy, Louise B; O'Colmain, Benita J; Hobson, Reeti Desai

    2017-09-01

    To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. Community. N = 10 792. Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. Meta-analysis using pooled effect sizes. Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

  3. Statistical coordinates of the LEADER Program implementation process in Romania

    Directory of Open Access Journals (Sweden)

    Klára - Dalma POLGÁR (DESZKE

    2015-12-01

    Full Text Available The LEADER program, the fourth priority direction for financing through European Agricultural Fund for Rural Development – EAFRD, consists in implementing local development strategies for improving administrative governance in rural areas. This paper presents the management of rural development by the National Network for Rural Development and the status of implementation of the LEADER program in Romania, until December 2014. The funded projects of rural development meet the requirements of local communities identified by the operational structures of type LAG - Local Action Group, through appropriate measures, specific to each county.

  4. Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability

    Science.gov (United States)

    Michel, George; Rosenfeld, Richard M; Davidson, Caryn

    2011-01-01

    Objective To demonstrate the feasibility of capturing the knowledge required to create guideline recommendations in a systematic, structured, manner using a software assistant. Practice guidelines constitute an important modality that can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. However, many guideline recommendations are vague and underspecified, lack any linkage to supporting evidence or documentation of how they were developed, and prove to be difficult to transform into systems that influence the behavior of care providers. Methods The BRIDGE-Wiz application (Building Recommendations In a Developer's Guideline Editor) uses a wizard approach to address the questions: (1) under what circumstances? (2) who? (3) ought (with what level of obligation?) (4) to do what? (5) to whom? (6) how and why? Controlled natural language was applied to create and populate a template for recommendation statements. Results The application was used by five national panels to develop guidelines. In general, panelists agreed that the software helped to formalize a process for authoring guideline recommendations and deemed the application usable and useful. Discussion Use of BRIDGE-Wiz promotes clarity of recommendations by limiting verb choices, building active voice recommendations, incorporating decidability and executability checks, and limiting Boolean connectors. It enhances transparency by incorporating systematic appraisal of evidence quality, benefits, and harms. BRIDGE-Wiz promotes implementability by providing a pseudocode rule, suggesting deontic modals, and limiting the use of ‘consider’. Conclusion Users found that BRIDGE-Wiz facilitates the development of clear, transparent, and implementable guideline recommendations. PMID:21846779

  5. Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals

    Directory of Open Access Journals (Sweden)

    Warira Ann

    2009-07-01

    Full Text Available Abstract Background Although considerable efforts are directed at developing international guidelines to improve clinical management in low-income settings they appear to influence practice rarely. This study aimed to explore barriers to guideline implementation in the early phase of an intervention study in four district hospitals in Kenya. Methods We developed a simple interview guide based on a simple characterisation of the intervention informed by review of major theories on barriers to uptake of guidelines. In-depth interviews, non-participatory observation, and informal discussions were then used to explore perceived barriers to guideline introduction and general improvements in paediatric and newborn care. Data were collected four to five months after in-service training in the hospitals. Data were transcribed, themes explored, and revised in two rounds of coding and analysis using NVivo 7 software, subjected to a layered analysis, reviewed, and revised after discussion with four hospital staff who acted as within-hospital facilitators. Results A total of 29 health workers were interviewed. Ten major themes preventing guideline uptake were identified: incomplete training coverage; inadequacies in local standard setting and leadership; lack of recognition and appreciation of good work; poor communication and teamwork; organizational constraints and limited resources; counterproductive health worker norms; absence of perceived benefits linked to adoption of new practices; difficulties accepting change; lack of motivation; and conflicting attitudes and beliefs. Conclusion While the barriers identified are broadly similar in theme to those reported from high-income settings, their specific nature often differs. For example, at an institutional level there is an almost complete lack of systems to introduce or reinforce guidelines, poor teamwork across different cadres of health worker, and failure to confront poor practice. At an individual

  6. Reconciling Pairs of Concurrently Used Clinical Practice Guidelines Using Constraint Logic Programming

    Science.gov (United States)

    Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

    2011-01-01

    This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack. PMID:22195153

  7. Developing programs for homeless veterans: understanding driving forces in implementation.

    Science.gov (United States)

    Nakashima, John; McGuire, Jim; Berman, Stephen; Daniels, William

    2004-01-01

    Between 1992 and 2003, services for homeless veterans at the Veterans Affairs Greater Los Angeles Healthcare System went from inappropriate utilization of hospital medical and psychiatric beds, to a continuum of residential treatment, transitional housing, and employment programs through arrangements with private agencies. The authors use elements of Hasenfeld and Brock's Political Economy Model (1991) to explain this transformation in service delivery that was spearheaded by a VA social work leadership team. It is argued that three driving forces crucial to program implementation were present: technological certainty, economic stability, and concentration of power. Evidence of the implementation's impact includes creation of new homeless program beds, a reduction in use of medical/psychiatric beds, and a large number of formerly homeless veterans with housing and employment at program discharge. Study limitations and implications for future studies are discussed.

  8. Analysis and Implement of Broadcast Program Monitoring Data

    Directory of Open Access Journals (Sweden)

    Song Jin Bao

    2016-01-01

    Full Text Available With the rapid development of the radio and TV industry and the implementation of INT (the integration of telecommunications networks, cable TV networks and the Internet, the contents of programs and advertisements is showing massive, live and interactive trends. In order to meet the security of radio and television, the broadcast of information have to be controlled and administered. In order to master the latest information of public opinion trends through radio and television network, it is necessary research the specific industry applications of broadcast program monitoring. In this paper, the importance of broadcast monitoring in public opinion analysis is firstly analysed. The monitoring radio and television programs broadcast system architecture is proposed combining with the practice, focusing on the technical requirements and implementation process of program broadcast, advertisement broadcast and TV station broadcast monitoring. The more efficient information is generated through statistical analysis, which provides data analysis for radio and television public opinion analysis.

  9. Comparison of acrylamide intake from Western and guideline based diets using probabilistic techniques and linear programming.

    Science.gov (United States)

    Katz, Josh M; Winter, Carl K; Buttrey, Samuel E; Fadel, James G

    2012-03-01

    Western and guideline based diets were compared to determine if dietary improvements resulting from following dietary guidelines reduce acrylamide intake. Acrylamide forms in heat treated foods and is a human neurotoxin and animal carcinogen. Acrylamide intake from the Western diet was estimated with probabilistic techniques using teenage (13-19 years) National Health and Nutrition Examination Survey (NHANES) food consumption estimates combined with FDA data on the levels of acrylamide in a large number of foods. Guideline based diets were derived from NHANES data using linear programming techniques to comport to recommendations from the Dietary Guidelines for Americans, 2005. Whereas the guideline based diets were more properly balanced and rich in consumption of fruits, vegetables, and other dietary components than the Western diets, acrylamide intake (mean±SE) was significantly greater (Plinear programming and results demonstrate that linear programming techniques can be used to model specific diets for the assessment of toxicological and nutritional dietary components. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Design and implementation of modular software for programming mobile robots

    Directory of Open Access Journals (Sweden)

    Luca Iocchi

    2008-11-01

    Full Text Available This article describes a software development toolkit for programming mobile robots, that has been used on different platforms and for different robotic applications. We address design choices, implementation issues and results in the realization of our robot programming environment, that has been devised and built from many people since 1998. We believe that the proposed framework is extremely useful not only for experienced robotic software developers, but also for students approaching robotic research projects.

  11. Design and Implementation of Modular Software for Programming Mobile Robots

    Directory of Open Access Journals (Sweden)

    Alessandro Farinelli

    2006-03-01

    Full Text Available This article describes a software development toolkit for programming mobile robots, that has been used on different platforms and for different robotic applications. We address design choices, implementation issues and results in the realization of our robot programming environment, that has been devised and built from many people since 1998. We believe that the proposed framework is extremely useful not only for experienced robotic software developers, but also for students approaching robotic research projects.

  12. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness.

    Science.gov (United States)

    Tistad, Malin; Palmcrantz, Susanne; Wallin, Lars; Ehrenberg, Anna; Olsson, Christina B; Tomson, Göran; Holmqvist, Lotta Widén; Gifford, Wendy; Eldh, Ann Catrine

    2016-04-11

    Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a

  13. Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

    Directory of Open Access Journals (Sweden)

    Malin Tistad

    2016-08-01

    Full Text Available Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs, yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the

  14. Federal communication about obesity in the Dietary Guidelines and checkoff programs.

    Science.gov (United States)

    Wilde, Parke E

    2006-06-01

    The new Dietary Guidelines for Americans focus on obesity prevention. They recommend increased consumption of whole grains, fruits, vegetables, fish, and low-fat dairy products, within a balanced diet whose total calories have been moderately reduced. Meanwhile, other well-known and well-funded federally sponsored consumer communications promote increased total consumption of beef, pork, and dairy products, including energy dense foods such as bacon cheeseburgers, barbecue pork ribs, pizza, and butter. These latter communications are sponsored by the federal government's commodity promotion programs, known as "checkoff" programs. The programs are established by Congress, approved by a majority of the commodity's producers, managed jointly by a producer board and the U.S. Department of Agriculture, and funded through a tax on the producers. The federal government enforces the collection of more than 600 million US dollars annually in mandatory assessments, approves the advertising and marketing programs, and defends checkoff communication in court as the federal government's own message-in legal jargon, as its own "government speech." Federal support for promoting fruits and vegetables is small by comparison. The checkoff programs recently have become more clearly identified as federal programs. After a recent decision by the U.S. Supreme Court upholding the constitutionality of the checkoff programs, calls for consistency with the Dietary Guidelines may get louder. The current inconsistencies in federal communication undermine the effectiveness of the Dietary Guidelines as an antidote to the shortcomings of the private sector market for information about weight and obesity.

  15. Implementing practice guidelines for anxiety disorders in secondary mental health care: a case study

    NARCIS (Netherlands)

    van Dijk, M.K.; Verbraak, M.J.P.M.; Oosterbaan, D.B.; van Balkom, A.J.L.M.

    2012-01-01

    Background: Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment of

  16. Implementing practice guidelines for anxiety disorders in secondary mental health care: a case study

    NARCIS (Netherlands)

    Dijk, M.K. van; Verbraak, M.J.; Oosterbaan, D.B.; Balkom, A.J. van

    2012-01-01

    ABSTRACT: BACKGROUND: Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment

  17. Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity

    Directory of Open Access Journals (Sweden)

    Fagan Abigail A

    2008-01-01

    Full Text Available Abstract Background Widespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured. Methods This paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness. Results Although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers, ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence. Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage. Student behavior and use of interactive teaching techniques (quality of delivery were positively related. No variables were related to student participation (student responsiveness. Conclusion Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that

  18. The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society.

    Science.gov (United States)

    Madden, Lori Kennedy; Hill, Michelle; May, Teresa L; Human, Theresa; Guanci, Mary McKenna; Jacobi, Judith; Moreda, Melissa V; Badjatia, Neeraj

    2017-12-01

    Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges. The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacotherapy to form a writing Committee in 2015. The group generated a set of 16 clinical questions relevant to TTM using the PICO format. With the assistance of a research librarian, the Committee undertook a comprehensive literature search with no back date through November 2016 with additional references up to March 2017. The Committee utilized GRADE methodology to adjudicate the quality of evidence as high, moderate, low, or very low based on their confidence that the estimate of effect approximated the true effect. They generated recommendations regarding the implementation of TTM based on this systematic review only after considering the quality of evidence, relative risks and benefits, patient values and preferences, and resource allocation. This guideline is intended for neurocritical care clinicians who have chosen to use TTM in patient care; it is not meant to provide guidance regarding the clinical indications for TTM itself. While there are areas of TTM practice where clear evidence guides strong recommendations, many of the recommendations are conditional, and must be contextualized to individual patient and system needs.

  19. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

    Science.gov (United States)

    Chan, Wiley V; Pearson, Thomas A; Bennett, Glen C; Cushman, William C; Gaziano, Thomas A; Gorman, Paul N; Handler, Joel; Krumholz, Harlan M; Kushner, Robert F; MacKenzie, Thomas D; Sacco, Ralph L; Smith, Sidney C; Stevens, Victor J; Wells, Barbara L; Castillo, Graciela; Heil, Susan K R; Stephens, Jennifer; Vann, Julie C Jacobson

    2017-02-28

    In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines. This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review. Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2

  20. [Challenges in the implementation of clinical practice guidelines in major public health institutions in Mexico: A multiple case study].

    Science.gov (United States)

    Gutiérrez-Alba, Gaudencio; González-Block, Miguel Ángel; Reyes-Morales, Hortensia

    2015-01-01

    To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish). We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire. The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment. The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.

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

    Science.gov (United States)

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

    2017-12-01

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

  2. Status of Satellite Television Broadcast Programs Implementation in ...

    African Journals Online (AJOL)

    (classroom interaction) is conducive for effective implementation of the satellite plasma television program? • What are the possible advantages and limitations of the plasma instruction? .... classroom teachers' use of lesson introduction. Accordingly, only 65.3% of .... 4 It decreases teachers creativity. 53. 47. 428. 5 It reduces ...

  3. Implementing a Moral Education Program through Attitude Change Theory.

    Science.gov (United States)

    Hughes, Richard L.; Casper, Daniel

    1979-01-01

    Major theories of attitude change are explained: stimulus-response and reinforcement theory, functional theory, social judgment theory, and consistency theory. These theories are applied to the problems of influencing staff toward implementing a program of moral education. (Author/SJL)

  4. A Framework for Implementing TQM in Higher Education Programs

    Science.gov (United States)

    Venkatraman, Sitalakshmi

    2007-01-01

    Purpose: This paper aims to provide a TQM framework that stresses continuous improvements in teaching as a plausible means of TQM implementation in higher education programs. Design/methodology/approach: The literature survey of the TQM philosophies and the comparative analysis of TQM adoption in industry versus higher education provide the…

  5. Learning Computer Programming: Implementing a Fractal in a Turing Machine

    Science.gov (United States)

    Pereira, Hernane B. de B.; Zebende, Gilney F.; Moret, Marcelo A.

    2010-01-01

    It is common to start a course on computer programming logic by teaching the algorithm concept from the point of view of natural languages, but in a schematic way. In this sense we note that the students have difficulties in understanding and implementation of the problems proposed by the teacher. The main idea of this paper is to show that the…

  6. Implementing Quality Service-Learning Programs in Community Colleges

    Science.gov (United States)

    Vaknin, Lauren Weiner; Bresciani, Marilee J.

    2013-01-01

    This cross-case comparative study at Western Community College and the University of the Coast explored through a constructive lens the characteristics that lead to sustainable, high quality service-learning programs and how they are implemented at institutions of higher education. The researchers determined that both Western Community College and…

  7. Implementation of a proton pump inhibitor stewardship program.

    Science.gov (United States)

    Davis, Kelly W; Hanners, Rachel E; Lockwood, Sean M

    2017-06-15

    The development and implementation of a proton pump inhibitor (PPI) stewardship program at a single institution are described. Due to the overuse of PPIs and the increasing awareness of the adverse drug events associated with long-term PPI therapy, the pharmacy and internal medicine services of a medical center implemented a PPI stewardship program. All patients admitted to the internal medicine service were evaluated by the PPI stewardship team to determine if they had an appropriate indication for PPI continuation in the hospital as well as after discharge. If patients did not meet specified criteria for continuation of PPI use during hospitalization, PPI therapy was suspended and replaced by as-needed acid suppressive therapy, and the patients received discharge counseling regarding the implemented medication regimen changes. Challenges encountered during program development included establishing appropriate criteria for PPI continuation and determining the best method for discontinuing PPIs in order to reduce the risk of rebound hyperacidity. In an effort to reduce unnecessary PPI use, a PPI stewardship program was developed and implemented to ensure appropriate continuation of PPIs for patients admitted and discharged from an internal medicine service. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Designing and Implementing Effective Adapted Physical Education Programs

    Science.gov (United States)

    Kelly, Luke E.

    2011-01-01

    "Designing and Implementing Effective Adapted Physical Education Programs" was written to assist adapted and general physical educators who are dedicated to ensuring that the physical and motor needs of all their students are addressed in physical education. While it is anticipated that adapted physical educators, where available, will typically…

  9. Evaluating the Implementation of an Olympic Education Program in Greece

    Science.gov (United States)

    Grammatikopoulos, Vasilios; Tsigilis, Nikolaos; Koustelios, Athanasios; Theodorakis, Yannis

    2005-11-01

    The aim of this study was to develop an instrument for evaluating how an education program has been implemented. Such evaluation can provide insight into the effectiveness of a program. Examined here was the Olympic Education Program used in Greek schools since 2000. In it, students learn the history of the Olympic games and the importance of exercise for health along with the principles and values of sports and volunteerism. The evaluation instrument underlying this study addressed the following six factors: `facilities', `administration', `educational material', `student-teacher relationships', `educational procedures', and `training'. Results indicate that the instrument, while adequate for assessing effectiveness, should be combined with advanced statistical methods.

  10. Implementing Probabilistic Abductive Logic Programming with Constraint Handling Rules

    DEFF Research Database (Denmark)

    Christiansen, Henning

    2008-01-01

    A class of Probabilistic Abductive Logic Programs (PALPs) is introduced and an implementation is developed in CHR for solving abductive problems, providing minimal explanations with their probabilities. Both all-explanations and most-probable-explanations versions are given. Compared with other...... probabilistic versions of abductive logic programming, the approach is characterized by higher generality and a flexible and adaptable architecture which incorporates integrity constraints and interaction with external constraint solvers. A PALP is transformed in a systematic way into a CHR program which serves...

  11. 75 FR 63480 - Medicaid Program: Implementation of Section 614 of the Children's Health Insurance Program...

    Science.gov (United States)

    2010-10-15

    ... HUMAN SERVICES Medicaid Program: Implementation of Section 614 of the Children's Health Insurance... Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3. Section 614... Security Act and for child health assistance expenditures under the Children's Health Insurance Program...

  12. Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity

    Science.gov (United States)

    Vogel, Joshua P.; Moore, Julia E.; Timmings, Caitlyn; Khan, Sobia; Khan, Dina N.; Defar, Atkure; Hadush, Azmach; Minwyelet Terefe, Marta; Teshome, Luwam; Ba-Thike, Katherine; Than, Kyu Kyu; Makuwani, Ahmad; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza Yvonne; Puchalski Ritchie, Lisa M.; Rashid, Shusmita; Straus, Sharon E.; Gülmezoglu, A. Metin

    2016-01-01

    Background Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO’s Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael’s Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. Methods We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). Results Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. Conclusion This approach to identifying barriers, facilitators and potential strategies for

  13. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT: Cluster randomised controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Francis Jill

    2008-02-01

    Full Text Available Abstract Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters, which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the

  14. Global quality criteria, standards, and indicators for doctoral programs in nursing; literature review and guideline development.

    Science.gov (United States)

    Kim, M J; McKenna, Hugh P; Ketefian, S

    2006-05-01

    Nursing profession has intensified education and training of nurse researchers who could enhance the health of people through the discovery and dissemination of knowledge. This resulted in rapid increase in the number of doctoral programs in nursing in many countries in recent decades, but the guidelines for quality programs are lacking. To develop guidelines for quality criteria, standards, and indicators for doctoral programs in nursing that may be used worldwide. The work of the quality criteria, standards and indicators (QCSI) committee of the International Network for Doctoral Education in Nursing formed the basis of this paper and authors supplemented it by a literature review and consultation with international experts. The major criteria of quality of doctoral program were: the nature of the mission, the quality of faculty, the students, the curriculum, program administration, and resources. Sub-criteria, standards and indicators for each of these criteria were identified in sufficient detail to provide guidance for quality doctoral programs in nursing. Concerns as to whether the QCSI would apply to those countries and doctoral programs that focus on a research thesis only, without formal coursework were addressed. Experts from across the world felt that the QCSI would be applicable for most program types. Global criteria, standards, and indicators for doctoral programs in nursing presented in this article may serve as guidelines for most doctoral programs in the world as these were developed by experienced nurse scholars representing eight countries from five continents. The degree of detail in these parameters is sufficient to enhance the utility of the QCSI for all doctoral programs worldwide.

  15. Medical Physics Practice Guideline 4.a: Development, implementation, use and maintenance of safety checklists.

    Science.gov (United States)

    Fong de Los Santos, Luis E; Evans, Suzanne; Ford, Eric C; Gaiser, James E; Hayden, Sandra E; Huffman, Kristina E; Johnson, Jennifer L; Mechalakos, James G; Stern, Robin L; Terezakis, Stephanie; Thomadsen, Bruce R; Pronovost, Peter J; Fairobent, Lynne A

    2015-05-08

    The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

  16. Emissions Scenarios, Costs, and Implementation Considerations of REDD Programs

    Energy Technology Data Exchange (ETDEWEB)

    Sathaye, Jayant; Andrasko, Ken; Chan, Peter

    2011-04-11

    Greenhouse gas emissions from the forestry sector are estimated to be 8.4 GtCO2-eq./year or about 17percent of the global emissions. We estimate that the cost forreducing deforestation is low in Africa and several times higher in Latin America and Southeast Asia. These cost estimates are sensitive to the uncertainties of how muchunsustainable high-revenue logging occurs, little understood transaction and program implementation costs, and barriers to implementation including governance issues. Due to lack of capacity in the affected countries, achieving reduction or avoidance of carbon emissions will require extensive REDD-plus programs. Preliminary REDD-plus Readiness cost estimates and program descriptions for Indonesia, Democratic Republic of the Congo, Ghana, Guyana and Mexico show that roughly one-third of potential REDD-plus mitigation benefits might come from avoided deforestation and the rest from avoided forest degradation and other REDD-plus activities.

  17. Savannah River Site Environmental Implementation Plan. Volume 2, Protection programs

    Energy Technology Data Exchange (ETDEWEB)

    1989-08-01

    Formal sitewide environmental planning at the . Savannah River Site (SRS) began in 1986 with the development and adoption of the Strategic Environmental Plan. The Strategic Environmental Plan describes the philosophy, policy, and overall program direction of environmental programs for the operation of the SRS. The Strategic Environmental Plan (Volume 2) provided the basis for development of the Environmental Implementation Plan (EIP). The EIP is the detailed, comprehensive environmental master plan for operating contractor organizations at the SRS. The EIP provides a process to ensure that all environmental requirements and obligations are being met by setting specific measurable goals and objectives and strategies for implementation. The plan is the basis for justification of site manpower and funding requests for environmental projects and programs over a five-year planning period.

  18. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

    Science.gov (United States)

    Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

    2016-07-15

    As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

  19. Implementation of SQLite database support in program gama-local

    Directory of Open Access Journals (Sweden)

    Vaclav Petras

    2012-03-01

    Full Text Available The program gama-local is a part of GNU Gama project and allows adjustment of local geodetic networks. Before realization of this project the program gama-local supported only XML as an input. I designed and implemented support for the SQLite database and thanks to this extension gama-local can read input data from the SQLite database. This article is focused on the specifics of the use of callback functions in C++ using the native SQLite C/C++ Application Programming Interface. The article provides solution to safe calling of callback functions written in C++. Callback functions are called from C library and C library itself is used by C++ program. Provided solution combines several programing techniques which are described in detail, so this article can serve as a cookbook even for beginner programmers.  This project was accomplished within my bachelor thesis.

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

    Science.gov (United States)

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

    2010-01-01

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

  1. Mind the gap! Guideline implementation for peripheral venous catheters in paediatric care : documetation, complications, adherence and context

    OpenAIRE

    Förberg, Ulrika

    2015-01-01

    Introduction: There is a knowledge translation gap between evidence, based on research findings and clinical practice. Clinical practice guidelines (CPGs) have been proposed as a strategy to condense and disseminate research findings. However their existence alone does not minimise the gap, they have to be implemented in everyday practice. Registered nurses’ (RNs) work context influences their research use, but little is known on what contextual factors that influence RNs’ adheren...

  2. The Clinical Pharmacogenetics Implementation Consortium Guideline for SLCO1B1 and Simvastatin-Induced Myopathy: 2014 Update

    OpenAIRE

    Ramsey, L B; Johnson, S G; Caudle, K E; Haidar, C E; Voora, D; Wilke, R A; Maxwell, W D; McLeod, H L; Krauss, R M; Roden, D M; Feng, Q; Cooper-DeHoff, R M; Gong, L; Klein, T E; Wadelius, M

    2014-01-01

    Simvastatin is among the most commonly used prescription medications for cholesterol reduction. A single coding single-nucleotide polymorphism, rs4149056T>C, in SLCO1B1 increases systemic exposure to simvastatin and the risk of muscle toxicity. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for simvastatin based on SLCO1B1 genotype. This article is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium guideline...

  3. VGB guideline - guide for implementation of the Betriebssicherheitsverordnung (Industrial Safety Ordinance); VGB-Richtlinie - Leitfaden zur Umsetzung der Betriebssicherheitsverordnung

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, O. [VGB PowerTech e.V. Essen (Germany); Harms, H.G. [RWE Power AG, KW Grevenbroich (Germany)

    2007-07-01

    The VGB guideline R 104 O provides the user with a modern information system that is accessible via the internet. It contains information on the BetrSichV (Industrial Safety Ordinance) and its interpretation and also provides answers to practical problems relating to the BetrSichV. This makes it easier to implement the BetrSichV and the Technical Rules in power stations. (orig.)

  4. Guideline implementation in clinical practice: Use of statistical process control charts as visual feedback devices

    National Research Council Canada - National Science Library

    Fahad A Al-Hussein

    2009-01-01

    Objective: To use statistical control charts in a series of audits to improve the acceptance and consistant use of guidelines, and reduce the variations in prescription processing in primary health care. Methods...

  5. Evaluation of the Low Back Pain Practice Guideline Implementation in the Army Medical Department

    National Research Council Canada - National Science Library

    Farley, Donna

    2004-01-01

    ... clinical care practices across the Army health system. This report presents the final results of the evaluation that RAND conducted as part of the demonstration for the low back practice guideline, which was conducted in 1999 and 2000...

  6. Implementing guidelines for depression on antidepressant prescribing in general practice : a quasi-experimental evaluation

    NARCIS (Netherlands)

    Franx, Gerdien; Huyser, Jochanan; Koetsenruijter, Jan; van der Feltz-Cornelis, Christina M.; Verhaak, Peter F. M.; Grol, Richard P. T. M.; Wensing, Michel

    2014-01-01

    Background: Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general

  7. Tentative Guidelines for the Development of an Ability-Based Emotional Intelligence Intervention Program for Gifted Students

    Science.gov (United States)

    Zeidner, Moshe

    2017-01-01

    This paper presents a number of general principles and guidelines for the development of an emotional intelligence training program designed to foster emotional abilities in gifted students. The presented guidelines underscore the need for EI theory-driven program planning geared to the needs of gifted students; integrating activities into routine…

  8. Oil program implementation plan FY 1996--2000

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-04-01

    This document reaffirms the US Department of Energy (DOE) Office of Fossil Energy commitment to implement the National Oil Research Program in a way to maximize assurance of energy security, economic growth, environmental protection, jobs, improved economic competitiveness, and improved US balance of trade. There are two sections and an appendix in this document. Section 1 is background information that guided its formulation and a summary of the Oil Program Implementation Plan. This summary includes mission statements, major program drivers, oil issues and trends, budget issues, customers/stakeholders, technology transfer, measures of program effectiveness, and benefits. Section 2 contains more detailed program descriptions for the eight technical areas and the NIPER infrastructure. The eight technical areas are reservoir characterization; extraction research; exploration, drilling, and risk-based decision management; analysis and planning; technology transfer; field demonstration projects; oil downstream operations; and environmental research. Each description contains an overview of the program, descriptions on main areas, a discussion of stakeholders, impacts, planned budget projections, projected schedules with Gantt charts, and measures of effectiveness. The appendix is a summary of comments from industry on an earlier draft of the plan. Although changes were made in response to the comments, many of the suggestions will be used as guidance for the FY 1997--2001 plan.

  9. Cabo Verde telemedicine program: initial results of nationwide implementation.

    Science.gov (United States)

    Latifi, Rifat; Dasho, Erion; Merrell, Ronald C; Lopes, Miguel; Azevedo, Vanda; Bekteshi, Flamur; Osmani, Kalterina L; Qesteri, Orland; Kucani, Julian; Lecaj, Ismet

    2014-11-01

    Telemedicine and e-health have been suggested as one solution for closing the health disparity gap between the developed world and the developing world. Yet evidence is lacking from current successful programs in the developing world and, in particular, from sub-Saharan Africa. The primary objective of our study was to present the preliminary results of our efforts in building the Integrated Telemedicine and e-Health Program for Cabo Verde (ITeHP-CV), with an emphasis on initial utilization and results. This is a prospective study of data collected while we worked to establish a fully functional, integrated national telemedicine network and virtual education network in Cabo Verde. We used the International Virtual e-Hospital Foundation strategic approach known as "initiate-build-operate-transfer" over a 26-month period (November 2011-December 2013). We describe herein the five main pillars of this process that have been implemented: (1) capacity building; (2) network development and deployment of equipment; (3) implementation of clinical telemedicine; (4) implementation of activities related to continuing medical education, delivered from within the country and from abroad; and (5) establishment and use of the electronic virtual library. Based on comprehensive technical and medical assessment of the country's needs, 10 fully functional telemedicine centers in all nine inhabited islands of the Republic of Cabo Verde have been established. RESULTS are presented under the five main pillars of capacity building, network deployment, implementation of clinical telemedicine, implementation of continuing medical education activities, and establishment of the electronic virtual library. The ITeHP-CV has been successfully launched, and the initial results are encouraging. The continuity of the program and sustainability are primary goals once the program is transferred fully to the Ministry of Health of Cabo Verde. A long-term follow-up study is required in order to ensure

  10. Listening to women: culturally tailoring the violence prevention guidelines from the put prevention into practice program.

    Science.gov (United States)

    Shoultz, Jan; Phillion, Nancy; Noone, Joanne; Tanner, Barbara

    2002-07-01

    To develop five reliable and valid (culturally tailored) guidelines focused on the prevention of violence as presented in the violence prevention guideline of the Put Prevention into Practice Clinician's Handbook on Preventative Services (PPIP). The data collection for this qualitative, descriptive design of naturalistic inquiry was focus group interviews with five different ethnic groups of women (Caucasian, Filipino, Hawaiian, Japanese and Hispanic) using a semi-structured interview guide. The women interviewed provided a variety of suggestions for adaptations to the guideline. Cultural similarities and differences are presented. Development of a nonjudgmental and trusting relationship is key to disclosure. Violence against women is recognized as a major public health problem. Little is known about the effectiveness of standardized interventions such as those contained in the PPIP Handbook. Even less is known about the efficacy of such protocols within culturally diverse populations. Providers should consider adaptation of the guideline based on the individual relationship with the client. The next phase of this research is to implement the culturally tailored adaptations of these guidelines and test their effectiveness.

  11. Standard Review Plan Update and Development Program. Implementing Procedures Document

    Energy Technology Data Exchange (ETDEWEB)

    1992-05-01

    This implementing procedures document (IPD) was prepared for use in implementing tasks under the standard review plan update and development program (SRP-UDP). The IPD provides comprehensive guidance and detailed procedures for SRP-UDP tasks. The IPD is mandatory for contractors performing work for the SRP-UDP. It is guidance for the staff. At the completion of the SRP-UDP, the IPD will be revised (to remove the UDP aspects) and will replace NRR Office Letter No. 800 as long-term maintenance procedures.

  12. Implementation of the parametric variation method in an EMTP program

    DEFF Research Database (Denmark)

    Holdyk, Andrzej; Holbøll, Joachim

    2013-01-01

    The paper presents an algorithm for- and shows the implementation of a method to perform parametric variation studies using electromagnetic transients programs applied to an offshore wind farm. Those kind of studies are used to investigate the sensitivity of a given phenomena to variation...... of parameters in an electric system. The proposed method allows varying any parameter of a circuit, including the simulation settings and exploits the specific structure of the ATP-EMTP software. In the implementation of the method, Matlab software is used to control the execution of the ATP solver. Two...

  13. Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment.

    Science.gov (United States)

    Smith, Patricia M; Sellick, Scott M; Spadoni, Michelle M

    2012-04-30

    This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269) via mail to the researchers. Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent benefits and motivation) encouraged nurses to intervene and work-related factors discouraged them (time and workloads). There were significant rural-urban differences--more rural nurses perceived intervening as part of their role, reported having more systems in place to support cessation, reported higher confidence for intervening, and more frequently assisted patients with quitting and arranged follow-up. The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

  14. Diretrizes para um Programa de Recolhimento de Medicamentos Vencidos no Brasil Guidelines for an Expired Medication Collection Program in Brazil

    Directory of Open Access Journals (Sweden)

    Débora Cynamon Kligerman

    2013-03-01

    Full Text Available O objetivo deste artigo é apontar e discutir diretrizes fundamentais para um programa de recolhimento de medicamentos vencidos para o Brasil e evidenciar a importância de campanhas de conscientização da população para seu sucesso. Este é um trabalho de revisão descritiva de base documental que analisa documentos oficiais, técnicos e normativos, de Portugal, México, Canadá e Colômbia, onde existem recolhimento de medicamentos vencidos em diferentes estágios de implementação, alguns já consolidados, outros em fase inicial, mas todos com bons resultados. Os países citados foram escolhidos objetivando-se representação da Europa, América do Norte e América Latina. Seis diretrizes comuns foram apontadas: corresponsabilidade na cadeia de fabricação e distribuição do medicamento; minimização de resíduos como estratégia; realização de programa piloto; investigação e classificação dos resíduos gerados; intersetorialidade entre diferentes esferas do governo e campanhas de sensibilização e conscientização da comunidade. Estas diretrizes constituem uma base para um Programa de Recolhimento de Medicamentos Usados no Brasil.The scope of this paper is to outline and discuss fundamental guidelines for an expired medication collection program for Brazil and to provide evidence supporting campaigns to raise the population's awareness for the program's success. It is a document-based descriptive review that analyzes official, technical and regulatory documents from Portugal, Canada and Colombia, where there are expired medication collection programs in different stages of implementation. Some of them are already fully implemented, while others are in the preliminary stages, but all of them are achieving good results. The countries listed above were chosen in order to represent Europe, North America and Latin America. Six common guidelines were outlined: co-responsibility in the drug's manufacturing and distribution chain; a

  15. Implementing Recommendations From Web Accessibility Guidelines: A Comparative Study of Nondisabled Users and Users With Visual Impairments.

    Science.gov (United States)

    Schmutz, Sven; Sonderegger, Andreas; Sauer, Juergen

    2017-09-01

    The present study examined whether implementing recommendations of Web accessibility guidelines would have different effects on nondisabled users than on users with visual impairments. The predominant approach for making Web sites accessible for users with disabilities is to apply accessibility guidelines. However, it has been hardly examined whether this approach has side effects for nondisabled users. A comparison of the effects on both user groups would contribute to a better understanding of possible advantages and drawbacks of applying accessibility guidelines. Participants from two matched samples, comprising 55 participants with visual impairments and 55 without impairments, took part in a synchronous remote testing of a Web site. Each participant was randomly assigned to one of three Web sites, which differed in the level of accessibility (very low, low, and high) according to recommendations of the well-established Web Content Accessibility Guidelines 2.0 (WCAG 2.0). Performance (i.e., task completion rate and task completion time) and a range of subjective variables (i.e., perceived usability, positive affect, negative affect, perceived aesthetics, perceived workload, and user experience) were measured. Higher conformance to Web accessibility guidelines resulted in increased performance and more positive user ratings (e.g., perceived usability or aesthetics) for both user groups. There was no interaction between user group and accessibility level. Higher conformance to WCAG 2.0 may result in benefits for nondisabled users and users with visual impairments alike. Practitioners may use the present findings as a basis for deciding on whether and how to implement accessibility best.

  16. Implementing a Fetal Health Surveillance Guideline in Clinical Practice: A Pragmatic Randomized Controlled Trial of Action Learning.

    Science.gov (United States)

    Snelgrove-Clarke, Erna; Davies, Barbara; Flowerdew, Gordon; Young, David

    2015-10-01

    The aim of this study was to determine the effects of an Action Learning intervention on nurses' use of a fetal health surveillance (FHS) guideline during labor of women who were low risk on admission for delivery. Using a pragmatic randomized controlled trial, nurses were randomized to Action Learning (n = 44) or Usual Care (n = 45). Low-risk women were assigned to either an Action Learning nurse (n = 122) or a Usual Care nurse (n = 148). Data on practices during an episode of care (nurses' FHS practices from admission through to delivery in low-risk women) were collected at three trial time points: 1 month prior, during 6 months, and 1 month following. Guideline adherence, women's perception of birth experience, and enablers and inhibitors to intermittent auscultation (IA) were collected. Multivariate logistic regression determined the variables (chosen by the nurses) that predicted Action Learning nurses' adherence to FHS practices. Statistically significant change was not evident between nurses' rate of FHS practices in the Action Learning group compared with Usual Care (Δ6.8%, odds ratio [OR] 0.16, 95% confidence interval [CI] 0.84-2.83). Postpartum, women reported high satisfaction with no significant difference by study group. Two labor events, epidural and narcotic analgesia, most influenced guideline appropriate care (p = .000, OR -4.04; p = .000, OR = 2.89) within the experimental group. Despite lack of between-group significant changes in FHS practices, Action Learning nurses, who chose areas of practice that presented obstacles to their guideline adherence ability (epidurals and narcotics), significantly changed their FHS practices. Researchers need to consider whether practice is long-standing acceptance of the evidence by healthcare providers, and the provider's intentions for implementation effectiveness when choosing an implementation strategy. Supportive nurses, Doppler availability, and clear policies support adherence to an IA guideline

  17. Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community-acquired pneumonia.

    Science.gov (United States)

    Guessous, Idris; Cornuz, Jacques; Stoianov, Rebecca; Burnand, Bernard; Fitting, Jean-William; Yersin, Bertrand; Lamy, Olivier

    2008-09-01

    Although there is no strong evidence of benefit, chest physiotherapy (CP) seems to be commonly used in simple pneumonia. CP requires equipment and frequently involves the assistance of a respiratory therapist, engendering a significant medical workload and cost. To measure and compare the efficacy of two modalities of chest physiotherapy (CP) guideline implementation on the appropriateness of CP prescription among patients hospitalised for community-acquired pneumonia (CAP). We measured the CP prescription rate and duration in all consecutive CAP inpatients admitted in a division of general internal medicine at an urban teaching community hospital during three consecutive one-year time periods: (1) before any guideline implementation; (2) after a passive implementation by medical grand rounds and guideline diffusion through mailing; (3) after adding a one-page reminder in the CAP patient's medical chart highlighting our recommendations. Death and recurrent hospitalisation rates within one year after hospitalisation were recorded to assess whether CP prescription reduction, if any, impaired patient outcomes. During the three successive phases, 127, 157, and 147 patients with similar characteristics were included. Among all CAP inpatients, the CP prescription rate decreased from 68% (86/127) to 51% (80/157), and to 48% (71/147), respectively (P for trend <0.01 for trend). A significant reduction in CP duration was observed after the active guideline implementation (12.0, 11.0, 7.0days, respectively) and persisted after adjustment for length of stay. Reductions in CP prescription rate and duration were also observed among CAP patients with COPD CP prescription rate: 97% (30/31), 67% (24/36), 75% (35/47), respectively (P<0.01 for trend). The mean cost of CP per patient was reduced by 56%, from $709 to $481, and to $309, respectively. Neither the in-hospital deaths, the one-year overall recurrent hospitalisation nor the one-year CAP-specific recurrent hospitalisation

  18. Y-12 Site environmental protection program implementation plan (EPPIP)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The Y-12 Plant Environmental Protection Program is conducted to: (1) protect public health and the environment from chemical and radiological releases occurring from current plant operations and past waste management and operational practices; (2) ensure compliance with federal, state, and local environmental regulations and DOE directives; (3) identify potential environmental problems; (4) evaluate existing environmental contamination and determine the need for remedial actions and mitigative measures; (5) monitor the progress of ongoing remedial actions and cleanup measures; and (6) inform the public of environmental issues relating to DOE operations. DOE Order 5400.1, General Environmental Protection Program, defines the general requirements for environmental protection programs at DOE facilities. This Environmental Protection Program Implementation Plan (EPPIP) defines the methods by which the Y-12 Plant staff will comply with the order by: (1) referencing environmental protection goals and objectives and identifying strategies and timetables for attaining them; (2) providing the overall framework for the design and implementation of the Y-12 Environmental Protection Program; and (3) assigning responsibilities for complying with the requirements of the order. The EPPIP is revised and updated annually.

  19. Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming.

    Science.gov (United States)

    Wilk, Szymon; Michalowski, Wojtek; Michalowski, Martin; Farion, Ken; Hing, Marisela Mainegra; Mohapatra, Subhra

    2013-04-01

    We propose a new method to mitigate (identify and address) adverse interactions (drug-drug or drug-disease) that occur when a patient with comorbid diseases is managed according to two concurrently applied clinical practice guidelines (CPGs). A lack of methods to facilitate the concurrent application of CPGs severely limits their use in clinical practice and the development of such methods is one of the grand challenges for clinical decision support. The proposed method responds to this challenge. We introduce and formally define logical models of CPGs and other related concepts, and develop the mitigation algorithm that operates on these concepts. In the algorithm we combine domain knowledge encoded as interaction and revision operators using the constraint logic programming (CLP) paradigm. The operators characterize adverse interactions and describe revisions to logical models required to address these interactions, while CLP allows us to efficiently solve the logical models - a solution represents a feasible therapy that may be safely applied to a patient. The mitigation algorithm accepts two CPGs and available (likely incomplete) patient information. It reports whether mitigation has been successful or not, and on success it gives a feasible therapy and points at identified interactions (if any) together with the revisions that address them. Thus, we consider the mitigation algorithm as an alerting tool to support a physician in the concurrent application of CPGs that can be implemented as a component of a clinical decision support system. We illustrate our method in the context of two clinical scenarios involving a patient with duodenal ulcer who experiences an episode of transient ischemic attack. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Using planned change to implement a pressure sore program.

    Science.gov (United States)

    Walsh, K C

    1989-08-01

    The establishment of a hospital-wide wound care program is a monumental endeavor requiring mobilization of all available resources. The clinical nurse specialist in a community hospital acted as a change agent to facilitate the formation of a wound care task force, development of wound care protocols and the purchase of wound care products to address the problem of pressure ulcers. With the theory of planned change as a framework, the driving and resisting forces at work are depicted and unanticipated events that speeded and impeded the change process are revealed. Collaboration between nursing and other disciplines is discussed with recommendations offered to other practitioners considering implementation of a wound care program.

  1. Standard Review Plan Maintenance Program implementing procedures document

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The implementing Procedures Document (IPD) was developed by the Inspection Program Projects Branch, Office of Nuclear Reactor Regulation, with assistance from Pacific Northwest National Laboratory, for the Standard Review Plan Maintenance Program (SRP-MP). The SRP-MP was established to maintain the Standard Review Plan (SRP) on an on-going basis. The IPD provides guidance, including an overall approach and procedures, for SRP-MP tasks. The objective of the IPD is to ensure that modifications to SRP need to reflect current NRC requirements and guidance are identified and that a consistent methodology is used to develop and revise SRP sections.

  2. Implementing a farmers' market incentive program: perspectives on the New York City Health Bucks Program.

    Science.gov (United States)

    Payne, Gayle Holmes; Wethington, Holly; Olsho, Lauren; Jernigan, Jan; Farris, Rosanne; Walker, Deborah Klein

    2013-08-29

    One strategy for lowering the prevalence of obesity is to increase access to and affordability of fruits and vegetables through farmers' markets. However, little has been documented in the literature on the implementation of such efforts. To address this gap, the Division of Nutrition, Physical Activity, and Obesity (DNPAO) sponsored an evaluation of the New York City Health Bucks program, a farmers' market coupon incentive program intended to increase access to fresh fruits and vegetables in underserved neighborhoods while supporting local farmers. We conducted a process evaluation of Health Bucks program implementation. We interviewed 6 farmer/vendors, 3 market managers, and 4 program administrators, and collected data on site at 86 farmers' markets, including surveys of 81 managers and 141 farmer/vendors on their perspectives on promotion and redemption of the incentive coupons; knowledge and attitudes regarding the program; experiences with markets and products; and facilitators and barriers to program participation. Results indicate that respondents view Health Bucks as a positive program model. Farmers' market incentive coupon programs like Health Bucks are one strategy to address the problem of obesity and were associated with higher fruit and vegetable access and purchases in low-income communities. This evaluation identified some areas for improving implementation of the Health Bucks program. Farmers' market incentive programs like Health Bucks may be one avenue to increase access to and affordability of fruits and vegetables among low-income persons. Further research is needed to assess the potential effects of these programs on access and health outcomes.

  3. SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective

    Energy Technology Data Exchange (ETDEWEB)

    James, J; Place, V; Panda, A [Mayo Clinic, Scottsdale, AZ (United States); Edmonson, H [Mayo Clinic College of Medicine, Rochester, MN (United States); Felmlee, J [Mayo Clinic, Rochester, MN (United States); Pooley, R [Mayo Clinic, Jacksonville, FL (United States)

    2014-06-01

    Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality is compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over

  4. The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

    Science.gov (United States)

    Del Boca, Frances K; McRee, Bonnie; Vendetti, Janice; Damon, Donna

    2017-02-01

    Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. Overview and narrative description of the SBIRT Program Matrix. The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts. © 2017 Society for the Study of Addiction.

  5. Proposed guidelines for international clinical education in US-based physical therapist education programs: results of a focus group and Delphi Study.

    Science.gov (United States)

    Pechak, Celia M; Black, Jill D

    2014-04-01

    Physical therapist students are increasingly engaging in international clinical education (ICE). The growth of international engagement has been accompanied by appeals to ensure that these experiences are conducted in an ethical manner. Although detailed guidelines have been developed to guide global health training in general, they do not specifically address all aspects relevant to ICE in physical therapist education. The purpose of this study was to systematically develop recommendations for the implementation of ICE in physical therapist education to promote ethical practice. An initial virtual focus group of 5 physical therapist faculty with expertise in ICE provided input to review and revise global health training guidelines previously developed by non-physical therapists. The revised guidelines were distributed to a pool of 19 physical therapist faculty with ICE experience for additional review and revision through 3 online Delphi survey rounds. The participants accepted 31 of the original guidelines with or without revisions, rejected 2 guidelines, and developed 10 new guidelines or subguidelines. Most notably, they rejected a guideline related to students pursuing training outside of a structured program, stressing that ICE should never be done outside of a formal program. The primary limitation is that the study included only faculty from sending institutions and thus lacked the voices of the host institutions, students, partner organizations, or funders. This study systematically produced guidelines for ICE in physical therapist education using a range of ICE experts from sending institutions. The recommendations may be used by educators and other decision makers to optimally design new ICE opportunities or to improve existing ones. Additional validation should be done to ensure relevance for all stakeholders.

  6. User's Manual for Program PeakFQ, Annual Flood-Frequency Analysis Using Bulletin 17B Guidelines

    Science.gov (United States)

    Flynn, Kathleen M.; Kirby, William H.; Hummel, Paul R.

    2006-01-01

    Estimates of flood flows having given recurrence intervals or probabilities of exceedance are needed for design of hydraulic structures and floodplain management. Program PeakFQ provides estimates of instantaneous annual-maximum peak flows having recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years (annual-exceedance probabilities of 0.50, 0.20, 0.10, 0.04, 0.02, 0.01, 0.005, and 0.002, respectively). As implemented in program PeakFQ, the Pearson Type III frequency distribution is fit to the logarithms of instantaneous annual peak flows following Bulletin 17B guidelines of the Interagency Advisory Committee on Water Data. The parameters of the Pearson Type III frequency curve are estimated by the logarithmic sample moments (mean, standard deviation, and coefficient of skewness), with adjustments for low outliers, high outliers, historic peaks, and generalized skew. This documentation provides an overview of the computational procedures in program PeakFQ, provides a description of the program menus, and provides an example of the output from the program.

  7. Improving Service Quality of Rusunawa Implementation Program in Kudus

    Directory of Open Access Journals (Sweden)

    Septiana Pancawati

    2014-02-01

    Full Text Available Development of housing and settlements are still faced the main problems as follows: the limited supply of homes, inadequate housing that is not supported by infrastructure, environmental facilities and public utilities, as well as the growing slums widespread. Government issues Rusunawa Implementation Program to overcome those problems. However some problems arose in its implementation, such as poor environmental condition, poor building quality, inadequate infrastructure and public services. The objectives of the research are to describe, to analyze, and to interpret things as follows: (1 The management of Rusunawa implementation program in order to improve service quality, (2 Improving service quality of Rusunawa program by the authorities. This research used qualitative method with descriptive approach. Information can be obtained byinterview stakeholders, field observations and documentation. From research findings, there are some records that should be highlighted as follows: (1 Rusunawa construction and its supervision influence the building quality. Low performance of those service providers will result in low building quality and vice versa. (2 Rent arrears are higher, an indication of dissatisfaction Rusunawa residents during they stay there. Keywords: Rusunawa, building condition, service quality

  8. Pile Structure Program, Projected Start Date : January 1, 2010 (Implementation).

    Energy Technology Data Exchange (ETDEWEB)

    Collins, Chris; Corbett, Catherine [Lower Columbia River Estuary Partnership; Ebberts, Blaine [U.S. Army Corps of Engineers

    2009-07-27

    The 2008 Federal Columbia River Power System Biological Opinion includes Reasonable and Prudent Alternative 38-Piling and Piling Dike Removal Program. This RPA directs the Action Agencies to work with the Estuary Partnership to develop and implement a piling and pile dike removal program. The program has since evolved to include modifying pile structures to enhance their habitat value and complexity by adding large woody debris. The geographic extent of the Pile Structure Program (PSP) includes all tidally-influenced portions of the lower Columbia River below Bonneville Dam; however, it will focus on the mainstem. The overarching goal of the PSP is to enhance and restore ecosystem structure and function for the recovery of federally listed salmonids through the active management of pile structures. To attain this goal, the program team developed the following objectives: (1) Develop a plan to remove or modify pile structures that have lower value to navigation channel maintenance, and in which removal or modification will present low-risk to adjacent land use, is cost-effective, and would result in increased ecosystem function. (2) Determine program benefits for juvenile salmonids and the ecosystem through a series of intensively monitored pilot projects. (3) Incorporate best available science and pilot project results into an adaptive management framework that will guide future management by prioritizing projects with the highest benefits. The PSP's hypotheses, which form the basis of the pilot project experiments, are organized into five categories: Sediment and Habitat-forming Processes, Habitat Conditions and Food Web, Piscivorous Fish, Piscivorous Birds, and Toxic Contaminant Reduction. These hypotheses are based on the effects listed in the Estuary Module (NOAA Fisheries in press) and others that emerged during literature reviews, discussions with scientists, and field visits. Using pilot project findings, future implementation will be adaptively managed

  9. Effectiveness of supporting intensive care units on implementing the guideline 'End-of-life care in the intensive care unit, nursing care': a cluster randomized controlled trial.

    Science.gov (United States)

    Noome, Marijke; Dijkstra, Boukje M; van Leeuwen, Evert; Vloet, Lilian C M

    2017-06-01

    The aim of this study was to examine the effectiveness of supporting intensive care units on implementing the guidelines. Quality of care can be achieved through evidence-based practice. Guidelines can facilitate evidence-based practice, such as the guidelines 'End-of-life care in the intensive care unit, nursing care'. Before intensive care nurses are able to use these guidelines, they needs to be implemented in clinical practice. Implementation is a complex process and may need support. Cluster randomized controlled trial. Intensive care nurses of eight intensive care units in the intervention group followed a supportive programme that educated them on implementation, strategies, goals, project management and leadership. The intervention group focused on a stepwise approach to implement the guidelines. The control group (n = 5) implemented the guidelines independently or used the standard implementation plan supplementary to the guideline. The effectiveness of the programme was measured using questionnaires for nurses, interviews with nurses and a questionnaire for family of deceased patients, in the period from December 2014-December 2015. Overall, an increase in adherence to the guidelines was found in both groups. Overall, use of the guidelines in the intervention group was higher, but on some aspects the control group showed a higher score. Care for the patient and the overall nursing care scored significantly higher according to family in the intervention group. The increase in adherence to the guidelines and the significantly higher satisfaction of family in the intervention group indicate that the supportive programme had a more positive effect. © 2016 John Wiley & Sons Ltd.

  10. Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice.

    Science.gov (United States)

    Coombs, Maureen; Puntillo, Kathleen A; Franck, Linda S; Scruth, Elizabeth A; Harvey, Maurene A; Swoboda, Sandra M; Davidson, Judy E

    2017-01-01

    Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College of Critical Care Medicine/Society of Critical Care Medicine, explore the evidence base in 5 key areas of family-centered care. Evidence in each of the guideline areas is outlined and recommendations are made about how critical care nurses can use this information in family-centered care practice. ©2017 American Association of Critical-Care Nurses.

  11. Toward public health nutrition strategies in the European Union to implement food based dietary guidelines and to enhance healthier lifestyles.

    Science.gov (United States)

    Stockley, L

    2001-04-01

    This paper suggests strategies for implementing the EU food based dietary guidelines. Dietary guidelines have been developed and disseminated in many countries across the world. However, the EU guidelines are the first to include a specific section on implementation. The aims of the guidelines are twofold, 1) to provide food based dietary guidelines which can be used as a consistent communication tool and 2) as a springboard to planning, implementing, and evaluating public health nutrition strategies. The report is not intended to be prescriptive. It aims to build upon a solid evidence base to provide practical and cost effective suggestions for developing public health strategies, which member countries can use and tailor to the social, cultural and health needs of their populations. Diet and physical activity related diseases impose vast costs on the European economy. However, despite the enormous costs to healthcare systems and in terms of lost productivity, there have been a very few resources allocated in Europe to attempting to prevent these, rather than treating them. The burden of disease exists in the majority of the population, and not in high-risk groups. The optimal public health strategy is thus to focus on the population as a whole, rather than targeting those with increased risk factors or pre-existing disease. Reviews have been carried out on the health impact effectiveness of various types of intervention to promote healthy eating and physical activity in the population. These conclude that the most effective interventions a) adopt an integrated, multidisciplinary, and comprehensive approach b) involve a complementary range of actions, and c) work at an individual, community, environmental and policy level. Information provision in isolation is not effective, and may exacerbate inequalities in health. In some countries inequities in diet and physical activity are not only significant contributors to inequalities in health, but are increasing

  12. Adopting and implementing nutrition guidelines in recreational facilities: public and private sector roles. A multiple case study.

    Science.gov (United States)

    Olstad, Dana Lee; Raine, Kim D; McCargar, Linda J

    2012-05-25

    Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children's access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers' nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for

  13. Implementation of psychiatric-focused lifestyle medicine programs in Asia.

    Science.gov (United States)

    Sarris, Jerome; Nishi, Daisuke; Xiang, Yu-Tao; Su, Kuan-Pin; Bannatyne, Amy; Oliver, Georgina; Kua, Ee-Heok; Ng, Chee Hong

    2015-12-01

    Lifestyle-focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle-focused health programs to enhance mental and physical health are considered to include the evidence-based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal-setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures. © 2015 Wiley Publishing Asia Pty Ltd.

  14. Implementation of R & QA practices in Research and Development programs

    Science.gov (United States)

    Bankaitis, H.

    1983-01-01

    DOE has established a number of broad programs aimed at reducing fuel consumption. Several programs address the R&D of ground transportation propulsion alternatives to the conventional spark-ignition engine. NASA Lewis is responsible for managing the effort between the Government and industry teams involving American and foreign companies. Thus, existing NASA SR&QA procedure were modified/adapted to these R&D programs and implemented to assure that the test hardware design intent was met, the hardware was not hazardous to personnel, it would demonstrate reliable operation, and it would help establish the future R&D quality assurance and maintainability requirements. This successful low-cost approach might be applicable to other similar projects.

  15. Implementation of a Psychosocial Intervention Program for Working Caregivers.

    Science.gov (United States)

    Jimenez, Daniel E; Schulz, Richard; Perdomo, Dolores; Lee, Chin Chin; Czaja, Sara J

    2017-12-01

    The overall aim of this pilot study was to examine the feasibility and acceptability of a multicomponent, psychosocial intervention specifically designed to meet the unique needs of caregivers who are balancing caregiving duties with work responsibilities. Seventy-one family caregivers employed at a private, nonprofit institution in South Florida were randomized to either the Caregiver Workstation condition ( n = 35) or a control condition ( n = 36). Sixty-two caregivers completed the 5-month follow-up. Our results indicate that an intervention tailored to the time demands of a working caregiver is feasible, acceptable to caregivers, and has the potential to have positive long-term effects. Currently, there are limited data available regarding the benefits of employer programs for caregivers or the type of programs caregivers find most useful. This pilot study is the first step in developing a working caregiver intervention program that can be implemented on a broad-scale basis.

  16. DIRKS: putting ISO 15489 to work: any records manager using ISO 15489 to develop a new program or evaluate an existing one should become familiar with the DIRKS implementation process

    National Research Council Canada - National Science Library

    Macintosh, Stephen; Real, Lynne

    2007-01-01

    ... implementation document for ISO 15489: ISO/TR 15489-2 Information and Documentation--Records Management--Part 2: Guidelines. Any records manager using ISO 15489--either in developing a new program or evaluating an existing one--should become familiar with the related implementation process known as DIRKS (Developing and Implementing a Recordkeeping Sy...

  17. Challenges in the implementation of the EAACI AIT guidelines

    DEFF Research Database (Denmark)

    Ryan, D; Gerth van Wijk, R; Angier, E

    2017-01-01

    PURPOSE: The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe. METHODS: We undertook a mixed-methods, situational analysis. This ...

  18. Clinical implementation of guidelines for cardioverter defibrillator implantation: lost in translation?

    NARCIS (Netherlands)

    Borleffs, C. J. W.; Wilde, A. A. M.; Cramer, M. J. M.; Wever, E.; Mosterd, A.

    2007-01-01

    Purpose: Guidelines for implantation of cardioverter defibrillators (ICD) are increasingly including indications for primary prevention of sudden cardiac death in high-risk groups, where ICDs were traditionally implanted for secondary prevention. We performed a single-centre audit to evaluate

  19. Utility Green Pricing Programs: Design, Implementation, and Consumer Response

    Energy Technology Data Exchange (ETDEWEB)

    Bird, L.; Swezey, B.; Aabakken, J.

    2004-02-01

    The term green pricing refers to programs offered by utilities in traditionally regulated electricity markets, which allow customers to support the development of renewable energy sources by paying a small premium on their electric bills. Since the introduction of the concept in the United States, the number of unique utility green pricing programs has expanded from just a few programs in 1993 to more than 90 in 2002. About 10% of U.S. utilities offered a green pricing option to about 26 million consumers by the end of 2002. This report provides: (1) aggregate industry data on consumer response to utility programs, which indicate the collective impact of green pricing on renewable energy development nationally; and (2) market data that can be used by utilities as a benchmark for gauging the relative success of their green pricing programs. Specifically, the paper presents current data and trends in consumer response to green pricing, as measured by renewable energy sales, participants, participation rates, and new renewable energy capacity supported. It presents data on various aspects of program design and implementation, such as product pricing, ownership of supplies, retention rates, marketing costs, the effectiveness of marketing techniques, and methods of enrolling and providing value to customers.

  20. Translation of tobacco control programs in schools: findings from a rapid review of systematic reviews of implementation and dissemination interventions.

    Science.gov (United States)

    Wolfenden, L; Carruthers, J; Wyse, R; Yoong, S

    2014-08-01

    School-based programs targeting the prevention of tobacco use are a key strategy for reducing the overall tobacco-related mortality and morbidity in the community. While substantial research investment has resulted in the identification of various effective tobacco prevention interventions in schools, this research investment will not result in public health benefits, unless effectively disseminated and implemented. This rapid review aimed to identify effective implementation or dissemination interventions, targeting the adoption of school-based tobacco prevention programs. A systematic search was conducted to identify published systematic reviews that examined the effectiveness of implementation and dissemination strategies for facilitating the adoption of tobacco policies or programs in schools from 1992 to 2012. The search yielded 1028 results, with one relevant systematic review being identified. The review included two controlled studies examining the implementation and dissemination of tobacco prevention programs and guidelines. The two randomised trials examined the delivery of active face-to-face training to implement a school-based curriculum compared with video-delivered or mail-based training. Improvements in the implementation of the programs were reported for the face-to-face training arm in both trials. Little rigorous evidence exists to guide the implementation and dissemination of tobacco prevention programs in schools. SO WHAT? Few systematic reviews exist to inform the implementation of evidence-based tobacco prevention programs in schools. In the absence of a strong evidence base, health care policymakers and practitioners may need to draw on setting-based frameworks or parallel evidence from other settings to design strategies to facilitate the adoption of tobacco prevention initiatives.

  1. Economic evaluation of active implementation versus guideline dissemination for evidence-based care of acute low-back pain in a general practice setting.

    Directory of Open Access Journals (Sweden)

    Duncan Mortimer

    Full Text Available INTRODUCTION: The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. METHODS: Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination against standard dissemination alone. RESULTS: The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective, yielding savings of $135 per x-ray referral avoided (-$462.93/3.43. However, confidence intervals around point estimates for the primary outcome suggest that--irrespective of willingness to pay (WTP--we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. CONCLUSIONS: Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.

  2. Using health promotion guidelines for persons with disabilities to develop and evaluate a physical activity program for individuals with multiple sclerosis: A feasibility study.

    Science.gov (United States)

    Dixon-Ibarra, Alicia; Nery-Hurwit, Mara; Driver, Simon; MacDonald, Megan

    2017-04-01

    The Health Education for Persons with Multiple Sclerosis (HEMS) program was developed in response to the need for interventions aimed at increasing physical activity for individuals with Multiple Sclerosis (MS). It was developed and evaluated using Drum and colleagues (2009) guidelines for implementing health promotion programs for individuals with disabilities. The purpose of this feasibility study is to describe the development, implementation, and evaluation of the HEMS program. Thirteen individuals with MS completed the 8-week health education program. A mixed method approach for evaluation was implemented (i.e., survey and focus groups). Process and resource feasibility demonstrated that over half of the participants attended at least 80% of the weekly sessions. Focus group data provided valuable feedback for future iterations of the program including critiques on the delivery, content, and group support provided. Outcome evaluation showed increases in self-efficacy (survey), improvements in theoretical constructs (focus groups), and increased physical activity (focus groups). Results show that health promotion programs for persons with MS can improve physical activity and related constructs. Next steps will be to revise, implement, and reevaluate the HEMS program in a larger randomized control trial. Published by Elsevier Ltd.

  3. Healthcare professionals' and policy makers' views on implementing a clinical practice guideline of hypertension management: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Ping Yein Lee

    Full Text Available Most studies have reported barriers to guideline usage mainly from doctors' perspective; few have reported the perspective of other stakeholders. This study aimed to determine the views and barriers to adherence of a national clinical practice guideline (CPG on management of hypertension from the perspectives of policymakers, doctors and allied healthcare professionals.This study used a qualitative approach with purposive sampling. Seven in depth interviews and six focus group discussions were conducted with 35 healthcare professionals (policy makers, doctors, pharmacists and nurses at a teaching hospital in Kuala Lumpur, Malaysia, between February and June 2013. All interviews were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyse the data.Two main themes and three sub-themes emerged from this study. The main themes were (1 variation in the use of CPG and (2 barriers to adherence to CPG. The three sub-themes for barriers were issues inherent to the CPG, systems and policy that is not supportive of CPG use, and attitudes and behaviour of stakeholders. The main users of the CPG were the primary care doctors. Pharmacists only partially use the guidelines, while nurses and policy makers were not using the CPG at all. Participants had suggested few strategies to improve usage and adherence to CPG. First, update the CPG regularly and keep its content simple with specific sections for allied health workers. Second, use technology to facilitate CPG accessibility and provide protected time for implementation of CPG recommendations. Third, incorporate local CPG in professional training, link CPG adherence to key performance indicators and provide incentives for its use.Barriers to the use of CPG hypertension management span across all stakeholders. The development and implementation of CPG focused mainly on doctors with lack of involvement of other healthcare stakeholders. Guidelines should be made simple, current

  4. Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial.

    NARCIS (Netherlands)

    Visschere, L. De; Schols, J.; Putten, G.J. van der; Baat, C. de; Vanobbergen, J.

    2012-01-01

    OBJECTIVE: To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium). BACKGROUND: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline 'Oral health care in care homes for elderly people' was

  5. Implementation and evaluation of a nursing home fall management program.

    Science.gov (United States)

    Rask, Kimberly; Parmelee, Patricia A; Taylor, Jo A; Green, Diane; Brown, Holly; Hawley, Jonathan; Schild, Laura; Strothers, Harry S; Ouslander, Joseph G

    2007-03-01

    To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs). A quality improvement project with data collection throughout FMP implementation. NHs in Georgia owned and operated by a single nonprofit organization. All residents of participating NHs. A convenience sample of 19 NHs implemented the FMP. The FMP is a multifaceted quality improvement and culture change intervention. Key components included organizational leadership buy-in and support, a designated facility-based falls coordinator and interdisciplinary team, intensive education and training, and ongoing consultation and oversight by advanced practice nurses with expertise in falls management. Process-of-care documentation using a detailed 24-item audit tool and fall and physical restraint use rates derived from quality improvement software currently used in all Georgia NHs (MyInnerView). Care process documentation related to the assessment and management of fall risk improved significantly during implementation of the FMP. Restraint use decreased substantially during the project period, from 7.9% to 4.4% in the intervention NHs (a relative reduction of 44%), and decreased in the nonintervention NHs from 7.0% to 4.9% (a relative reduction of 30%). Fall rates remained stable in the intervention NHs (17.3 falls/100 residents per month at start and 16.4 falls/100 residents per month at end), whereas fall rates increased 26% in the NHs not implementing the FMP (from 15.0 falls/100 residents/per month to 18.9 falls/100 residents per month). Implementation was associated with significantly improved care process documentation and a stable fall rate during a period of substantial reduction in the use of physical restraints. In contrast, fall rates increased in NHs owned by the same organization that did not implement the FMP. The FMP may be a helpful tool for NHs to manage fall risk while attempting to reduce physical restraint use in response to the Centers for

  6. Facilitating as a guidelines implementation tool to target resources for high risk patients - the Helsinki Prevention Programme (HPP).

    Science.gov (United States)

    Sipilä, Raija; Ketola, Eeva; Tala, Tiina; Kumpusalo, Esko

    2008-01-01

    Interprofessional care may provide some answers to the challenge of scarce healthcare resources, through the utilization of the expertise of various professionals to improve evidence-based care. This was a two-year programme in primary care, where doctor and nurse pairs acted as intrinsic facilitators creating and implementing local guidelines and encouraging multiprofessional teamwork. The effect of implementation was studied by auditing professional opinion change, blood pressure, serum lipid and HbA1C levels. After one year, 20 health stations reported improvement in treatment practices of hypertension and the division of tasks across team members, and seven and eight health stations reported improvement in treatment of diabetes and dyslipidemia. After two years, the corresponding figures were 29, 25 and 22, respectively. Active guidance to home measurements increased from 90% to 100% and every health station identified a dedicated area for patient self-measurement. At baseline, in poor control were 17% of blood pressure measurements, and 31% of diabetic and 71% of dyslipidemic patients. At follow-up, the corresponding figures were 22%, 34% and 64%, respectively. Multiprofessional facilitation and learning proved to be effective in implementing guidelines, improving multiprofessional collaboration and sharing duties and responsibilities, as well as targeting preventative activities and resources adequately.

  7. Systematic tailoring for the implementation of guideline recommendations for anxiety and depressive disorders in general practice: perceived usefulness of tailored interventions

    NARCIS (Netherlands)

    Sinnema, H.; Terluin, B.; Wensing, M.; Volker, D.; Franx, G.; Balkom, A. van; Lange, J.

    2013-01-01

    BACKGROUND: The uptake of guideline recommendations in general practice can potentially be improved by designing implementation interventions that are tailored to prospectively identify barriers. However, there is insufficient evidence regarding the most effective and efficient approaches to

  8. Systematic tailoring for the implementation of guideline recommendations for anxiety and depressive disorders in general practice: perceived usefulness of tailored interventions

    NARCIS (Netherlands)

    Sinnema, H.; Terluin, B.; Wensing, M.; Volker, D.; Franx, G.; van Balkom, A.J.L.M.; de Lange, J.

    2013-01-01

    Background: The uptake of guideline recommendations in general practice can potentially be improved by designing implementation interventions that are tailored to prospectively identify barriers. However, there is insufficient evidence regarding the most effective and efficient approaches to

  9. The Triple P Implementation Framework: the Role of Purveyors in the Implementation and Sustainability of Evidence-Based Programs.

    Science.gov (United States)

    McWilliam, Jenna; Brown, Jacquie; Sanders, Matthew R; Jones, Liz

    2016-07-01

    Evidence-based programs are considered critical in the human services field if major social and health problems are to be addressed. Despite the large number of programs that have been developed and implemented, there is much to learn about how to effectively implement these programs in community settings. One perspective that is rarely represented in the literature is that of the purveyor organization (an organization that actively works to disseminate and support the implementation of a program or practice). This paper introduces the Triple P Implementation Framework, developed by the program's purveyor organization, and discusses principles underlying the design and implementation of the Framework. The Framework incorporates two key underlying principles of the Triple P system: minimal sufficiency and self-regulation. Lessons learned from the application of these principles and the implementation process are discussed, along with directions for future research.

  10. Implementing embedded artificial intelligence rules within algorithmic programming languages

    Science.gov (United States)

    Feyock, Stefan

    1988-01-01

    Most integrations of artificial intelligence (AI) capabilities with non-AI (usually FORTRAN-based) application programs require the latter to execute separately to run as a subprogram or, at best, as a coroutine, of the AI system. In many cases, this organization is unacceptable; instead, the requirement is for an AI facility that runs in embedded mode; i.e., is called as subprogram by the application program. The design and implementation of a Prolog-based AI capability that can be invoked in embedded mode are described. The significance of this system is twofold: Provision of Prolog-based symbol-manipulation and deduction facilities makes a powerful symbolic reasoning mechanism available to applications programs written in non-AI languages. The power of the deductive and non-procedural descriptive capabilities of Prolog, which allow the user to describe the problem to be solved, rather than the solution, is to a large extent vitiated by the absence of the standard control structures provided by other languages. Embedding invocations of Prolog rule bases in programs written in non-AI languages makes it possible to put Prolog calls inside DO loops and similar control constructs. The resulting merger of non-AI and AI languages thus results in a symbiotic system in which the advantages of both programming systems are retained, and their deficiencies largely remedied.

  11. Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section.

    Science.gov (United States)

    Lomas, J; Enkin, M; Anderson, G M; Hannah, W J; Vayda, E; Singer, J

    1991-05-01

    A randomized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section. The guideline recommended clinical actions to increase trial of labor and vaginal birth rates. Charts for all 3552 cases in the study groups were audited. After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group, but rates were 46% and 85% higher, respectively, among physicians educated by an opinion leader. Duration of hospital stay was lower in the opinion leader education group than in the other two groups. The overall cesarean section rate was reduced only in the opinion leader education group. There were no adverse clinical outcomes attributable to the interventions. The use of opinion leaders improved the quality of care.

  12. Canadian Association of Gastroenterology policy on the application for, and implementation of, clinical practice guidelines.

    Science.gov (United States)

    Singh, Harminder; Leontiadis, Grigorios I; Hookey, Lawrence; Enns, Robert; Bistritz, Lana; Rioux, Louis-Charles; Hope, Louise; Sinclair, Paul

    2014-10-01

    An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association's governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research; Improving patient care provided by members by providing focus on quality and evidence; Creating legislative environments that favour effective clinical practice; Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; and Identifying areas that require further information or research to improve clinical care. The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement.

  13. Implementing hospital guidelines improves warfarin use in non-valvular atrial fibrillation: a before-after study

    Directory of Open Access Journals (Sweden)

    Piobbici Marina

    2007-08-01

    Full Text Available Abstract Background The use of oral anticoagulant therapy (OAT to prevent non-valvular atrial fibrillation (NVAF related-strokes is often sub-optimal. We aimed to evaluate whether implementing guidelines on antithrombotic therapy (AT by a multifaceted strategy may improve appropriateness of its prescription in NVAF-patients discharged from a large tertiary-care hospital. Methods A survey was conducted on all consecutive NVAF patients discharged before (1st January–30th June 2000, n = 313 and after (1st January–30th June 2004, n = 388 guideline development and implementation. Results When strongly recommended, OAT use increased from 56.6% (60/106 in 2000 to 81.9% (86/105 in 2004, with an absolute difference of +25.3% (95%CI: 15% 35%. In patients for whom the choice OAT/acetylsalicylic acid should be individualised, those discharged without any AT were 33.7% (34/101 in 2000 and 16.9% (21/124 in 2004 (-16.7%;95%CI: -26.2% -7.2%. In a logistic regression model, OAT prescription in 2004 was increased by 2.11 times (95%CI: 1.47 3.04, after accounting for stroke risk, presence of contraindications (OR = 0.18; 0.13 0.27, older age (OR = 0.30; 0.21 0.45, prophylaxis at admission (OR = 3.03; 2.08 4.43. OAT was positively associated with the stroke risk in the 2004 sample only. Conclusion The guideline implementation has substantially improved the appropriateness of OAT at discharge, through a better evaluation at patient's individual level of the benefit-to-risk ratio.

  14. New features of the National Cholesterol Education Program Adult Treatment Panel III lipid-lowering guidelines.

    Science.gov (United States)

    Brewer, H Bryan

    2003-04-01

    The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines for lipid-lowering therapy to reduce coronary heart disease (CHD) risk contain a number of features that distinguish them from the previous ATP guidelines. These new features include modifications in lipid/lipoprotein levels considered optimal, abnormal, or reflective of risk; increased focus on primary prevention through use of Framingham risk scoring to define risk in persons with multiple lipid/nonlipid risk factors; and increased focus on the association of the metabolic syndrome with CHD risk. The introduction of the category of CHD risk equivalents-including persons with atherosclerotic disease, diabetes, or 10-year CHD risk > 20% based on Framingham scoring-results in an increase over previous guidelines in the proportion of patients categorized as being at high risk and therefore eligible for more intensive low-density lipoprotein cholesterol (LDL-C)-lowering therapy. Use of the new secondary therapeutic target of non-high-density lipoprotein cholesterol should improve management of lipid risk factors in patients who have elevated triglyceride levels after LDL-C goals have been met. These new features of the NCEP ATP III guidelines should improve identification and treatment of patients with dyslipidemias associated with CHD risk.

  15. A theory-based evaluation of a dissemination intervention to improve childcare cooks? intentions to implement nutritional guidelines on their menus

    OpenAIRE

    Yoong, Sze Lin; Jones, Jannah; Marshall, Josephine; Wiggers, John; Seward, Kirsty; Finch, Meghan; Fielding, Alison; Wolfenden, Luke

    2016-01-01

    Background Childcare services represent a key setting to implement nutritional interventions to support the development of healthy eating behaviours in young children. Childcare-specific nutritional guidelines outlining recommendations for provision of food in care have been developed. Despite this, research suggests that few childcare services currently implement these guidelines. This study aimed to examine the impact of providing printed educational materials on childcare service cooks? in...

  16. Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice.

    Science.gov (United States)

    Saunders, Hannele

    2015-07-01

    To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.

  17. Clinical Pharmacogenetics Implementation Consortium guidelines for cytochrome P450 2D6 genotype and codeine therapy: 2014 update.

    Science.gov (United States)

    Crews, K R; Gaedigk, A; Dunnenberger, H M; Leeder, J S; Klein, T E; Caudle, K E; Haidar, C E; Shen, D D; Callaghan, J T; Sadhasivam, S; Prows, C A; Kharasch, E D; Skaar, T C

    2014-04-01

    Codeine is bioactivated to morphine, a strong opioid agonist, by the hepatic cytochrome P450 2D6 (CYP2D6); hence, the efficacy and safety of codeine are governed by CYP2D6 activity. Polymorphisms are a major cause of CYP2D6 variability. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for codeine based on CYP2D6 genotype. This document is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for CYP2D6 genotype and codeine therapy.

  18. Measure Guideline. Five Steps to Implement the Public Housing Authority Energy-Efficient Unit Turnover Checklist

    Energy Technology Data Exchange (ETDEWEB)

    Liaukus, Christine [Building American Research Alliance, Kent, WA (United States)

    2015-07-09

    Five Steps to Implementing the PHA Energy Efficient Unit Turnover Package (ARIES, 2014) is a guide to prepare for the installation of energy efficient measures during a typical public housing authority unit turnover. While a PHA is cleaning, painting and readying a unit for a new resident, there is an opportunity to incorporate energy efficiency measures to further improve the unit's performance. The measures on the list are simple enough to be implemented by in-house maintenance personnel, inexpensive enough to be folded into operating expenses without needing capital budget, and fast enough to implement without substantially changing the number of days between occupancies, a critical factor for organizations where the demand for dwelling units far outweighs the supply. The following guide lays out a five step plan to implement the EE Unit Turnover Package in your PHA, from an initial Self-Assessment through to Package Implementation.

  19. Implementation of the Danish return-to-work program

    DEFF Research Database (Denmark)

    Aust, Birgit; D. Nielsen, Maj Britt; Grundtvig, Gry

    2015-01-01

    (defined as implementation consistent with the principles of the interdisciplinary RTW process). Five municipalities had high and eight had low fidelity scores. Similar large differences were found with regard to dose-delivered, particularly in the quality of cooperation with beneficiaries, employers...... of the Danish RTW program, however, large variations existed between municipalities. Establishment of well-functioning interdisciplinary RTW teams might require more time and resources, while ensuring early assessment and more frequent cooperation with employers might need more general adjustments in the Danish...

  20. Experience of adapting and implementing an evidence-based nursing guideline for prevention of diaper dermatitis in a paediatric oncology setting.

    Science.gov (United States)

    Espirito Santo, Anelise; Choquette, Anne

    2013-06-01

    Diaper dermatitis is one of the most common skin problems in children often caused by irritants that promote skin breakdown, such as moisture and faecal enzymes. It has been estimated that the incidence of diaper dermatitis is as high as 50% in children receiving chemotherapy. The scientific literature suggests a variety of preventative measures, but only a minority are systematically tested and supported by clinical evidence. The purpose of this paper is to adapt and implement a skincare guideline to better prevent diaper dermatitis in the paediatric oncology population. The Knowledge to Action process was used to guide the adaptation and implementation of the new guideline. As part of this process, different tools were used to identify and review selected knowledge (Appraisal of Guidelines Research Evaluation instrument), to tailor and adapt knowledge to the local context (ADAPTE process), to implement interventions (Registered Nurses' Association of Ontario toolkit) and to evaluate outcomes (qualitative analysis). The main outcomes measured included implementation of the guideline and nursing practice change. The guideline was successfully implemented as reported by nurses in focus group sessions and as measured by changes in nursing documentation. The implementation of the guideline was successful on the account of the interplay of three core elements: The level and nature of the evidence; the context in which the research was placed; the method in which the process was facilitated. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

  1. Dynamics of the public concern and risk communication program implementation.

    Science.gov (United States)

    Zaryabova, Victoria; Israel, Michel

    2015-09-01

    The public concern about electromagnetic field (EMF) exposure varies due to different reasons. A part of them are connected with the better and higher quality of information that people receive from science, media, Internet, social networks, industry, but others are based on good communication programs performed by the responsible institutions, administration and persons. Especially, in Bulgaria, public concern follows interesting changes, some of them in correlation with the European processes of concern, but others following the economic and political processes in the country. Here, we analyze the dynamics of the public concern over the last 10 years. Our explanation of the decrease of the people's complaints against EMF exposure from base stations for mobile communication is as a result of our risk communication program that is in implementation for >10 years.

  2. Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the meantime, some challenges and recommendations.

    Science.gov (United States)

    Martin, Seth S; Metkus, Thomas S; Horne, Aaron; Blaha, Michael J; Hasan, Rani; Campbell, Catherine Y; Yousuf, Omair; Joshi, Parag; Kaul, Sanjay; Miller, Michael; Michos, Erin D; Jones, Steven R; Gluckman, Ty J; Cannon, Christopher P; Sperling, Laurence S; Blumenthal, Roger S

    2012-07-15

    The National Cholesterol Education Program Adult Treatment Panel (ATP) has provided education and guidance for decades on the management of hypercholesterolemia. Its third report (ATP III) was published 10 years ago, with a white paper update in 2004. There is a need for translation of more recent evidence into a revised guideline. To help address the significant challenges facing the ATP IV writing group, this statement aims to provide balanced recommendations that build on ATP III. The authors aim for simplicity to increase the likelihood of implementation in clinical practice. To move from ATP III to ATP IV, the authors recommend the following: (1) assess risk more accurately, (2) simplify the starting algorithm, (3) prioritize statin therapy, (4) relax the follow-up interval for repeat lipid testing, (5) designate <70 mg/dl as an "ideal" low-density lipoprotein cholesterol target, (6) endorse targets beyond low-density lipoprotein cholesterol, (7) refine therapeutic target levels to the equivalent population percentile, (8) remove misleading descriptors such as "borderline high," and (9) make lifestyle messages simpler. In conclusion, the solutions offered in this statement represent ways to translate the totality of published reports into enhanced hyperlipidemia guidelines to better combat the devastating impact of hyperlipidemia on cardiovascular health. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Implementing good participatory practice guidelines in the FEM-PrEP Preexposure Prophylaxis Trial for HIV Prevention among African Women: a focus on local stakeholder involvement

    Directory of Open Access Journals (Sweden)

    Mack N

    2013-10-01

    Full Text Available Natasha Mack,1 Stella Kirkendale,1 Paul Omullo,2 Jacob Odhiambo,2 Malebo Ratlhagana,3 Martha Masaki,4 Phumzile Siguntu,5 Kawango Agot,2 Khatija Ahmed,3 Saidi Kapiga,4 Johan Lombaard,5 Lut Van Damme,1 Amy Corneli1 1FHI 360, Durham, NC, USA; 2Impact Research and Development Organization, Bondo, Kenya; 3Setshaba Research Centre, Soshanguve, South Africa; 4Kilimanjaro Christian Medical Center, Moshi, Tanzania; 5Josha Research, Bloemfontein, South Africa Abstract: Biomedical HIV-prevention research is most likely to succeed when researchers actively engage with community stakeholders. To this effect, the Joint United Nations Programme on HIV/AIDS and the AIDS Vaccine Advocacy Coalition developed good participatory practice guidelines for biomedical HIV-prevention trials in 2007 and updated them in 2011. The Preexposure Prophylaxis Trial for HIV Prevention among African Women (FEM-PrEP clinical trial, testing once-daily Truvada as preexposure prophylaxis among women at higher risk of HIV in Kenya, South Africa, and Tanzania, included a community program to engage with local stakeholders. Following the trial, we revisited the community program to situate activities in the context of the 2011 guidelines. In the paper, we describe implementation of the six guidelines relevant to local stakeholder engagement – stakeholder advisory mechanisms, stakeholder engagement plan, stakeholder education plan, communications plan, issues management plan, trial closure, and results dissemination – in light of on-the-ground realities of the trial. We then identify two cross-cutting themes from our considerations: (1 stakeholder education beyond the good participatory practice recommendation to increase research literacy about the specific trial is needed; education efforts should also communicate a base of information on HIV transmission and prevention; and (2 anticipatory preparation is useful in communications planning, issues management, and trial closure and

  4. Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences.

    Science.gov (United States)

    Chimeddamba, Oyun; Peeters, Anna; Ayton, Darshini; Tumenjargal, Enkhjargal; Sodov, Sonin; Joyce, Catherine

    2015-08-11

    Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting. A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework. The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased

  5. Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.

    LENUS (Irish Health Repository)

    Sheehan, Sharon R

    2012-02-01

    OBJECTIVE: Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. STUDY DESIGN: We conducted a survey of practice in the five individual countries of Great Britain and Ireland. A postal questionnaire was sent to all lead consultant obstetricians and anaesthetists with responsibility for the labour ward. We explored the use of oxytocin bolus and infusion, the measurement of blood loss at caesarean section and the rates of major haemorrhage. Existing clinical guidelines from the National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) and ALSO (Advanced Life Support in Obstetrics) were used to benchmark reported practice against recommended practice for the management of blood loss at caesarean section. RESULTS: The response rate was 82% (391 respondents). Use of a 5 IU oxytocin bolus was reported by 346 respondents (85-95% for individual countries). In some countries, up to 14% used a 10 IU oxytocin bolus despite recommendations against this. Routine use of an oxytocin infusion varied greatly between countries (11% lowest-55% highest). Marked variations in choice of oxytocin regimens were noted with inconsistencies in the country-specific recommendations, e.g. NICE (which covers England and Wales) recommends a 30 IU oxytocin infusion over 4h, but only 122 clinicians (40%) used this. CONCLUSIONS

  6. The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study.

    Science.gov (United States)

    Narayanaswami, Pushpa; Gronseth, Gary; Dubinsky, Richard; Penfold-Murray, Rebecca; Cox, Julie; Bever, Christopher; Martins, Yolanda; Rheaume, Carol; Shouse, Denise; Getchius, Thomas S D

    2015-08-13

    Evidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences. Our aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines "Complementary and alternative medicine in multiple sclerosis" ("CAM in MS") and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations. Outcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians ("physicians"). The primary outcome was the difference in participants' intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS). Response rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence

  7. Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines

    Directory of Open Access Journals (Sweden)

    E. L. Mc Goldrick

    2016-10-01

    Full Text Available Abstract Background The ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand antenatal corticosteroid clinical practice guidelines among health professionals, using the Theoretical Domains Framework. Methods Semi-structured interviews or online questionnaires were conducted across four health professional groups and three district health boards in Auckland, New Zealand. The questions were constructed to reflect the 14 behavioural domains from the Theoretical Domains Framework. Relevant domains were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour using thematic analysis. The influence of health professional group and organisation on the different barriers and enablers identified were explored. Results Seventy-three health professionals completed either a semi-structured interview (n = 35 or on-line questionnaire (n = 38. Seven behavioural domains were identified as overarching enablers: belief about consequences; knowledge; social influences; environmental context and resource; belief about capabilities; social professional role and identity; and behavioural regulation. Five behavioural domains were identified as overarching barriers: environmental context and resources; knowledge; social influences; belief about consequences; and social professional role and identity. Differences in beliefs between individual health professional groups were identified within the domains: belief about consequences; social professional role and identity; and emotion. Organisational differences were identified within the domains: belief about consequences; social influences; and belief about capabilities. Conclusion This study has identified some of the

  8. Implementation and Monitoring of a Gestational Trophoblastic Disease Management Program in a Tertiary Hospital in Morocco: Opportunities and Challenges

    Directory of Open Access Journals (Sweden)

    Imane Khachani

    2017-01-01

    Full Text Available Objective. Gestational Trophoblastic Disease (GTD management requires clear guidelines for diagnosis, treatment, and follow-up. Unequal management skills among practitioners, inadequate treatment, irregular surveillance, and drop-out are common in resource-limited settings and can lead to life-threatening complications and morbidities. To address these challenges, we implemented a GTD Management Program at the National Center for Reproductive Health in Rabat, Morocco. Methods and Program Description. In-depth review of management protocols was carried out, and concise guidelines were developed, with targeted training for physicians. A physical space and a weekly fixed GTD consultation were set, and personalized follow-up was established for each patient. An electronic database documenting patients’ surveillance was created, allowing immediate outreach in case of irregularities. Results. During the period from October 2013 to June 2016, 50 patients were included in this program. Patients’ mean age was 33 years; 92% were illiterate and 82% had a low socioeconomic status. 68% had a positive evolution, while 32% developed gestational trophoblastic neoplasia, requiring 2 to 6 chemotherapy sessions. An average of 2.8 outreach reminders were necessary for each patient. 94% fully adhered to the program of care and completed properly their follow-up. Conclusion. Implementation and thorough monitoring of this program helped optimize patients’ care, avoiding drop-outs and delays in diagnosing and treating complications.

  9. Implementation and Monitoring of a Gestational Trophoblastic Disease Management Program in a Tertiary Hospital in Morocco: Opportunities and Challenges

    Science.gov (United States)

    Alami, Mohamed Hassan; Bezad, Rachid

    2017-01-01

    Objective. Gestational Trophoblastic Disease (GTD) management requires clear guidelines for diagnosis, treatment, and follow-up. Unequal management skills among practitioners, inadequate treatment, irregular surveillance, and drop-out are common in resource-limited settings and can lead to life-threatening complications and morbidities. To address these challenges, we implemented a GTD Management Program at the National Center for Reproductive Health in Rabat, Morocco. Methods and Program Description. In-depth review of management protocols was carried out, and concise guidelines were developed, with targeted training for physicians. A physical space and a weekly fixed GTD consultation were set, and personalized follow-up was established for each patient. An electronic database documenting patients' surveillance was created, allowing immediate outreach in case of irregularities. Results. During the period from October 2013 to June 2016, 50 patients were included in this program. Patients' mean age was 33 years; 92% were illiterate and 82% had a low socioeconomic status. 68% had a positive evolution, while 32% developed gestational trophoblastic neoplasia, requiring 2 to 6 chemotherapy sessions. An average of 2.8 outreach reminders were necessary for each patient. 94% fully adhered to the program of care and completed properly their follow-up. Conclusion. Implementation and thorough monitoring of this program helped optimize patients' care, avoiding drop-outs and delays in diagnosing and treating complications. PMID:28567058

  10. Implementation and Monitoring of a Gestational Trophoblastic Disease Management Program in a Tertiary Hospital in Morocco: Opportunities and Challenges.

    Science.gov (United States)

    Khachani, Imane; Alami, Mohamed Hassan; Bezad, Rachid

    2017-01-01

    Objective. Gestational Trophoblastic Disease (GTD) management requires clear guidelines for diagnosis, treatment, and follow-up. Unequal management skills among practitioners, inadequate treatment, irregular surveillance, and drop-out are common in resource-limited settings and can lead to life-threatening complications and morbidities. To address these challenges, we implemented a GTD Management Program at the National Center for Reproductive Health in Rabat, Morocco. Methods and Program Description. In-depth review of management protocols was carried out, and concise guidelines were developed, with targeted training for physicians. A physical space and a weekly fixed GTD consultation were set, and personalized follow-up was established for each patient. An electronic database documenting patients' surveillance was created, allowing immediate outreach in case of irregularities. Results. During the period from October 2013 to June 2016, 50 patients were included in this program. Patients' mean age was 33 years; 92% were illiterate and 82% had a low socioeconomic status. 68% had a positive evolution, while 32% developed gestational trophoblastic neoplasia, requiring 2 to 6 chemotherapy sessions. An average of 2.8 outreach reminders were necessary for each patient. 94% fully adhered to the program of care and completed properly their follow-up. Conclusion. Implementation and thorough monitoring of this program helped optimize patients' care, avoiding drop-outs and delays in diagnosing and treating complications.

  11. Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation.

    Science.gov (United States)

    Benjamin-Chung, Jade; Sultana, Sonia; Halder, Amal K; Ahsan, Mohammed Ali; Arnold, Benjamin F; Hubbard, Alan E; Unicomb, Leanne; Luby, Stephen P; Colford, John M

    2017-05-01

    To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. SHEWA-B did not meet UNICEF's ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B's design was suboptimal for improving these outcomes.

  12. Canadian Association of Gastroenterology Policy on the Application for, and Implementation of, Clinical Practice Guidelines

    Directory of Open Access Journals (Sweden)

    Harminder Singh

    2014-01-01

    Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research;Improving patient care provided by members by providing focus on quality and evidence;Creating legislative environments that favour effective clinical practice;Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; andIdentifying areas that require further information or research to improve clinical care.The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement.

  13. Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy: 2013 Update

    Science.gov (United States)

    Scott, S A; Sangkuhl, K; Stein, C M; Hulot, J-S; Mega, J L; Roden, D M; Klein, T E; Sabatine, M S; Johnson, J A; Shuldiner, A R

    2013-01-01

    Cytochrome P450 (CYP)2C19 catalyzes the bioactivation of the antiplatelet prodrug clopidogrel, and CYP2C19 loss-of-function alleles impair formation of active metabolites, resulting in reduced platelet inhibition. In addition, CYP2C19 loss-of-function alleles confer increased risks for serious adverse cardiovascular (CV) events among clopidogrel-treated patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary intervention (PCI). Guideline updates include emphasis on appropriate indication for CYP2C19 genotype–directed antiplatelet therapy, refined recommendations for specific CYP2C19 alleles, and additional evidence from an expanded literature review (updates at http://www.pharmgkb.org). PMID:23698643

  14. A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention.

    Science.gov (United States)

    Semin-Goossens, Astrid; van der Helm, Jelle M J; Bossuyt, Patrick M M

    2003-01-01

    An evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a 30% reduction. Implementation had failed though. Between 1999 and 2001 the guideline was updated. A multifaceted intervention was chosen based on a model for implementing change. The study was performed in 2 wards. All recommendations of Grol's 5-step implementation model were followed. The aim was a reduction of 30% in fall incidence within a year. Data on falls were extracted from nursing records and Incidence Report Forms (IRFs). In a pilot study an average of 9 falls per 1000 patients per day had been recorded in the department of internal medicine and 16 in the neurology ward. Given the desired reduction of 30%, the target averages were 6 and 11 falls respectively. During the intervention year the average incidences were 8 and 13 falls (95% CI: 6-11 and 10-15). There was a changeable pattern over time without any declining trend. The percentage filled in IRFs varied strongly, with an average of 52% in the department of internal medicine and 60% in the neurology department. There has been no durable decrease in monthly falls despite the use of a model-based procedure for implementing change. Neither did we observe any improvement in filling in IRFs. It can be questioned if the nurses themselves did experience patient falls to be troublesome enough. Investigating this is difficult though. Although the most successful strategy still appears to be changing attitudes of nurses in order to increase fall prevention, there is no clear strategy on how to create this successfully.

  15. Implementation of physical activity programs after COPD hospitalizations: Lessons from a randomized study.

    Science.gov (United States)

    Benzo, Roberto; Wetzstein, Marnie; Neuenfeldt, Pamela; McEvoy, Charlene

    2015-02-01

    Pulmonary rehabilitation (PR), following an acute exacerbation of chronic obstructive pulmonary disease (COPD), has been found effective in some studies in reducing readmission rates as and has recently been recommended by the PR guidelines. However, very recent reports suggested that PR is not feasible after a hospital admission for a COPD exacerbation. The objective of this study is to investigate the knowledge gap on the underlying reasons for nonparticipation in PR in the posthospitalization period. We qualitatively analyzed the responses of 531 patients hospitalized for a COPD exacerbation who were not interested in participating in either PR (home or center based) or physical activity monitoring program after being discharged from the hospital. The responses were coded thematically, and independent reviewers compiled the raw data into themes. The characteristics of the 531 subjects (45% male) who declined the intervention are as follows: age was 70 ± 10 years, mean forced expiratory volume in one second (FEV1%) predicted 40 ± 16, and age, dyspnea, and airflow obstruction index 6.0 ± 1.6 (scale 0-10). The themes for not attending include lack of interest (39%), the perception of "being too ill or frail or disabled" (24%), the perception of being "too busy or having too much to do" (11%), distance or the need of travel (11%), commitment issues (7%), comorbidities (6%), and lack of social support (2%). We identified barriers for PR or just physical activity programs after a hospitalization that may affect implementation of such programs. Implementing posthospitalizations program in COPD may require patient engagement and mindful and compassionate professionals who may individualize program components to focus specific deficits and particularly patients' preferences. © The Author(s) 2014.

  16. Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

    Directory of Open Access Journals (Sweden)

    Dogherty Elizabeth J

    2012-02-01

    Full Text Available Abstract Background Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. Methods To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. Results The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were

  17. Behavioural effect of self-treatment guidelines in a self-management program for adults with asthma

    NARCIS (Netherlands)

    Palen, J.A.M. van der; Klein, J.J.; Zielhuis, G.A.; Herwaarden, C.L.A. van; Seydel, E.R.

    2001-01-01

    To assess the efficacy of self-management programs it is important to know what behavioural changes take place. This paper assesses whether including self-treatment guidelines (action plans) in a self-management program for adult asthmatics, leads to greater behavioural changes than a program

  18. Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools.

    Science.gov (United States)

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-07-01

    The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen. © 2010 Blackwell Publishing Ltd.

  19. Clinical practice guideline adherence before and after implementation of the HEARTFELT (HEART Failure Effectiveness & Leadership Team) intervention.

    Science.gov (United States)

    Dykes, Patricia C; Acevedo, Kim; Boldrighini, Jodie; Boucher, Carole; Frumento, Katherine; Gray, Peggy; Hall, Danielle; Smith, Lisa; Swallow, Anne; Yarkoni, Alon; Bakken, Suzanne

    2005-01-01

    HEART Failure Effectiveness & Leadership Team (HEARTFELT) is a multifaceted intervention designed to improve adherence with the American College of Cardiology/American Heart Association practice guidelines for heart failure (HF). The purpose of this study was to assess differences in clinician adherence with clinical practice guidelines before and after implementation of HEARTFELT. A quasi-experimental, untreated control group design with separate pretest/posttest samples was employed at a community hospital in Connecticut. The untreated historical control group included patients aged 65 years or older with HF and a nonequivalent comparison group of patients with stroke. The posttest samples included patients with the diagnosis of HF and stroke admitted after implementation of the HEARTFELT intervention. The HEARTFELT intervention included automated pathway in electronic medical record (order sets, interdisciplinary plan of care, self-management plan), access to evidence for clinicians and patients, HF self-management education tools, and ongoing discipline-specific feedback regarding adherence. Data were analyzed using parametric and nonparametric methods. The HEARTFELT intervention significantly improved clinician adherence with addressing all self-management categories in the electronic medical record (P = .000) and adherence with self-management education given to the patient in writing at discharge (P = .000). There were no significant differences in adherence with medical interventions (P = .39). While guideline adherence is associated with less practice variation and improved processes, methods of integration into practice in community hospital settings have been largely unexplored. The multifaceted HEARTFELT intervention is promising for its potential to integrate evidence at the point of care, to reduce unwarranted variation in practice, and ultimately to improve the outcomes of individuals with HF.

  20. Guidelines for youth sports clubs to develop, implement, and assess health promotion within its activities.

    Science.gov (United States)

    Kokko, Sami

    2014-05-01

    The settings approach to health promotion is a world-known concept concerning settings like city, hospital, school, and workplace. The concept has also been used in some regionally specific settings, such as island, prison, or university. However, there are still many, often noninstitutional, settings that have a lot of potential but have not yet been recognized. One of the newcomers is the youth sports club, which has the potential to reach a lot of children and adolescents and is effective, via its casual educational nature based on voluntary participation. According to research, health is an important aim for most youth sports clubs, but it has not been converted into practical actions. Indeed, the clubs often recognize the importance of healthy lifestyles, but there is a lack of understanding of what to do to reinforce it within one's activities. That is why, on the basis of the results of the Health Promoting Sports Club survey in Finland, guidelines for clubs to enhance health promotion as a part of their activities were created. The aim of this article is to present the guidelines, theirs rationale, and practical examples.

  1. Midwife or doctor local opinion leader to implement a national guideline in babies on postnatal wards (DesIGN): protocol of a cluster-randomised, blinded, controlled trial.

    Science.gov (United States)

    Alsweiler, Jane Marie; Crowther, Caroline A; Harding, Jane E

    2017-11-22

    Neonatal hypoglycaemia is a common condition that can cause developmental delay. Treatment of neonatal hypoglycaemia with oral dextrose gel has been shown to reverse hypoglycaemia and reduce admissions to neonatal intensive care for hypoglycaemia. An evidence-based clinical practice guideline was written to guide the use of dextrose gel to treat neonatal hypoglycaemia in New Zealand. However, it is unclear what clinical discipline might most effectively lead the implementation of the guideline recommendations. To determine if midwife or doctor local opinion leaders are more effective in implementing a clinical practice guideline for use of oral dextrose gel to treat hypoglycaemia in babies on postnatal wards. A cluster-randomised, blinded, controlled trial. New Zealand maternity hospitals that care for babies born at risk of neonatal hypoglycaemia will be randomised to having either a local midwife or doctor lead the guideline implementation at that hospital. The primary outcome will be the change in the proportion of hypoglycaemic babies treated with dextrose gel from before implementation of the guideline to 3 months after implementation. Approved by Health and Disability Ethics Committee: 15/NTA/31. Findings will be disseminated to peer-reviewed journals, guideline developers and the public. ISRCTN61154098. © 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.

  2. Translating infection control guidelines into practice: implementation process within a health care institution.

    Science.gov (United States)

    Raveis, Victoria H; Conway, Laurie J; Uchida, Mayuko; Pogorzelska-Maziarz, Monika; Larson, Elaine L; Stone, Patricia W

    2014-04-01

    Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants' narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate.

  3. Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

    Directory of Open Access Journals (Sweden)

    Olstad Dana

    2012-05-01

    Full Text Available Abstract Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter

  4. Project Hanford Management Contract (PHMC) pollution prevention program implementation plan

    Energy Technology Data Exchange (ETDEWEB)

    Place, B.G., Westinghouse Hanford

    1996-12-31

    This plan documents the Project Hanford Management Contract (PHMC) Pollution Prevention/Waste Minimization (P2/WMin) Program. The subject implementation plan has been updated to reflect the Fiscal Year (FY) 1997 contract structure in which Fluor Daniel Hanford, Inc. (FDH) is the management and integration contractor. The P2/WMin Program scope includes FDH as the principal PHMC contractor, and B&W Hanford Company (BWHC), Duke Engineering & Services Hanford, Inc. (DESH), Lockheed Martin Hanford Corporation, (LMHC), Numatec Hanford Corporation (NHC), Rust Federal Services of Hanford, Inc. (RFSH), and DynCorp Tri-Cities Services, Inc. (DYN) as PHMC contractors, as well as subcontracting enterprise companies, such as Fluor Daniel Northwest, Inc. (FDNW), Lockheed Martin Services, Inc. (LMSI), and Rust Federal Services Northwest (RFS), which provide engineering, operation, construction, maintenance, and computer services for the Hanford Site. The P2/WMin Program scope also includes all other subcontractor-affiliated enterprise companies, such as B&W Protec, Inc. (BWP), DE&S Northwest, Inc. (DESNW), and SGN Eurisys Services Corp. (SESC).

  5. Development and Implementation of An Administrative Internship Program

    Directory of Open Access Journals (Sweden)

    Esther Wermuth

    2017-04-01

    Full Text Available This article describes the development and implementation of a pilot program to prepare teachers seeking New York state certification as school district administrators, by assigning them as administrative interns to a school district. The superintendent of a large urban school district and the director of a college program to prepare school district administrators partnered to design a pilot experiential course in which candidates for a master’s degree and state certificate would have an opportunity to develop skills and learn by experiencing situations that support new learning (Kolb, 1984, to take the place of an existing internship course for eight candidates. The dual purpose was to provide an authentic learning experience for the candidates and to provide actionable information for the superintendent for improvement of the district instructional program. To identify areas of academic concern, the candidates reviewed the New York State District Report Card1, conducted research, and interviewed district personnel in order to be able tomake actionable suggestions and recommendations to the superintendent that might result in academic improvement. Findings and recommendations to inform district improvement efforts and for improvement of the existing course were presented to the superintendent and his administrative staff. Recommendations are included.

  6. Implementing the NPDES program: An update on the WET ...

    Science.gov (United States)

    The U.S. EPA has utilized the Clean Water Act - National Pollutant Discharge Elimination System permitting program to protect waters of the U.S for over 40 years. NPDES permit effluent limitations serve as the primary mechanism for controlling discharges of pollutants to receiving waters. When developing effluent limitations for an NPDES permit, a permit writer must consider limits based on both the technology available to control the pollutants (i.e., technology-based effluent limits) and limits that are protective of the water quality standards of the receiving water (i.e., water quality-based effluent limits). WET testing is one of the water quality-based effluent limitation mechanisms available to permit writers that is useful in determining how the additive, synergistic and compounding effects of toxic effluents effect streams. This presentation will provide an overview of the current EPA NPDES permit program direction for increasing the efficacy of NPDES permits program administered by the U.S. EPA and States. The training implementation plan is expected to provide permit writers with a clearer understanding of WET requirements as established via the U.S. EPA WET test manuals, NPDES permitting regulatory authorities, and the WET science which has been long established. not applicable

  7. Open Groups: Adaptations in Implementing a Parent Training Program

    Directory of Open Access Journals (Sweden)

    Donna-Jean P. Brock

    2013-12-01

    Full Text Available Background: Programs that focus on positive parenting have been shown to improve parental attitudes, knowledge, and behaviors, and increase parent and child bonding. These programs are typically conducted in a closed group format. However, when individual or community needs are more immediate, programmers sometimes opt for an open group format. To determine the effectiveness of this adaptation to an open group format, the present study compared both groups on parental outcomes. Methods: Both closed and open group formats were offered and implemented between January 2009 and December 2012. Participants for both formats were recruited through similar means and the format placement for each family was determined by the immediacy of the need for an intervention, the time lapse until a new cycle would begin, and scheduling flexibility. Chi-Square analyses were conducted to determine demographic differences between the two groups and gain scores were calculated from the pre- and post-test AAPI-2 scales within a mixed MANOVA to determine group for-mat effectiveness. Results: Though open groups contained higher risk families; parental out-come improvements were significant for both groups. All participants, regardless of group membership, demonstrated the same statistically significant improvements following completion of the program. Conclusion: Findings provide support for adapting group formats when necessary to fit community and individual needs.

  8. Barriers of clinical practice guidelines development and implementation in developing countries: A case study in Iran

    Directory of Open Access Journals (Sweden)

    Zahra Baradaran Seyed

    2013-01-01

    Conclusion: The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed.

  9. Challenges to implementing the food-based dietary guidelines in the ...

    African Journals Online (AJOL)

    Conclusions: The principals and curriculum advisors anticipated many barriers to the success of implementing nutrition education using the FBDG in the primary school curriculum. Adequately addressing such barriers through improved awareness and knowledge of the FBDG by school staff could improve the potential of ...

  10. Effect of editors' implementation of CONSORT guidelines on the reporting of abstracts in high impact medical journals: interrupted time series analysis.

    Science.gov (United States)

    Hopewell, Sally; Ravaud, Philippe; Baron, Gabriel; Boutron, Isabelle

    2012-06-22

    To investigate the effect of the CONSORT for Abstracts guidelines, and different editorial policies used by five leading general medical journals to implement the guidelines, on the reporting quality of abstracts of randomised trials. Interrupted time series analysis. We randomly selected up to 60 primary reports of randomised trials per journal per year from five high impact, general medical journals in 2006-09, if indexed in PubMed with an electronic abstract. We excluded reports that did not include an electronic abstract, and any secondary trial publications or economic analyses. We classified journals in three categories: those not mentioning the guidelines in their instructions to authors (JAMA and New England Journal of Medicine), those referring to the guidelines in their instructions to authors but with no specific policy to implement them (BMJ), and those referring to the guidelines in their instructions to authors with an active policy to implement them (Annals of Internal Medicine and Lancet). Two authors extracted data independently using the CONSORT for Abstracts checklist. Mean number of CONSORT items reported in selected abstracts, among nine items reported in fewer than 50% of the abstracts published across the five journals in 2006. We assessed 955 reports of abstracts of randomised trials. Journals with an active policy to enforce the guidelines showed an immediate increase in the level of mean number of items reported (increase of 1.50 items; P=0.0037). At 23 months after publication of the guidelines, the mean number of items reported per abstract for the primary outcome was 5.41 of nine items, a 53% increase compared with the expected level estimated on the basis of pre-intervention trends. The change in level or trend did not increase in journals with no policy to enforce the guidelines (BMJ, JAMA, and New England Journal of Medicine). Active implementation of the CONSORT for Abstracts guidelines by journals can lead to improvements in the

  11. Implementation of a primary care physician network obesity management program.

    Science.gov (United States)

    Bowerman, S; Bellman, M; Saltsman, P; Garvey, D; Pimstone, K; Skootsky, S; Wang, H J; Elashoff, R; Heber, D

    2001-11-01

    Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10-minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House-Calls, Mobile, AL). Patients were seen for follow-up by their physician at weeks 4, 12, 24, 36 and 52. A total of 252 patients (202 women and 50 men) were referred by 18 primary care physicians to the program. The comorbid conditions reported for all patients at baseline included low back pain, 29% (n = 72); hypertension, 45% (n = 113); hypercholesterolemia, 41% (n = 104); type 2 diabetes, 10% (n = 26); and sleep apnea, 5% (n = 12). When offered a choice of meal plans based on foods or meal replacements, two-thirds of patients (n = 166) chose to use meal replacements (Ultra Slim-Fast; Slim-Fast Foods Co., West Palm Beach, FL) at least once daily. Baseline weights of subjects averaged 200 +/- 46 lb for women (n = 202) and 237 +/- 45 lb for men (n = 50). Patients completing 6 months in the program lost an average of 19.0 +/- 4.0 lb for women (n = 94) and 15.5 +/- 8.2 lb for men (n = 26). Physicians reported a high degree of satisfaction with the program, suggesting that a brief, effective physician-directed program with nutritionist support by telephone can be implemented in a busy primary care office.

  12. Implementation of Client Incentives within a Recovery Navigation Program.

    Science.gov (United States)

    Brolin, Mary; Torres, Maria; Hodgkin, Dominic; Horgan, Constance; Lee, Margaret; Merrick, Elizabeth; Ritter, Grant; Panas, Lee; DeMarco, Natasha; Hopwood, Jonna; Gewirtz, Andrea; Straus, John; Harrington, Janice; Lane, Nancy

    2017-01-01

    Multiple detoxification admissions among clients with substance use disorders (SUD) are costly to the health care system. This study explored the impact on behavior and cost outcomes of recovery support navigator (RSN) services delivered with and without a contingent incentive intervention. New intakes at four detoxification programs were offered RSN-only (N=1116) or RSN plus incentive (RSN+I; N=1551) services. The study used a group-level cross-over design with the intervention in place at each clinic reversed halfway through the enrollment period. RSN+I clients could earn up to $240 in gift cards for accomplishing 12 different recovery-oriented target behaviors. All eligible clients entering the detoxification programs were included in the analyses, regardless of actual service use. Among RSN+I clients, 35.5% accessed any RSN services compared to 22.3% in the RSN-only group (p<.01). Of RSN+I clients, 19% earned one, 12% earned two and 18% earned three or more incentives; 51% did not earn any incentives. The majority of incentives earned were for meeting with the RSN either during or after detoxification. Adjusted average monthly health care costs among clients in the RSN-only and RSN+I groups increased at a similar rate over 12 months post-detoxification. Possible explanations for limited uptake of the incentive program discussed include features of the incentive program itself, navigator-client communication, organizational barriers and navigator bias. The findings provide lessons to consider for future design and implementation of multi-target contingency management interventions in real-world settings. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Update on the National Cholesterol Education Program Adult Treatment Panel III guidelines: getting to goal.

    Science.gov (United States)

    McKenney, James M

    2003-09-01

    Considerable data on the pathophysiology, epidemiology, and treatment of dyslipidemia-induced coronary heart disease (CHD) have accumulated in recent years. These data have been assessed and incorporated into the guidelines of the National Cholesterol Education Program Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel [ATP] III). A major focus of the new guidelines is the assessment of the near-term (i.e., 10-yr) risk of experiencing a CHD event and matching the intensity of treatment to this risk. Patients with diabetes and those with a greater than 20% 10-year risk of experiencing a CHD event have been elevated to the risk level of CHD equivalent. The ATP III guidelines also modify several lipid and lipoprotein classifications. A low-density lipoprotein cholesterol (LDL) level below 100 mg/dl is now considered optimum for all individuals. In addition, high-density lipoprotein cholesterol (HDL) and triglyceride cutoff points have been modified to reflect more accurately the risk associated with abnormalities in these lipoproteins. As with the previous guidelines, the primary target of therapy remains LDL. Therapeutic lifestyle changes consisting of diet, weight reduction, and increased physical activity should be included in all treatment regimens. Based on their potent LDL-lowering properties and their proven ability to decrease mortality in a variety of patient populations, statins are generally the first choice for pharmacologic therapy. A secondary target of therapy includes non-HDL goals for patients with high triglyceride levels and the metabolic syndrome, which is characterized by abdominal obesity, elevated triglyceride levels, low HDL levels, and insulin resistance. Management of these secondary targets includes weight reduction and increased physical activity, and treatment of the lipid and nonlipid risk factors. Overall, ATP III represents an aggressive approach to treating dyslipidemia

  14. Design and Implementation of the Futhark Programming Language

    DEFF Research Database (Denmark)

    Henriksen, Troels

    reasoning. Fifth, we perform an evaluation on 21 benchmarks that demonstrates the impact of the language and compiler features, and shows application-level performance that is in many cases competitive with hand-written GPU code. Sixth, we make the Futhark compiler freely available with full source code......In this thesis we describe the design and implementation of Futhark, a small data-parallel purely functional array language that offers a machine-neutral programming model, and an optimising compiler that generates efficient OpenCL code for GPUs. The overall philosophy is based on seeking a middle...... sequentialised, while keeping access patterns intact, which then permits further locality-of-reference optimisations. We demonstrate this capability by showing instances of automatic loop tiling, as well as optimising memory access patterns. Second, to support the flattening transformation, we present...

  15. Survey of Implementation of Antiemetic Prescription Standards in Indian Oncology Practices and Its Adherence to the American Society of Clinical Oncology Antiemetic Clinical Guideline

    Science.gov (United States)

    Patil, Vijay; Noronha, Vanita; Joshi, Amit; Parikh, Purvish; Bhattacharjee, Atanu; Chakraborty, Santam; Jandyal, Sunny; Muddu, Vamshi; Ramaswamy, Anant; Babu, K. Govinda; Lokeshwar, Nilesh; Hingmire, Sachin; Ghadyalpatil, Nikhil; Banavali, Shripad

    2017-01-01

    Purpose Adherence to international antiemetic prophylaxis guidelines like those of ASCO can result in better control of chemotherapy-induced nausea and vomiting; however, the extent of implementation of such guidelines in India is unknown. Therefore, this survey was planned. Methods This study was an anonymized cross-sectional survey approved by the ethics committee. Survey items were generated from the clinical questions given in the ASCO guidelines. The survey was disseminated through personal contacts at an oncology conference and via e-mail to various community oncology centers across India. The B1, B2, and B3 domains included questions regarding the optimal antiemetic prophylaxis for high, moderate, and low-minimal emetogenic regimens. Results Sixty-six (62.9%) of 105 responded and 65 centers (98.5%) were aware of the published guidelines. The partial, full, and no implementation scores were 92.5%, 4.5%, and 3.0%, respectively. Full implementation was better for the low-minimal emetogenic regimens (34.8%) than the highly emetogenic regimens (6.1%). The three most frequent reasons for hampered implementation of ASCO guidelines in routine chemotherapy practice cited by centers were a lack of sensitization (26 centers; 39.4%), lack of national guidelines (12 centers; 18.2%), and lack of administrative support (10 centers; 15.2%). Conclusion Awareness regarding ASCO antiemetic guidelines is satisfactory in Indian oncology practices; however, there is a need for sensitization of oncologists toward complete implementation of these guidelines in their clinical practice. PMID:28831443

  16. Survey of Implementation of Antiemetic Prescription Standards in Indian Oncology Practices and Its Adherence to the American Society of Clinical Oncology Antiemetic Clinical Guideline

    Directory of Open Access Journals (Sweden)

    Vijay Patil

    2017-08-01

    Full Text Available Purpose: Adherence to international antiemetic prophylaxis guidelines like those of ASCO can result in better control of chemotherapy-induced nausea and vomiting; however, the extent of implementation of such guidelines in India is unknown. Therefore, this survey was planned. Methods: This study was an anonymized cross-sectional survey approved by the ethics committee. Survey items were generated from the clinical questions given in the ASCO guidelines. The survey was disseminated through personal contacts at an oncology conference and via e-mail to various community oncology centers across India. The B1, B2, and B3 domains included questions regarding the optimal antiemetic prophylaxis for high, moderate, and low-minimal emetogenic regimens. Results: Sixty-six (62.9% of 105 responded and 65 centers (98.5% were aware of the published guidelines. The partial, full, and no implementation scores were 92.5%, 4.5%, and 3.0%, respectively. Full implementation was better for the low-minimal emetogenic regimens (34.8% than the highly emetogenic regimens (6.1%. The three most frequent reasons for hampered implementation of ASCO guidelines in routine chemotherapy practice cited by centers were a lack of sensitization (26 centers; 39.4%, lack of national guidelines (12 centers; 18.2%, and lack of administrative support (10 centers; 15.2%. Conclusion: Awareness regarding ASCO antiemetic guidelines is satisfactory in Indian oncology practices; however, there is a need for sensitization of oncologists toward complete implementation of these guidelines in their clinical practice.

  17. Energy Efficiency Finance Programs: Use Case Analysis to Define Data Needs and Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Larsen, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Kramer, Chris [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Goldman, Charles [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-07-01

    There are over 200 energy efficiency loan programs—across 49 U.S. states—administered by utilities, state/local government agencies, or private lenders.1 This distributed model has led to significant variation in program design and implementation practices including how data is collected and used. The challenge of consolidating and aggregating data across independently administered programs has been illustrated by a recent pilot of an open source database for energy efficiency financing program data. This project was led by the Environmental Defense Fund (EDF), the Investor Confidence Project, the Clean Energy Finance Center (CEFC), and the University of Chicago. This partnership discussed data collection practices with a number of existing energy efficiency loan programs and identified four programs that were suitable and willing to participate in the pilot database (Diamond 2014).2 The partnership collected information related to ~12,000 loans with an aggregate value of ~$100M across the four programs. Of the 95 data fields collected across the four programs, 30 fields were common between two or more programs and only seven data fields were common across all programs. The results of that pilot study illustrate the inconsistencies in current data definition and collection practices among energy efficiency finance programs and may contribute to certain barriers.

  18. Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence

    Directory of Open Access Journals (Sweden)

    Tim Stokes

    2016-10-01

    Full Text Available Abstract Background Maternal mortality remains a major international health problem in low- and middle-income countries (LMIC, and most could have been prevented by quality improvement interventions already demonstrated to be effective, such as clinical guideline implementation strategies. The aim of this systematic review was to synthesise qualitative evidence on guideline implementation strategies to improve obstetric care practice in LMIC in order to identify barriers and enablers to their successful implementation. Methods We searched MEDLINE and CINAHL databases for articles reporting research findings on barriers and enablers to guideline implementation strategies in obstetric care practice in LMIC. We conducted a “best fit” framework synthesis of the included studies. We used an organisational “stages of change” model as our a priori framework for the synthesis. Results Nine studies were included: all were based in Sub-Saharan Africa and in hospital health care facilities. The majority of studies (seven evaluated one particular guideline implementation strategy: clinical audit and feedback (both criterion-based audit and maternal death reviews, and a minority (two evaluated educational interventions. A range of barriers and enablers to successful guideline implementation was identified. A key finding of the framework synthesis was that “high” and “low” intrinsic health care professional motivation are overall enablers and barriers, respectively, of successful guideline implementation. We developed a modified “stages of change” model to take account of these findings. Conclusion We have identified a number of quality improvement processes that are amenable to change at limited or no additional cost, although some identified barriers may be difficult to address without increased resources. We note the pathways to implementation may be complex and require further research to develop our understanding of individual and

  19. The Work Disability Prevention CIHR Strategic Training Program: program performance after 5 years of implementation.

    Science.gov (United States)

    Loisel, Patrick; Hong, Quan Nha; Imbeau, Daniel; Lippel, Katherine; Guzman, Jaime; Maceachen, Ellen; Corbière, Marc; Santos, Brenda R; Anema, Johannes R

    2009-03-01

    The Work Disability Prevention (WDP) Canadian Institutes of Health Research (CIHR) Strategic Training Program was developed in 2001 and is a unique program in the world. The main objective of this program is to help future researchers develop transdisciplinary knowledge, skills and attitudes regarding WDP. The purpose of this paper is to present a descriptive portrait of the program's performance over the past 5 years, as well as the trainees' and alumni's perspectives on the WDP CIHR Training Program. Data on the program's performance were collected from documents in the program records. The trainees' opinions on the WDP training program were obtained through focus groups and telephone interviews. The data collected were compiled and divided into themes to summarize the qualitative findings pertaining to each question. From 2003 to 2007, five successive summer sessions have been offered, involving 44 high-caliber applicants from nine countries, 34 mentors and collaborators, 29 guest speakers and 15 stakeholders. Overall, trainees appreciated the networking, the opportunity to interact with people from different disciplines and countries, the openness, and the international perspective and uniqueness of the program. The least appreciated aspects concerned mainly the e-learning course, evaluations and information on optional courses. The coordination and logistics were judged appropriate and several topics were suggested to improve the program quality. In general, the program implementation went well, with good participation from mentors, speakers and stakeholders; the program was appreciated by the trainees and alumni. This paper underscores the importance of the international perspective, the transdisciplinarity and the scientific networking established through the program.

  20. Normalization of stable isotope data for carbonate minerals: implementation of IUPAC guideline

    Science.gov (United States)

    Kim, Sang-Tae; Coplen, Tyler B.; Horita, Juske

    2015-01-01

    Carbonate minerals provide a rich source of geochemical information because their δ13C and δ18O values provide information about surface and subsurface Earth processes. However, a significant problem is that the same δ18O value is not reported for the identical carbonate sample when analyzed in different isotope laboratories in spite of the fact that the International Union of Pure and Applied Chemistry (IUPAC) has provided reporting guidelines for two decades. This issue arises because (1) the δ18O measurements are performed on CO2 evolved by reaction of carbonates with phosphoric acid, (2) the acid-liberated CO2 is isotopically fractionated (enriched in 18O) because it contains only two-thirds of