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PubMedDate not supplied

Continence for women: evaluation of AWHONN's third research utilization project. Association of Women's Health Obstetric and Neonatal Nurses.

OBJECTIVE: To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice. DESIGN: Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. SETTING: Twenty-one public, private, and other women's health sites. PARTICIPANTS: Women in ambulatory care settings (N = 1,474) provided demographic statistics. METHODS: The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. MAIN OUTCOME MEASURES: Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. RESULTS: The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. CONCLUSIONS: The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.

Adult↗
PubMed2003

PROGRESS results: implementation in stroke guidelines.

The most important issues facing clinicians is the transfer of evidence from clinical trials into practice. Physician, patient and community acceptance of the evidence are key components of this process. Although barriers to this exist, in the case of transfer of evidence from the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) into clinical practice, these are minimal. Hence, transfer of this information into clinical practice should put blood pressure lowering in place as the fourth major secondary prevention strategy for stroke.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

Commitment to change instrument enhances program planning, implementation, and evaluation.

INTRODUCTION: This study investigates the use of a commitment to change (CTC) instrument as an integral approach to continuing medical education (CME) planning, implementation, and evaluation and as a means of facilitating physician behavior change. METHODS: Descriptive statistics and grounded theory methods were employed. Data were collected from 20 consecutive CME programs. Physicians were asked to list up to three things they intended to change in their clinical practice as a result of the program. A copy was sent 3 weeks later as a reminder. Six months later, a summary of peer-intended changes was sent to reinforce intended behavior change. RESULTS: Of 602 participants, 291 (48%) completed CTC forms, resulting in 803 citations. Responses were congruent with the educational objectives and intentions of the program planners. Using the constant comparative method of analysis, a framework was identified for interpreting physician learning strategies. It included change strategies and motivation, learning issues, better doctoring, changes to clinic practice, and diffusion. DISCUSSION: CTC was useful as a multipurpose tool providing planners with meaningful feedback to (1) assess congruence of intended changes in physician behavior with program objectives, (2) document unanticipated learning outcomes, and (3) enable and reinforce intended behavior change.

British Columbia↗
PubMed2007

[Pharmacovigilance implementation and operational conditions in the pharmaceutical industry in São Paulo State, Brazil].

UNLABELLED: The development of new drugs and limitations of clinical trials have increased the likelihood of adverse drug events. Pharmacovigilance is essential to detect and evaluate adverse drug events, thereby reducing risks and avoiding excessive public health costs. This study focused on the pharmacovigilance programs in the pharmaceutical industry in São Paulo State, Brazil. Data were collected through questionnaires sent electronically to 105 companies, 41.9% of which responded. The main reason for implementing pharmacovigilance programs was to comply with legal requirements, while the main justification for its absence was production limited to herbal remedies, officinal products, and supplements. The article discusses the obstacles to program implementation, resources used, and characteristics of several such programs. CONCLUSIONS: (a) standardization is the reason for the increasing number of programs and reports, but more specific guidelines are needed; (b) results depend on multi-sector involvement; (c) customer service centers are an important source of reports; and (d) operation of the service requires only modest human and material resources.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

[The exercise of partnership: an exploratory analysis throughout the development of a crisis intervention service in the Haut-Richelieu territory].

This article analyzes the concept, the implementation process and the objective of a crisis intervention center in the Haut-Richelieu area. It examines the driving and resisting forces to the practice of partnership as established by the Quebec government in its official policy for mental health. The authors describe the practice of partnership during the different phases of the project's implementation by showing the impact of this approach on the risks involved or on the potential for misdirection. In addition, the authors identify some of the weaknesses related to this approach. Following this description of how the project has progressed, the authors discuss the constraints and success factors of this type of partnership in order to compare the logic and obligations of this approach with an approach originating from the common desire and collective will to meet familiar needs.

Crisis Intervention↗
PubMed2002

Targeting dental sealants in school-based programs: evaluation of an approach.

Several guidelines have been published in the United States to promote the appropriate use of sealants in both individual care and public health programs. Targeting sealants to children and teeth at high risk for dental caries has been accepted as a desirable strategy in school-based programs. However, there is little evidence to show that programs are complying with these guidelines. This report examined the extent to which sealants were targeted to high-risk children at 11 different school-based programs in New York State. Data on 3357 children ages seven to nine were analyzed. The percent of children receiving sealants ranged from 41% to 88%. While in two sites (St. Lawrence & Onondaga) fewer than 52% of the children received sealants; more than 73% received sealants in the remaining nine sites (P < 0.05). The results suggest that there was a wide variation in the implementation of the guidelines for sealant use. Some reasons for not adhering to the guidelines were: difficulty in assuring parents and local dentists that some children were not at risk for caries; lack of confidence in the risk-assessment method; uncertainty regarding what constitutes deep pits and fissures; fear of misclassifying children and requests by school administrators, parents and local dentists that all children should benefit from preventive measures.

Chi-Square Distribution↗
PubMedDate not supplied

Community readiness: the journey to community healing.

Community readiness is a research-based theory that provides a basic understanding of the intervention process in communities. This theory allows us to accurately describe the developmental level of a community relative to a specific issue or problem. In order to move the community toward implementing and maintaining efforts that are effective and sustainable, community mobilization must be based on involvement of multiple systems and utilization of within-community resources and strengths. Successful local prevention and intervention efforts must be conceived from models that are community-specific, culturally relevant, and consistent with the level of readiness of the community to implement an intervention. The community readiness model is an innovative method for assessing the level of readiness of a community to develop and implement prevention programming. It can be used as both a research tool to assess distribution of levels of readiness across a group of communities or as a tool to guide prevention efforts at the individual level. This tool has proven useful in addressing a gamut of problems ranging from health and nutritional issues to environmental and social issues. The model identifies specific characteristics related to different levels of problem awareness and readiness for change.

Alcoholism↗
PubMed2005

[Are bonus systems applicable to guideline-oriented depression treatment provided by general practitioners and neurologists?].

In the outpatient treatment of depression, the potential of diagnostic and therapeutic methods is seldom exhausted resulting in variable quality of treatment and partly insufficient cost effectiveness. Implementation of a guideline-oriented reimbursement system seems to be an option to improve quality of treatment. Corresponding incentive systems have been outlined and evaluated for the health care of somatic diseases such as diabetes. Acting on these experiences, an attempt was made to utilize them for the area of psychiatric disorders. Taking depression as an example, a model for a quality-oriented, guideline-based reimbursement system for general and specialist practice is presented.

Ambulatory Care↗
PubMed2005

Evaluation of the clinical pathway for laparoscopic cholecystectomy.

Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (+/-768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (+/-618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction.

Cholecystectomy, Laparoscopic↗
PubMed2000

Clinical practice guidelines: reality bites.

In 1995, the National Health and Medical Research Council (NHMRC) announced its commitment to developing evidence-based clinical practice guidelines "to promote best practice linked to outcomes and effective cost management". To date, resources for dissemination and implementation have been identified for only two guidelines developed by the NHMRC as part of that commitment. Clinical practice guidelines for the management of men with lower urinary tract symptoms (LUTS) were launched in 1997. We were members of the working party that developed these guidelines, and here we give our personal account, offering insights into the tensions and contradictions impeding the translation of political commitment to evidence-based medicine into policy and practice.

Australia↗
PubMed2004

From bedside to boardroom - nursing shared governance.

A brand-new nursing shortage is revitalizing shared governance. This innovative organizational model gives staff nurses control over their practice and can extend their influence into administrative areas previously controlled only by managers. But nursing shared governance is hard to define. Its structures and processes are different in every organization; and its implementation is like pinning Jell-O to a wall. Is it appropriate for every situation? Is it worth the price? And can it really measure up to its glowing reputation? This article presents an overview of nursing shared governance, looking at themes and experiences from its rich 25-year tradition. The author identifies its essential elements, provides guidance for professionals who wish to embark on the journey, and describes the current status of shared governance as of 2004.

Cost-Benefit Analysis↗
PubMed1996

Mechanism of action and impact of a cystitis clinical practice guideline on outcomes and costs of care in an HMO.

BACKGROUND: A study was conducted in 1995 at five primary care clinics of a staff-model health maintenance organization in the Midwest to assess the impact of a cystitis clinical guideline and to help elucidate the guideline implementation process. METHODOLOGY: Two hundred one eligible women with uncomplicated cystitis were treated in a three-month period before the guideline, and 241 similar cases were treated in a three-month period after the guideline. Nursing supervisors and clinic managers at each clinic were interviewed about how the cystitis guideline was implemented at each clinic. RESULTS: Use of a recommended three-day antibiotic treatment increased from 28% to 52% of cases (chi-square = 25.01, p < 0.001). Use of urine cultures decreased from 70% to 37% of cases (chi-square = 48.19, p < 0.001). The proportion of eligible cystitis cases coordinated primarily by the nurse increased from 21% to 78% (chi-square = 142.93, p < 0.001). However, desired changes in use of antibiotics and urine cultures were limited to nurse-coordinated cases. There was no increase in hospital admissions, emergency room visits, repeat office visits (p > 0.05), or repeat antibiotic courses (p > 0.05) after cystitis guideline implementation. Cost of cystitis care delivered after guideline implementation was 35% lower than before guideline implementation. CONCLUSIONS: Use of the guideline was associated with desirable changes in antibiotic use, nurse coordination of care, costs of care, and comparable clinical outcomes. Clinics that used clinical systems and tools to support nurse-coordinated cystitis care had greater guideline adherence than clinics that did not support nurse-coordinated care.

Adult↗
PubMed2006

Evidence-based implementation of evidence-based guidelines.

PURPOSE: There is evidence that some strategies for guideline implementation are more successful than others. This paper aims to describe the process of developing an evidence-based guideline implementation strategy for use in rural emergency departments. DESIGN/METHODOLOGY/APPROACH: Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge translation. Attendance at these workshops, associated reading and a literature review allowed those implementation strategies with the most supportive evidence of effectiveness to be determined. FINDINGS: A multi-faceted implementation strategy was developed. This strategy involved the use of an implementation team as well as addressing issues surrounding individual clinicians, the "emergency department team", the physical structure and processes of the ED and the culture of the department as a whole. Reminders, audit and feedback, education, the use of opinion leaders, and evidence-based formatting of guidelines were all integral to the process. PRACTICAL IMPLICATIONS: It is postulated that an evidence-based implementation strategy will lead to greater changes in clinician behaviour than other strategies used in quality improvement projects. ORIGINALITY/VALUE: This is an important article as it describes the concept and development of evidence-based interventions, which, if tailored to the individual hospital (as evidence-based medicine is tailored to the individual patient), has the potential to improve compliance with clinical guidelines beyond that achieved with most QI projects.

Adult↗
PubMed2001

Developing and implementing clinical practice tools: the legal and ethical implications.

The complexity of health care is ever increasing, as is the volume of research and literature available. In response there has been a corresponding emphasis on basing clinical decisions on the best available research evidence. The development and implementation of clinical practice tools is cited as a means of ensuring research utilisation as well as moderating variations in clinical practice. It is important that nurses contribute to the development of these clinical tools in order to actively shape their own practice. Nurses therefore need to have an understanding of the terminology and processes involved, and the implications for practice. This paper outlines definitions of the various clinical tools, the development process, and the legal and ethical implications of clinical practice tools.

Clinical Protocols↗
PubMed2003

[First evaluation of the surveillance systems of notifiable diseases under the infectious disease control law in Germany].

INTRODUCTION: The implementation of the infectious disease control law (IfSG) in 1.1.2001 standardised the German surveillance system for notifiable diseases. For management and transmission of reports health departments use either the software programme Surv Net@RKI, which was developed by the Robert Koch-Institut (RKI), or one of five commercially offered disease-reporting software. After more than one year of its existence, we investigated the success of the implementation of the new surveillance system with the aim to identify possibilities for further improvement. METHODS: Based on 2001 data available to the RKI, we evaluated the criteria simplicity (standardisation of legal regulation and of software systems), acceptability (number of reporting regional counties), time (period from data entry at the health department to entry at the RKI) and data quality (information on immunisation status among reports of hepatitis A cases). RESULTS: For electronic processing 5 versions of Surv Net@RKI and 47 versions of the 5 commercial products are used. Additional rules of individual states expand the legal obligation for notification of the IfSG, by adding new diseases, different definitions or different reporting channels. Within the first quarter after implementation of the IfSG, 393 (90 %) of the 425 counties transmitted data weekly. The median transmission time from data entry at the health department and entry at the RKI was 5 to 7 days after the fourth reporting week. The proportion of hepatitis A case reports with information on immunisation status was 58 % (1323 of 2277); among the 1052 reports by health departments using Surv Net@RKI the proportion was 82 % (n = 858); among the 1225 reports from health departments using other programmes the proportion was 38 %. CONCLUSION: Implementation of the new surveillance system is successful. Electronic data systems should be standardised to improve data quality and simplicity. The deadlines for transmission should be shortened to allow earlier detection and control of multi-state outbreaks. State-specific rules on notifiable diseases should be standardised to avoid conflicting or redundant reporting channels.

Communicable Disease Control↗
PubMed1999

[The DEGAM-concept--development, dissemination, implementation and evaluation of guidelines for general practice].

The German Society for General Practice/Family Medicine (DEGAM) has launched a project to develop and implement national guidelines for general practice accordingly to international models. Guidelines are seen as statements to assist practitioners and patients in deciding about appropriate, effective and efficient health care. They should be evidence-based, feasible for primary care practices, and purposefully addressing to physicians as well as practice staff and patients. The development follows a comprehensive and well-structured programme (10 stages) which requires the appraisal of medical evidence, the involvement of experienced general practitioners on various stages (primary review, feasibility testing), and comments of concerned specialists, before a guideline is promulgated. Implementation of each guideline is promoted by at least five tools (full text, quick reference guide, telephone card for practice staff; patient leaflet, and information-prescription--"infozept"). Methodological quality is checked for the first time in Germany according to the standards of the German Agency for Quality Assurance. Different targets and criteria for evaluation of guidelines in primary care are mandatory part of the DEGAM-concept.

Evaluation Studies as Topic↗
PubMed2003

Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants.

OBJECTIVE: Using an evidence-based approach, a Vermont Oxford Network focus group whose goal was to reduce brain injury developed and implemented a number of potentially better practices. Each center approached implementation of the practices differently. Reducing the incidence of intraventricular hemorrhage and periventricular leukomalacia are important for improving long-term outcomes for low birth weight infants. METHODS: Implementation approaches for some but not all of the practices at the various centers are discussed. The practices reviewed include optimal peripartum management, such as resuscitation, avoidance of hypothermia, optimal surfactant delivery, early neonatal management by the most experienced providers, and measures to minimize pain and stress. Additional practices include maintenance of neutral head positioning, fluid volume therapy for hypotension, indomethacin prophylaxis, ventilator management, avoidance of routine suctioning, and limiting the use of sodium bicarbonate and postnatal dexamethasone. RESULTS: Approaches to implementation were center specific, and results vary. Although some practices were easier to implement than others, communication, education, and leadership were critical to the process. CONCLUSIONS: The quality improvement multidisciplinary approach is a useful tool for finding ways to reduce the incidence of intraventricular hemorrhage and periventricular leukomalacia.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

[Organization of cardiologic rehabilitation in central Europe: retrospect, present, future outlook].

Cardiological rehabilitation, the comprehensive efficient treatment of chronic cardiac patients, is presented with regard to its difficult theoretical and practical development from the viewpoint of a senior specialist in this field practising in Central Europe. The accompanying WHO lifestyle concept is now considered to be scientifically well-founded, but has not yet been practically implemented on a large scale nor incorporated in the teaching schedule. A requirement for the future is a special medical philosophy for chronic heart patients, i.e., further development of the theoretical basis of rehabilitation, practical application of the scientific recommendations on the importance of life-style alterations, a greatly improved network of all doctors treating chronic heart patients, updating of the training of general medical specialists as well as cardiologists in Public Health, and intensified objective assessment of research on the cardiological rehabilitation of in- and outpatients.

Combined Modality Therapy↗