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PubMed1994

Five-year experience with exercise stress testing in a family practice program.

OBJECTIVE: This study describes the implementation of exercise stress testing at a family practice residency program, looking at safety and the feasibility of having family practice faculty serve as instructors. METHODS: Results from the first 5 years of testing were collected, and residency graduates were polled about their experience with treadmill testing during and after residency. RESULTS: A total of 202 treadmill tests were performed, all without serious complications. Family practice faculty provided the instruction. One quarter of graduates were performing treadmill tests in their practices, and most of the others felt the training was beneficial. CONCLUSIONS: It is both feasible and safe for family practice faculty to provide training in exercise treadmill testing to residents.

Adult↗
PubMed1995

Dramatic decrease in tuberculin skin test conversion rate among employees at a hospital in New York City.

BACKGROUND: The Centers for Disease Control and Prevention recently issued updated guidelines for preventing the transmission of tuberculosis in health care facilities. Many recommendations, including the use of high-efficiency particulate air filter respirators, are expensive to implement and of unproven efficacy. We therefore reviewed the tuberculin skin test conversion rate among our employees from 1991 to 1993, before introduction of high-efficiency particulate air filter respirators. During this period, several other improvements in tuberculosis control were implemented. METHODS: Employee tuberculin test conversion rates were reviewed by 6-month interval from 1991 to 1993. RESULTS: Throughout the study period, several tuberculosis control measures were implemented, including early isolation of patients with suspected cases of tuberculosis in rooms with negative-pressure ventilation, placement of germicidal UV light fixtures into patient rooms and common areas, and use of Technol shields (Technol, Inc., Fort Worth, Texas) (1991), particulate respirators (1992), and dust-mist-fume respirators (1993). With these improvements, the conversion rate among employees fell from 20.7% in the first 6 months of 1991 to 5.8% in the latter half of 1993. CONCLUSIONS: The rate of skin test conversion among our employees decreased before introduction of high-efficiency particulate air filter respirators. This suggests that nosocomial spread of tuberculosis can be decreased by means of previously established, less costly methods.

Cross Infection↗
PubMed2002

A practical guide to the implementation of an effective incident reporting scheme to reduce medication error on the hospital ward.

This paper discusses an anonymous incident reporting scheme to reduce drug administration error on the hospital ward, as part of an effective, non-punitive, systems-focused approach to safety. Drug error is costly in terms of increased hospital stay, resources consumed, patient harm, lives lost and careers ruined. Safety initiatives that focus, not on blaming individuals, but on improving the wider system in which personnel work have been adopted in a number of branches of health care. However, in nursing, blame remains the predominant approach for dealing with error, and the ward has seen little application of the systems approach to safety. Safety interventions founded on an effective incident scheme typically pay for themselves in terms of dollar savings arising from averted harm. Recent calls for greater health-care safety require finding new ways to make drug administration safer throughout the hospital, and the scope for such safety gains on the hospital ward remains considerable.

Health Plan Implementation↗
PubMed2001

The potential of telemedicine: barriers, incentives and possibilities in the implementation phase.

Between 1998 and 1999, the Swedish Institute for Health Services Development (Spri) evaluated three applications in which specialist competence was being accessed via telemedicine. The results indicated that these kinds of application can be cost-effective in an organization well adapted to new technology and that telemedicine can improve continuity of care for patients. However, the new technology was seldom supported by the old organization and better education and technical support are needed. In a study called 'Incentives and Implementation', the Federation of Swedish County Councils interviewed people in Swedish health-care with a lot of experience of telemedicine. The interviewees agreed that telemedicine was likely to affect the whole structure of health-care. Peripheral competence was expected to increase and referral patterns to change, as well as the functions of the personnel and the hospitals. New working conditions and methods of work were expected to be made possible by telemedicine and health-care was expected to become more process oriented, partly because patients are likely to be more demanding and better informed. To be able to utilize this potential, health-care managers will have to show more interest in and commitment to telemedicine. Old organizational patterns must be called into question and be developed along with information technology and telemedicine. It is also important to give priority to training in telemedicine for physicians and nurses.

Attitude of Health Personnel↗
PubMed1997

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) will be considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) will be tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Emergency Medical Services↗
PubMed2005

Universal newborn hearing screening in Singapore: the need, implementation and challenges.

With about 1 in 1000 born with severe to profound hearing loss and about 5 in 1000 with lesser degrees of loss, congenital deafness is the commonest major birth defect. It is the recommended standard that hearing loss in newborns be detected by 3 months of age and intervention implemented by 6 months of age. Delayed detection and intervention may affect speech, language and psychosocial development, resulting in poor academic achievements. Universal newborn hearing screening (UNHS) is the only effective way of detecting all babies with hearing loss, within the recommended time frame. A survey in Singapore revealed that traditional childhood hearing screening programmes resulted in late detection (mean age, 20.8 months; range, 0 to 86 months) and late intervention (mean age, 42.4 months; range, 1 to 120 months). Increasingly, UNHS is becoming standard medical care in developed countries. In Singapore, UNHS has been implemented in all hospitals with obstetric services. Although a screening rate of more than 99% has been achieved in public hospitals, private hospitals have a screening rate of only about 77%. Parents' awareness and acceptance of early detection is still lacking, and this needs to be addressed by appropriate public education. Support from obstetricians and paediatricians will significantly contribute towards this objective. Effective programme management is essential; this includes the use of data management systems, the maintenance of a team of experienced screeners, and efficient coordination between screening and diagnostic services. Early detection of childhood deafness, together with early and effective intervention, maximises the chances of successful integration into mainstream education and society.

Audiometry, Evoked Response↗
PubMedDate not supplied

Implementation of an evidence-based feeding protocol and aspiration risk reduction algorithm.

Aspiration pneumonia is a serious complication of mechanical ventilation and enteral tube feedings. It results in increased patient mortality, increased length of hospital stay, and increased healthcare costs. This article describes an evidence-based practice approach to the creation of an enteral feeding protocol and an aspiration risk reduction algorithm. These tools were piloted in a Medical Intensive Care Unit at a Midwest tertiary care center. Chart audits show an increase in the percentage of patients who reach their goal rate for enteral feedings from 78% to 85%. Reported aspiration pneumonias decreased from an average count of 4.8 patients per month to 4.3 per month and ventilator-associated pneumonia rates decreased from 6.8 to 3.2 per 1000 patient days.

Algorithms↗
PubMed2005

Implementing alcohol screening and intervention in a family medicine residency clinic.

The purpose of this study was to evaluate the impact of simultaneous systems interventions and clinician training on management of hazardous and harmful drinking in a residency clinic. Systems interventions included forming a multi-disciplinary implementation team, training registration clerks to distribute health risk questionnaires using the AUDIT-C alcohol screen, and training nurses to score the AUDIT-C and administer the AUDIT to screen-positive patients. Clinicians were trained to perform brochure-based interventions on screen-positive patients. Research staff provided compliance feedback. Over 12 months, 8.0% (241/3014) of patients screened positive and 3.8% (115/3014) received brief interventions. For screen-positive patients, comparisons with baseline measurements found increased rates of alcohol assessment (50% vs. 0%, p < .0001) and intervention (48.1% vs. 9.4%, p < .0001). Clinicians intervened more often when prompted with completed AUDITs (72% vs. 23%, p < .0001). Program modifications resulted in progressive increases in numbers of patients screened. This model shows promise for use in other residency programs.

Adult↗
PubMed2002

Impact of a dental/dental hygiene tobacco-use cessation curriculum on practice.

Tobacco use is the chief avoidable cause of morbidity and mortality in North America and is associated with increased risk for oral cancer and increased prevalence and severity of periodontitis and other oral conditions. By delivering two- to three-minute tobacco-use cessation counseling (TUCC), oral health professionals can achieve quit rates substantially higher than the spontaneous quit rate. However, many clinicians report lack of training and knowledge in TUCC as barriers to providing cessation counseling. The purpose of this study was to evaluate whether implementation of a comprehensive, dental school-based, tobacco-use cessation program would increase the extent to which tobacco-using patients received TUCC. The school's program was based on the critical administrative, cultural, structural, and policy components of effective TUCC interventions outlined by Fiore et al. A pre- and post-program telephone interview of tobacco-using patients assessed TUCC intervention by students. A significantly greater proportion of patients received TUCC post-program compared to pre-program in terms of consequences associated with tobacco use as well as advice to quit. A comprehensive TUCC program resulted in an improvement of 11.7 percent for consequences and 23 percent for advice to quit.

Adult↗
PubMed1996

The role of village leaders in the implementation of multidrug therapy for leprosy, Sudan -- a pilot study in the Angasana Hills.

The purpose of this study is to implement multidrug therapy (MDT) and to evaluate the possible role of village leaders in supervising MDT treatment in remote and inaccessible areas in Sudan where health facilities are poor. Three villages from the Angasana Hills in the south-east of Sudan, where leprosy is endemic, have been chosen for this study. A health education course for village leaders in the area was conducted. Three medical assistants from a nearby village were identified to examine all leprosy suspects and to put the diagnosed cases on treatment. The village leaders were to supervise the treatment of the patients during the rainy season. Out of 43 cases detected all paucibacillary (PB) cases detected (11 cases) completed their treatment and 28 out of 32 multibacillary (MB) cases were regularly on treatment. It has been obvious that the village leaders were useful in supervising MDT in the Angasana area, a process which can be extended to other inaccessible areas in the Sudan.

Adolescent↗
PubMed1984

[Effect of various environmental factors on the incidence of mastitis in cows and implementation of prevention programs].

The analysis carried out aimed at obtaining numerical data concerning the environmental conditions and finding about whether their improvement would contribute to control mastitis. Examinations of the environmental conditions were made seven times during the year, and mastitis was found in 2,088 cows of the black and white breed in 12 cowsheds of the state farms in the Szczecin district. The analysis resulted in gradual improvement of zoo sanitary conditions and in a decrease of mastitis cases. This correlation was proved statistically. A characteristic correlation was found between the sanitary state and infection intensity r = 0,948, between the sanitary state aNd irritation intensity of this gland r = 0,945. Moreover, the duration of udder dryness in cows was analysed. In 50,43% of the cows examined the period of dryness was short. In these cows the intensity of infection was higher (81,7%) than in cows with a normal period of dryness (33,5%).

Animal Husbandry↗
PubMed2000

Key elements for implementing comprehensive health care models for persons with HIV: a stakeholder analysis.

A semistructured interview was conducted with 69 stakeholders in three university-based health care projects that were funded to provide an integrated continuum of care for persons living with HIV/AIDS. Data from the key informant interviews yielded composite indicators of familiarity with the service model, the importance of the elements in the service model, and the perceived quality of services provided by these innovative HIV service demonstration projects. Ratings of service quality were related to ratings of the respondent's knowledge of the service demonstration project, the importance of the various elements in the service continuum, and several indicators of stakeholder characteristics using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). The groups of stakeholders most likely to give the highest quality or success ratings for these projects are identified. The implications of these findings for developing collaborative and comprehensive service models for persons with HIV/AIDS are discussed.

Comprehensive Health Care↗
PubMed1993

Community-based rehabilitation cadres: their motivation for volunteerism.

Volunteer workers, or cadres, are critical to the successful implementation of community-based rehabilitation (CBR) programmes. To date, relatively little research has examined the importance of motivation in health volunteers in general, and especially CBR workers. This paper reports the major findings of a field study in rural Indonesia. A multimethod design within a broad qualitative research framework which focused on the personal experiences of CBR volunteers was utilized. Descriptive data were obtained from written questionnaires, focus groups and key informant interviews. Research findings indicated that volunteer cadres perform considerable duties and face numerous difficulties in the course of their CBR activities. Incentives also play an important role in determining the motivation and ultimate performance of volunteer cadres. Developing an understanding of what it is like to be a volunteer CBR cadre has important implications for rehabilitationists interested in developing and sustaining CBR programmes and is clearly critical to any evaluation of CBR.

Adult↗
PubMed2002

[Mycologic surveillance of the environment for preventive invasive aspergillosis. Proposals for standardization of the methodologies and implementation].

A MAJOR RISK: The infection of immunodepressed patients by Aspergillus-type fungi increases morbidity and mortality, particularly in hematology units or during solid organ transplantation. Although present diagnostic means benefit from the progress over the last years, they remain limited and chemoprophylaxis protocols have still not demonstrated significant efficacy. THE NEED FOR RECOMMENDATIONS: Today, the handling of environmental risks is the only strategy that has proved its efficacy and usefulness. On the basis of administrative recommendations and data from the literature, a multicentric and pluri-disciplinary task force, grouping clinicians, microbiologists and hygienists, has assessed different methods and has proposed recommendations for the standardization and optimization of fungal surveillance of the environment.

Air Microbiology↗
PubMed2000

Implementing evidence-based recommendations for health care: a roundtable comparing European and American experiences.

BACKGROUND: A roundtable held October 5-6 1999, in Maidstone, Kent, United Kingdom, was convened to identify current strategies and ongoing challenges in implementing evidence-based practice guidelines in health care. Despite numerous new medical research findings for improving health care and despite the dissemination of many practice guidelines, the recommendations from these efforts are not being uniformly adopted. Overuse, underuse, and misuse plague the practice of medicine today. IMPLEMENTING GUIDELINES: Multiple implementation strategies are more likely to succeed that a single implementation method; local selection and adaptation of guidelines are critical; and reminders, educational outreach (for prescribing), and interactive educational workshops are generally effective. EXPERIENCE IN EUROPE: In most countries, guideline development has progressed from consensus conference, to evidence-based statements, and finally to evidence-based guidelines that also consider cost-effectiveness. Guideline development is the most advanced in The Netherlands, where physicians have coordinated their efforts with the government to achieve more uniformity than is found elsewhere. EXPERIENCE IN THE UNITED STATES: Designing systems that will facilitate change--not changing physician behavior--should be the focus. The concern for effecting improvement in health care is now more acute because of the increased attention being given to medical errors and patient safety. SUMMARY STATEMENT: Multifaceted approaches are clearly the most important method for improving care. Such approaches may include many improvement methods, none of which work well alone most of the time or any of the time.

Accreditation↗
PubMed2004

Developing and implementing transdisciplinary rehabilitation competencies.

The Commission on Accreditation of Rehabilitation Facilities (CARF) requires that brain and spinal cord injury (SCI) specialty programs assure a base competency level for staff. At the authors' institution, senior staff members from all rehabilitation disciplines developed a Competency Fair based on a transdisciplinary approach to care. Each module contained reading material and a competency test. Some modules required a return demonstration. Topics included dysphagia, skin care, cognition, and bedside emergencies, among others. At a 4-day Competency Fair, 95 of the 110 staff members completed the training. Additional training was provided to those who failed the examinations. The training met CARF standards, and staff expressed a greater appreciation of others' roles and felt empowered to share their roles with others. Greater crossover of duties among disciplines, and a better understanding of the transdisciplinary approach to care, were apparent. Staff also reported improvements in patient care and an expansion of their knowledge base.

Arizona↗
PubMed2003

Collaborative initiatives: where the rubber meets the road in community partnerships.

Amajor challenge facing a community partnership is the implementation of its collaborative initiatives. This article examines the progress Community Care Networks (CCNs) made in implementing their initiatives and factors that helped or hindered their progress. Study findings suggest that partnership progress is affected by external market and regulatory factors beyond the control of the partnership, the availability of local community resources to support efforts, the scope and intensity of tasks associated with an initiative, expansion of the partnership to include new members, and the balance of work between partners and paid partnership staff. Implications of study findings for community partnerships include (1) recognizing and anticipating dependency on others, (2) acknowledging that the tasks that lie ahead will be more complicated than imagined, (3) maintaining focus on priorities, and (4) learning to be adaptive and creative, given a constantly changing environment.

Community Health Services↗
PubMed1995

Teleradiology/telepathology requirements and implementation.

Teleradiology and telepathology form an integral part of the telemedicine concept. Teleradiology is becoming a mature technology because of advances in imaging technology, database design and communications infrastructure and capabilities. Telepathology has also made significant progress but more development is needed in the definition of required images, database design and standards. While the requirements of most clinical applications of teleradiology are well established, telemammography still presents some impediments. Technical difficulties in telemammography are presented in terms of the lack of a clinically accepted digital imaging system and large data volume required per image. Another important aspect in tele-imaging is the database question. Workstations constitute a window into database. Comprehensive database development is the most difficult and expensive technology for tele-imaging and operational features of such systems are discussed. Finally, we explore current examples of the use of telepathology and teleradiology in the global telemedicine context.

Computer Communication Networks↗