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Implementation Strategies (implementation + strategy)

Distribution by Scientific Domains

Medical Sciences	67%
Humanities and Social Sciences	12%
Life Sciences	5%
Information Science and Computing	5%
Engineering	5%
2 Other Domains	6%

Distribution within Medical Sciences

Consumer Health General	25%
Occupational Therapy	14%
11 Other Subdomains	61%

Selected Abstracts

Advancing Entertainment Education: Using The Rosie O'Donnell Show to Recognize Implementation Strategies for Saturated Markets

COMMUNICATION THEORY, Issue 2 2009
Deborah L. Larson
Entertainment-education (E-E) has been widely and successfully implemented in developing countries around the world, but it is much harder to utilize in media-saturated countries. However, talk shows can be a niche market for E-E campaigns. As evidence, The Rosie O'Donnell Show has made a significant contribution to the television industry and to entertainment-education research by redefining how advocacy, education, and entertainment can work through a variety talk show format. An extemporaneous talk show can implement E-E campaigns through four main strategies to target its viewers: (1) Variability, or using a variety of forms to provide campaign information, (2) using multimediated synergistic avenues and online connections, (3) creating audience proactivity by using a small group elements to promote self and collective efficacy, and host appeal to bridge the local to national gap, and (4) the host's use of instinctive intentionality in aggregating campaign messages. As executive producer and host of her show, Rosie O'Donnell affected awareness, disseminated educational information, and encouraged proactive behavior with social, political, and philanthropic agendas through repetitive, positive, and proactive entertainment-education messages. [source]

Where can social learning be improved in international river basin management in Europe?

ENVIRONMENTAL POLICY AND GOVERNANCE, Issue 4 2008
Ilke Borowski
Abstract In recent years, collaborative planning and processes of social learning (SL) have gained increasingly in interest in river basin management. In this paper, we first summarize the prerequisites for SL to take place in collaborative management processes. These are openness, gains and incentives, and a perceived pressure to learn. We then study the European situation subsequent to the introduction of the European Water Framework Directive (2000/60/EC; WFD) as an example. Based on an analysis of policy documents, a case study of the Elbe river basin and an elaboration of concepts related to theories of international regimes, we conclude that the conditions for SL are often not met if management processes are highly formalised. Considering SL that is necessary for innovation and change, this can best be supported through the establishment of parallel "learning processes", such as the Common Implementation Strategy that accompanies implementation of the WFD at European level. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment. [source]

A multidisciplinary guideline for the acute phase of stroke: barriers perceived by Dutch neurologists

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2004
Trudy Van Der Weijden PhD MD
Abstract Rationale, aims and objectives, Guidelines for stroke management should improve quality of care. Dissemination of guidelines, however, does not guarantee guideline adherence. The aim of this paper is to investigate barriers for guideline adherence to bring about suggestions for possible implementation strategies. Method, Questionnaire survey among all Dutch neurologists working on neurology wards in general hospitals during the year 2000 in The Netherlands. Results, The neurologists expressed a high degree of agreement with the diagnostic and preventive recommendations, but expressed doubts with regard to the therapeutic recommendations, especially for the recombinant tissue plasminogen activator therapy. In general, barriers at the organizational and the multidisciplinary team level were most prominent. Conclusions, Active implementation of the guidelines seems necessary. Implementation strategies should be focused on the different sources of barriers: the caregiver, the patient and the organization of care. [source]

Design and implementation of a high-performance CCA event service,

CONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 9 2009
Ian Gorton
Abstract Event services based on publish,subscribe architectures are well-established components of distributed computing applications. Recently, an event service has been proposed as part of the common component architecture (CCA) for high-performance computing (HPC) applications. In this paper we describe our implementation, experimental evaluation, and initial experience with a high-performance CCA event service that exploits efficient communications mechanisms commonly used on HPC platforms. We describe the CCA event service model and briefly discuss the possible implementation strategies of the model. We then present the design and implementation of the event service using the aggregate remote memory copy interface as an underlying communication layer for this mechanism. Two alternative implementations are presented and evaluated on a Cray XD-1 platform. The performance results demonstrate that event delivery latencies are low and that the event service is able to achieve high-throughput levels. Finally, we describe the use of the event service in an application for high-speed processing of data from a mass spectrometer and conclude by discussing some possible extensions to the event service for other HPC applications. Published in 2009 by John Wiley & Sons, Ltd. [source]

The Northwest Forest Plan as a Model for Broad-Scale Ecosystem Management: a Social Perspective

CONSERVATION BIOLOGY, Issue 2 2006
SUSAN CHARNLEY
conservación y desarrollo; comunidades rurales; gestión forestal; monitoreo socioeconómico Abstract:,I evaluated the Northwest Forest Plan as a model for ecosystem management to achieve social and economic goals in communities located around federal forests in the U.S. Pacific Northwest. My assessment is based on the results of socioeconomic monitoring conducted to evaluate progress in achieving the plan's goals during its first 10 years. The assessment criteria I used related to economic development and social justice. The Northwest Forest Plan incorporated economic development and social justice goals in its design. Socioeconomic monitoring results indicate that plan implementation to achieve those goals met with mixed success, however. I hypothesize there are two important reasons the plan's socioeconomic goals were not fully met: some of the key assumptions underlying the implementation strategies were flawed and agency institutional capacity to achieve the goals was limited. To improve broad-scale ecosystem management in the future, decision makers should ensure that natural-resource management policies are socially acceptable; land-management agencies have the institutional capacity to achieve their management goals; and social and economic management goals (and the strategies for implementing them) are based on accurate assumptions about the relations between the resources being managed and well-being in local communities. One of the difficulties of incorporating economic development and social justice goals in conservation initiatives is finding ways to link conservation behavior and development activities. From a social perspective, the Northwest Forest Plan as a model for ecosystem management is perhaps most valuable in its attempt to link the biophysical and socioeconomic goals of forest management by creating high-quality jobs for residents of forest communities in forest stewardship and ecosystem management work, thereby contributing to conservation. Resumen:,Evalué el Plan Forestal del Noroeste como un modelo para la gestión de ecosistemas para alcanzar metas sociales y económicas en comunidades localizadas alrededor de bosques federales en el Pacífico Noroeste de E.U.A. Mi evaluación se basa en los resultados del monitoreo socioeconómico desarrollado para evaluar el progreso en el logro de las metas del plan durantes sus 10 primeros años. Los criterios de evaluación que utilicé se relacionan con el desarrollo económico y la justicia social. El diseño del Plan Forestal del Noroeste incorporó metas de desarrollo económico y de justicia social. Sin embargo, los resultados del monitoreo socioeconómico indican que éxito en la implementación del plan para alcanzar esas metas fue combinado. Postulé la hipótesis de que hay dos razones importantes por las que las metas socioeconómicas del plan no se cumplieron totalmente: algunas de las suposiciones clave en las estrategias de implementación fueron deficientes y la capacidad institucional de la agencia para alcanzar las metas era limitada. Para mejorar la gestión de ecosistemas a gran escala en el futuro, los tomadores de decisiones deberán asegurarse que las políticas de gestión de recursos naturales sean aceptables socialmente; que las agencias de gestión de tierras tengan la capacidad institucional para cumplir sus metas de gestión; y que las metas de gestión sociales y económicas (y las estrategias para su implementación) se basen en suposiciones precisas de las relaciones entre los recursos a gestionar y el bienestar de las comunidades locales. La manera de vincular comportamiento de conservación y actividades de desarrollo es una de las dificultades para la incorporación de metas de desarrollo económico y de justicia social en las iniciativas de conservación. Desde una perspectiva social, el Plan Forestal del Noroeste como modelo para la gestión de ecosistemas quizás es más valioso por su intento de vincular las metas biofísicas y socioeconómicas de la gestión forestal mediante la creación de empleos de alta calidad para residentes de las comunidades en labores de regulación y supervisión forestal y de gestión de ecosistemas, por lo tanto contribuye a la conservación. [source]

Providers' Beliefs, Attitudes, and Behaviors before Implementing a Computerized Pneumococcal Vaccination Reminder

ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
Judith W. Dexheimer MS
Abstract Background The emergency department (ED) has been recommended as a suitable setting for offering pneumococcal vaccination; however, implementations of ED vaccination programs remain scarce. Objectives To understand beliefs, attitudes, and behaviors of ED providers before implementing a computerized reminder system. Methods An anonymous, five-point Likert-scale, 46-item survey was administered to emergency physicians and nurses at an academic medical center. The survey included aspects of ordering patterns, implementation strategies, barriers, and factors considered important for an ED-based vaccination initiative as well as aspects of implementing a computerized vaccine-reminder system. Results Among 160 eligible ED providers, the survey was returned by 64 of 67 physicians (96%), and all 93 nurses (100%). The vaccine was considered to be cost effective by 71% of physicians, but only 2% recommended it to their patients. Although 98% of physicians accessed the computerized problem list before examining the patient, only 28% reviewed the patient's health-maintenance section. Physicians and nurses preferred a computerized vaccination-reminder system in 93% and 82%, respectively. Physicians' preferred implementation approach included a nurse standing order, combined with physician notification; nurses, however, favored a physician order. Factors for improving vaccination rates included improved computerized documentation, whereas increasing the number of ED staff was less important. Relevant implementation barriers for physicians were not remembering to offer vaccination, time constraints, and insufficient time to counsel patients. The ED was believed to be an appropriate setting in which to offer vaccination. Conclusions Emergency department staff had favorable attitudes toward an ED-based pneumococcal vaccination program; however, considerable barriers inherent to the ED setting may challenge such a program. Applying information technology may overcome some barriers and facilitate an ED-based vaccination initiative. [source]

Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review

ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2007
S. Weinmann
Objective:, To identify evidence from comparative studies on the effects of psychiatric guideline implementation on provider performance and patient outcome. Effects of different implementation strategies were reviewed. Method:, Articles published between 1966 and March 2006 were searched through electronic databases and hand search. A systematic review of comparative studies of structured implementation of specific psychiatric guidelines was performed. Rates of guideline adherence, provider performance data, illness detection and diagnostic accuracy rates were extracted in addition to patient relevant outcome data. Results:, Eighteen studies (nine randomized-controlled trials, six non-randomized-controlled studies and three quasiexperimental before-and-after studies) were identified. Effects on provider performance or patient outcome were moderate and temporary in most cases. Studies with positive outcomes used complex multifaceted interventions or specific psychological methods to implement guidelines. Conclusion:, There is insufficient high-quality evidence to draw firm conclusions on the effects of implementation of specific psychiatric guidelines. [source]

The Australian experience of deinstitutionalization: interaction of Australian culture with the development and reform of its mental health services

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2006
A. Rosen
Objective:, To describe the Australian experience of deinstitutionalization of the Australian National Mental Health Strategy in the context of the history of mental health services in Australia, and of Australian culture. Method:, The development of Australian Mental Health Services is described with reference to developments in both psychiatric intervention research and Australian culture. The effects and achievements of national mental health reforms are described and critically examined. Results:, The relationship in Australia between the development of mental health services and the development of Australian society includes the stories of colonization, gold rushes, suppression of indigenous peoples' rights, incarceration of mentally ill people, and incompatible state service systems. Mental health services required reform to provide consistent services and support for full citizenship and rights for such individuals who are still on the margins of society. Recent national developments in service models and service system research have been driven by the Australian National Mental Health Strategy. The translation of national policy into state/territory mental health service systems has led to a ,natural' experiment between states. Differing funding and implementation strategies between states have developed services with particular strengths and limitations. Conclusion:, The effects of competition for limited resources between core mental health service delivery and the shift to a population-based public health approach (to prevention of mental illness and promotion of mental health), leaves our services vulnerable to doing neither particularly well. The recent loss of momentum of these reforms, due to failure of governments to continue to drive and fund them adequately, is causing the erosion of their considerable achievements. [source]

Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysis

DIABETIC MEDICINE, Issue 2 2006
R. F. Dijkstra
Abstract Aims Economic evaluations of diabetes interventions do not usually include analyses on effects and cost of implementation strategies. This leads to optimistic cost-effectiveness estimates. This study reports empirical findings on the cost-effectiveness of two implementation strategies compared with usual hospital outpatient care. It includes both patient-related and intervention-related cost. Patients and methods In a clustered-randomized controlled trial design, 13 Dutch general hospitals were randomly assigned to a control group, a professional-directed or a patient-centred implementation programme. Professionals received feedback on baseline data, education and reminders. Patients in the patient-centred group received education and diabetes passports. A validated probabilistic Dutch diabetes model and the UKPDS risk engine are used to compute lifetime disease outcomes and cost in the three groups, including uncertainties. Results Glycated haemoglobin (HbA1c) at 1 year (the measure used to predict diabetes outcome changes over a lifetime) decreased by 0.2% in the professional-change group and by 0.3% in the patient-centred group, while it increased by 0.2% in the control group. Costs of primary implementation were < 5 Euro per head in both groups, but average lifetime costs of improved care and longer life expectancy rose by 9389 Euro and 9620 Euro, respectively. Life expectancy improved by 0.34 and 0.63 years, and quality-adjusted life years (QALY) by 0.29 and 0.59. Accordingly, the incremental cost per QALY was 32 218 Euro for professional-change care and 16 353 for patient-centred care compared with control, and 881 Euro for patient-centred vs. professional-change care. Uncertainties are presented in acceptability curves: above 65 Euro per annum the patient-directed strategy is most likely the optimum choice. Conclusion Both guideline implementation strategies in secondary care are cost-effective compared with current care, by Dutch standards, for these patients. Additional annual costs per patient using patient passports are low. This analysis supports patient involvement in diabetes in the Netherlands, and probably also in other Western European settings. [source]

Ideas, Interests, and Institutions: Challenging the Property Rights Paradigm in Botswana

GOVERNANCE, Issue 4 2003
Amy R. Poteete
Recent work in international studies and comparative politics scrutinizes the relative importance of ideas, interests, and institutions as sources of policy change. A growing body of scholarship identifies ideas as the main causal factors, influencing perceived interests as well as perceived policy options. Others contend that policies can best be understood as products of institutions. Neither explanation can account for both policy choice by politicians and the implementation strategies of administrators. In Botswana, the use of professional criteria for hiring and advancement encourages adherence to international professional norms within the bureaucracy, but electoral competition gives politicians more reason to be attentive to local political concerns. The institutions that define relations of authority among actors with different motivations shape the outcomes of policy choice and implementation. Institutions influence the attentiveness of policy-makers to ideas when making decisions, the degree of attention particular policy-makers give to ideas from particular sources, and the degree of acceptance that ideas must achieve to affect policy. Better evaluations of political development can be achieved through attentiveness to the mix of actors involved in policy decisions, the diversity of institutions and ideas that affect their policy preferences, and the relations of authority that shape their relative influence over policy choice and implementation. [source]

Optimal clinical trial design using value of information methods with imperfect implementation

HEALTH ECONOMICS, Issue 5 2010
Andrew R. Willan
Abstract Traditional sample size calculations for randomized clinical trials are based on the tests of hypotheses and depend on somewhat arbitrarily chosen factors, such as type I and II errors rates and the smallest clinically important difference. In response to this, many authors have proposed the use of methods based on the value of information as an alternative. Previous attempts have assumed perfect implementation, i.e. if current evidence favors the new intervention and no new information is sought or expected, all future patients will receive it. A framework is proposed to allow for this assumption to be relaxed. The profound effect that this can have on the optimal sample size and expected net gain is illustrated on two recent examples. In addition, a model for assessing the value of implementation strategies is proposed and illustrated. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Evaluating decision aids , where next?

HEALTH EXPECTATIONS, Issue 2 2004
Alicia O'Cathain BSc MSc MA
Abstract Decision aids have been developed to help patients become involved in decision-making about their individual health care. During the evaluation of a particular decision aid in maternity care , a set of 10 ,Informed Choice' leaflets , we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these ,decision aid implementation packages' are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision-making, and the use of decision aids, in the real world. These ,packages' can then be submitted to pragmatic evaluation. [source]

REALISE-ing their potential?: implementing local library projects to support evidence-based health care

HEALTH INFORMATION & LIBRARIES JOURNAL, Issue 2 2001
Louise Falzon
Librarian involvement in Evidence-based Health Care provides many opportunities at a local level. Unfortunately, the potential for innovative projects to inform future developments is generally lost by a failure to ,pass the baton',to identify lessons learnt and transferable principles. The ,Library Support for Evidence-based Health Care' Project, funded by the NHS Executive Northern and Yorkshire, resulted in the implementation of locally responsive packages of hardware and software in six of the Region's libraries. The opportunity to evaluate the collective experience of these sites, and to synthesize principles of good practice, was provided by a separately funded post-hoc evaluation, the Research Evaluation to Audit Library and Information Support for EBHC (REALISE). This paper reports on how this evaluation was conducted, documents the strengths and weaknesses of the Project itself, and attempts to provide a checklist for use in similar projects. The paper concludes by outlining the relevance of the findings to the introduction of planned organizational approaches to quality (clinical governance) and the development of local implementation strategies across the UK, required by the NHS Information Strategy, Information for Health. [source]

An institutional perspective on developing and implementing intranet- and internet-based information systems

INFORMATION SYSTEMS JOURNAL, Issue 3 2003
Tom Butler
Abstract. ,This paper adopts a constructivist, case-based research strategy to examine the development and implementation of intranet- and internet-based information systems (IS) in a single organization. Institutional theory is used to describe, explain and understand the commitments of social actors in the development of web-based IS. The findings illustrate that: (1) social and organizational problems similar to those that beset ,traditional' IS development arise in the development and implementation of web-based IS; (2) ,top-down' development and implementation strategies give rise to more conflict and change management problems than ,bottom-up' approaches; and (3) fostering high levels of commitment to organizational imperatives is key to the successful development and implementation of web-based IS. [source]

Adaptive moving mesh methods for simulating one-dimensional groundwater problems with sharp moving fronts

INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 11 2002
Weizhang Huang
Abstract Accurate modelling of groundwater flow and transport with sharp moving fronts often involves high computational cost, when a fixed/uniform mesh is used. In this paper, we investigate the modelling of groundwater problems using a particular adaptive mesh method called the moving mesh partial differential equation approach. With this approach, the mesh is dynamically relocated through a partial differential equation to capture the evolving sharp fronts with a relatively small number of grid points. The mesh movement and physical system modelling are realized by solving the mesh movement and physical partial differential equations alternately. The method is applied to the modelling of a range of groundwater problems, including advection dominated chemical transport and reaction, non-linear infiltration in soil, and the coupling of density dependent flow and transport. Numerical results demonstrate that sharp moving fronts can be accurately and efficiently captured by the moving mesh approach. Also addressed are important implementation strategies, e.g. the construction of the monitor function based on the interpolation error, control of mesh concentration, and two-layer mesh movement. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Large eddy simulation of turbulent flows in complex and moving rigid geometries using the immersed boundary method

INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 7 2005
Mayank Tyagi
Abstract A large eddy simulation (LES) methodology for turbulent flows in complex rigid geometries is developed using the immersed boundary method (IBM). In the IBM body force terms are added to the momentum equations to represent a complex rigid geometry on a fixed Cartesian mesh. IBM combines the efficiency inherent in using a fixed Cartesian grid and the ease of tracking the immersed boundary at a set of moving Lagrangian points. Specific implementation strategies for the IBM are described in this paper. A two-sided forcing scheme is presented and shown to work well for moving rigid boundary problems. Turbulence and flow unsteadiness are addressed by LES using higher order numerical schemes with an accurate and robust subgrid scale (SGS) stress model. The combined LES,IBM methodology is computationally cost-effective for turbulent flows in moving geometries with prescribed surface trajectories. Several example problems are solved to illustrate the capability of the IBM and LES methodologies. The IBM is validated for the laminar flow past a heated cylinder in a channel and the combined LES,IBM methodology is validated for turbulent film-cooling flows involving heat transfer. In both cases predictions are in good agreement with measurements. LES,IBM is then used to study turbulent fluid mixing inside the complex geometry of a trapped vortex combustor. Finally, to demonstrate the full potential of LES,IBM, a complex moving geometry problem of stator,rotor interaction is solved. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Participatory land-use planning and conservation in northern Tanzania rangelands

AFRICAN JOURNAL OF ECOLOGY, Issue 2009
Abiud L. Kaswamila
Abstract In developing countries, participatory land-use planning is seen as a panacea to mitigate land-use conflicts and enhance land productivity. This assumption has not been thoroughly tested in wildlife corridors. Three villages were selected for this study. Several methods were used to provide indication of the performance of the plans against their stated objectives of mitigating conflicts and conserving wildlife corridors. Three hundred and fifty-eight households and eight park and extension workers were interviewed. In addition, focus group discussion with the nomadic Barabeig, field assessment and review of land-use plan/general management plan reports were carried out. Results reveal that land-use plans failed to achieve their set objectives. For example, 75% of the households held this view. Major causes of failure were insufficient participation by stakeholders in the planning process, lack of robust, transparent and accountable implementation strategies, inadequacy of qualified staff and lack of ,holistic approach' to the planning process. Taking these findings into account, an improved buffer zone land-use planning framework is suggested. For the framework to enhance both conservation and development and to enable policies and legislation, equitable benefit sharing and conservation education, initiation of compensation schemes for depredation caused by wild animals and intensification of patrols are required. [source]

Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2004
Gail M. Powell-Cope PhD ARNP
Abstract Rationale, aims and objectives, Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. Method, As part of a larger study to test the effects of an intervention on provider adherence to ischaemic heart disease (IHD) guidelines, we conducted five focus groups at three Veterans Administration Medical Centers with 32 primary care providers, cardiologists, and internists to identify key barriers and facilitators to adherence of the guidelines. Using content analysis, responses were grouped into categories. Results, The main perceived advantages of using the IHD guidelines were improvements in quality and the cost of care. Perceived barriers were the lack of ability of guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients. While providers agreed on the benefits of aspirin, beta-blockers and angiotensin converting enzyme inhibitors, barriers for use of these medications were lack of consensus about contraindications, difficulty in providing follow-up during medication titration, and lack of patient adherence. Sources of influence for guideline use were: professional cardiology organizations, colleagues, mainly cardiologists, and key cardiology journals. However, most providers acknowledged that following guidelines was a personal practice decision. Conclusions, While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers. [source]

A multidisciplinary guideline for the acute phase of stroke: barriers perceived by Dutch neurologists

A Five-Country Comparative Review of Accommodation Support Policies for Older People With Intellectual Disability

JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 1 2010
Christine Bigby
Abstract International covenants and domestic social policies in most developed countries regard people with intellectual disability as citizens with equal rights, suggesting they should have the similar aspirations of a healthy and active old age as the general community, and an expectation of the necessary supports to achieve this. This article compares the development and implementation of accommodation support policies for people aging with intellectual disabilities in five liberal welfare states. It describes the limited development of policies in this area and suggests possible reasons why this is the case. A review of the peer reviewed and grey or unpublished advocacy and policy literature on aging policies for people with intellectual disability was conducted which covered Australia, Canada, Ireland, the UK, and the U.S. Despite consistent identification of similar broad policy issues and overarching goals, little progress has been made in the development of more specific policies or implementation strategies to address issues associated with accommodation support as people age. Policy debates have conceptualized the problem as aging in place and the shared responsibility of the aged-care and disability sectors. This may have detracted from either sector leading the development of, or taking responsibility for, formulating, implementing, and resourcing a strong policy framework. [source]

Breaking New Ground in Juvenile Justice Settings: Assessing for Competencies in Juvenile Offenders

JUVENILE AND FAMILY COURT JOURNAL, Issue 2 2005
JULIETTE R. MACKIN
ABSTRACT The field of juvenile justice has made great strides in developing a research base of effective practices and principles, including an understanding of risk factors and needs that contribute to juvenile offending. However, the research base and practice of systematic assessment has not yet fully incorporated youth, family, and community strengths. To address this need, three juvenile justice agencies in the northwestern United States participated in a pilot study to develop and implement an assessment tool (the Youth Competency Assessment) and process that would identify and utilize strengths to help balance the risk and needs focus of their assessment and case planning practices. This article provides descriptions and implementation strategies of the three pilot sites. The article concludes with recommended system changes and policy interventions to support ongoing utilization of this kind of strength-based tool in juvenile justice settings, and a clear set of recommendations for other communities wishing to implement strength-based assessment in their own agencies. [source]

Development and implementation of guidelines in allergic rhinitis , an ARIA-GA2LEN paper

ALLERGY, Issue 10 2010
J. Bousquet
To cite this article: Bousquet J, Schünemann HJ, Zuberbier T, Bachert C, Baena-Cagnani CE, Bousquet PJ, Brozek J, Canonica GW, Casale TB, Demoly P, Gerth van Wijk R, Ohta K, Bateman ED, Calderon M, Cruz AA, Dolen WK, Haughney J, Lockey RF, Lötvall J, O'Byrne P, Spranger O, Togias A, Bonini S, Boulet LP, Camargos P, Carlsen KH, Chavannes NH, Delgado L, Durham SR, Fokkens WJ, Fonseca J, Haahtela T, Kalayci O, Kowalski ML, Larenas-Linnemann D, Li J, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Papadopoulos N, Passalacqua G, Rabe KF, Pawankar R, Ryan D, Samolinski B, Simons FER, Valovirta E, Yorgancioglu A, Yusuf OM, Agache I, Aït-Khaled N, Annesi-Maesano I, Beghe B, Ben Kheder A, Blaiss MS, Boakye DA, Bouchard J, Burney PG, Busse WW, Chan-Yeung M, Chen Y, Chuchalin AG, Costa DJ, Custovic A, Dahl R, Denburg J, Douagui H, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Kaliner MA, Keith PK, Kim YY, Klossek JM, Kuna P, Le LT, Lemiere C, Lipworth B, Mahboub B, Malo JL, Marshall GD, M vale-Manuel S, Meltzer EO, Morais-Almeida M, Motala C, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Ouedraogo S, Palkonen S, Popov TA, Price D, Rosado-Pinto J, Scadding GK, Sooronbaev TM, Stoloff SW, Toskala E, van Cauwenberge P, Vandenplas O, van Weel C, Viegi G, Virchow JC, Wang DY, Wickman M, Williams D, Yawn BP, Zar HJ, Zernotti M, Zhong N, In collaboration with the WHO Collaborating Center of Asthma and Rhinitis (Montpellier). Development and implementation of guidelines in allergic rhinitis , an ARIA-GA2LEN paper. Allergy 2010; 65: 1212,1221. Abstract The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients' values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved. [source]

Infant feeding and allergy prevention: a review of current knowledge and recommendations.

ALLERGY, Issue 10 2009
A EuroPrevall state of the art paper
The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies. [source]

Comparing health care delivery systems , initiating a student exchange project between Europe and the United States

MEDICAL EDUCATION, Issue 7 2001
Elizabeth G Armstrong
Background Cross-cultural contact among different health care systems can provide a framework for identifying the strengths and weaknesses of one's own healthcare system. However, such contact has rarely had much impact upon medical education curricula. Despite intense debate on reforming the healthcare delivery systems (HCDS) in Europe and the United States, there is very little formal representation of this interdisciplinary field in our educational programs. Description To address this problem, a medical student exchange program was conducted in which students developed case studies that produced comparative analyses of HCDS in Germany, Sweden, Denmark and the United States. Each case is intended to highlight critical differences among the systems. Evaluation Students and their faculty preceptors completed pre- and post-exchange questionnaires to assess perceived knowledge of the HCDS and the adequacy of time devoted to it in their curricula. Both perceived that too little attention was devoted to this content in their programs. Following the exchange, students described clear increases in perceived knowledge. Discussion Our common interest in curriculum reform was key to implementing the exchange. The written cases generated by the students are being developed as course material in some of the schools and a conference is planned to disseminate the cases and the implementation strategies for their inclusion in medical curricula. [source]

Task-specific training: evidence for and translation to clinical practice

OCCUPATIONAL THERAPY INTERNATIONAL, Issue 3-4 2009
Isobel J. Hubbard
Abstract There is mounting evidence of the value of task-specific training as a neuromotor intervention in neurological rehabilitation. The evidence is founded in the psychology of motor skill learning and in the neuroscience of experience-dependent and learning-dependent neural plastic changes in the brain in animals and humans. Further, there is growing empirical evidence for the effectiveness of task-specific training in rehabilitation and for neural plastic changes following task-oriented training. In this paper, we position the evidence for task-specific training in the context of rehabilitation; review its relevance for occupation-based neurological rehabilitation, particularly in relation to upper limb function and everyday activities; and recommend evidence-driven strategies for its application. We recommend that task-specific training be routinely applied by occupational therapists as a component of their neuromotor interventions, particularly in management related to post-stroke upper limb recovery. Specifically, we propose five implementation strategies based on review of the evidence. These are: task-specific training should be relevant to the patient/client and to the context; be randomly assigned; be repetitive and involve massed practice; aim towards reconstruction of the whole task; and be reinforced with positive and timely feedback. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Building e-government in East and Southeast Asia: Regional rhetoric and national (in)action

PUBLIC ADMINISTRATION & DEVELOPMENT, Issue 4 2002
Ian HollidayArticle first published online: 9 OCT 200
Among many regional policy initiatives taken by states in East and Southeast Asia in the wake of the 1997 financial crisis, one central project launched by the Association of Southeast Asian Nations (ASEAN), and taken up by its dialogue partners in East Asia, was promotion of information and communication technology. While part of ASEAN's 1999,2004 action plan focused on services for business, another part sought to put public sectors online, and to promote electronic government, or e-government. Taking the 16 states and quasi-states of East and Southeast Asia, this article evaluates progress at the action plan's mid-point in January 2002. It begins by defining e-government and reviewing three academic literatures on the information age, developmental states, and Confucian societies. It then describes the major policy initiatives taken by ASEAN and its partner states, and surveys implementation progress through an analysis of government homepages and sites. Its main finding is that e-government activity in East and Southeast Asia is highly diverse, reflecting national strengths and weaknesses rather than regional capacity for policy change. The article argues for increased attention to national implementation strategies. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Potential Advantages and Limitations of Applying the Chronic Kidney Disease Classification to Kidney Transplant Recipients

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2006
J. S. Gill
The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) classification of Chronic Kidney Disease (CKD) characterizes patients by their level of kidney function and includes kidney transplant recipients (KTRs). Most KTRs have stage ,3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and may benefit from aggressive CKD care. Recent modifications to the K/DOQI CKD classification reflect the recognition of KTRs as a unique subset of CKD patients in whom the presentation, progression and implications of CKD may vary from those in nontransplant CKD populations. Currently, there is limited information about how adopting the CKD classification in KTRs will influence clinical management and outcomes. Appropriately designed studies are needed to develop transplant-specific CKD treatment recommendations, and to ensure patient, health provider and payer acceptance of the continued need for aggressive CKD care after transplantation. Education and implementation strategies will be required to ensure appropriate integration of the CKD classification and treatment guidelines into existing posttransplant care programs. The CKD classification thus represents an exciting potential strategy to improve clinical outcomes that should be adopted, further studied and modified to incorporate considerations unique to KTRs. [source]

Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidence

AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2010
Mary Stergiou-Kita
Background:,Clinical Practice Guidelines (CPGs) are prominent tools in evidence-based practice which integrate research evidence, clinical expertise and client input to develop recommendations for specific clinical circumstance. With the push to use research evidence in health care, it is anticipated that occupational therapists will become increasingly involved in implementing CPGs in practice. The research evidence has revealed several factors that can affect guideline uptake, and a variety of strategies that can facilitate implementation. Methods:,This narrative review examines the health-related literature in CPGs to answer the following questions. Based on the research evidence, (i) what are the factors that may influence guideline implementation? (ii) What implementation strategies may enhance guideline implementation? Results:,Factors within the guideline itself (e.g. quality, complexity and clarity), within the practitioner (e.g. experience, perceptions and beliefs), the patient (e.g. expectations and preferences) and the practice context (e.g. resource availability, organisational culture and opinion leaders) can all affect implementation success. Currently, there is no conclusive evidence to support the use of one implementation strategy over another, in all situations. The choice of implementation strategy must take into account the guideline to be implemented, the practice context and the anticipated challenges to implementation. Conclusions:,By understanding the factors that can influence implementation and the strategies for successful implementation, occupational therapists will be better prepared to implement guidelines. Recommendations to assist with guideline uptake and implementation are provided. [source]

Barriers to Metered-dose Inhaler/spacer Use in Canadian Pediatric Emergency Departments: A National Survey

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Martin H. Osmond MDCM
Background Metered-dose inhalers and spacers (MDI+S) are at least as effective as nebulizers for treating children with mild to moderate asthma exacerbations. Despite advantages in terms of efficacy, side effects, and ease of use, MDI+S are not used in many North American pediatric emergency departments (PEDs). Objectives To survey emergency physicians, emergency nurses, and respirologists in Canadian pediatric teaching hospitals regarding their practices, beliefs, and barriers to change with respect to bronchodilator delivery. Methods This was a cross-sectional, mailed survey of all emergency physicians, all respirologists, and a random sample of emergency nurses at ten Canadian PEDs. Results A total of 291 of 349 health care professionals (83%) responded. Twenty-one percent of emergency physicians use MDI+S in the PED (largely concentrated at two "user sites"). A majority at nonuser sites, and virtually all professionals at user sites, responded that MDI+S are at least as effective as nebulizers, switching to MDI+S is justified by existing research, patient outcomes would be equal or better, and they have the required knowledge and skills to use MDI+S in the emergency department. The largest perceived barriers to MDI+S implementation include concerns regarding safety and costs, related to feasibility of providing and sterilizing spacers, and parental expectations for nebulizers. Other barriers included staff beliefs regarding the effectiveness of MDI+S, changes in nursing workload, and lack of a physician champion for change. Conclusions MDI+S are infrequently used to treat patients with acute asthma in Canadian PEDs, despite the fact that most emergency staff believe they are effective. Important barriers to using MDI+S have been identified in this study and should be used to guide future implementation strategies. [source]

Development and implementation of new educational concepts in a dental curriculum

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2007
H. W. Kersten
Abstract, The Academic Centre for Dentistry Amsterdam introduced a fully renewed 5-year dental curriculum in September 2003. In this article, the educational principles and didactic choices that form the basis of the curriculum development are presented and attention is given to the process of development and the implementation strategy that constitute such an important part of the success of introducing a new curriculum. Special characteristics of the new curriculum are the clinical training practice, professional conduct, the elective profiles and academic education. In clinical practice, groups of students from different levels run a group practice in which they learn to work together, delegate tasks, solve clinical problems and apply evidence-based dentistry. In the new curriculum students learn to conduct themselves as professionals. In the third and in the fifth year, students choose an elective profile oriented, respectively, on research and on clinical knowledge and skills. Academic education is an important spearhead in this curriculum in which students not only learn why research is important to dentistry but also how dentists can use research to their own benefit. In development and implementation, a stepwise approach was used in which as many people as logistically possible were involved. [source]