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Improved Implementation (improved + implementation)

Distribution by Scientific Domains

Medical Sciences	50%

Selected Abstracts

Toward Improved Implementation of Evidence-based Clinical Algorithms: Clinical Practice Guidelines, Clinical Decision Rules, and Clinical Pathways

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Gary M. Gaddis MD
This is a summary of the consensus-building workshop entitled "Guideline Implementation and Clinical Pathways," convened May 15, 2007, at the Academic Emergency Medicine Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake." A new term, "evidence-based clinical algorithms" is suggested to encompass evidence-based information codified into clinical pathways, clinical practice guidelines, and clinical decision rules. Examples of poor knowledge translation (KT) relevant to the specialty of emergency medicine are identified, followed by brief descriptions of important research and concepts that inform the research recommendations. Four broad themes for research to improve the KT of evidence-based clinical algorithms are suggested: organizational factors, cognitive factors, social factors, and motivational factors. In all cases, research regarding optimizing KT for the subthemes identified by Glasziou and Haynes, "getting the evidence straight," and "getting the evidence used," are interwoven into the thematic research recommendations. Consensus was reached that the majority of research efforts to evaluate means to improve KT need to be centered on the factors that show promise to enhance "getting the evidence used," focused especially on organizational factors. [source]

Improved implementation and robustness study of the X-FEM for stress analysis around cracks

INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 8 2005
E. Béchet
Abstract Numerical crack propagation schemes were augmented in an elegant manner by the X-FEM method. The use of special tip enrichment functions, as well as a discontinuous function along the sides of the crack allows one to do a complete crack analysis virtually without modifying the underlying mesh, which is of industrial interest, especially when a numerical model for crack propagation is desired. This paper improves the implementation of the X-FEM method for stress analysis around cracks in three ways. First, the enrichment strategy is revisited. The conventional approach uses a ,topological' enrichment (only the elements touching the front are enriched). We suggest a ,geometrical' enrichment in which a given domain size is enriched. The improvements obtained with this enrichment are discussed. Second, the conditioning of the X-FEM both for topological and geometrical enrichments is studied. A preconditioner is introduced so that ,off the shelf' iterative solver packages can be used and perform as well on X-FEM matrices as on standard FEM matrices. The preconditioner uses a local (nodal) Cholesky based decomposition. Third, the numerical integration scheme to build the X-FEM stiffness matrix is dramatically improved for tip enrichment functions by the use of an ad hoc integration scheme. A 2D benchmark problem is designed to show the improvements and the robustness. Copyright © 2005 John Wiley & Sons, Ltd. [source]

The U.S. Policy and Strategy toward DPRK: Comparison and Evalution of the Clinton and Bush Administrations

PACIFIC FOCUS, Issue 2 2002
Hun Kyung Lee
This article focuses on studying and evaluating the Clinton and Bush administrations' policies and strategies toward North Korea. The Clinton administration's policy toward North Korea was a continuation of the abandonment of containment and confrontation strategies of the Cold War era. That policy was based on a strategic transfer of power for the purpose of preventing a war, through a combination of aid and deterrence in the Korean peninsula by its engagement policy. The Administration believed that additional food aid and easing of economic sanctions would make a contribution to North Korean survival, and hence, a reduction in its bellicose disposition. Providing that this policy continued, it would be possible not merely to lead North Korea's change, but also to help it enter into international society by breaking down its self-imposed isolation. To the contrary, the Bush administration points out that the Clinton administration's engagement policy did not lead to North Korea's change, and even left the wrong precedent in nuclear and missile negotiations. Focusing on nonproliferation of weapons of mass destruction with an emphasis of transparency, monitoring, and verification, the Bush administration has claimed a broad agenda. This includes an improved implementation of the Agreed Framework relating to North Korea's nuclear activities, verifiable control over North Korea's missile programs and a ban on its missile exports, and a less threatening conventional military posture. With the different views of these two administrations as a background, this article explores the U.S. efforts for achieving such policy goals as freezing North Korea's nuclear weapons program and halting its missile development and sales, together with looking at North Korea's response. American efforts for supporting the necessities for life, easing of some economic sanctions toward DPRK are also described. At the same time, the U.S. policy toward DPRK is evaluated on the whole in considering U.S. policy limits for nonproliferation of weapons of mass destruction, the lack of effort by North Korea for peacemaking and survival, and inconsistency on U.S. assistance. Lastly, this article suggests a way for an alternative solution by thinking about some dilemmas for the U.S. and the DPRK. [source]

Litigation related to inadequate anaesthesia: an analysis of claims against the NHS in England 1995,2007

ANAESTHESIA, Issue 8 2009
R. Mihai
Summary Inadequate anaesthesia may cause distress to the patient and lead to medical litigation. All claims made to the NHS Litigation Authority 1995,2007 were obtained and the data was examined independently by all authors and classified. In a dataset of 1067 claims there were 161 cases of inadequate anaesthesia and data were suitable for analysis in 159: intra-operative awareness (79), brief awake paralysis (20) and inadequate regional anaesthesia (60). The total cost of closed claims was £3.2m. Cost was incurred in 100% of claims of brief awake paralysis, 87% of claims of awareness and 80% of claims of inadequate regional blockade. Mean cost of closed claims was £32 680 for anaesthetic awareness, £29 345 for inadequate regional blockade and £24 364 for brief awake paralysis. Inadequate anaesthesia accounts for 19% of anaesthesia-related claims in the NHS in England. Strategies that reduce anaesthetic awareness, drug errors and inadequate regional blockade are known and their improved implementation is likely to reduce such claims. [source]