Comprehensive Implementation Plan Research Articles

Analysis of the composition and influencing factors of hospitalization expenses for 1517 patients with lung malignant tumors in Beijing.

This study aimed to analyze the composition of the total hospitalization expenses of patients with lung cancer in Beijing TongRen Hospital from January 2018 to December 2020 before and after the implementation of the "Beijing Medical Consumption Linkage Comprehensive Reform Implementation Plan" (hereinafter referred to as "Reform"). The SPSS 25.0 statistical software was used to perform descriptive statistics on the total hospitalization costs of selected 1517 patients with lung malignant tumors, and single factor and multivariate regression analysis were used to clarify the influencing factors of the patients' total hospitalization costs. From 2018 to 2020, the total hospitalization costs of patients with lung malignant tumors increased year by year (P < .05), and the average length of hospital stay decreased year by year (P < .05). The total hospitalization expenses of patients with lung malignant tumors mainly include material expenses, surgical expenses, inspection expenses, inspection expenses and medicine expenses. After the implementation of the "Reform," the proportion of medicine, inspection, nursing and other expenses in the total hospitalization expenses of patients with lung malignant tumors has been significantly reduced (P < .05), and the proportion of surgical expenses has been significantly increased (P < .05). The results of the univariate analysis showed that gender, age, length of stay in the hospital, surgery, and tumor location were the main factors affecting the total hospitalization expenses of patients (P < .05). The results of multivariate analysis showed that gender (female), age (<40 years old), length of stay (≥15 days), surgery (yes), and tumor location (right lung) are the main factors affecting the total hospitalization cost of patients with malignant tumors (P < .05). Under the premise of ensuring the efficacy of patients, the economic burden of patients is reduced by reducing the cost of materials, shortening the length of hospitalization, strengthening hospital management, and controlling the continuous growth of hospitalization costs.

부패방지법의 입법체계 정비방안

The Criminal Law, the Unfair Solicitation Prohibition Act, the Conflict of Interest Prevention Act, the Public Officials Ethics Act, and the Public Officials Report Protection Act have been enacted and implemented in Korea to eradicate corruption according to the type of corruption, the degree of corruption, and the change of the times. After the enactment of the Unfair Solicitation Prohibition Act and the Conflict of Interest Prevention Act, Korea ranked 31st in 2022. Since the Public Officials Ethics Act contains a number of contents to be regulated in the Conflict of Interest Act, it is necessary to regulate it in the Conflict of Interest Act, but it is necessary to reasonably improve the Public Officials Ethics Act. In addition, although it was originally intended to enact the Unfair Solicitation and Conflict of Interest Prevention Act, the anti-corruption system is operated under the division of law, so the efficiency and effectiveness of corruption prevention need to be reorganized into an integrated law. On December 4, 1998, and December 2, 1999, the Framework Act on Anti-Corruption was proposed to the National Assembly twice to prevent and eliminate fundamental corruption, but the Framework Act on the Prevention of Corruption was withdrawn or automatically discarded due to the expiration of the National Assembly due to differences in positions between the ruling and opposition lawmakers. In 2001, the Corruption Prevention Act, a general corporation of the Public Officials Act, was enacted to establish a clean social climate by efficiently regulating corruption prevention and corruption activities. After examining the main contents of Korea's anti-corruption legislation, including the Constitution, and related anti-corruption laws, it is necessary to consider the implications of the anti-corruption legal system by referring to legislative examples in the UK, the US, and France. Korea's anti-corruption system under the Corruption Prevention Act is centered around public organizations and public officials, but it does not regulate corruption prevention and corrupt practices for companies, making it impossible to break the chain of corruption. There is a need to strengthen democracy, the rule of law and national competitiveness by enacting the Basic Anti-Corruption Act and introducing an anti-corruption system not only for public officials but also for companies above a certain size (mid-sized companies and large corporations). Therefore, the relationship with other laws, the anti-corruption responsibilities of the state, local governments, public organizations, companies, and citizens, basic anti-corruption principles, anti-corruption policies, comprehensive anti-corruption plan and implementation plan, corruption risk assessment system, and civil rights. It would be desirable to regulate the committee's compulsory investigation rights, city/provincial anti-corruption committees, public organization anti-corruption committees, establishment of anti-corruption offices, internal audits and public audit request systems, and penalties, etc., in the Framework Act on Corruption Prevention.

Analisis Penerapan Model Pembelajaran Project Based Learning Pada Pembelajaran Tematik

This research aims to determine: 1) the application of the Project Based Learning (PjBL) Learning Model, 2) the results of the application of the Project Based Learning (PjBL) Model, and 3) the inhibiting factors encountered in the application of the Project Based Learning model in class IV Thematic lessons in MI Al Islam Mranggen, Polokarto subdistrict, Sukoharjo Regency in 2023/2024. The type of research used was descriptive qualitative, the research subjects in this study were fourth grade students of Madrasah Ibtidaiyah Al Islam Mranggen and the data collection techniques used were observation, interviews and documentation. The research results show that: 1) in its application, teachers plan learning by creating a comprehensive Learning Implementation Plan (RPP). 2) the results of implementing PjBL show that project-based learning encourages students to think creatively and act systematically. 3) inhibiting factors in implementing PjBL were also identified, such as the allocation of time required that goes beyond class hours, limited tools and materials, teachers' lack of understanding of the PjBL model, students' unfamiliarity with project-based learning, and difficulties in determining projects that are appropriate to the learning model.

Implementing One-at-a-Time Therapy in community addiction and mental health centres: a retrospective exploration of the implementation process and initial outcomes

BackgroundThe Department of Health of the Government of New Brunswick and Regional Health Authorities elected to implement Stepped Care 2.0 (SC2.0) in 2021, and began with One-at-a-Time (OAAT) therapy in Community Addiction and Mental Health Centres (CAMHCs) to facilitate rapid access to addiction and mental healthcare. This study: 1) explicated the process of implementing OAAT therapy as it aligned to evidence-based implementation frameworks and strategies; 2) assessed readiness for change among providers during the implementation; and 3) evaluated initial client and system outcomes.MethodsThe process of implementing OAAT therapy within CAMHCs was documented and retrospectively aligned with the Active Implementation Frameworks-Stages of Implementation, Consolidated Framework for Implementation Research, and incorporated strategies endorsed by the Expert Recommendations for Implementing Change. Providers working in CAMHCs completed online asynchronous courses in OAAT therapy and SC2.0, and were recruited to participate in research on perceptions of organizational readiness. Initial outcomes of the implementation were evaluated through client satisfaction surveys administered in CAMHCs and system performance indicators.ResultsAligning with implementation stages, key strategies included: 1) continuously monitoring readiness and soliciting stakeholder feedback for iterative improvement; 2) building a representative implementation team with engaged leaders; 3) creating a comprehensive implementation plan on staff training, communication, and system changes; and 4) supporting sustainability. Providers who participated in research (N = 170, ~ 50% response rate) agreed that their organization was ready for implementation, and that OAAT therapy delivered within a SC2.0 framework was acceptable, appropriate, and feasible. More than 3,600 OAAT therapy sessions were delivered during the initial implementation stage, and waitlists were reduced by 64.1%. The majority of clients who completed surveys (N = 1240, ~ 35% response rate) reported that their OAAT therapy session was helpful, with a minority reporting that additional intervention was needed.ConclusionsThoughtful planning and execution, aligned with evidence-based implementation frameworks and strategies, played an important role in this provincial change initiative. Implementation steps outlined can help inform others looking to enact large-scale change.

Charting the Course to Advance DEI in the Ocean Sciences: A Case Study

The Louisiana State University College of the Coast &amp; Environment (LSU CC&amp;E) developed a multi-faceted strategic initiative to increase its diversity, equity, and inclusion. Elements of this initiative began one-by-one over the last decade and were aggregated into a comprehensive implementation plan—the 2020 CC&amp;E Diversity, Equity, and Inclusion Action Plan. Based on best practices in the “physical sciences” (i.e., geosciences, including oceanography), the plan aims to augment recruitment and retention using limited resources and personnel. The long-range goal is to increase the number of PhD graduates from underrepresented groups by employing strategies that start at the 6–12th grade level. The plan involves a change in culture, clear communications about needs and goals, and active participation and engagement of CC&amp;E faculty, students, staff, supporters, and partners. This plan is increasing the diversity of enrollment in our academic programs and will ultimately lead to more students with both undergraduate and graduate degrees.

The Influence of Organizational Health on Reducing the Job Burnout during the COVID- 19 Pandemic -An Applied Study on the medical section -

This study desires to identify the level of job burnout among health workers during the COVID-19 pandemic crisis and examine the impact of organizational health in reducing this feeling. A random sample of 400 individuals distributed among doctors and nurses working in hospitals in Saudi Arabia, Egypt and Jordan was selected to achieve this goal. The questionnaire was used as a tool for data collection. The number of returned questionnaires was 318 (79.5%). The study confirmed the existence of an average level of organizational health application within the hospitals under study, which needs to raise awareness of the importance of organizational health. The study also confirmed the presence of high levels of burnout among the medical staff which explains the professional pressures that the medical staff were exposed during COVID-19. Also, the statistical results confirmed that organizational health has a significant positive effect on reducing job burnout. Accordingly, a comprehensive implementation plan was prepared that explains how to apply the dimensions of organizational health within hospitals in a way that contributes to creating an appropriate healthy organizational environment that improves the performance of health workers and reduces their sense of pressure and job burnout.

A Secure Interoperable API Wrapper Tunnel for Integration of GIS-Based ICS-IIoT and Digital Twins in Industry 4.0 Clouds

Industry 4.0 is the most disruptive revolution engulfing all the digital transformation from sensors nodes to cloud applications. A sustainable and secure Industry 4.0 ecosystem is a core challenge for stakeholders and state agencies addressed in this work by layered API tunnel interoperability instead of conventional cybersecurity methods and techniques. In this work, an interoperable application programmer interface (API) wrapper is being proposed to manage heterogeneous cloud architectures using Eucalyptus, Apache CloudStack, and OpenNebula. A comprehensive design and implementation plan from things layer to user interface has been accomplished in this work. Infrastructure as a Service (IaaS) is being automated using Ansible from Web Servers Layers through Common Gateway Interface (CGI) scripting. The Web Servers are being managed using WebSockets by micro–Web Servers Gateway Interface (uWSGI) from cloudstack managers (CSM) API. The Platform as a Service (PaaS) for big data, web servers, and machine learning platforms is accomplished using uWSGI from CSM. The public and private clouds are being managed using individual APIs. The wrapper, proposed in this work enables the big challenge of Industry 4.0 for realizing interoperability, scalability, heterogeneity, and automated cloud integration by functioning at the Software as a Service (SaaS) Layer.

COVID-19 vaccination clinics: meeting clinical hours and improving nursing students’ skills

BackgroundAs 2020 drew to an end and the country was looking forward to 2021, the University of Texas Medical Branch School of Nursing was presented with the challenge of administrating large quantities of COVID-19 vaccines. As the vaccines became more readily available, staff skilled in intramuscular injections (IM) were needed at multiple locations to administer the vaccinations. MethodThe school of nursing faculty recognized this as an opportunity for nursing students to gain clinical experience by substituting one virtual clinical day with one day at the in-person vaccine clinic. A comprehensive implementation plan was developed in collaboration with leadership from across the health system. ResultsThe students were able to increase confidence in IM injection skills while helping the community by administering life-saving doses of vaccine to patients and Galveston county residents. ConclusionsVaccination clinic participation proved to be a worthwhile experience for the nursing students and faculty.

Research on Calibration Technology of TEV Partial Discharge Smart Sensors

TEV partial discharge detection is an important method to judge the insulation status of the switchgear. However, the quality of TEV smart sensors produced by different manufacturers on the market is uneven. Some TEV smart sensors that have been put into operation have deficiencies in measurement sensitivity, data stability, and long-term operational reliability. In response to these problems, this paper proposes a TEV smart sensor calibration method and builds a test platform, which is composed of program-controlled signal source, signal coupling device, protocol conversion device, host computer and corresponding integrated control software. On the basis of the existing standards such as sensitivity and linearity, the evaluation of the data stability, reliability and battery lifetime of the TEV smart sensor has been added. It provides a more comprehensive and effective implementation plan for TEV smart sensor performance verification in power grid access test.

Using web-based technology to improve depression screening in primary care settings

BackgroundGiven the high rates at which patients present with behavioural health (BH) concerns in primary care (PC), this setting has become the de facto mental health system. As a result,...

Sustainable knowledge flow and innovation in higher education: the implementation of change management in universities

One of the most difficult tasks in higher educational institutions is to implement effective and constructive changes within already functioning system. Resistance and unwillingness of the institutional members are the main barriers for an institution to implement a required change. This paper intends to describe how to facilitate the flow of knowledge and adopt an innovation mindset in the context of higher education or higher learning institutions. In addition, this paper also discusses three domains of a comprehensive implementation or change management plan: structure, culture, and strategies. The change management plan presented in this paper demonstrates how a change initiative can be undertaken in a higher educational institution in the context of knowledge flow and adoption of the innovation mindset. The main outcome of the paper is that institutional mission, vision and priorities need to be clearly understood by every member of the staff in order to support and facilitate change and innovative thinking.

Marine Corps Force Design 2030 and Implications for Allies and Partners: Case Norway

Force Design 2030 describes major organizational changes to the U.S. Marine Corps. Arguably, these changes will affect the Joint force, allies, and partners. The United States, and in particular the Marine Corps, is an important part of the deterrence and defense of many countries, especially Norway. Thus, the Norwegian Armed Forces should adapt to these changes to increase interoperability and strengthen the common warfighting capability. A comprehensive implementation plan, including allies and partners to operationalize the changes in the Marine Corps as well as the new U.S. Service and Joint concepts, is needed to succeed in creating an advantage over China and Russia.

We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology

BackgroundExercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate research into practice; however, implementation barriers have limited their success in part because successful translation of exercise oncology research into practice requires context-specific implementation plans. The aim of this study was to employ the implementation mapping protocol to develop an implementation plan to support programming of a co-located exercise clinic and cancer treatment center.MethodsThe Implementation Mapping protocol, which consists of five specific iterative tasks, was used. A stakeholder advisory group advised throughout the process.ResultsA comprehensive needs assessment was used to identify the organization’s general manager as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified. The theoretical domains framework was used to identify likely determinants of change, which informed the selection of eight individual implementation strategies across the individual and organizational levels. Finally, an evaluation plan was developed which will be used to measure the success of the implementation plan in the project’s next phase.ConclusionThe Implementation Mapping protocol provided a roadmap to guide development of a comprehensive implementation plan that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to development of the plan.

Translating reablement research for dementia practice: development of a handbook using implementation science

Purpose Reablement is a strategy recommended in clinical practice guidelines that could maximise functioning and quality of life in people living with dementia. This project sought to develop a practical handbook for health professionals illustrating the best, currently available evidence via newly-developed composite reablement programs. Materials and methods Handbook development occurred over five phases, informed by Normalisation Process Theory: (1) literature review, (2) sector interviews to explore how handbook implementation may impact practice, (3) workshop to determine final handbook content, (4) reablement program synthesis and handbook development, and (5) dissemination and implementation planning to support optimal uptake and normalisation within the sector. Results Interviews (n = 22) identified sector support for development of the reablement handbook. Workshop (n = 24 participants) outcomes informed the final eight reablement programs sorted by functional outcomes (everyday living activities; mobility and physical function; and cognition and communication). A technical guide and consumer information booklet were developed to support the handbook. A comprehensive handbook implementation plan involving dynamic assessment and monitoring was developed. Conclusions The reablement handbook provides a practical and accessible avenue to support function in people with dementia. Robust, coordinated dissemination, implementation and assessment of the new resource across a range of practice settings is now required. Implications for rehabilitation Dementia leads to disability and dependence, impacting the person with dementia, their family and society. Reablement, an approach consistent with rehabilitation, is a strategy recommended in clinical practice guidelines that could maximise functional performance and quality of life in people living with dementia. This study describes development of a freely available evidence-informed reablement handbook designed to support delivery of high-quality reablement programs by allied health/nursing professionals for people living with dementia. Outcomes have potential to inform future implementation work and to ultimately improve the quality of services offered within the dementia sector.

Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel's assessment and priority recommendations.

IntroductionUnhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs).ObjectiveWe aimed to examine healthy food environment policies in Kenya and identify priorities for future action.MethodsUsing the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized.ResultsIn the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in ‘implementation’ phase, including: food composition targets, packaged foods’ ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in ‘implementation’ phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be ‘in development’. Compared to international best practice, the Kenyan Government was judged to be performing relatively well (‘medium’ implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7%) indicators were rated as ‘low’ or ‘very little’. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized.ConclusionThis baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya.

Leveraging Health Information Technology to Meet The Joint Commission's Standard for Measurement-Based Care: A Case Study

Three decades of research have shown that routinely collecting patient-reported outcomes throughout treatment to inform clinical decision making or measurement-based care (MBC) can improve clinical outcomes, yet widespread adoption continues to be elusive. This article describes how a community behavioral health center addressed Element of Performance (EP) 1 of The Joint Commission's revised MBC standard using health information technology (HIT)-facilitated MBC and a comprehensive implementation plan grounded in the Consolidated Framework for Implementation Research. Across the initial 15-month implementation period, 96.8% of patients who had an intake evaluation also completed baseline measurements via an HIT known as a measurement feedback system (MFS), and 91.5% (78.6%-100%) completed at least one repeated measure. MFS reduces many of the logistical barriers of MBC, but implementation of MFS-facilitated MBC requires a comprehensive implementation plan that includes strategies to address barriers across all relevant domains for successful uptake.

Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital.

To develop an implementation plan for delirium prevention. The use of non-pharmacological interventions to prevent hospital-acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical. Ethnographic study was conducted in a 24-bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews and document review. Inductive analysis was used to generate themes that described enablers and barriers. Enablers included a ward culture that embraced safety and placing the person at the centre of care. Barriers were in tension with the enablers and included limited staff knowledge, specialist forms exclusive to the nursing discipline, inflexible ward routines and frequent disruptions. In addition to standard implementation strategies such as individual education and leadership, implementing delirium prevention requires consideration of team practices, review of policy document design and identification of outcomes data than can support collaborative reflexive practice. The use of a theory-informed ethnographic approach exposed tensions that may be otherwise invisible. Understanding the tensions increases the likelihood of implementation success. Using a systematic assessment approach can create a comprehensive implementation plan.

A logic model for precision medicine implementation informed by stakeholder views and implementation science

PurposePrecision medicine promises to improve patient outcomes, but much is unknown about its adoption within health-care systems. A comprehensive implementation plan is needed to realize its benefits. MethodsWe convened 80 stakeholders for agenda setting to inform precision medicine policy, delivery, and research. Conference proceedings were audio-recorded, transcribed, and thematically analyzed. We mapped themes representing opportunities, challenges, and implementation strategies to a logic model, and two implementation science frameworks provided context. ResultsThe logic model components included inputs: precision medicine infrastructure (clinical, research, and information technology), big data (from data sources to analytics), and resources (e.g., workforce and funding); activities: precision medicine research, practice, and education; outputs: precision medicine diagnosis; outcomes: personal utility, clinical utility, and health-care utilization; and impacts: precision medicine value, equity and access, and economic indicators. Precision medicine implementation challenges include evidence gaps demonstrating precision medicine utility, an unprepared workforce, the need to improve precision medicine access and reduce variation, and uncertain impacts on health-care utilization. Opportunities include integrated health-care systems, partnerships, and data analytics to support clinical decisions. Examples of implementation strategies to promote precision medicine are: changing record systems, data warehousing techniques, centralized technical assistance, and engaging consumers. ConclusionWe developed a theory-based, context-specific logic model that can be used by health-care organizations to facilitate precision medicine implementation.

Status of water resources in Nepal and existing use in Irrigation

The surface water available in the country is estimated to be about 225 billion cu.m per annum, out of which only 15 billion cu.m per annum is in use. In addition to surface water, a large volume of water is available in the shallow and deep aquifers which are estimated to be 8.8 billion cu.m annually which can be used for irrigation and domestic water supplies. At present less than 50% of the cultivated area has intermittent irrigation facilities and less than 20% of cultivated area has year round irrigation.Nepal’s economy is largely based on agriculture however, Nepalese agriculture is mainly rain fed and agriculture production in both rain fed as well as irrigated areas are being badly affected due to droughts, flooding, erratic rainfall, and other extreme weather events. It is necessary that the modern agriculture practice with the help of year round irrigation we can increase the GDP and provides greater employment opportunities and ultimately we can do sustainable agriculture development. Present water consumption rate is less than 8% of the country’s water potential for irrigation sector. This water consumption rate is very low for our country. This consumption rate can be increase by making a comprehensive study and implementation plan by making multipurpose reservoir type irrigation project for maximum use of available water resources. Year round irrigation scheme also become great tool to get optimum economic development in agricultural sector and maximum crop yield.

Developing a Nurse-Led Intervention for Men With Advanced Prostate Cancer: A Preimplementation Study

Background: Men with advanced prostate cancer can experience poor life quality and health outcomes compared with men with localized disease. Closely matching men's needs and identifying barriers and facilitators to implementation were critical first steps for ensuring the feasibility of our nurse-led telephone-based supportive care intervention for men with advanced prostate cancer. Aim: The aim of this study is to understand the context for implementing ProsCare from PCSNs, and in doing so, further develop the intervention and implementation strategy. Methods: A total of 30 Prostate Cancer Specialist Nurses (PCSNs) participated in 4 semistructured focus groups. Data were coded into the Consolidated Framework for Implementation Research (CFIR) to evaluate the ProsCare program content and guide the implementation and evaluation of this targeted program for men with advanced prostate cancer. Results: Participants validated ProsCare components of (1) decision support; (2) treatment education with self-management and skills training for symptom effects, including exercise prescription; (3) routine screening for psychological distress with referral; (4) psycho-education with tailored distress management strategies; and (5) communicating with health professionals. Data supported a revised treatment schedule and a comprehensive implementation plan including professional education and centralised administration. Conclusion: ProsCare is a valid supportive care nurse-led intervention. The CFIR framework is useful for the structured identification of implementation factors.