Development Of Best Practices Research Articles

Sustaining Ambulatory Comprehensive Medication Management Practices: Perspectives from a Minnesota Pharmacist Collaborative.

In a time of evolving health care landscapes, pharmacists who provide comprehensive medication management (CMM) need to demonstrate financial and quality value to sustain their practice. Minnesota CMM programs started providing services in 1998, before recognition or reimbursement existed, and continue practices today. This long history lends itself well to the development of best practices for sustaining CMM practices. The Health-Systems for Integrated Medication Management (HAIMM) represents 13 Minnesota health systems, including 90 pharmacists and 121 clinics across the state. Pharmacist representatives from each of the participating health systems were polled to determine commonly implemented sustainability strategies. Common trends were identified, and the group was surveyed for important considerations on implementation of each strategy. Poll results of strategies for CMM practice sustainability were placed into 2 categories: fiscal and quality-based initiatives. Each strategy was discussed to determine implementation options and lessons learned from the collaborative. Numerous strategies were identified to ensure CMM practice sustainability. HAIMM's programs found it best to use a mixture of fiscal and quality-based strategies to sustain their practices. No outside funding supported this study. The authors have no conflicts of interest to declare. The information within this article should not be construed as legal advice, and the Health-Systems Alliance for Integrated Medication Management (HAIMM) disclaims all liability of action or lack of action resulting from use of this content. Readers should obtain legal and/or professional advice from a licensed professional within their state.

Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study.

OBJECTIVEComplications after complex tethered spinal cord (cTSC) surgery include infections and cerebrospinal fluid (CSF) leaks. With little empirical evidence to guide management, there is variability in the interventions undertaken to limit complications. Expert-based best practices may improve the care of patients undergoing cTSC surgery. Here, authors conducted a study to identify consensus-driven best practices.METHODSThe Delphi method was employed to identify consensual best practices. A literature review regarding cTSC surgery together with a survey of current practices was distributed to 17 board-certified pediatric neurosurgeons. Thirty statements were then formulated and distributed to the group. Results of the second survey were discussed during an in-person meeting leading to further consensus, which was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree).RESULTSSeventeen consensus-driven best practices were identified, with all participants willing to incorporate them into their practice. There were four preoperative interventions: (1, 2) asymptomatic AND symptomatic patients should be referred to urology preoperatively, (3, 4) routine preoperative urine cultures are not necessary for asymptomatic AND symptomatic patients. There were nine intraoperative interventions: (5) patients should receive perioperative cefazolin or an equivalent alternative in the event of allergy, (6) chlorhexidine-based skin preparation is the preferred regimen, (7) saline irrigation should be used intermittently throughout the case, (8) antibiotic-containing irrigation should be used following dural closure, (9) a nonlocking running suture technique should be used for dural closure, (10) dural graft overlay should be used when unable to obtain primary dural closure, (11) an expansile dural graft should be incorporated in cases of lipomyelomeningocele in which primary dural closure does not permit free flow of CSF, (12) paraxial muscles should be closed as a layer separate from the fascia, (13) routine placement of postoperative drains is not necessary. There were three postoperative interventions: (14) postoperative antibiotics are an option and, if given, should be discontinued within 24 hours; (15) patients should remain flat for at least 24 hours postoperatively; (16) routine use of abdominal binders or other compressive devices postoperatively is not necessary. One intervention was prioritized for additional study: (17) further study of additional gram-negative perioperative coverage is needed.CONCLUSIONSA modified Delphi technique was used to develop consensus-driven best practices for decreasing wound complications after cTSC surgery. Further study is required to determine if implementation of these practices will lead to reduced complications. Discussion through the course of this study resulted in the initiation of a multicenter study of gram-negative surgical site infections in cTSC surgery.

Air Force Nursing Executive leadership impact on health care 2004–2008

Recorded history allows us to recognize our past and can contribute to the present and future nursing practice. The purpose of this study is to examine the impact of the United States Air Force Nursing Executive leadership on military health care transformation, through Major General (Retired) Melissa A. Rank's personal stories and experiences. This study explores the development and impact of Air Force nursing in its historical, social, and global context between the years of 2004–2008. The oral history method was used to explore and record the professional life experiences of a great military nurse leader. The United States Air Force Nurse Corps has contributed to global healthcare via humanitarian medical support, medical disaster relief, aeromedical patient transport, development of best practices, advances in technology, education programs, and transformation in deployed medical care during times of war, peace, and natural disasters.

A learning algorithm for optimizing continuous integration development and testing practice

SummaryContinuous integration, at its core, includes a set of practices that aim to prevent and reduce the cost of software integration issues by merging working software copies often. Regression testing is considered a good practice in software development with continuous integration, which ensures that code changes are not negatively affecting software functionality. As, nowadays, software development is carried out iteratively, with small code increments continuously developed and regression tested, it is of critical importance that continuous regression testing is time efficient. However, in practice, regression testing is often long lasting and faces scalability problems as software grows larger or as software changes are made more frequently. One contributing factor to these issues is test redundancy, which causes the same software functionality being tested multiple times across a test suite. In large‐scale software, especially highly configurable software, redundancy in continuous regression testing can significantly grow the size of test suites and negatively affect the cost effectiveness of continuous integration. This paper presents a practical learning algorithm for optimizing continuous integration testing by reducing ineffective test redundancy in regression suites. The novelty of the algorithm lies in learning and predicting the fault‐detection effectiveness of continuous integration tests using historical test records and combining this information with coverage‐based redundancy metrics. The goal is to identify ineffective redundancy, which is maximally reduced in the resulting regression test suite, thus reducing test time and improving the performance of continuous integration. We apply and evaluate the algorithm in two industrial projects of continuous integration. The results show that the proposed algorithm can improve the efficiency of continuous integration practice in terms of decreasing test execution time by 38% on average compared to the industry practice of our case study and by 40% on average compared to the retest‐all approach. The results further demonstrate no significant reduction in fault‐detection effectiveness of continuous regression testing. This suggests that the proposed algorithm contributes to the state of the practice in the continuous integration development and testing of highly configurable systems.

Стан і перспективи розвитку інформаційних технологій в Україні

Розглянуто актуальність інформаційних технологій, як одного з найважливіших чинників стимулювання економічного зростання та розвитку громадянського суспільства, зайнятості населення, соціального та політичного розвитку нашої країни. Встановлено, що на сучасному етапі переходу світового співтовариства до інформаційного суспільства ступінь розвитку інформаційних технологій стає безпосереднім чинником становлення активного та свідомого громадянина, національної конкурентоспроможності. Проаналізовано динаміку внутрішнього ринку інформаційних технологій та розглянуто вплив IT-сектору на економіку України в питаннях зростання валютних надходжень, експорту ІТ-послуг, збільшення відрахувань у бюджет. З'ясовано, що саме рівень технологічного розвитку визначає не лише економічний потенціал країни та якість життя її громадян, а також роль і місце цієї країни в глобальному суспільстві, масштаби та перспективи її економічної та політичної інтеграції з усім світом. За результатами дослідження оцінено внутрішні перешкоди, з якими стикається український сектор інформаційних технологій, виявлено проблеми щодо попиту на ІТ серед населення України. Запропоновано напрями подолання цифрової нерівності способом впровадження міжнародних стандартів і кращих практик, зокрема з питань розроблення, впровадження та використання інформаційних технологій, продуктів і послуг, за умови належного наукового, технічного і правового забезпечення реформування галузі інформаційних технологій.

Schedule Modeling to Estimate Typical Construction Durations and Areas of Risk for 1000 MW Ultra-Critical Coal-Fired Power Plants

To date, Korea has built four 1000 MW gross-power ultra-critical coal-fired power plants. With the introduction of this new power plant type, there is a need for the development of best practices and lessons learned associated with its construction. One such need identified as a gap in literature is the early project planning estimation of project duration. To fill this research gap, this study utilized the Program Evaluation and Review Technique/Critical Path Method (PERT/CPM) and Monte Carlo simulations for estimating the appropriate construction duration at the planning stage of a new 1000 MW class coal-fired power plant project. Through the case study of the four Korean ultra-critical coal-fired power plants in operation, there was found an 85% likelihood of construction duration to be between 64 and 68 months. From interviews with subject matter experts, the most significant risk factors were found to be labor strikes and construction safety incidents. The findings within aid early planning decision makers by providing a replicable and accurate schedule estimation process. While the findings are based on Korean power plants, the results of this research can be used as a tool for coal-fired power plant construction schedule estimation worldwide.

Development of Best Practices of Peer Review in Lung Radiation Therapy

Given the increasing complexity in lung radiation therapy (RT), peer review (PR) is an important component in ensuring high quality and consistent RT plans. However there are inconsistencies in the extent, timing, and minimum requirements for PR across centres. We sought to develop guidelines of best practices for PR in curative lung RT through a Pan-Canadian expert consensus process. A modified Delphi process was conducted. A literature review was first carried out to define important elements for PR with respect to target delineation, organs-at-risk (OAR), and dosimetric plan quality, which was followed with an initial review by a dedicated steering committee. Candidate PR elements were then stratified by cases pertaining to treatment of locally-advanced (LA) disease with conventional RT, or stereotactic ablative body radiotherapy (SABR) for early-stage disease. A pan-Canadian, multidisciplinary Delphi panel was then assembled, and three Delphi rounds were undertaken (one pre-meeting survey, one face-to-face meeting, and one post-meeting ratification survey) to quantify participants’ rankings of the importance of each PR element, as well as the clarity of the wording for each. Finally, all endorsed elements were discussed for final wording by the steering committee. For LA cases, a total of six elements were considered as essential in the PR process. These included i) indications to treat with RT, ii) gross tumor volume (GTV), iii) clinical target volume (CTV), iv) internal target volume (ITV), v) dose/fractionation selection, and vi) normal lung dosimetry (ie V20, mean lung dose). Of these six elements, 90-100% of the panel in the final round endorsed these to be important to PR, and 80% felt that the PR should be done by a second radiation oncologist (RO). There were an additional three elements deemed optional for PR in these cases, including OAR contour review, PTV dosimetric coverage and maximum point dose, with review conditional dependent on the clinical scenario. In the cases of SABR, a total of six PR elements were deemed essential. These included i) indications to treat, ii) GTV, iii) CTV/ITV, iv) OAR contours, v) choice of dose/fractionation, and vi) review of composite plan for cases treated with previous RT. On the final round, 90-100% of panel members felt these elements to be important to PR, and unanimously agreed that PR should be done by a second RO. A further four elements were deemed optional based on the clinical scenario, including PTV dosimetric coverage, maximum point dose, OAR dosimetry, and best practices for daily image guidance. A suite of elements for lung radiation PR has been developed and endorsed with high consensus across a multidisciplinary group of national experts in lung RT. These elements should serve as a basis to help streamline and create consistency among PR practices across centres, and to help develop novel PR approaches going forward.

The effects of self-regulated learning and cognitive load on beginning to watch and completing video lectures at a cyber-university

PurposeThe paper aims to examine the effect of levels of self-regulated effort (SRE) and levels of cognitive load on the watching and completing of video lectures used as the main source of instruction in online learning environments.Design/methodology/approachA survey provided data on the students’ engagement with video lectures, their level of SRE and the level of cognitive load they perceived while watching video lectures. The relationships between these variables and statistical significance were analyzed.FindingsThere were three key findings: a positive relationship between SRE and both watching and completing lectures; a negative relationship between SRE and perceptions of existing cognitive load; and students in different demographic groups watched fewer lectures, experienced higher cognitive load and reported lower levels of SRE.Research limitations/implicationsImplications of this study are that video lecture creation would benefit from the development of best practices, consideration of students’ levels of self-regulation, minimization of extraneous load and individual differences among groups of students. Limitations are the context-specific nature of the findings and the fact that data were drawn from self-reported survey responses, meaning they are subjective in nature.Originality/valueThe originality of this paper lies in its investigation of relationship between SRE, cognitive load and video lecture viewership. No research of this topic could be found during the literature review. Findings are of value to those interested in reaping increased levels of video lecture viewership by showing elements that will encourage engagement, satisfaction and better transmission of instruction.

Maternal health services for refugee populations: Exploration of best practices

ABSTRACTThe full scope of women’s health needs is not necessarily addressed in refugee camps and after resettlement, particularly pregnancy and postnatal services. The aims of this research are to examine the maternal care services provided to refugee women in camps and after resettlement to the United States, and to analyse organisational successes and challenges in service provision. With this understanding, policies can improve service delivery for refugee women. We interviewed respondents from five organisations, ranging from local non-profits to international non-governmental organisations. Most of the organisations do not provide direct medical care, but rather education and social service support to clients, and in some cases midwife training. Their success stemmed from a focus on client capacity building, individualised support, effective partnerships, and cultural competency. Respondents described the need for physical resources, effective leadership, and additional personnel, especially with linguistic capabilities. The dialogue in the interviews supports themes of education as empowerment and client self-sufficiency. Respondents emphasised the importance of funding and policies that support their work. This knowledge can lead to improved models of service delivery and inform the development of best practices and policies in maternal and reproductive health for refugee women.

Comparative Analysis of Multi-Trade Prefabrication Construction Methods

This paper proposes a construction method for efficient application of multi-trade prefabrication (MTP). The currently most advanced prefabrication method, MTP was recently introduced in North America and Europe. However, there have been few reports and studies of MTP in Asia. This paper discusses MTP construction method application in a workshop and presents solutions to identified problems. MTP pilot test 1 was performed using combinations of conventional chain block and scissor lift. Productivity analysis indicated that on-site MTP construction increased an extra labor input which was 19.6% compared to the total labor input of the conventional method. Pilot test 2 used manual material lifts for on-site MTP construction. Labor input per MTP module was reduced to 75.8% of that required for pilot test 1, but the manual lifts extended overall construction time. Pilot test 3 used a proposed optimized stacker based lifting device. Labor input for on-site MTP construction was reduced to 47.0% of that for pilot test 1. These results will be the basis for development of best practices for future MTP construction and provide better understanding as well as directions for improving MTP construction.

Best Practices. Managerial Early Warning System as Best Practice for Project Selection at a Smart Factory

The purpose of the paper is to contribute to the development of best practices at emerging factories of the future, i.e. smart factories of Industry 4.0. Smart factories need to develop effective managerial early warning systems to identify and respond to subtle threats or opportunities, i.e. weak signals, in order to adapt to an ever-changing environment in a timely manner and thus gain or maintain a competitive advantage on the market. These factories need to develop and implement a several-stage early warning system that is specific to their industry. The aim of our study is, with the help of semi-structured group interviews, to examine which stages of a managerial early warning system are present in the case of a global innovative supplier in the automotive industry. As such, a four-stage managerial early warning system model for a knowledge-based automotive smart factory is proposed, in which aggregate activities and management decision-making strategies are defined for each stage, with the importance of intuition being taken into consideration. We found that managers rely on intuition and extensive analysis for satisficing strategies and teamwork for optimizing strategies, when using their managerial early warning system.

Applying Innovative Performance Metrics for Corridor Evaluation

Widespread application of traditional performance metrics such as vehicle level of service has resulted in transportation networks that are often suited for only one mode of transportation to the detriment of others. Moreover, the continued investment in capacity expansion intended to meet level of service expectations increases financial burdens on transportation agencies for the capital, operating, and maintenance costs of these facilities, without regard to whether those resources are being used efficiently. Shifting focus to alternative and more comprehensive performance metrics can result in a more economical approach to transportation infrastructure, allowing communities to understand what investment combinations provide the best bang for the buck. Innovative performance metrics also allow communities to consider priorities beyond level of service, and design infrastructure accordingly. The Wasatch Front Central Corridor Study, undertaken in the Salt Lake City metropolitan area, is one example of a regional application of efficiency-focused performance metrics such as person throughput, seat utilization, benefit–cost ratio, access to employment, and economic impacts. Further research opportunities could include development of best practices to standardize benefit–cost analysis for transportation projects, other methods of evaluating overall system efficiency, and the role of parking policy and land use change in maximizing use of transportation resources.

Bark paintings conservation: Eucalyptus tetrodonta properties, bark harvesting and various mounting systems in the Northern Territory

In the past, various mounting systems have been developed with no real consensus on the most appropriate system to display bark paintings that also considers the cultural values of Aboriginal Traditional Owners. In addressing this gap, the Museum and Art Gallery of the Northern Territory (MAGNT) has been reviewing their current mounting systems and the preparation of bark supports with Injalak Arts to enable the development of evidence-based best practices for the display and preservation of bark paintings. A holistic study was undertaken to fully understand the life cycle of bark supports from when they are first made, to their display and collections trajectory in the cultural institution context. This paper examines Eucalyptus tetrodonata’s bark properties and harvesting techniques used by the Injalak Art Centre artists from the Aboriginal Traditional Owners’ perspective. With a holistic understanding of the material and cultural contexts, past display techniques were subsequently assessed which informed improvements of current bark painting mounting methods deployed at MAGNT. The purpose of this paper is not only to inform the development of appropriate mounting systems, but also to provide insight for the development of best practice decision-making and ‘proofed concepts’ of preventive conservation for the preservation and display of Aboriginal bark paintings.

Survey of Authentication and Authorization for the Internet of Things

The Internet of Things is currently getting significant interest from the scientific community. Academia and industry are both focused on moving ahead in attempts to enhance usability, maintainability, and security through standardization and development of best practices. We focus on security because of its impact as one of the most limiting factors to wider Internet of Things adoption. Numerous research areas exist in the security domain, ranging from cryptography to network security to identity management. This paper provides a survey of existing research applicable to the Internet of Things environment at the application layer in the areas of identity management, authentication, and authorization. We survey and analyze more than 200 articles, categorize them, and present current trends in the Internet of Things security domain.

Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer.

Scale development and validation are critical to much of the work in the health, social, and behavioral sciences. However, the constellation of techniques required for scale development and evaluation can be onerous, jargon-filled, unfamiliar, and resource-intensive. Further, it is often not a part of graduate training. Therefore, our goal was to concisely review the process of scale development in as straightforward a manner as possible, both to facilitate the development of new, valid, and reliable scales, and to help improve existing ones. To do this, we have created a primer for best practices for scale development in measuring complex phenomena. This is not a systematic review, but rather the amalgamation of technical literature and lessons learned from our experiences spent creating or adapting a number of scales over the past several decades. We identified three phases that span nine steps. In the first phase, items are generated and the validity of their content is assessed. In the second phase, the scale is constructed. Steps in scale construction include pre-testing the questions, administering the survey, reducing the number of items, and understanding how many factors the scale captures. In the third phase, scale evaluation, the number of dimensions is tested, reliability is tested, and validity is assessed. We have also added examples of best practices to each step. In sum, this primer will equip both scientists and practitioners to understand the ontology and methodology of scale development and validation, thereby facilitating the advancement of our understanding of a range of health, social, and behavioral outcomes.

College Student Athletes and Social Media: The Psychological Impacts of Twitter Use

Twitter, the popular social-media platform, is a staple in intercollegiate athletics. Although it is often regarded merely as a pastime, Twitter boasts advantages and disadvantages to college student athletes and their programs. This is primarily due to the nature of interactions and exchanges that take place between student athletes and the general public, be they fans, critics, or somewhere in between. Using a semistructured protocol, the researchers conducted a 75-min focus-group interview with 7 National Collegiate Athletic Association (NCAA) Division I student athletes to examine the psychological impacts of Twitter use. A modified version of consensual qualitative research was used for data analysis. Results indicated that student athletes were heavily influenced and affected by Twitter use across various domains in their lives. Participants reflected on both advantages (e.g., avenue for advocacy and moral support and promoting team cohesion) and disadvantages (e.g., receipt of critical tweets and detrimental performance implications) of using the microblogging platform, thereby corroborating extant literature and providing a more balanced perspective of Twitter’s resulting impact. The researchers explicated practical implications including improved social-media training and the development of best practices to support student athletes in their responsible use of Twitter. Further research is necessary to better understand the differences in experiences of student athletes competing in revenue-generating sports compared with those competing in non-revenue-generating sports.

Challenges to decision-making processes in the national HTA agency in Brazil: operational procedures, evidence use and recommendations

BackgroundThe quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures.MethodsThis is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics.ResultsWe evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was ‘drugs’ (68.3%), followed by ‘procedures’ (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports.ConclusionsThe characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.

Emotional Maps: Participatory Crowdsourcing of Citizens´ Perceptions of Their Urban Environment

Public participation and civic engagement in the urban planning process are societal trends that stretch across countries, cultures, and classes. After decades of communist regimes in the Eastern Bloc, where there was basically no civic participation, civic society in the Czech Republic began to engage in discussions with the authorities, and citizens became more active in local planning. In 1994 eleven municipalities started the Network of Healthy Cities of the Czech Republic as a platform for sharing good practices in sustainable development and local participation. In the last three years, members of the Network have used emotional mapping activities to facilitate and improve the process of participatory planning. This paper describes the timeline of development and the deployment of an emotional mapping methodology in various workshops in the Healthy Cities network. A total of forty-six emotional mapping workshops were organised in thirty-five municipalities of the Czech Republic. The paper presents the change from crayon-based maps to digital web-mapping platforms; and presents a case study of the Prague 12 district, where emotional mapping workshops were used to explore the perception of safety, among other issues.

Comparing Building and Neighborhood-Scale Variability of CO₂ and O₃ to Inform Deployment Considerations for Low-Cost Sensor System Use.

The increased use of low-cost air quality sensor systems, particularly by communities, calls for the further development of best-practices to ensure these systems collect usable data. One area identified as requiring more attention is that of deployment logistics, that is, how to select deployment sites and how to strategically place sensors at these sites. Given that sensors are often placed at homes and businesses, ideal placement is not always possible. Considerations such as convenience, access, aesthetics, and safety are also important. To explore this issue, we placed multiple sensor systems at an existing field site allowing us to examine both neighborhood-level and building-level variability during a concurrent period for CO2 (a primary pollutant) and O3 (a secondary pollutant). In line with previous studies, we found that local and transported emissions as well as thermal differences in sensor systems drive variability, particularly for high-time resolution data. While this level of variability is unlikely to affect data on larger averaging scales, this variability could impact analysis if the user is interested in high-time resolution or examining local sources. However, with thoughtful placement and thorough documentation, high-time resolution data at the neighborhood level has the potential to provide us with entirely new information on local air quality trends and emissions.

Who do UK consumers trust for information about nanotechnology?

This paper investigates UK consumers’ trust in sixteen information sources, from government institutions to food handlers and media, to provide accurate information about the use of nanotechnology in food production and packaging. We elicit the perceived trust using a well-known choice-based stated preference technique, namely best-worst scaling. The results from the analysis of a scale-adjusted latent class model show considerable heterogeneity in consumers’ perceptions of trust and choice variability. The findings from this study provide insights into the development of best practices and policies in risk communication and management for novel foods produced by nanotechnologies. More specifically, they highlight how targeted approaches can be used by policymakers responsible for disseminating information relating to novel technologies.