First Phase Of Implementation Research Articles

Laying the foundations for implementing Magnet principles in hospitals in Europe: A qualitative analysis

BackgroundMagnet hospitals, a concept developed in the U.S., have been associated with improved nurse recruitment and retention, and better patient outcomes. Magnet principles may be useful to address workforce challenges in European hospitals, but they have not been implemented or evaluated on a large scale in the European hospital context. ObjectiveThis study aims to explore the initial phase of implementing Magnet principles in 11 acute care hospitals in six European countries. The specific objectives of the study were to investigate the type of work that characterises the early phase of implementation and how implementation leaders engage with their context. MethodsA multinational qualitative study was conducted, with data from 23 semi-structured, one-to-one interviews with implementation leaders in 11 acute care hospitals in six European countries. Thematic analyses guided the analysis of data. FindingsThree themes of core work processes during the early phase of implementing Magnet principles in European hospitals were identified. The first theme, ‘Creating space for Magnet’, describes how work was directed towards creating both political and organisational space for the project. The second theme, ‘Framing to fit: understanding and interpreting Magnet principles’, describes the translational work to understand what the Magnet model entails and how it relates to the local hospital context. Finally, the third theme, ‘Calibrating speed and dose’, describes the strategic work of considering internal and external factors to adjust the process of implementation. ConclusionsThe first phase of implementation was characterised by conceptual and relational work; translating the Magnet concepts, considering the fit into existing structures and practices and making space for Magnet in the local context. Understanding the local context played an important role in shaping and guiding the navigation of professional and organisational tensions. Hospitals employed diverse strategies to either emphasise or downplay the role of nurses and nursing to facilitate progress in the implementation.

A153 IMPLEMENTATION OF THE CHAMPLAIN REGION GASTROINTESTINAL ENDOSCOPY CENTRAL INTAKE (GICI) PROGRAM

Abstract Background The Champlain region of Ontario is implementing a regional central intake triage program for screening colonoscopy services (FIT+, screening and surveillance indications). The aim of this program is to improve the delivery of regional endoscopy services, so that access to resource-intensive endoscopy procedures can be equitable, timely and evidence-based. We characterized the first phase of implementation of the Champlain Regional GI Central Intake (GICI). Aims The primary objective of this study is to identify program strengths and opportunities for quality improvement. Methods Prospective data was collected from August 1, 2022 to August 31, 2023. Descriptive statistics were analyzed. Discrete data were presented in terms of counts, percentages and means where appropriate. Results 1942 CIP referrals were received during the period of study. 1478(76.1%) referrals were submitted by fax, and 571(29.4%) were for positive FITs. 703(36.2%) referrals were declined, with 374(19.3%) not meeting Cancer Care Ontario (CCO) referral indications, 84(4.3%) being duplicates and 56(2.9%) being symptomatic. Prior to a policy change in March 2023, 23(1.2%) referrals were declined due to incomplete referral forms. 581(29.9%) referrals indicated a preferred physician or hospital site. On average, triage decisions were made within 11.4 hours of receipt of referrals for positive FIT, and 6.8 days for other indications. The average time from FIT positivity to referral receipt at CIP was 20.0 days. In the first quarter of 2023, 75th percentile wait times for colonoscopy were 35 days for FIT positivity, 150 days for symptoms, and 346 days for other screening indications. Conclusions GICI and the use of CCO evidence-based guidance reduces the need for colonoscopy in nearly 20% of referrals. It also decreases physician administrative burdens by eliminating duplicate referrals. Referrals should not be declined due to incomplete forms. Measures to improve timely access to colonoscopy for symptomatic patients should be explored. Most referred patients do not have a preferred physician or hospital site. Further primary care support and engagement is needed to encourage the use of the GICI as well as immediate referral for FIT+ colonoscopy. Funding Agencies None

Training nursing home social workers in the Pre‐loss Group Support intervention

AbstractBackgroundPre‐loss Group Support (PLGS) is a 10‐session multi‐modal, psychotherapy group intervention administered by nursing home social workers (NH‐SWs) for dementia family care partners (CPs) whose PLWD resides in a nursing home.1 While the overarching purpose of this project is to determine if telehealth‐delivered PLGS reduces risk of poor bereavement outcome in family CPs of PLWD when delivered by NH‐SWs, in this presentation we describe developing and applying the PLGS clinical training for NH‐SWs in this phase of our NIH‐Stage 52 implementation and dissemination study.MethodUsing professional actors, we created a simulated PLGS 10‐session group as a series of training videos. Training utilized our Stage‐3 PLGS Facilitator manual.3 We developed a training curriculum incorporating these video vignettes, didactic content, interactive case examples and pragmatic application concepts of PLGS for telehealth delivery to CPs by NH‐SWs. The full training is deliverable in one full day or two half day sessions and is provided on an interactive distance platform. Training was delivered to two cohorts of NH‐SWs in a stepped‐wedge design.ResultWe are evaluating this implementation study using the RE‐AIM measures.4 In this training phase, we have successfully achieved Reach—defined as buy‐in and training of NH SWs, Adoption—defined as uptake by NHs and SWs, and the first phase of Implementation—Defined as training completion. Trained NH‐SWs were assessed for satisfaction with the training. On a 7‐item satisfaction scale with a range of 3‐21, satisfaction rate was 95% (highly valuable), with 100% indicating they would recommend training to SWs in other facilities. In this session, we will share PLGS training content and procedures.ConclusionNursing home SWs are the last clinicians with opportunity to support CPs as they approach the death of their PLWD in the facility. NH‐SWs have clinical expertise to learn and implement PLGS, allowing us to simultaneously evaluate telehealth SW training acceptability, telehealth delivered PLGS outcomes. Carefully tailoring PLGS training content and delivery for NH‐SWs to equip them for telehealth implementation, engagement to recruit and retain enthusiastic SWs, and available consultation have contributed to the success of this phase in the project.

Human factors in cybersecurity: Designing an effective cybersecurity education program for healthcare staff.

Leaders who promote cybersecurity education focused on the human factors of cyberattack build a resilient workforce that complements technical protections, reducing organizational risk. Cybersecurity is a priority for information technology teams, relying primarily on technology to protect systems. As technical protections mature, the vulnerability shifts to human factors. Education must focus on the risk presented by humans rather than machines. A human factors-centred education program trains human reaction to threats considering the unique healthcare environment. Leaders may look to industries, like aviation, experiencing similar technical advancement, for education practices based on human factors. This article outlines a cybersecurity education program developed for healthcare, applying strategies adopted from commercial aviation. Four core pillars of training are defined: (1) dynamic education delivery options, (2) social engineering focused simulations, (3) high-risk positions and role-based training, and (4) stakeholder and leadership engagement. The first phase of implementation is analyzed, and lessons learned defined.

Affordable Real-Time Heart Rate, ECG & SpO2 Monitoring System Using Internet of Things (IoT)

Abstract: The healthcare industry now has an incomparable platform thanks to the Internet of Things technology, making it possible to quickly and effectively deal with challenges concerning healthcare. There has been a steady rise in the number of deaths due to sudden cardiac arrest (SCA) cases in developing countries and a lack of widespread use of an AED in these countries. The purpose of this study is to create an affordable Automated External Defibrillator (AED) that can be connected to IoT and can overcome certain drawbacks of the current AEDs. In the first phase of implementation, we attempt to create a Heart Monitoring System that can read Beats Per Minute (BPM), Electrocardiogram (ECG), and Saturation of Peripheral Oxygen (SpO2) using off-the-shelf sensors and display the data on a smartphone app. These sensors are connected to a Raspberry Pi 3b+, a single-board computer (SBC), which controls the entire system. The implementation of the system is successful, transmitting heart vitals to a smartphone app in real time. Further, the limitations of the system and future improvements are also discussed. The study builds a Heart Monitoring System under $67 with a few drawbacks. Further studies with better equipment are required to make the system accessible and less error-prone.

HTLML: Hybrid AI Based Model for Detection of Alzheimer's Disease.

Alzheimer’s disease (AD) is a degenerative condition of the brain that affects the memory and reasoning abilities of patients. Memory is steadily wiped out by this condition, which gradually affects the brain’s ability to think, recall, and form intentions. In order to properly identify this disease, a variety of manual imaging modalities including CT, MRI, PET, etc. are being used. These methods, however, are time-consuming and troublesome in the context of early diagnostics. This is why deep learning models have been devised that are less time-intensive, require less high-tech hardware or human interaction, continue to improve in performance, and are useful for the prediction of AD, which can also be verified by experimental results obtained by doctors in medical institutions or health care facilities. In this paper, we propose a hybrid-based AI-based model that includes the combination of both transfer learning (TL) and permutation-based machine learning (ML) voting classifier in terms of two basic phases. In the first phase of implementation, it comprises two TL-based models: namely, DenseNet-121 and Densenet-201 for features extraction, whereas in the second phase of implementation, it carries out three different ML classifiers like SVM, Naïve base and XGBoost for classification purposes. The final classifier outcomes are evaluated by means of permutations of the voting mechanism. The proposed model achieved accuracy of 91.75%, specificity of 96.5%, and an F1-score of 90.25. The dataset used for training was obtained from Kaggle and contains 6200 photos, including 896 images classified as mildly demented, 64 images classified as moderately demented, 3200 images classified as non-demented, and 1966 images classified as extremely mildly demented. The results show that the suggested model outperforms current state-of-the-art models. These models could be used to generate therapeutically viable methods for detecting AD in MRI images based on these results for clinical prospective.

An integrated open source CAT based on Skin Model Shapes

The control of geometrical deviations and form variations throughout the product life-cycle is a fundamental task in geometric dimensioning and tolerancing. As product complexity increases, it has not only become necessary to rely on computers to process geometrical and non-geometrical information from early design stages but also to come up with more realistic shape representation. Most of computer-aided tolerancing (CAT) packages used nowadays are fully integrated to computer-aided design softwares like CATIA and SolidWorks and they allow to model 2D and 3D tolerances stack-up through worst-case or statistical models. These CAT systems are generally available as proprietary commercial software which can sometimes restrict their domain of application and slow the implementation of new paradigms like the Skin Model. The Skin Model is an abstract surface model that represents the interface between a workpiece and its environment whose implementation involves the modeling of finite instances of the Skin Model called Skin Model Shapes (SMS) that encompass different sources of deviations and constitute a non-ideal geometrical model. The aim of this work is to show the first phase of implementation of an integrated open source environment based on PolitoCAT and Salome to model Skin Model Shapes. An Unified Model Language (UML) based logical data model of the integrated system is presented, it is an extended version of current data models for geometric modeling that includes the objects and relationships to manage form variations at different design stages. The work carried out contributes to the conceptualization of Skin Model Shapes model and it constitutes a support on the implementation of SMS in an open source CAT. An example of this integration involving a Skin Model Shapes implementation is shown as an illustration of the functionality of the platform.

Comprehensive evaluation of Salud Escolar a health school program in Mexico: Rationale, design and methods

The prevalence of obesity and overweight in Mexican children and adolescents is high (greater than 30%) and lifestyle behaviors are far from achieving health recommendations. Salud Escolar is a complex cross-sectoral multi-level policy-based program in Mexico aiming to support schoolchildren healthy behaviors. We describe the rationale, design and methods for the comprehensive evaluation of Salud Escolar during its first phase of implementation. Using a mixed-methods approach and the logic model of Salud Escolar as a guide, a comprehensive evaluation involving 3 types of evaluations was designed: 1) A design evaluation before program implementation, to determine the consistency between the design of Salud Escolar and the problem to be addressed (i.e., childhood obesity), 2) An implementation evaluation to assess potential execution bottlenecks, and 3) An outcomes evaluation, to measure short-term (i.e., knowledge, attitudes and practices related to healthy eating, drinking plain water and doing regular physical activity) and intermediate outcomes (i.e., fruit and vegetable intake, water consumption and daily moderate to vigorous physical activity). This evaluation will provide essential knowledge about program design and implementation processes, which are vital for drawing robust conclusions about the effectiveness of the program. Results and lessons learned from this comprehensive evaluation will provide evidence to improve Salud Escolar program and facilitate its upscaling process and may provide relevant information for school-based programs in other places sharing socio-contextual conditions.

Leading University Change: A Case Study of Meaning-Making and Implementing Online Learning Quality Standards

ABSTRACT This case study reports the collaborative meaning-making process and strategies for organizational change used by a diverse leadership team at a regional comprehensive university. The purpose of the study was to engage in continuous learning and improvement by producing knowledge for informing action; that is, to learn from analyzing the first phase of implementation in order to continue to improve, understand, and perhaps adjust in order to contribute to institutional change. Initiated by outcomes from a 2017 regional accreditation review and the recent development of a Global Campus, administrators, faculty, and instructional design and technology staff were charged with developing standards for quality university distance education. This study addresses lived experiences in the story of institutional change by reporting critical events, tensions, and turning points experienced by the leadership team relative to a change framework applied to distance education in a higher education setting. Over a two-year period (2018–2020), the team piloted, communicated, and refined plans as they began implementing the first of four phases in their quality assurance plan, including assessing 751 course syllabi for entry-level design standards. Findings indicate the process of enacting change also began shifting the culture of the university for purposes of quality assurance, consistency, and shared understandings of rigor. In this article, the team describes and discusses their framework using Kotter’s Change Model, their process, and their outcomes related to organizational change in higher education. Discussion addresses starting points for other higher education stakeholders involved in pursuing quality distance education.

Changes in food purchases after the Chilean policies on food labelling, marketing, and sales in schools: a before and after study

In 2016, Chile implemented a unique law mandating front-of-package warning labels, restricting marketing, and banning school sales for products high in calories, sodium, sugar, or saturated fat. We aimed to examine changes in the calorie, sugar, sodium, and saturated fat content of food and beverage purchases after the first phase of implementation of this law. This before and after study used longitudinal data on food and beverage purchases from 2381 Chilean households from Jan 1, 2015, to Dec 31, 2017. Nutrition facts panel data from food and beverage packages were linked to household purchases at the product level using barcode, brand name, and product description. Nutritionists reviewed each product for nutritional accuracy and categorised it as high-in if it contained added sugar, sodium, or saturated fat and exceeded phase 1 nutrient or calorie thresholds, and thus was subject to the labelling, marketing, and school regulations. Using fixed-effects models, we examined the mean nutrient content (overall calories, sugar, saturated fat, and sodium) of purchases in the post-policy period compared to a counterfactual scenario based on pre-policy trends. Compared with the counterfactual scenario, overall calories purchased declined by 16·4 kcal/capita/day (95% CI -27·3 to -5·6; p=0·0031) or 3·5%. Overall sugar declined by 11·5 kcal/capita/day (-14·6 to -8·4; p<0·0001) or 10·2%, and saturated fat declined by 2·2 kcal/capita/day (-3·8 to -0·5; p=0·0097) or 3·9%. The sodium content of overall purchases declined by 27·7 mg/capita/day (-46·3 to -9·1; p=0·0035) or 4·7%. Declines from high-in purchases drove these results with some offset by increases in not-high-in purchases. Among high-in purchases, relative to the counterfactual scenario, there were notable declines of 23·8% in calories purchased (-49·4 kcal/capita/day, 95% CI -55·1 to -43·7; p<0·0001), 36·7% in sodium purchased (-96·6 mg/capita/day,-105·3 to -87·8; p<0·0001), and 26·7% in sugar purchased (-20·7 kcal/capita/day, -23·4 to -18·1; p<0·0001). The Chilean phase 1 law of food labelling and advertising policies were associated with reduced high-in purchases, leading to declines in purchased nutrients of concern. Greater changes might reasonably be anticipated after the implementation of phases 2 and 3. Bloomberg Philanthropies, International Development Research Center, and Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

Association between hourly wages and dietary intake after the first phase of implementation of the Minneapolis minimum wage ordinance.

In 2018, Minneapolis began phased implementation of an ordinance to increase the local minimum wage to $15/h. We sought to determine whether the first phase of implementation was associated with changes in frequency of consumption of fruits and vegetables (F&V), whole-grain-rich foods, and foods high in added sugars among low-wage workers. Natural experiment. The Wages Study is a prospective cohort study of 974 low-wage workers followed throughout the phased implementation of the ordinance (2018-2022). We used difference-in-difference analysis to compare outcomes among workers in Minneapolis, Minnesota, to those in a comparison city (Raleigh, North Carolina). We assessed wages using participants' pay stubs and dietary intake using the National Cancer Institute Dietary Screener Questionnaire. Analyses use the first two waves of Wages data (2018 (baseline), 2019) and includes 267 and 336 low-wage workers in Minneapolis and Raleigh, respectively. After the first phase of implementation, wages increased in both cities, but the increase was $0·84 greater in Minneapolis (P = 0·02). However, the first phase of the policy's implementation was not associated with changes in daily frequency of consumption of F&V (IRR = 1·03, 95 % CI: 0·86, 1·24, P = 0·73), whole-grain-rich foods (IRR = 1·23, 95 % CI: 0·89, 1·70, P = 0·20), or foods high in added sugars (IRR = 1·13, 95 % CI: 0·86, 1·47, P = 0·38) among workers in Minneapolis compared to Raleigh. The first phase of implementation of the Minneapolis minimum wage policy was associated with increased wages, but not with changes in dietary intake. Future research should examine whether full implementation is associated dietary changes.

Analysis of an Airport Pavement Management System during the Implementation Phase

The study analyzes an airport pavement management system (APMS) during the implementation phase. After a report on the characteristic of an APMS and a literature review on its application all over the world, the research work focuses on a case of study related to one of the most relevant airports in Southern Italy. To define a maintenance program, the evaluation of data available relating to inventory data, pavement condition and performance curves is the essential prerequisite. The latter concern the identification of critical areas, in order to subsequently define the maintenance alternatives. The obtained findings concern the planning of M&R activities over the years. Depending on pre-established scenarios, the design choices are the result of the most profitable strategy among those technically admissible. The study highlights current limitations of the implemented APMS regarding data available. For this reason, subsequent studies will improve the system through the implementation of traffic and climate conditions data as well as the evaluation of collateral costs. Moreover, it is possible to confirm that the use of an APMS is important from the first phase of implementation, as it allows to simplify and rationalize some processes, even if it is still necessary to implement the database with further data, also to solve the inevitable approximations on the performance curves. Furthermore, the calibration of the latter will improve the maximization of network conditions and the cost / benefit ratio. Anyway, the paper provides useful information to practitioners for future applications, highlighting at the same time the research steps still to be taken to get a more efficient APMS.

Association between hourly wages and dietary intake after the first phase of implementation of the Minneapolis minimum wage ordinance

Association between hourly wages and dietary intake after the first phase of implementation of the Minneapolis minimum wage ordinance

Shareholder Activism Today: Did Barbarians Storm the Gate?

Shareholder Activism Today: Did Barbarians Storm the Gate?

Professional secondary education system in Ukraine: legal supply

Problem setting. Nowadays the content of secondary education in Ukraine does not take into account individual characteristics of the students and it is not focused on the formation of creative potential and system of knowledge by interests, the educational process is overburdened with secondary factual material and is overly regulated. It necessitates the search and implementation of new approaches to organization of educational process in high school. One of such approaches is career counselling for secondary school students that provides thourough and specialized general education, access to quality education in accordance with the individual skills and needs of the student youth.Recent research and publications analysis. The problem of career counselling for secondary school students in Ukraine has become the subject of research by Ukrainian scholars. In particular, theoretical and conceptual foundations of career counselling training were investigated by N. Bibik, M. Burda, S. Volyanskaya, O. Adamenko, V. Kizenko, A. Samodrin, B. Fedorishin, G. Vashchenko, M. Goncharov, N. Dmitrenko.Highlighting previously unsettled parts of the general problem. The introduction of specialized secondary education is one of the priorities of public education policy. Therefore, it is advisable to investigate the legal bases for introducing career counselling for secondary education system in Ukraine within the science of public administration.The aim of the article is to analyze the legal support for the introduction of career counselling for secondary education system in Ukraine.Paper main body. According to Article 53 of the Constitution of Ukraine everyone has the right to education. However, the deterioration of indicators of competitiveness and the innovative attractiveness of secondary education system in Ukraine need a thorough reform within the framework of the Concept of Implementation of the State Policy for the Reform of General Secondary Education “New Ukrainian School” for the period up to 2029. The aim of the reform of the education system in Ukraine is to create the conditions for personal development and creative self-realization of every citizen of Ukraine, to create generations capable of learning throughout life, to create and develop the values of civil society.In accordance with the objectives of the first phase of implementation of the Concept (2017 – 2018), a new Law of Ukraine “On Education” was adopted, Article 10 of which defines three levels of secondary education: primary education lasting four years; basic secondary education lasting five years; specialized secondary education lasting three years. At the third stage of the Concept implementation (2023 – 2029), it is planned to introduce a specialized level of secondary education – a process of individual and differentiated learning, the basic ideas of which are the education of students in grades 10 – 12 by: interests; competencies; plans for self-realization.According to the Law of Ukraine “On Education”, obtaining a specialized secondary education involves two directions:– academic – specialized education based on the combination of the content of education which is defined by the standard s of secondary specialized education, and in-depth study of individual subjects taking into account the abilities and educational needs of education recipients focusing on continuing education at higher levels of education;– professional – labor market oriented specialized education based on a combination of educational content defined by the standard of secondary specialized education and a professionally oriented approach to learning taking into account the abilities and needs of students.Conclusions of the research and prospects for further studies.1. The crisis and the challenges of the problem have led to the reform of the content of secondary education in Ukraine on the basis of competent and personally oriented approaches to learning; orientation to the acquisition of skills necessary for successfu students self-realization in their professional activity.2. One of the directions of modernization and improvement of the secondary education system in Ukraine is to ensure the acquisition of appropriate qualitative skills and competences at school needed for work, innovation and active citizenship through the introduction of a specialized link education. The content of career counselling for secondary education involves the introduction of the process of individual and differentiated learning of students in grades 10 – 12 by interests, competencies and plans for self-realization.3. The legal basis for career counselling for secondary education system in Ukraine is the Constitution of Ukraine, the Laws of Ukraine “On Education”, “On Complete General Secondary Education”, the Concept of the implementation of state policy in the field of reforming general secondary education “New Ukrainian School” for the period up to 2029. For the effective reform of the general secondary education with the introduction of the career counselling component it is necessary to implement the provisions of the Law of Ukraine “On comprehensive general secondary education”, to develop and adopt the new Law of Ukraine “On Vocational Education”.The subject of further scientific research in this area will be the content and forms of organization of specialized education in secondary school.

First phase implementation of cardio-oncology program in the middle-income country of Costa Rica at Hospital Metropolitano healthcare system.

e24091 Background: Developing a cardio-oncology program in a middle-income country like Costa Rica can present unique opportunities and challenges. Hospital Metropolitano is a health care system in Costa Rica with a network of two hospitals, 36 clinics, and over 150,000 patients enrolled in its health plan, Medismart. Here we summarize our program, and the initial results of the implementation phase, hoping that institutions with similar resources in low-and-middle-income countries will use this as guidance to develop their own cardio-oncology program. Methods: A cardio-oncology committee was established in May 2019 and includes medical providers, clinical coordinators, administrative workers, and nursing and laboratory staff. A 4-month pre-launch period was established to create an institutional protocol after we reviewed guidelines and literature from similar programs in the United States and Europe. The protocol targets both active cancer patients undergoing treatment and cancer survivors. The program was launched in September 2019 and is currently in the first phase of implementation. Results: During the first phase of implementation, the program was limited to the outpatient setting and patients were referred exclusively by the medical oncology providers from our health care system. In this period, 28 patients met criteria for referral and all enrolled according to our protocol. The median age of our patients was 49 (range 16-77). 25 patients (89%) were female and 20 (71%) had a diagnosis of breast cancer. At the time of enrollment, 21 (75%) were receiving active cancer treatment and 7 (25%) were identified as cancer survivors. All patients are being followed prospectively. A committee review at the end of the first phase of implementation revealed that the most important challenges that the program needs to address for the second phase of implementation include the following: 1) patient education and outreach, 2) cost of care associated with the interventions recommended by the protocol, and 3) data tracking/registry given the lack of an electronic medical record. Conclusions: Our program represents a real-life experience of the challenges and opportunities that institutions in middle-income countries need to consider when launching such initiatives. To our knowledge, this is the first cardio-oncology program formally established in Central America and we are committed to continue to measure our outcomes prospectively and share these with the global oncology community.

From clinical guidelines to clinical care – Employee involvement makes a positive difference to implementation

Objectives Implementation of new knowledge into routine care is a complex endeavour. Involving employees in the change process, good planning and communication as well as a commitment to training has been highlighted as important factors for successful implementation. Acknowledging change as a process may also be helpful. The aim of this paper was to describe the initial phase of the implementation process in changing to evidence-based practisepractices within a child and adolescent mental health service. Method Prior to the five-year project, an external service evaluation was carried out. The employees expressed a need for a clear direction from management to guide their clinical practice. A vision and strategy for the service was developed. Employees participated in the process of developing clinical standards during the first phase of implementation. Results Fixsen’s four stage model and the PSDA circle were used to guide the implementation process. The employees developed a template for a clinical standard based on national and international clinical guidelines. During the period, 17 clinical standards were established and 10 new evidence-based methods were implemented. All service leads (13) and a group of senior clinicians (32) were invited to participate in an evaluation five years after the initial service evaluation. There was overall agreement that the mental health service was developing positively providing high quality services for children and adolescents. In addition, both groups agreed that the introduction of clinical standards was important in ensuring quality care. Conclusion Involving employees in the implementation process seemed to be an important factor in changing a mental health service.

Atrial fibrillation case finding in over 65 s with cardiovascular risk factors – Results of initial Scottish clinical experience

BackgroundAtrial fibrillation (AF) is a major preventable risk factor for stroke and may be silent in elderly individuals who are at especially high risk. This paper describes the first phase of implementation of a clinical AF detection programme in a community setting. Objectives were (i) to determine the feasibility of using a handheld ECG recording system for AF detection among individuals aged 65 years or more, who have cardiovascular risk factors. (ii) to estimate the yield of previously undiagnosed atrial fibrillation cases, and the proportion of these who would be suitable for oral anticoagulation. Methodsa handheld ECG monitor was placed in each of 23 primary care practices across Scotland. Eligible patients attending for annual health checks had ECGs recorded, and the ECGs were transmitted and interpreted by two senior cardiologists. ECG quality was rated, and an adjudication made on the rhythm. For patients confirmed with AF, stroke and bleeding risk were estimated using CHA2DS2-VASc and HAS-BLED scoring tools. Resultssingle lead ECGs were recorded in 1805 patients (703 female and 1102 male), mean (SD) age 74.9 (7.1) years. Rhythm regularity could be assessed in 98.7% of ECGs recorded. 92 patients (5.1%) were found to have AF. Median [range]CHA2DS2-VASc score was 4 ([2–7) and median [range] HAS-BLED score was 2 (1–5). Conclusionhandheld ECG recording can be used to identify AF in the primary care setting, with minimal training. The yield was relatively high.

What do young people prioritize to achieve sustainable development? An exercise of the Pilot University of Colombia in the framework of the beginning of the Sustainable Development Goals and the 2030 Agenda

As part of the approval of the new agenda 2030, the Faculty of Environmental Sciences at the University Pilot of Colombia organized the event “Foro de la Sostenibilidad”. Event aimed to present results of the Millennium Development Goals - MDGs and their transition to Sustainable Development Goals – SDG’s - where a survey was conducted to attendees about 17 SDG’s would prioritize , in order to know the pint of view of young people on the issue. In Colombia, through the Global Survey of the United Nations, My World, It was possible to capture the opinion, the priorities and views of 45,479 citizens; among these priorities highlights the importance of a good education for development, better health care, better job opportunities and the need for an honest and responsive government. On the other hand “Professor Jeffrey Sachs, renowned advocate and activist of the SDG’s, has suggested that 8 of the 17 goals are particularly relevant to Colombia in the first phase of implementation.” (PNUD Colombia, 2015b). This document aims to establish a parallel between the SDG’s prioritized by the university students attending the event “Foro de la Sostenibilidad”, the prioritization of Colombians in the survey My World and the objectives mentioned by Professor Jeffrey Sachs, With the purpose of identify training needs for young people in recognition of Agenda 2030 and the ODS.

THE MODEL OF EXTRACURRICULAR WORK WITH STUDENTS OF ENGINEERING SPECIALTIES

The subject of the research is the analysis of the development experience and the first phase of implementation of the model of extracurricular work with students of engineering specialties at Chernihiv National University of Technology (Ukraine), which was developed on the basis of the author's methodology ALM (active learning methods) at Tallinn University of Technology (Estonia) in combination with forms and methods of extracurricular work. The purpose of this model is to promote the enhancement of the motivation of students in engineering specialіties to succeed in learning. The main task of the research is to evaluate the readiness of students of engineering specialіties to participate in extracurricular activities and their awareness of the forms and methods of extracurricular work, the analysis of the first results of the implementation of the model of extracurricular work of students of engineering specialіties. For the observing stage of the experiment, such methods were used as theoretical, empirical, pedagogical experiment, mathematical and statistical methods. Participants were 92 students of the 3rd year of engineering specialіties of Chernihiv National University of Technology. Most students (82%) believe that extracurricular work has an impact on the formation of the individual and on the professional growth of a future specialist. The motivation for success among most respondents (73%) is average, 33% of respondents are not very good interlocutors who have shortcomings in communication; 60% have an average level of communication skills, 58% of respondents need to build self-confidence. Based on the received results from the questionnaire and tests carried out among students, a model of extracurricular work with students of engineering specialіties has been developed. The first stage of the implementation of this model has shown a positive dynamics. The model requires further testing and research of the impact on the students’personality.