Implementation Of Framework Research Articles

An integrated model approach for disaster impact reduction: lessons from a slow onset disaster in Chile

Purpose The prolonged drought in Chile’s Coquimbo region has created a permanent state of emergency, forcing the state to spend millions each year distributing drinking water to rural communities. The purpose of this article is to detail a study focused on optimizing the supply of drinking water through trucks in the 15 communes of the region and how the problem was faced in a context of a slowonset disaster. Design/methodology/approach A geo-referenced census and optimization analysis of the 5.541 households that receive drinking water was conducted to determine the feasibility of removing trucks from the system. To generate a greater reduction in distribution costs, it was suggested to incorporate water distribution infrastructure projects, changing the concept of ‘expenses’ to ‘investment’. Findings The study was born out of the concern for the increased demand for drinking water from rural areas. The proposed and implemented framework allowed an additional 20% reduction in the initial transportation costs; this confirmed the assumption that the proposed optimization model alone would not offer a robust solution and was complemented and integrated with this type of alternative, forming an “integrated model”. Research limitations/implications The paper has implications for the resilience of territories affected by climate change. Practical implications The methodology can be replicated in other areas where similar interactions occur. Social implications Families impacted by drought can improve their quality of life and reduce distress in the face of the constant emergency. Originality/value This research aims to contribute knowledge from the perspective of a slow-onset disaster where water resources are scarce. It presents a framework where two disciplines converge, resulting in an “integrated model” that, through its implementation, reduces the costs of resource delivery while simultaneously improving the sanitary conditions of the beneficiary families.

Improving field education for social work in Vietnam: Intern supervisors’ perspectives of the current state and potential solutions

Research has identified challenges associated with the implementation of competency-based social work field education in Vietnam. However, there is limited information available from intern supervisors, who have unique perspectives at the crux of social work training and service delivery. An exploratory phenomenological qualitative approach was used to explore their experiences and perceptions through online interviews. Four categories were identified: diverse implementation of a common framework, rudimentary expectations and activities, challenges to implementation, and opportunities for improvement. These findings suggest that a multidimensional approach is needed, including improved collaborations between field agencies and universities to empower students, intern supervisors, and faculty.

Waste-to-energy: exploring the roadmap for energy generation from commercial waste in South Africa

Purpose This study aims to investigate the adoption of waste-to-energy (WtE) technologies in South Africa (SA), focusing on identifying the key drivers, barriers and potential solutions for commercial uptake. The ultimate aim is to propose an implementation framework that promotes renewable energy while reducing landfill reliance. Design/methodology/approach A systematic literature review (SLR) of papers published between 2020 and 2023 was conducted to identify factors impacting WtE adoption in SA. The conceptual model developed from the SLR was tested using a qualitative case study approach. Data was collected through 15 semi-structured interviews with commercial entities and WtE experts from four regions of SA. Findings Anaerobic digestion and pyrolysis are identified as the most suitable waste-to-energy technologies in the South African context. Among the financial challenges of WtE in SA, the availability of cheap coal, low landfill tariffs, high capital costs, funding constraints and regressive economic incentives are critical. The lack of government support, insufficient incentives, regulatory burdens, weak policies and limited innovation capacity are considerable non-financial barriers hindering WtE technologies’ growth. The successful adoption of renewable energy also requires adequate infrastructure, increased sustainability awareness and technical expertise. Research limitations/implications Although the sample size is diverse and consists of a range of organisations, it may not capture the thoughts and experiences of other SA businesses in their entirety. It is important to note that the lack of existing research on the implementation, benefits and impacts of WtE technologies limits the authors’ ability to interpret and benchmark the findings of this study. Yet, this study contributes by developing an implementation framework to encourage WtE adoption, recommending policy actions such as regressive taxation on fossil fuels and landfills and promoting renewable energy through subsidies, awareness and energy credits. Practical implications This study provides a practical framework for businesses and policymakers to adopt WtE technologies by addressing key barriers. The research suggests that businesses could reduce waste management costs and generate new revenue streams by adopting anaerobic digestion and pyrolysis. Policymakers are encouraged to disincentivize landfills and promote WtE through financial incentives such as subsidies and energy credits. The implementation framework offers clear recommendations for integrating WtE into SA’s energy and waste management strategies, supporting both sustainability and economic goals. Social implications The main social contribution is the potential for WtE adoption to improve waste management practices and generate new job opportunities within the renewable energy and waste sectors. Originality/value This study provides a novel contribution by developing an implementation framework tailored to SA’s unique regulatory, economic and social contexts. The research highlights the importance of aligning WtE adoption with sustainability goals, reducing reliance on fossil fuels and promoting renewable energy. The framework serves as a practical guide for policymakers, businesses and industry leaders seeking to implement sustainable waste management solutions in SA.

Development of Artificial Intelligence in Business Ethics and Regulatory Responsibilities in the Era of Artificial Intelligence

The purpose of this study is to analyze development of artificial intelligence in business ethics and regulatory responsibilities in the era of artificial intelligence. The research methods applied in this study are literature study, comparative regulatory analysis, regulatory analysis, and regulatory risk analysis. Through this research method, it is expected to provide a comprehensive picture of the regulatory framework, ethics, and responsibilities related to the development of artificial intelligence in a business context. The results of the study show that the implementation of a regulatory framework for the use of artificial intelligence in business faces a number of complex challenges, such as regulatory uncertainty, unclear regulatory obligations, data privacy and security, algorithmic bias, compliance with regulations and standards, ethical challenges in autonomous decisions, accountability in cases of failure, understanding by stakeholders, risks at the personal level, and changes in job and market dynamics. Keywords: Development, Artificial Intelligence, Business Ethics, Regulatory Responsibilities, Era of Artificial Intelligence

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Broadening the entrepreneurial mindset to meet sustainable goals – Introducing the 4-foci mindset

In the field of entrepreneurship education, the subject matter has changed from a focus on venture creation to one that encourages the development of broader skills and attitudes that prompt students to live in an entrepreneurial way. The emphasis on an ‘entrepreneurial mindset’ (EM) is increasing. However, global issues, such as climate change and the mental health crisis, require a transformation in the way we think and act. Our external environment is increasingly seen as a manifestation of deeply held beliefs, values, attitudes, and perceptions of the world—the inner dimensions of sustainability. Thus, we must reflect on individual values, increase inner capacities, and achieve sustainable life skills prior to creating more sustainable ventures and futures-an overlooked perspective in the current definition of EM. This paper introduces a design perspective and the 4-Foci Mindset, which includes both an outer focus aimed at sustainable value creation and connections with others and with nature, as well as an inward orientation that achieves inner capacities related to ‘being’. The paper presents the implementation and evaluation of the 4-Foci Mindset framework in an educational setting, concentrating on the inner focus as the most radical new perspective in education. The results reveal the clear necessity and value of addressing ‘the inner focus’.

Evaluation of a youth-focused suicide prevention HOPE aftercare service: protocol for a non-randomized hybrid effectiveness-implementation type I design.

Suicide is the fourth leading cause of death among young people aged 15-29 worldwide. Young people often present to emergency departments (EDs) with self-harm and suicide-related behaviors. The period following discharge from the ED is recognized as one of elevated risk for both repeated self-harm and suicide. During this critical time, suicide prevention aftercare services are recommended. Despite their increased popularity, evidence demonstrating the effectiveness of these models is very limited. Using a hybrid effectiveness-implementation type I design, this evaluation will assess the effectiveness and implementation of a suicide prevention aftercare (Hospital Outreach Post-suicidal Engagement; HOPE) service designed to reduce risk of self-harm and suicide in young people aged 12-25 who are referred to the service following an ED presentation for self-harm or suicide attempt. Two complementing theoretical frameworks will guide this evaluation, specifically the design, data collection, analysis, and interpretation of results. The RE-AIM evaluation framework will be used to assess Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance of the HOPE aftercare service. The PRISM implementation framework will be used to assess multi-level contextual factors hypothesized to affect the RE-AIM outcomes. Several data sources will be used to assess the changes in primary and secondary outcomes from baseline to post-intervention, and at follow-up, including user and provider self-report surveys, semi-structured interviews, and routinely collected hospital data. An historical control study will also be conducted using data from the Self-Harm Monitoring System for Victoria to examine the impact of the service on rates of self-harm and suicide-related presentations to ED, and compare trends prior to and following commencement of the HOPE aftercare service. In addition, dynamic systems modelling will be used to assess the future scalability of the service. Findings from this evaluation will determine the effectiveness, including cost-effectiveness, of the HOPE aftercare service and describe the implementation context. They will inform the future development and sustainability of this and other similar services across Australia and internationally. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the19th December 2023 (Registration number ACTRN12623001332617). We do not foresee any amendments to this protocol however, if any unforeseen modifications are required, they will be submitted to ANZCTR. Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia.

Nutrition as therapy - the role of dietitian counseling: a best practice implementation project.

The objective of this best practice implementation project was to improve dieticians' professional practice and dietary care through the use of counseling strategies. Improving the design and implementation of evidence-based practice depends on successful behavior change interventions. This requires an appropriate method for designing the interventions and then analyzing the targeted behavior. Behavior change techniques (BCTs) have been demonstrated to improve the patient-dietitian relationship and patient treatment outcomes. This evidence-based quality improvement project used the JBI Evidence Implementation Framework to identify gaps in clinical practice and barriers to changing practice. We recruited 20 dietitians and conducted a baseline audit to determine their level of knowledge of BCTs, the extent to which they applied BCTs in their practice, and barriers to using BCTs. To address the identified barriers, a 5-hour training session was conducted by a dietitian with psychological training. A follow-up audit was then conducted to measure improvements in compliance with best practice. The baseline audit revealed that 80% of participants used some of the targeted counseling strategies. The most common barriers were lack of guidance on the use of BCTs or insufficient knowledge of BCTs. The follow-up audit revealed that 93% of participants used some counseling strategies, representing a 13% improvement from baseline. Applying BCTs is a challenge in dietary practice. The results indicate that education about these techniques is needed. As the next step, we suggest disseminating the relevant recommendations among dietitians in Poland and providing education about the use of these methods. http://links.lww.com/IJEBH/A289.

Pain assessment and management in patients with dementia in Taiwan: a best practice implementation project.

The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia. The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community. The project followed the JBI Evidence-based Healthcare Model and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance. This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1-3, respectively. For Criteria 4-8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses' perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome. Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study. http://links.lww.com/IJEBH/A294.

Computational Stabilization of a Non‐Heme Iron Enzyme Enables Efficient Evolution of New Function

AbstractDeep learning tools for enzyme design are rapidly emerging, and there is a critical need to evaluate their effectiveness in engineering workflows. Here we show that the deep learning‐based tool ProteinMPNN can be used to redesign Fe(II)/αKG superfamily enzymes for greater stability, solubility, and expression while retaining both native activity and industrially relevant non‐native functions. This superfamily has diverse catalytic functions and could provide a rich new source of biocatalysts for synthesis and industrial processes. Through systematic comparisons of directed evolution trajectories for a non‐native, remote C(sp3)−H hydroxylation reaction, we demonstrate that the stabilized redesign can be evolved more efficiently than the wild‐type enzyme. After three rounds of directed evolution, we obtained a 6‐fold activity increase from the wild‐type parent and an 80‐fold increase from the stabilized variant. To generate the initial stabilized variant, we identified multiple structural and sequence constraints to preserve catalytic function. We applied these criteria to produce stabilized, catalytically active variants of a second Fe(II)/αKG enzyme, suggesting that the approach is generalizable to additional members of the Fe(II)/αKG superfamily. ProteinMPNN is user‐friendly and widely accessible, and our results provide a framework for the routine implementation of deep learning‐based protein stabilization tools in directed evolution workflows for novel biocatalysts.

Governance Frameworks for Renewable Energy Development: Energy Transition and Public Governance

Objective: The objective of this study is to investigate governance frameworks for renewable energy development, with the aim of understanding how effective governance can facilitate the energy transition and contribute to sustainable development. Theoretical Framework: This research draws on key theories in public governance and energy transition, focusing on regulatory mechanisms, stakeholder engagement, and the integration of renewable energy policies. Concepts from energy security and sustainable development underpin the analysis. Method: A comprehensive literature review and case study analysis were conducted. The study design includes an examination of regulatory and policy mechanisms, stakeholder involvement, and institutional structures across various regions. Data collection was based on case studies from different countries, analyzing the challenges and successes in renewable energy governance. Results and Discussion: The results revealed the critical role of policy coherence, long-term stability, and stakeholder engagement in the successful implementation of governance frameworks. Key challenges such as regulatory uncertainty, grid integration, and public acceptance were identified. The discussion contextualizes these findings within the theoretical framework, offering insights into the relationships between governance and energy policy outcomes. Research Implications: The study provides practical and theoretical implications for policymakers and energy practitioners. It underscores the need for coherent, stable, and inclusive governance frameworks that can address barriers and promote the integration of renewable energy into national energy systems. Originality/Value: This study contributes to the literature by offering an in-depth analysis of governance frameworks and their role in the renewable energy transition. It highlights best practices and offers valuable lessons for stakeholders engaged in energy governance.

The Role of AI in Personalizing Insurance Policies

This article analyzes the transformative impact of artificial intelligence on the insurance industry through four key innovations. It examines how AI has enabled real-time risk assessment and dynamic pricing through personalized policy optimization, integrated terabytes of daily customer data for precise underwriting, implemented advanced analytics frameworks for enhanced fraud detection and customer segmentation, and automated operations for improved efficiency. The findings demonstrate that AI implementation has achieved an 82% improvement in risk prediction accuracy, reduced operational costs by 67%, and increased customer satisfaction by 76%. However, these technological advancements necessitate robust ethical governance frameworks, particularly in data privacy and algorithmic fairness. The research comprehensively analyzes AI's role in reshaping insurance operations while emphasizing the critical balance between technological innovation and ethical implementation. These insights offer valuable guidance for insurance providers pursuing digital transformation while maintaining regulatory compliance and customer trust.

Abstract 4126950: Program Evaluation of a Team-Based Telemedicine Hypertension Intervention by Patients

Background: We pilot tested a 12-week, team-based, telemedicine hypertension management intervention tailored for patients with greater social needs. Our study included home blood pressure (BP) guided pharmacotherapy, frequent self-management support, and social support by pharmacists, nurses, community health workers and social workers. Twenty patients, including 17 Black patients, from 2 clinics in NC participated. We conducted program evaluation to inform future research. Methods: After program completion, we conducted semi-structured interviews and administered validated surveys for program evaluation. We used Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation Frameworks to guide our study design. We utilized inductive and deductive coding methods, with thematic analysis to organize emergent themes. We used descriptive statistics to summarize survey results. We triangulated themes from interviews with survey results during analysis/results interpretation using concurrent embedded mixed methods (Qual + quant) for convergence/complementarity. Results: Nineteen patients completed the interviews and 18 completed the surveys. A patient withdrew from the study. Several themes emerged around acceptability, appropriateness, feasibility, and patient centeredness about the program (Table). Patients’ perceptions that the program was acceptable and measuring BP at home was easy were most salient. Program was found to be highly patient centered. Conclusions: Patients found our team-based telemedicine intervention acceptable, appropriate, feasible, and patient centered. The tailored telemedicine program holds promise for adoption by patients with greater social needs.

Transient Ischemic Attack and Mild Stroke Participant Perspectives on Barriers and Enablers to Participation in Cardiovascular Rehabilitation

Background Exercise-based cardiac rehabilitation reduces the risk factors and recurrence of cardiovascular disease in patients with coronary heart disease. Despite similar risk factors, people with transient ischemic attack (TIA) and mild stroke do not attend cardiac rehabilitation. Cardiovascular rehabilitation (CVR), including TIA, stroke, and coronary heart disease, could be a solution for increasing participation. Perspectives from TIA and stroke survivors on barriers and enablers to participation in CVR are limited, and implementation strategies for CVR are currently unknown. Objectives We sought to determine (1) What were the perspectives of participants with TIA and mild stroke on barriers and enablers to uptake, engagement, and participation in CVR? and (2) What implementation strategies may influence people with TIA and mild stroke to participate in CVR? Methods In-depth semistructured interviews were conducted with CVR participants. Inductive thematic analysis was completed before deductively mapping themes to implementation frameworks, the Capability, Opportunity, Motivation, and Behavior Model and Theoretical Domains Framework. Results Twenty participants aged 73 ± 11 years were interviewed. Most were men, stroke survivors, tertiary educated, and retired. Six themes were generated to explain the barriers and enablers to CVR participation. Themes and subthemes mapped to 8 Theoretical Domains Framework domains and 5 Capability, Opportunity, Motivation, and Behavior constructs. Prioritizing participants' physical and social opportunities, reflective motivation, and physical and psychological capabilities may improve their participation in CVR. Conclusions Barriers and enablers to CVR participation were similar to those in the coronary heart disease population. Increasing access and availability of CVR for people with TIA and mild stroke should be prioritized for future implementation.

EXTH-67. ONCOLYTIC ADENOVIRAL INFECTION OF CHORDOMA ACHIEVES TREATMENT EFFICACY THROUGH IMMUNOGENIC CELL DEATH AND TUMOR MICROENVIRONMENT ALTERATION

Abstract Chordomas are locally aggressive neoplasms of the axial skeleton with recurrence rates approaching 40%. Moreover, recurrent chordomas are nearly impossible to eradicate—highlighting an unmet clinical need. Immunotherapeutic approaches, such as immune checkpoint inhibition (ICI), has been a successful tool to modulate the tumor microenvironment (TME) towards a pro-inflammatory, antitumor state. There is emerging interest in exploring immunomodulatory agents for chordomas. Oncolytic viral (OV) therapy uses genetically modified viruses which selectively replicate in tumor cells, mediate tumor cell lysis, and initiate a pro-inflammatory response within the infected TME. These findings suggest that OV therapy may be a clinically relevant, novel immunotherapeutic approach for chordoma. Using the replicating oncolytic adenovirus Delta-24-RGD, we investigate the efficacy of chordoma treatment using in vitro approaches, ex vivo bone scaffolds, and in vivo murine models. Additionally, we explore the underlying mechanism of OV cytotoxicity, immunogenic cell death, Brachyury modulation, and reshaping of the TME towards a pro-inflammatory state. Across a panel of human chordoma cell lines, Delta-24-RGD achieved viral infectivity, oncolysis and immunogenic cell death. This treatment response was similarly demonstrated in chordoma cultured in bone scaffold models. Delta-24-RGD infection was associated with concomitant Brachyury downregulation within both infected and uninfected chordoma cells in vitro, suggesting a pleiotropic effect following oncolytic viral infection. In vivo models of CH22 chordoma treated with Delta-24-RGD demonstrated shrinkage in tumor volume and enhanced overall survival. Utilizing a human chordoma tissue microarray, the immunosuppressive macrophage marker CD163 was associated with shortened recurrence free survival. Using macrophage/chordoma co-culture, Delta-24-RGD infection achieved a reduction in macrophage expression of CD163. Taken together, Delta-24-RGD demonstrated efficacy in multiple models of chordoma including mice bearing CH22 tumors. The chordoma TME is associated with clinical outcomes and Delta-24-RGD infection reverses a deleterious immunosuppressive immune profile. These studies provide a framework for future clinical trial implementation for patients with metastatic or recurrent chordoma.

Emergency hospital admissions for stress-related presentations among secondary school-aged minoritised young people in England.

Minoritised young people face a double burden of discrimination through increased risk of stress and differential treatment access. However, acute care pathways for minoritised young people with urgent mental health needs are poorly understood. To explore variation in stress-related presentations (SRPs) to acute hospitals across racial-ethnic groups in England. We examined rates, distribution, duration and types of SRPs across racial-ethnic groups in a retrospective cohort of 11- to 15-year-olds with one or more emergency hospital admissions between April 2014 and March 2020. SRPs were defined as emergency admissions for potentially psychosomatic symptoms, self-harm and internalising, externalising and thought disorders. White British (8-38 per 1000 births) and Mixed White-Black (9-42 per 1000 births) young people had highest rates of SRPs, whereas Black African (5-14 per 1000 births), Indian (6-19 per 1000 births) and White other (4-19 per 1000 births) young people had the lowest rates of SRPs. The proportion of readmissions were highest for Pakistani (47.7%), White British (41.4%) and Mixed White-Black (41.3%) groups. Black Other (36.4%) and White Other (35.8%) groups had the lowest proportions of readmissions. The proportion of admission durations ≥3 days was higher for Black Other (16.6%), Bangladeshi (16.3%), Asian Other (15.9%) and Black Caribbean (15.8%) groups than their White British (11.9%) and Indian (11.8%) peers. The type of SRPs varied across racial-ethnic groups. Patterns of SRP admissions systematically differed across racial-ethnic groups, indicative of inequitable triage, assessment and treatment processes. These findings highlight the need for implementation of race equality frameworks to address structural racism in healthcare pathways.

Big Data in Pharmacy: Transforming Patient Care with Analytics

The integration of big data analytics in pharmacy is revolutionizing patient care by providing insights that enhance medication management and therapeutic outcomes. By leveraging vast amounts of health data, pharmacists can deliver more personalized treatment and optimize drug therapy. Despite the potential benefits, existing methods in pharmacy often suffer from data silos, lack of interoperability, and insufficient analytical capabilities, leading to suboptimal patient outcomes and inefficient medication management. These limitations hinder the effective utilization of data for real-time decision-making in patient care. To address these challenges, it propose the Patient Care Transformation using Big Data Analytics (PCT-BDA) framework, which facilitates a holistic approach to patient data integration and analysis within smart grid systems. This framework enables seamless data flow between various healthcare entities, improving collaboration and fostering a comprehensive view of patient health profiles. The proposed method emphasizes real-time analytics, predictive modeling, and machine learning algorithms to enhance decision-making processes in medication management. By utilizing big data analytics, pharmacists can better predict patient responses, identify potential drug interactions, and tailor therapy plans to individual needs. Preliminary findings from the implementation of the PCT-BDA framework indicate significant improvements in patient outcomes, including reduced medication errors, enhanced adherence to treatment protocols, and overall increased satisfaction with pharmacy services. This innovative approach highlights the transformative potential of big data analytics in optimizing patient care in the pharmacy sector.

Implementation of trans-cystic biliary stenting during acute cholecystectomy to facilitate elective ERCP: a quality improvement initiative.

A predominantly endoscopic approach for acute admissions with choledocholithiasis with a gallbladder in situ (CGIS) resulted in prolonged hospital length of stay due to delays at investigation and treatment junctures. We initiated a quality improvement program of trans-cystic biliary stenting to facilitate efficient patient progress to acute cholecystectomy and outpatient ERCP if required. We utilized implementation frameworks with regular re-assessment for this quality improvement project. Patients who required both ERCP and cholecystectomy for management of CGIS were identified for comparison of total length of stay before and after implementation. The outcomes for stent insertion and ERCP were also collected for analysis. Twenty-three trans-cystic stents were attempted with 22 inserted successfully. The median total length of stay for all patients requiring both ERCP and cholecystectomy for management of CGIS was shorter compared to 6 months prior to implementation (5 days (range 3-18) vs. 6 days (range 5-17); P = 0.009). The median stenting time was 14 min (range 9-48). After stent insertion, more ERCPs were performed as day-only outpatient cases (20/23 (87.0%) vs. 6/44 (13.6%) P < 0.001). The rate of pancreatic duct wire cannulation at ERCP was also lower (1/23 (4.3%) vs. 18/44 (40.9%); P = 0.002). No complications of stent insertion or ERCP were recorded in the study cohort. Implementation of trans-cystic stents can lead to reductions in total hospital length of stay and improve ERCP processes. Our experience suggests that surgical initiatives can be successfully added to routine practice by establishing a project team and applying quality improvement principles.

Commentary: Bridging and Reducing the Gaps Between Research and Practice: Pathways to Outcomes and the Interactive Systems Framework for Dissemination and Implementation 2.0.

There are many ways proposed to achieve better societal outcomes (e.g., in health, education, and well-being) including: (1) bridging research and practice, (2) building the motivation and capacity of service delivery organizations (e.g., schools, hospitals, clinics, and community-based organizations) to innovate, and (c) providing service delivery systems with high-quality support via training and technical assistance. The Interactive Systems Framework for Dissemination and Implementation (ISF) was developed to describe how relevant systems, organizations, and processes can interact and work toward these goals. Stimulated by the 13 articles contained in the two special issues of Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers, we describe several enhancements to the ISF including: how service delivery systems can operate better, how motivation and capacity can be built, and how training and technical assistance centers can provide more evidence-informed technical assistance and other promising innovations. ISF 2.0 incorporates these and other enhancements with the goal of achieving better outcomes. We conclude that the actions and accountability of funders and of organizations and systems to funders would accelerate progress in the systems to achieve outcomes-and result in improving the science and practice of implementation support.

Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) in Puno, Peru: rationale and study protocol for a hybrid type 2 effectiveness and implementation randomized controlled trial

BackgroundHypertension is the most common cardiovascular disease in Peru despite the availability of cost-effective, evidence-based treatment. Here we describe the rationale and study design for a hybrid type 2 randomized controlled trial to test the implementation and effectiveness of a community health worker (CHW)-led hypertension control program within the national primary care system in Puno, Peru.MethodsWe will recruit 1068 adult participants with hypertension aged ≥ 18 years in Puno, Peru, via facility-based enrollment and community health fairs. Participants will be individually randomized (1:1) to either continue with usual care or participate in a 12-month CHW-led home-based hypertension control program consisting of blood pressure monitoring, medication adherence support, and healthy lifestyle counseling. Outcome development and reporting are guided by the Consolidated Framework for Implementation Research (CFIR), the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, and the Proctor et al. framework. Clinical effectiveness outcomes include mean change in systolic blood pressure (primary outcome), diastolic blood pressure, and HbA1C. Implementation outcomes include fidelity (i.e., CHW protocol adherence and dose), reach, adoption, sustainability, acceptability, and cost-effectiveness.DiscussionThe ANDES trial is testing the first CHW-led multicomponent strategy for hypertension and type 2 diabetes management in Peru. This type 2 hybrid trial will provide critical insights into the individual, community, and system-level factors necessary for successful implementation and effectiveness. These data can inform the future adaptation and scaling of the ANDES strategy in Peru and other LMICs, as well as influence policies at the system level to support this transition. Furthermore, by addressing both hypertension and diabetes, the ANDES strategy supports integrated care approaches advocated by the WHO HEARTS technical package, ultimately enhancing health outcomes and reducing morbidity and mortality in the region.Trial registrationClinicalTrials.gov, ID: NCT05524987, Addressing Hypertension and Diabetes through Community-Engaged Systems in Puno, Peru (ANDES study), prospectively registered on September 1, 2021.