Implementation Guide Research Articles

Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study

BackgroundEvidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations.MethodsThis study examined the facilitators and barriers (collectively termed “determinants”) to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams.ResultsSalient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses.ConclusionsFindings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.

StayHome: A FHIR-Native Mobile COVID-19 Symptom Tracker and Public Health Reporting Tool.

As the COVID-19 pandemic continues to unfold and states experience the impacts of reopened economies, it is critical to efficiently manage new outbreaks through widespread testing and monitoring of both new and possible cases. Existing labor-intensive public health workflows may benefit from information collection directly from individuals through patient-reported outcomes (PROs) systems. Our objective was to develop a reusable, mobile-friendly application for collecting PROs and experiences to support COVID-19 symptom self-monitoring and data sharing with appropriate public health agencies, using Fast Healthcare Interoperability Resources (FHIR) for interoperability. We conducted a needs assessment and designed and developed StayHome, a mobile PRO administration tool. FHIR serves as the primary data model and driver of business logic. Keycloak, AWS, Docker, and other technologies were used for deployment. Several FHIR modules were used to create a novel "FHIR-native" application design. By leveraging FHIR to shape not only the interface strategy but also the information architecture of the application, StayHome enables the consistent standards-based representation of data and reduces the barrier to integration with public health information systems. FHIR supported rapid application development by providing a domain-appropriate data model and tooling. FHIR modules and implementation guides were referenced in design and implementation. However, there are gaps in the FHIR specification which must be recognized and addressed appropriately. StayHome is live and accessible to the public at https://stayhome.app. The code and resources required to build and deploy the application are available from https://github.com/uwcirg/stayhome-project.

102 Online Supportive Conversations & Reflection Sessions [OSCARS] with Care Home Staff Following A Resident’s Death: Improving Coping Mechanisms, Team Cohesion and Communication

IntroductionCOVID-19 Trauma Guidance suggests opportunities for structured, time-limited discussions about challenging experiences should be offered. It is unknown if such discussions can be effectively delivered online by palliative care specialists to support care home (CH) staff in relation to death/dying. Funded by Scotland’s Chief Scientist Office COVID-19 “rapid research” fund, online OSCaRS is being piloted.MethodsFortnightly OSCaRS delivered to small groups of CH staff via a secure online platform in three local CHs over 10 weeks. Sessions are digitally recorded. The shortened version of the Chesney coping self-efficacy questionnaire is completed by all staff pre/post. Additional post-study questions asked of OSCaRS participants and in-depth staff interviews will be undertaken (n = 10). Thematic analysis of the recorded sessions and interviews will be undertaken and related to the staff questionnaire and context of each CH.ResultsNew learning on the feasibility and acceptability of providing OSCaRS to frontline staff. The benefit of OSCaRS to CH staff coping mechanisms, team cohesion and communicaton with relatives during the COVID-19 pandemic will be presented. Initial results show that OSCaRS are feasible, valued by all care home staff and support staff in coping with the challenges of COVID-19/.Key ConclusionsThe analysis will inform future practice, and an Implementation Guide for OSCaRS in CHs will be produced. Key learning on the potential for online support in relation to death/dying during the pandemic and beyond will contribute to future education, training and staff wellbeing resources. It will also inform the role of such sessions in developing individual coping mechanisms and team working alongside communication with relatives during lockdown.

Cyber security in industrial control system

For any system to secure them industrial control system plays an important role in it. It helps to design the isolated procure system, specialized communication mechanisms is used to help for the setup. And with the help of this setup the flexibility, safety, threats, and vulnerabilities are the most important things to make. To secure them from risk assessment and other protection measurement need to specify with good instruments and security. The paper describes technical aspects on Denial of Service (Dos) attack. We also identify how smart grid communication networks works in security technical implementation guides of the different countries as a defense information systems agency. A brief chronicle of cyber storm on ICS; common challenges, some mitigation of those challenge, all levels of the multi-layered ICS architecture. This paper demonstrates railway control systems (RCS) compliance estimation of immovable control system design, operational scenarios that can be used for mitigation measures and security assessment.

Towards a Semantic Knowledge Base for Competency-Based Training of Airline Pilots

The acquisition and maintenance of non-technical skills by the pilots are fundamental factors for the prevention of aviation accidents. The aviation authorities are promoting that air crew training be carried out through simulator sessions using scenarios specifically designed to develop and assess the global performance of pilots in such skills. When designing custom flight training scenarios, choosing the correct events and conditions from the myriad of possible combinations with respect to their potential utility in training specific competencies is a costly task that depends entirely on highly specialized expert knowledge. In this paper, we present EBTOnto, an OWL DL ontology that allows to formalize this knowledge and other useful data from real cases, laying the foundations for a semantic knowledge base of scenarios for airline pilots training. Previous advances in this matter and possible applications of this system are reviewed. EBTOnto is built on top of a source validated by experts, the Evidence-Based Training Implementation Guide by the International Air Transport Association, and then checked using an automatic reasoner and a database of 37,568 aviation safety incidents, extracted from the widely regarded Aviation Safety Reporting System by the U.S. National Aeronautics and Space Administration. The results suggest that it is possible to classify real aviation scenarios in terms of non-technical competencies and filter useful incident reports for design and enrichment of these training scenarios. EBTOnto opens up new possibilities for interoperability between incident databases and training organizations, and smoothes the path to represent, share and generate custom simulation training scenarios for pilots based on real data.

Compliance with Canadian Internal Control Regulations by Smaller Public Companies: A Practical Implementation Guide

Compliance with Canadian Internal Control Regulations by Smaller Public Companies: A Practical Implementation Guide

Leveraging the Value of CDISC SEND Data Sets for Cross-Study Analysis: Incidence of Microscopic Findings in Control Animals.

Implementation of the Clinical Data Interchange Standards Consortium (CDISC)'s Standard for Exchange of Nonclinical Data (SEND) by the United States Food and Drug Administration Center for Drug Evaluation and Research (US FDA CDER) has created large quantities of SEND data sets and a tremendous opportunity to apply large-scale data analytic approaches. To fully realize this opportunity, differences in SEND implementation that impair the ability to conduct cross-study analysis must be addressed. In this manuscript, a prototypical question regarding historical control data (see Table of Contents graphic) was used to identify areas for SEND harmonization and to develop algorithmic strategies for nonclinical cross-study analysis within a variety of databases. FDA CDER's repository of >1800 sponsor-submitted studies in SEND format was queried using the statistical programming language R to gain insight into how the CDISC SEND Implementation Guides are being applied across the industry. For each component needed to answer the question (defined as "query block"), the frequency of data population was determined and ranged from 6 to 99%. For fields populated <90% and/or that did not have Controlled Terminology, data extraction methods such as data transformation and script development were evaluated. Data extraction was successful for fields such as phase of study, negative controls, and histopathology using scripts. Calculations to assess accuracy of data extraction indicated a high confidence in most query block searches. Some fields such as vehicle name, animal supplier name, and test facility name are not amenable to accurate data extraction through script development alone and require additional harmonization to confidently extract data. Harmonization proposals are discussed in this manuscript. Implementation of these proposals will allow stakeholders to capitalize on the opportunity presented by SEND data sets to increase the efficiency and productivity of nonclinical drug development, allowing the most promising drug candidates to proceed through development.

Improving Cancer Data Interoperability: The Promise of the Minimal Common Oncology Data Elements (mCODE) Initiative.

Because of expanding interoperability requirements, structured patient data are increasingly available in electronic health records. Many oncology data elements (eg, staging, biomarkers, documentation of adverse events and cancer outcomes) remain challenging. The Minimal Common Oncology Data Elements (mCODE) project is a consensus data standard created to facilitate transmission of data of patients with cancer. In 2018, mCODE was developed through a work group convened by ASCO, including oncologists, informaticians, researchers, and experts in terminologies and standards. The mCODE specification is organized by 6 high-level domains: patient, laboratory/vital, disease, genomics, treatment, and outcome. In total, 23 mCODE profiles are composed of 90 data elements. A conceptual model was published for public comment in January 2019 and, after additional refinement, the first public version of the mCODE (version 0.9.1) Fast Healthcare Interoperability Resources (FHIR) implementation guide (IG) was presented at the ASCO Annual Meeting in June 2019. The specification was approved for balloting by Health Level 7 International (HL7) in August 2019. mCODE passed the HL7 ballot in September 2019 with 86.5% approval. The mCODE IG authors worked with HL7 reviewers to resolve all negative comments, leading to a modest expansion in the number of data elements and tighter alignment with FHIR and other HL7 conventions. The mCODE version 1.0 FHIR IG Standard for Trial Use was formally published on March 18, 2020. The mCODE project has the potential to offer tremendous benefits to cancer care delivery and research by creating an infrastructure to better share patient data. mCODE is available free from www.mCODEinitiative.org. Pilot implementations are underway, and a robust community of stakeholders has been assembled across the oncology ecosystem.

Deprescribing: A Tool to Optimize Medications Across the Continuum of Care

Deprescribing: A Tool to Optimize Medications Across the Continuum of Care

A Multiple Adaptive Neuro-Fuzzy Inference System for Predicting ERP Implementation Success

The implementation of modern ERP solutions has introduced tremendous opportunities as well as challenges into the realm of intensely competent businesses. The ERP implementation phase is a very costly and time-consuming process. The failure of the implementation may result in the entire business to fail or to become incompetent. This fact along with the complexity of data streams has led the researchers to develop a hierarchical multi-level predictive solution to automatically predict the implementation success of ERP solution. This study exploits the strength and precision of the Adaptive Neuro-Fuzzy Inference System (ANFIS) for predicting the implementation success of ERP solutions before the initiation of the implementation phase. This capability is obtained by training the ANFIS system with a data set containing a large number of ERP implementation efforts that have led to success, failure, or a mid-range implementation. In the initial section of the paper, a brief review of the recent ERP solutions as well as ANFIS architecture and validation procedure is provided. After that, the major factors of ERP implementation success are deeply studied and extracted from the previous literature. The major influential implementation factors in the businesses are titled as Change Orchestration (CO), Implementation Guide (IG), and Requirements Coverage (RC). The factors represent the major elements that guide the implementation project to a final success or to a possible failure if mismanaged. Accordingly, three initial ANFIS models are designed, trained, and validated for the factors. The models are developed by gathering data from 414 SMEs located in the Islamic Republic of Iran during a three-year period. Each model is capable of identifying the weaknesses and predicting the successful implementation of major factors. After this step, a final ANFIS model is developed that integrates the outputs of three initial ANFIS models into a final fuzzy inference system, which predicts the overall success of the ERP implementation project before the initiation phase. This model provides the opportunity of embedding the previous precious experiences into a unified system that can reduce the heavy burden of implementation failure.

The Value of Domain Information Models for Achieving Interoperability.

The value of data models in general and information models in specific has been evaluated by many scientific papers. UML as one modelling notation has documented its value as a foundation for precise specifications. Analyzing implementation guides for data exchange, they rarely include or are based on information models but simple data sets, if at all, as simple technical representation thereof. This paper wants to argue in favor of information models as a basis for creating interoperability specifications using a quite simple example and to include - or at least reference - them when providing implementation guides. The reader is invited to transfer this example to even more complex scenarios.

Brazilian’s Health Policy and its misalignment with international guidelines for Health Promotion

Abstract Following the First Health Promotion Conference in Ottawa in 1986, several other global level Conferences were held, and Shanghai was the last City to host the 9th Health Promotion Conference in 2016, where several world leaders assume commitments that meet the common cause of the topic in question, presenting robust outcomes such as the Letters, Declarations and Implementation Guides. This work aimed to analyze the coherence of the development of the current National Health Plan in Brazil in relation to the central axes of the most recent international documents, referring to the Shanghai Declaration and the Guide for the National Implementation of the Shanghai Declaration. The results showed that Brazil presents a National Health Plan that definitely does not include the actions proposed in the most recent international documents, such as the Shanghai Conference report and the Guide for National Implementation of the Shanghai Declaration. Paradoxically, Brazil has other institutionally implemented instruments that consider the activities recommended from these international documents in a very satisfactory way. Among these instruments are a specific National Policy on Health Promotion, and several Health Care Programs and Networks aimed at some of the National Policy on Health Promotion strengthening axes, such as the National Tobacco Control Program, the Health at School Program, the Health Gym Program, in addition to other related National Policies, such as the National Policy on Integrative and Complementary Practices and the National Policy on Medicinal Plants and Herbal Medicines. It is concluded that the National Health Plan is a symbolic instrument that is not in line with international recommendations and, contradictorily, it is also not in line with the own policies and programs that are successfully implemented and developed in national territory. Key messages There is a misalignment between the real meaning that a National Health Plan should present and its current content, what leads to an insuficent instrument for enhancing health promotion. While the national health plan is out of alignment with strengthening health promotion, other nationwide specific policies developed reinforce international guidelines.

Valuable, but not useful: Barriers to use in implementation of patient reported outcomes

Patient-reported outcome (PRO) measures can capture a patient’s perspective on their health. In an effort to increase use of PROs in ambulatory practice, an app-based survey tool was tested in nine diverse ambulatory settings. The Office of the National Coordinator for Health Information Technology’s (ONC) PRO FHIR Implementation Guide was used to modify an existing app. The app was utilized in nine diverse ambulatory settings with ninety patients. Nine interviews with patients and nine interviews with providers were completed during the data collection process to better understand the facilitators and barriers to implementation. The interviews revealed that human computer interaction, survey relevance, and clinical context could all have a significant impact on the success of a PRO app implementation.

Global Forum on Quality Assurance in CE/CPD: Assuring Quality across Boundaries.

As a result of the globalization of access and provision of continuing education and continuing professional development (CE/CPD), the national CE/CPD accreditation organizations of Australia, Canada, Ireland, New Zealand, South Africa, United Kingdom and United States formed the Global Forum on Quality Assurance of Continuing Education and Continuing Professional Development (GFQACE) to investigate and develop means of recognizing CE/CPD across boundaries. Two priorities were identified at their first meeting in 2016: (1) the development of an accreditation framework and (2) the identification of models and approaches to mutual recognition. The GFQACE approved an accreditation framework and facilitated review approach to mutual recognition in 2018 and is currently working on implementation guides. As background to the work of the GFQACE, this article provides a brief history of continuing education (CE) and continuing professional development (CPD) and discusses the value and benefits of CE/CPD to professional development of pharmacy professionals, innovation of pharmacy practice and the provision of quality patient care. Due to the essential role of CE/CPD accreditation in enabling recognition across boundaries, the nature and role of accreditation in defining, assuring and driving quality CE/CPD is described. Four conclusions regarding the broad sharing of perceptions of quality CE/CPD, the potential for expansion of the GFQACE and the benefits to pharmacy professionals, providers and pharmacy practice are discussed.

Development of Customizable Implementation Guides to Support Clinical Adoption of Pharmacogenomics: Experiences of the Implementing GeNomics In pracTicE (IGNITE) Network.

IntroductionClinical adoption of genomic medicine has lagged behind the pace of scientific discovery. Practice-based resources can help overcome implementation challenges.MethodsIn 2015, the IGNITE (Implementing GeNomics In pracTicE) Network created an online genomic medicine implementation resource toolbox that was expanded in 2017 to incorporate the ability for users to create targeted implementation guides. This expansion was led by a multidisciplinary team that developed an evidence-based, structured framework for the guides, oversaw the technical process/build, and pilot tested the first guide, CYP2C19-Clopidogrel Testing Implementation.ResultsSixty-five resources were collected from 12 institutions and categorized according to a seven-step implementation framework for the pilot CYP2C19-Clopidogrel Testing Implementation Guide. Five months after its launch, 96 CYP2C19-Clopidogrel Testing Implementation Guides had been created. Eighty percent of the resources most frequently selected by users were created by IGNITE to fill an identified resource gap. Resources most often included in guides were from the test reimbursement (22%), Implementation support gathering (22%), EHR integration (17%), and genetic testing workflow steps (17%).ConclusionLessons learned from this implementation guide development process provide insight for prioritizing development of future resources and support the value of collaborative efforts to create resources for genomic medicine implementation.

About Multiculturalism and Language Rights : A Linguistic Landscape of Governmental Public Signs in Garibong-Dong, Seoul

The following study analyzes the linguistic landscape of governmental public signs with focus on whether language rights are being fulfilled, in Garibong-Dong, Seoul, which has a high proportion of people with Chinese citizenship in Korea, most of whom are Korean-Chinese, utilizing “Language Rights of Linguistic Minorities: A Practical Guide for Implementation” (Izsak-Ndiaye, 2013) published by the UN OHCHR (Office of the High Commissioner for Human Rights) as a framework to see whether language rights are being fulfilled by governmental public signs. The study includes interviews with two workers of Korea Support Center for Foreign Workers about whether language rights of Garibong-dong's residents could be affected by the linguistic landscape and what efforts could the governments make for residents.

A comprehensive overview and qualitative analysis of government-led nutrition policies in Australian institutions

BackgroundInstitutions are a recommended setting for dietary interventions and nutrition policies as these provide an opportunity to improve health by creating healthy food environments. In Australia, state and territory governments encourage or mandate institutions in their jurisdiction to adopt nutrition policies. However, no work has analysed the policy design across settings and jurisdictions. This study aimed to compare the design and components of government-led institutional nutrition policies between Australian states and territories, determine gaps in existing policies, and assess the potential for developing stronger, more comprehensive policies.MethodsGovernment-led institutional nutrition policies, in schools, workplaces, health facilities and other public settings, were identified by searching health and education department websites for each Australian state and territory government. This was supplemented by data from other relevant stakeholder websites and from the Food Policy Index Australia website. A framework for monitoring and evaluating nutrition policies in publicly-funded institutions was used to extract data and a qualitative analysis of the design and content of institutional nutrition policies was performed. Comparative analyses between the jurisdictions and institution types were conducted, and policies were assessed for comprehensiveness.ResultsTwenty-seven institutional nutrition policies were identified across eight states and territories in Australia. Most policies in health facilities and public schools were mandatory, though most workplace policies were voluntary. Twenty-four included nutrient criteria, and 22 included guidelines for catering/fundraising/advertising. While most included implementation guides or tools and additional supporting resources, less than half included tools/timelines for monitoring and evaluation. The policy design, components and nutrient criteria varied between jurisdictions and institution types, though all were based on the Australian Dietary Guidelines.ConclusionsNutrition policies in institutions present an opportunity to create healthy eating environments and improve population health in Australia. However, the design of these policies, including lack of key components such as accountability mechanisms, and jurisdictional differences, may be a barrier to implementation and prevent the policies having their intended impact.

A Model for Developing Instructional Design Professionals for Higher Education Through Apprenticeship: Blending Theory and Practice

In light of the growing number of instructional designers (IDs) of diverse educational and professional backgrounds in higher education, there is a need for formalized professional development programs. Currently no systematic pathway exists for equipping novice IDs with the requisite knowledge, skills, and experiences for successful performance and career growth. This article introduces the Development of Instructional Designers Apprenticeship (DIDA) model, comprised of four stages: (1) Observation and Modeling, (2) Tasks with Coaching, (3) Contextualized Practice, and (4) Reflection and Exploration. In this cognitive apprenticeship approach, an expert ID guides a novice through a continuum of tasks that graduate in level of difficulty over time. Case studies and sample tasks for each stage of development are provided as guides for implementation.

Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in Practice.

The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.

Implementation Guide for Rapid Integration of an Outpatient Telemedicine Program During the COVID-19 Pandemic

BackgroundIn the novel coronavirus disease 2019 (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, medical practices have limited access to in-person visits. This poses a challenge to maintain appropriate patient care while preventing a substantial backlog of patients once stay-at-home restrictions are lifted. In practices that are naïve to telehealth as an alternative option, providers and staff are experiencing challenges with telemedicine implementation. We aim to provide a comprehensive guide on how to rapidly integrate telemedicine into practice during a pandemic.MethodsWe built a toolkit that details the following 8 essential components to successful implementation of a telemedicine platform: provider and staff training, patient education, an existing electronic medical record system, patient and provider investment in hardware, billing and coding integration, information technology support, audiovisual platforms, and patient and caregiver participation.ResultsRapid integration of telemedicine in our practice was required to be compliant with our institution’s COVID-19 task force. Within 3 days of this declaration, our large specialty-care clinic converted to a telemedicine platform and we completed 638 visits within the first month of implementation.ConclusionsEffective and efficient integration of a telemedicine program requires extensive staff and patient education, accessory platforms to facilitate video and audio communication, and adoption of new billing codes that are outlined in this toolkit.