Implementation Team Research Articles

Towards an Inclusive Village: Literacy and Education for People with Disabilities Through the Development of Grape Planting Techniques (Vitis Vinifera L) Taman Ayu Village

People with disabilities are identical to people who are disabled, weak, stupid and backward. People with disabilities are no longer seen as problematic people, by providing equal access and being inclusive for everyone in their society (168 169). Equal roles for people with disabilities are an important issue for the government. Recognition of equal rights for groups with disabilities, both in terms of education, employment opportunities and others. Community service activities carried out by Herdiana, et al. in Taman Ayu village, in 2023 became the main basis for empowering people with disabilities and knowledge for people with disabilities, especially in the equality garden by involving groups with disabilities. Taman Ayu Village, Gerung District, West Lombok Regency, West Nusa Tenggara (NTB) in the "Equality Garden" group consisting of 15 people consisting of people with hearing and speech impairments which was carried out in June-December 2024 with the community service implementation team being a collaboration of 3 fields of science, namely agribusiness, accounting and agroecotechnology and involving 3 students from different study programs (fields of science). The purpose of this activity is to provide literacy and education about grape cultivation techniques, improve grape cultivation technique skills, financial management in business through ongoing training and mentoring. The forms of activities include literacy counseling and education for people with disabilities in grape cultivation techniques (Vitis Vinifera L), business management training and financial recording management, mentoring and coaching in marketing using digital marketing (marketplace: Facebook, Shopie, Tokopedia) and mentoring in submitting business legality. The hope of this activity is that groups with disabilities have skills in the field of grape cultivation, skills in management and financial recording of businesses so that from this activity a new business can be formed so that the goal of this activity is the independence of the disabled group's business. Collaboration between the service team (academics) and the village in the form of ongoing mentoring and coaching will be carried out until they have an independent business

The Management of Teacher Creativity Development in Optimizing the Merdeka Curriculum

The Merdeka Curriculum is one of the government’s effort in enhancing the quality of education in Indonesia. In its implementation, the Merdeka Curriculum initiating differentiated learning based on student’s needs. Therefore, teacher creativity is crucial in creating effective learning experiences. This study aims to explore the management of teacher creativity development done in SMP Negeri 3 Balikpapan in optimizing the implementation of the Merdeka Curriculum. This research was carried by using a qualitative method with a case study approach. To obtain the data needed, this research did interviews with the principal and teachers, observations, and school document analysis. Data analysis was conducted using Biklen & Bogdan's qualitative data analysis method. The research found that the management of teacher creativity development at SMP Negeri 3 Balikpapan is carried out through the stages of planning, organizing, implementation, and controlling. Planning involves setting objectives, conducting joint discussions, planning programs, and evaluating programs. The school implements several programs for teacher creativity development, including learning communities (kombel), PMM, and teacher training. Organizing stage involves task allocation, collaboration, and forming implementation teams. During the implementation stage, the principal motivates, provides guidance, and builds effective communication. Meanwhile, the controlling stage includes evaluation meetings, monitoring, and supervision. In implementing the teacher creativity management program, the school encounters several obstacles, such as administrative burdens, time constraints, and limited use of technology.

Influence of dementia-specialized care team on clinical outcomes in a general hospital

BackgroundBecause of the increasing prevalence of dementia in Japan, the government introduced financial incentives for specialized care for dementia at acute care hospitals in 2016. Our hospital then introduced a multidisciplinary collaborative specialized team, referred to as dementia-specialized care team. The aim of this study is to examine the influence of dementia-specialized care team on clinical outcomes for elderly inpatients. MethodsIn this retrospective observational study at a general hospital with 650 beds in Japan, we compared clinical outcomes such as incidence of falls, prescription of hypnotics, length of hospital stay, in-hospital mortality, and discharge destinations in inpatients aged 65 years and older between a two-year pre-intervention period (2014–2015) and a two-year post-intervention period (2017–2018). ResultsDuring the observation period, a total of 34,097 patients were admitted, with 16,237 patients in the pre-intervention period and 17,860 patients in the post-intervention period. The proportion of patients receiving any hypnotics decreased from 21.2 % to 19.2 %, notably with benzodiazepine from 19.8 % to 13.2 %. The incidence of falls from a seated or lying position, particularly at night, was significantly lower (from 0.5 % to 0.2 %) as was the length of hospital stay (from 13.7 days to 13.2 days) during the post-intervention period. ConclusionAfter the implementation of dementia-specialized care team, favorable outcomes such as a reduction in the use of hypnotics, the incidence of falls, and the length of hospitalization were observed. Introduction of the team and associated incentives may be effective in improving clinical outcomes in elderly inpatients.

Reducing mental health emergency visits: population-level strategies from participatory modelling

BackgroundEmergency departments (EDs) are often the front door for urgent mental health care, especially when demand exceeds capacity. Long waits in EDs exert strain on hospital resources and worsen distress for individuals experiencing a mental health crisis. We used as a test case the Australian Capital Territory (ACT), with a population surge of over 27% across 2011–2021 and a lagging increase in mental health care capacity, to evaluate population-based approaches to reduce mental health-related ED presentations.MethodsWe developed a system dynamics model for the ACT region using a participatory approach involving local stakeholders, including health planners, health providers and young people with lived experience of mental health disorders. Outcomes were projected over 2023–2032 for youth (aged 15–24) and for the general population.ResultsImproving the overall mental health care system through strategies such as doubling the annual capacity growth rate of mental health services or leveraging digital technologies for triage and care coordination is projected to decrease youth mental health-related ED visits by 4.3% and 4.8% respectively. Implementation of mobile crisis response teams (consisting of a mental health nurse accompanying police or ambulance officers) is projected to reduce youth mental health-related ED visits by 10.2% by de-escalating some emergency situations and directly transferring selected individuals to community mental health centres. Other effective interventions include limiting re-presentations to ED by screening for suicide risk and following up with calls post-discharge (6.4% reduction), and limiting presentations of frequent users of ED by providing psychosocial education to families of people with schizophrenia (5.1% reduction). Finally, combining these five approaches is projected to reduce youth mental health-related ED presentations by 26.6% by the end of 2032.ConclusionsPolicies to decrease youth mental health-related ED presentations should not be limited to increasing mental health care capacity, but also include structural reforms.

Regulating the system: Development and early implementation of a behavioral escalation response team in pediatric primary care.

Regulating the system: Development and early implementation of a behavioral escalation response team in pediatric primary care.

Supplemental Material for Regulating the System: Development and Early Implementation of a Behavioral Escalation Response Team in Pediatric Primary Care

Supplemental Material for Regulating the System: Development and Early Implementation of a Behavioral Escalation Response Team in Pediatric Primary Care

Strategies for Implementing GlobalConsent to Prevent Sexual Violence in University Men (SCALE): Study Protocol for a National Implementation Trial.

Globally, women 15-24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men's sexually violent behavior (Odds Ratio [OR] = 0.71, 95%CI 0.50-1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00-2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed. We will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater 1) pre- and post-implementation engagement with university leaders and faculty, and 2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time-series design includes 1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; 2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes, 3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities), and 4) time diaries and cost tracking to assess cost effectiveness of the two implementation-strategies bundles. This project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual-violence-prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale. NCT06443541. Retrospectively registered with clinicaltrials.gov.

PENINGKATAN MINAT BACA SISWA MELALUI METODE MEMBACA NYARING DI DESA PANTAI MEKAR

Low interest in reading can lead to low cognitive and intellectual abilities. The school literacy movement is present with the aim of developing good attitudes and noble character through multiliteracy learning, increasing students' interest in reading, and having a strong impact on student development. This community service activity is carried out by combining several methods such as lectures, discussions, and games, through reading aloud activities. The activity was carried out in July 2024. The implementation team created a reading corner and practiced reading aloud techniques for fourth grade students of SD Negeri Pantai Mekar 03, Muaragembong. Students were asked to repeat the content of the story that was read and answer some questions related to the content of the reading. This reading aloud activity was followed by the students with enthusiasm. In addition, students are also given an understanding of the utilization of the reading corner that has been provided. Students were very enthusiastic about seeing the collection of reading books and practicing how to read aloud again. The implementation team hopes that this activity can increase students' interest in reading and make students more happy to read and understand the contents of the reading presented as an effort to improve school literacy.

Development of Modified Ride-On-Cars for Children with Mobility Impairments

Introduction: The ability to move independently is an integral part of a child's development. Children with motor impairments often experience significant challenges with moving independently, resulting in expensive powered wheelchairs being purchased or having caregivers push them in strollers or wheelchairs. The purpose of this research is to adapt motorized ride-on-cars to enable children with motor impairments to explore their environment independently. Engineers, physiotherapists, and occupational therapists co-designed customized ride-on-cars with 10 children and their caregivers to support each child’s individual needs. Methods: Physiotherapists and occupational therapists led an initial diagnostic session to assess each child’s clinical needs. The engineers then brainstormed and implemented solutions. On the final day of testing, physiotherapists and occupational therapists conducted one further clinical assessment and made final changes. This process was repeated for 10 children ages 1-3 years old who had been identified as having mobility impairment. Results: The final cars were designed to minimize cost, weight, and size while prioritizing each child’s ability to operate the car independently and safely. The main modifications included replacing the original gas pedal with an assistive switch and constructing a support frame to ensure the child’s safety. Additional modifications such as adding a steering T-bar, adding LED lights, and varying the switch location were also implemented for specific children. Each modified car was tested to ensure client safety and car durability. Client feedback was positive, and caregivers expressed how their modified car will increase mobility for their child. Conclusions: The results from this iterative co-design process emphasize the importance of team assessment and implementation when creating assistive devices. It shows that modifying standard off-the-shelf toys to the specific needs of children with disabilities can be successful and improve their quality of life.

Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol

BackgroundOpioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.MethodsThis is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.DiscussionMost ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.Trial RegistrationClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991.

Implementation of a Speech-Language Pathologist–Led Tracheostomy Team in a Level 1 Trauma Hospital

Purpose: Cited benefits of a tracheostomy team include reduction in adverse events, length of stay (LOS), and hospital costs. However, there is a lack of research regarding the implementation and benefits of a speech-language pathologist (SLP)-led tracheostomy team. Our goal is to evaluate the effect of an SLP-led tracheostomy team in trauma patients. Method: An SLP-led tracheostomy team was implemented in the trauma service at Hospital Corporations of America Florida Kendall Hospital as a quality improvement project. Data were collected from January 1, 2021, to August 31, 2022. Patients were divided into a pre-tracheostomy team cohort, which served as a historical control, and a post-tracheostomy team cohort. SLP consult, days to SLP consult, Passy-Muir Valve (PMV) use, days to PMV, oral diet, days to start oral diet, downsizing the tracheostomy tube, days to downsize, decannulation, days to decannulation, and LOS were the outcome measures of interest. Pearson's chi-square and Mann–Whitney tests were used to evaluate for a significant difference ( p < .05) between the pre-tracheostomy team cohort and the post-tracheostomy team cohort. Results: Ninety-one patients were included in the final analysis (36 pre-tracheostomy team cohort, 55 post-tracheostomy team cohort). Pre-tracheostomy team and post-tracheostomy team cohorts were grossly similar ( p > .05) in age, sex, and primary admission diagnosis. We found an increase in SLP consultation (58.3%–89.1%, p < .001), PMV utilization (44.4%–67.3%, p = .031), and decannulation (8.3%–30.9%, p = .011). Days to SLP consult decreased when comparing pre-tracheostomy team to post-tracheostomy team cohorts from 6 to 2, respectively ( p < .001). Conclusions: Our approach of placing the SLP in the leading role is novel. After implementation of an SLP-led tracheostomy team, we saw improved outcomes of tracheostomy patients in the trauma population. SLPs should be included as integral members and potential leaders of tracheostomy teams based on their experience and expertise in tracheostomized patient care.

Development and Implementation of a Novel Emergency Department Based Procedure Team for Inpatient Hospital Procedures

BackgroundEmergency medicine (EM) demands proficiency in a broad set of procedural skills for emergency physicians (EPs). However, there is a literature gap on integrating EM expertise into procedure teams, especially in inpatient settings ObjectivesThis study aims to outline the development and implementation of a novel ED-based procedure team for inpatient care MethodsThis retrospective study conducted between June 6, 2022 and December 31, 2023, describes the development and implementation of an ED-based procedure team. Key procedures included central lines, arterial lines, and non-tunneled dialysis catheters, with specific guidelines to ensure safety and consistency ResultsDuring the study, the procedure team conducted 525 procedures. Midline insertions and paracentesis were the most common. The team performed an average of 27.3 procedures per month. Additional provider hours needed to complete the procedures averaged 4.8 per month and showed a trend toward stabilization over time. Financially, the team secured reimbursements for 516 cases at $98 per case, observing a positive trend in gross payments ConclusionsThe ED Procedure team has played a pivotal role in delivering essential bedside procedures for the patient, demonstrating improvements in provider proficiency, resident training, and favorable revenue outcomes. The interdepartmental collaborative and well-coordinated efforts have ensured the timely completion of necessary procedures.

Nephrology rapid response team in the intensive care unit

Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU), and it is known as an independent factor for adverse outcomes like increased length of hospital stay, the development of chronic kidney disease (CKD), and increased mortality with the associated high cost to healthcare systems. The use of AKI biomarkers and new tools such as point-of-care ultrasonography (POCUS) to perform a hemodynamic and volume status assessment has made it more feasible to detect or predict kidney damage in a very accurate way, thereby avoiding the progression of AKI. The design and implementation of a nephrology rapid response team (NRRT) should be considered to improve patient outcomes and healthcare costs. In this paper, we provide an overview of the implementation of an NRRT.

Microbiology testing capacity and antimicrobial drug resistance in surgical-site infections: a post-hoc, prospective, secondary analysis of the FALCON randomised trial in seven low-income and middle-income countries

Surgical-site infection (SSI) is one of the most common health-care-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis to prevent SSIs and effective treatment are crucial to controlling antimicrobial resistance (AMR). This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms in low-income and middle-income countries (LMICs). This analysis included patients undergoing abdominal surgery in seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) as part of the FALCON randomised controlled trial. Wound swabs were collected from patients diagnosed with SSI, as per US Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control definitions, were analysed alongside hospital-level data on local microbiological practices. An adjusted analysis was performed to identify perioperative factors associated with MDR. Testing capacity was assessed by the completion of swab testing in positively diagnosed SSIs. Between Dec 10, 2018, and Sept 7, 2020, 5788 patients were recruited to the FALCON trial. 1163 patients were diagnosed with an SSI, of whom 905 (77·8%) received prophylactic antibiotics before surgery. In patients with SSIs, 935 of 1163 (80·4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab performed (35 hospitals). Of 228 patients swabbed, 200 (88·5%) had microorganisms detected. Escherichia coli (89 of 200, 37·9%) was the most common microorganism and 116 of 200 (58·0%) patients were not covered by the perioperative prophylactic antibiotic. MDR was found in 102 of 147 (69·4%) patients for whom data were available to determine MDR status. Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0·43, 95% CI 0·19-0·96) and regular availability of infection control teams (0·32, 0·11-0·93) were associated with a significant reduction in MDR. Targeted perioperative antibiotic prophylaxis during contaminated abdominal surgery is insufficient in LMICs, with very few SSI organisms undergoing formal diagnosis. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams could support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR. National Institute for Health and Care Research. For the French and Spanish translations of the abstract see Supplementary Materials section.

Participation in Multidisciplinary Teams Among Healthcare Professionals: A Discrete Choice Experiment in Tertiary Public Hospitals in China.

Healthcare professionals' participation is crucial for the efficient implementation of multidisciplinary team (MDT) collaboration models. We identified the key factors influencing healthcare professionals' preference to participate in MDTs in tertiary hospitals. To clarify the attributes and levels of the discrete choice experiment (DCE), we conducted a targeted literature review and conducted in-depth interviews with MDT service providers. Following this, a DCE was designed to evaluate healthcare professionals' preferences for MDT participation, and the influence of factors such as salary subsidies, leadership attention, patient participation, quality assessment, working intensity, and case complexity. A conditional logit model estimated the utility of each attribute. Willingness-to-pay estimates were derived by taking the negative ratio of the coefficients of non-economic and economic attributes. A series of policy simulation analyses were conducted. Two hundred healthcare professionals completed the questionnaire, with 180 valid responses used for analysis. All attributes were statistically significant. Leadership attention and working intensity were the primary factors influencing staff willingness to participate in MDTs, followed by quality assessment and salary subsidies. Significant preference differences were observed between respondents; compared with mid-level staff, senior-level healthcare professionals believed patient engagement would be more helpful in boosting participation. The policy simulation showed that changing leadership attention from "neglect" to "emphasis" would increase the probability of staff choosing to participate in MDTs from 24.4% to 66.98%. Leadership attention was the primary concern for healthcare professionals in MDTs. To effectively motivate staff participation in MDTs, policymakers should adopt a holistic approach that considers work motivation and individual backgrounds, including competitive salary packages and a positive work environment. They should concurrently introduce MDT case complexity measurement tools to optimize resource allocation. Addressing staff members' unique needs and career aspirations by creating targeted training programs, pathways for advancement, and personalized career development plans are also crucial.

Appropriate Technological Innovation Towards An Independent Village Based On Agrotourism In Sumbergedang Village

Sumbergedang Village is one of the villages located in Pandaan District, Pasuruan Regency, East Java Province, which has green and cool natural conditions because it is located at the foot of Mount Penanggungan, West Side and has views of Mount Arjuno. Potential natural resources include rivers with a calm flow from springs throughout the year, livestock farming with sheep, goats and fish and around 30 springs. The aim of the Assisted Village Program activities is to exploit this natural potential into agrotourism so that it becomes an independent and prosperous village. The activity method involves direct assistance by the entire program implementation team and 5 students who work in the field for one semester. The activity begins with preparation by determining the schedule & compiling measurement instruments to carry out pre- and post-activity evaluations. Training includes: Building an entrepreneurial spirit, business motivation, digital bookkeeping and marketing, training on the operation of coper and feed ingredient flouring machines, making feed formulas and mixing feed, training on making various chips and drinks, training on the use of chopping machines for packaging chips and packaging drinks as well as Institutional development is directed at fostering group management. The results of the activity include: all partners consisting of livestock and fish farmer groups, village PKK, BUMDES and MSMEs increased their entrepreneurial spirit after receiving business motivation training. The complete result of this Assisted Village activity is that the use of appropriate technology (TTG) in the form of a multipurpose machine is able to increase the weight gain of sheep by more than 150 grams/head/day so that fattening time is shorter. With a fish feed machine, groups can make their own feed, thereby reducing feed costs to Rp. 10,000/ kg feed. The use of a chopping machine can increase the production capacity of chips to 150/200 kg/day and the use of a beverage packaging machine can increase the capacity of sinom drinks to 25 liters/day. The conclusion of this activity is that the application of appropriate technology is really needed by society to increase people's income and welfare.

Penyuluhan Makanan dan Obat yang Aman untuk Anak di KB-TK Alam Insan Kamil

The pattern of food and medicine consumption among children is a crucial thing that is important for parents and teachers to pay attention to at school. It is very important to provide guidance and reinforcement regarding hygiene, sanitation or food safety to food makers, including parents and the implementation team or school canteen organizers. Based on the results of initial observations, it was found that the food presentation met standards, but there were still teachers who did not understand how to use cooking utensils correctly. The aim of this service is to increase teachers' knowledge in terms of providing nutritious and safe food and the use of medicines that are commonly given in the school environment. The method used in this service is providing material in the form of counseling. The results of the service showed that there was an increase in the knowledge of service participants after being given counseling material in the form of providing food and medicine in a safe and hygienic manner.

Design Analysis and Analysis of Roof Structure Work in the Implementation of the Exit Gate and Cafeteria Construction Project at Delta Surya Sidoarjo Hospital

Building design and planning requires a very high level of precision and a relatively long time. Therefore, most consultants and construction implementers (contractors) rely on technical application support during project planning, design, and construction report preparation. A very commonly used application in Indonesia is AutoCAD. Supported with other applications such as SAP2000 and ETABS to create 2D and 3D images and analyze the strength of structures. The definition of design methods is the ways in which a designer creates an object. Some of the design methods that are often used are as follows: a. Explosing, which is a design method by seeking inspiration through critical thinking to produce a design that has never been created. b. Redefining, which is a design method by reprocessing a design to become something different and better. c. Managing, which is a design method by creating designs in a sustainable and continuous manner. d. Phototyping, which is a design method by improving and/or modifying the design of the ancestral heritage. e. Trendspotting, which is a design method by creating a design based on a developing trend. In the implementation process, the contractor PT Muliif Teknika Utama requires technical drawings that are used for work references. Where later the field results will be in accordance with the planning time. In the process of work on the structure of the field team, the implementation team needs shop drawings as a reference for implementation. Here is an example of a working drawing of a roof plan. Based on the results of the observations that have been made, the design needed in the work of the roof of the exit gate and cafeteria in the hospital. Delta Surya Sidoarjo includes: a. Drawing of the roof truss plan b. Drawing of the roof component plan in the form of placing curtains, rafters, battens, and breising column c. Cut drawings d. Detail drawings.

"It Empowers You to Empower Them": Health Professional Perspectives of Care for Hyperglycaemia in Pregnancy Following a Multi-Component Health Systems Intervention.

The Northern Territory (NT) and Far North Queensland (FNQ) have a high proportion of Aboriginal and Torres Strait Islander women birthing who experience hyperglycaemia in pregnancy. A multi-component health systems intervention to improve antenatal and postpartum care in these regions for women with hyperglycaemia in pregnancy was implemented between 2016 and 2019. We explored health professional perspectives on the impact of the intervention on healthcare. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) underpinned this mixed-methods evaluation. Clinicians were surveyed before (n = 183) and following (n = 137) implementation. The constructs explored included usual practice and satisfaction with care pathways and communication between services. Clinicians, policymakers and the implementation team were interviewed (n = 36), exploring the impact of the health systems intervention on practice and systems of care. Survey and interview participants reported improvements in clinical practice and systems of care. Self-reported glucose screening practices improved, including the use of recommended tests (72.0% using recommended first-trimester screening test at baseline, 94.8% post-intervention, p < 0.001) and the timing of postpartum diabetes screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, p < 0.001). Health professionals reported multiple improvements to care for women with hyperglycaemia in pregnancy following the health systems intervention.

Equity in practice: Integrating cross cultural health brokers for culturally safe primary care for immigrants and refugees in British Columbia.

Umbrella Multicultural Health Co-op is a community health centre serving cultural communities of immigrants/refugees in British Columbia. It uses Cross Cultural Health Brokers (CCHBs), multicultural workers bridging patients and the healthcare system, to better meet the primary care needs of immigrant/refugee populations. Through the Team Primary Care initiative, Umbrella Co-op: (1) added new CCHBs alongside allied health practitioners; and (2) implemented team workshops and evaluation for quality improvement. The learning health system framework guided project activities. Comprehensive, culturally responsive primary care for immigrants and refugees benefits from a team-based approach that includes the integration of CCHBs. Team development activities improved team function. Co-developing evaluation with the interprofessional team enabled meaningful participation. Health system design for equity-oriented team-based primary care for immigrants and refugees should include resources for CCHBs and team development infrastructure.