Post-implementation Assessment Research Articles

Le rôle infirmier en santé mentale en hémato-oncologie pédiatrique. Partie 2 : Stratégie d'implantation d'une pratique novatrice

Objective: The objective of this article is to describe the process of implementing and performing a preliminary assessment of an innovative mental health nursing practice in a pediatric hematology/oncology department. The preliminary assessment will help us determine whether the implementation strategy used was appropriate. Background: Pediatric cancers present patients and their families with many difficulties that can sometimes give rise to mental health issues during and after treatment. A mental health nurse clinician with expertise in hematology/oncology could help patients and families experiencing such issues by providing care that complements currently available psychosocial services. As implementing changes in practice is often challenging, and introducing a role without a clear plan can lead to failure, we decided it was important to develop a clear implementation strategy. Our project, which involves creating the role of a mental health nurse clinician (MHNC) in pediatric hematology/oncology, is divided into three stages: (1) development of the MHNC role, (2) development of an implementation strategy and (3) evaluation of role feasibility, acceptability and appreciation one year after implementation. In this article, we discuss the second stage. The objectives of this article are to (1) present the strategy involved in implementing the role of the MHNC and (2) report on the findings of a preliminary post-implementation assessment of the feasibility, acceptability and appreciation of the role for exploratory purposes. Methodology: The implementation strategy we developed was based on the approach proposed by Fry and Rogers (2009) and adapted to the context of our project. The five steps of the approach are: (1) the communication strategy, (2) the consultative process to define the role and scope of practice, (3) education, (4) the establishment of a support structure and (5) assessment and feedback mechanisms. This last step took the form of a preliminary exploratory assessment, which we performed by administering a survey to nurses, specialized nurse practitioners, and doctors three months after the MHNC role was implemented. Results: In the results section, we present our detailed five-step implementation plan. The preliminary results of the survey administered three months following implementation indicate that the MHNC worked an average of 150 hours a month and carried out 22.7 consultations and 52.3 follow-ups per month, the average length of which was 53.1 minutes. In all, 96% of the healthcare professionals who responded to the survey said that someone with this type of expertise is needed in pediatric hematology/oncology, and only 28% said that they themselves felt they had the knowledge and skills required to effectively manage the medications used to treat mental health disorders. Conclusion: Our results seem to confirm the feasibility, acceptability, and appreciation of the MHNC role, suggesting that the implementation strategy proposed by Fry and Rogers (2009) is well suited to the development of a mental health nursing practice in pediatric hematology/oncology. In the third stage of this project, we will carry out a structured, rigorous assessment of the role’s feasibility, acceptability, and appreciation by patients, families, and healthcare professionals one year after implementation.

The Punitive Exacerbation: A Fallacy in the Conception of the Social State of Law

This article aims to highlight the obstacles faced by negotiation methods within the reward system and restorative justice contemplated in Law 906 of 2004 of Colombia. It acknowledges that the possibility of achieving outcomes within figures such as plea bargains and pre-agreements is discarded as a negotiated way out of the criminal case due to increasing prohibitions, coincidentally for the most committed crimes in Colombia territory. This turns the criminal justice system into a scenario of inexorable oral trials, for which the burdens in capacity, institutionalization, and functionality are not given. Through these lines, we also seek to understand the importance of the emergence of a legal figure, in this case, a trial system, and the challenges it faces from the producing country to provide a post-implementation assessment. Perhaps from there, possible solutions can be derived, especially if a justice reform is proposed for the current year, 2024, with its main focus on the proper and swift performance of the trial system as a commitment to the opportune management of ius puniendi and criminal policy.

Assessing the Impact of the Project-Based Learning Approach on Students’ Academic Achievement and Attitudes toward English Lesson

This action research investigates the impact of Project-Based Learning (PBL) on students’ academic achievement and attitudes toward English lessons in grade twelve classrooms. PBL, characterized by inquiry-based projects, aims to cultivate higher-order thinking skills and enhance student engagement. The study compares the academic performance and attitudes of students exposed to PBL with those in traditional English learning settings. Data collection includes pre-and post-implementation assessments and surveys to gauge changes in achievement and attitudes. Findings suggest that PBL positively influences academic achievement and fosters favorable attitudes toward English lessons.

Achieving rapid value and ROI from supply chain visibility while building long-term capabilities

With the recent rapid advances in digital supply chain technologies, companies are investing significant capital in these solutions. So far, however, the results and benefits are falling short of expectations. The current authors have discovered through multiple post-implementation assessments and a detailed survey of senior operations leaders that only 20 per cent of digital supply chain investments return the expected result. By looking deeper into the root causes of these value traps, this paper describes how the authors uncovered ways to improve the probability of successful digital transformation. The paper also examines which technologies are being implemented by companies and discuss how those technologies can help improve supply chain management. In our experience, companies can enhance returns on supply chain investments by adhering to four crucial mantras as part of their digital transformations: 1) quantify the benefit opportunity; 2) build a sustainable digital-focused operating model; 3) align across the enterprise and partners; and 4) prepare the organisation for the needed change. The paper also provides examples of how PwC uses these steps to help increase probability of success and return on investment.

136. Impact of a Tele-Stewardship and Tele-Infection Prevention Program on Hospital-Onset Clostridioides Difficile Rates in a Community Three-Hospital Health System

Abstract Background Clostridioides difficile infection (CDI) is a common hospital-acquired infection (HAI) that can be difficult to diagnose accurately given the numerous test modalities with differing performance characteristics. Inaccurate diagnosis of CDI can negatively affect patient care decisions as well as reimbursement rates. Community and rural hospitals (CARH) may lack specialized personnel or knowledge to implement diagnostic best practices, but telehealth solutions like tele-infection prevention (TIP) and tele-antimicrobial stewardship (TASP) can provide specialist support for CARHs to optimize diagnostic pathways, improve accuracy, and reduce unnecessary treatment. Methods In June 2021 under the guidance of TIP and TASP recommendations, C. difficile testing was transitioned from a 1-step nucleic acid amplification test (NAAT)-only algorithm to a 2-step algorithm that included NAAT and toxin enzyme immunoassay (EIA) testing. A 6-month pre- and post-implementation assessment was conducted to assess the impacts of this change in hospital-onset CDI (HO-CDI) case rate. Additionally, total C. difficile (community- and hospital-onset CDI) rates per 1000 patient days (PD) and consumption of CDI therapeutics were assessed. For statistical analysis, Wilcoxon ranked-sum test to assess changes in CDI rates. Estimated annualized cost-savings for therapeutics were calculated based on institutional purchasing costs. Results Following implementation, a 35.9% reduction in HO-CDI was observed (pre 0.96 cases/1000PD vs. 0.61 cases/1000PD; p = 0.054). A 10.2% reduction was observed in total CDI (pre 3.66 cases/1000PD vs. 3.28 cases/1000PD; p = 0.37). Additionally, a 30.6% reduction was observed in consumption of CDI therapeutics (20.1 doses/1000PD vs. 14.0 doses/1000PD) resulting in an annualized cost-savings of approximately $9200. Conclusion Our TIP and TASP advised a community three-hospital health system on optimal diagnostics resulting in a change in their algorithm. Following this, considerable reductions were observed in HO-CDI, total CDI, consumption of CDI therapeutics, and the associated costs of care. Disclosures Erin K. McCreary, PharmD, Abbvie: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Honoraria|La Jolla (Entasis): Advisor/Consultant|LabSimply: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria

Impact of COIL: Learning From Student Nurses in Norway Who Collaborated With U.S. Students.

The aim of this study was to describe the experience of Norwegian nursing students with internationalization through participation in a Collaborative Online International Learning (COIL) course. Educators in Norway and the United States collaborated to incorporate internationalization and population health concepts into virtual courses during the pandemic. Literature gaps exist in post-implementation assessment data that ascertain internationalization through the COIL experience. This was a qualitative study with a descriptive design. Data were collected from focus group interviews and analyzed conventional content-analysis approaches. Fifteen Norwegian undergraduate nursing students who participated in the COIL opportunity completed focus group interviews. The themes identified included, "virtual conversation builds collaborations and enhances learning," and "this opened my eyes." Norwegian students acknowledged they had learned transferable lessons from their global partners that could be applied to patient care of the marginalized population in Norway.

Improving oral health of adolescent girls in Kenya through education - An observational study.

Dental caries and periodontal diseases are significant health concerns in developing nations. This study assessed the impact of a comprehensive oral health education program on adolescent girls in rural Kenya. Eighty-seven girls aged 13-18 years attending school in rural Nanyuki, Kenya, were enrolled in the study. The comprehensive program included personalized oral hygiene training, education and health advocacy coaching. Dental caries, gingival inflammation and dental plaque biofilm were assessed at baseline, 1- and 2.5-year post-implementation. The intervention was highly effective in arresting pre-existing carious lesions and preventing the formation of new ones in this population. The data revealed that there was a significant remineralization of incipient caries lesion, as shown by decreases in modified ICCMS™ scores from baseline to 1-year post-implementation. From baseline to the 2.5-year post-implementation assessment, only six new carious lesions developed. Dental plaque biofilm was reduced by 83.6%, and gingival inflammation was reduced by 81.6%. A comprehensive oral health program, which included behavioural awareness and educational approaches, resulted in significant positive oral health outcomes in caries, dental plaque biofilm and gingival inflammation.

Malaria Frontline Project: strategic approaches to improve malaria control program leveraging experiences from Kano and Zamfara States, Nigeria, 2016–2019

BackgroundThe Malaria Frontline Project (MFP) supported the National Malaria Elimination Program for effective program implementation in the high malaria-burden states of Kano and Zamfara adapting the National Stop Transmission of Polio (NSTOP) program elimination strategies.Project implementationThe MFP was implemented in 34 LGAs in the two states (20 out of 44 in Kano and all 14 in Zamfara). MFP developed training materials and job aids tailored to expected service delivery for primary and district health facilities and strengthened supportive supervision. Pre- and post-implementation assessments of intervention impacts were conducted in both states.ResultsA total of 158 (Kano:83; Zamfara:75) and 180 (Kano:100; Zamfara:80) healthcare workers (HCWs), were interviewed for pre-and post-implementation assessments, respectively. The proportions of HCWs with correct knowledge on diagnostic criteria were Kano: 97.5% to 92.0% and Zamfara: 94.7% to 98.8%; and knowledge of recommended first line treatment of uncomplicated malaria were Kano: 68.7% to 76.0% and Zamfara: 69.3% to 65.0%. The proportion of HCWs who adhered to national guidelines for malaria diagnosis and treatment increased in both states (Kano: 36.1% to 73.0%; Zamfara: 39.2% to 67.5%) and HCW knowledge to confirm malaria diagnosis slightly decreased in Kano State but increased in Zamfara State (Kano: 97.5% to 92.0%; Zamfara: 94.8% to 98.8%). HCWs knowledge of correct IPTp drug increased in both states (Kano: 81.9% to 94.0%; Zamfara: 85.3% to 97.5%).ConclusionMFP was successfully implemented using tailored training materials, job aids, supportive supervision, and data use. The project strategy can likely be adapted to improve the effectiveness of malaria program implementation in other Nigerian states, and other malaria endemic countries.

Applications of GIS and remote sensing in public participation and stakeholder engagement for watershed management

The use of Geographic Information Systems (GIS) and remote sensing technologies for the development of water quality management programs and for post-implementation assessments has increased dramatically in the past decade. This increase in adoption has been made more accessible through the interfaces of many popular software tools used in the regulation and assessment of water quality. Customized applications of these tools will increase, as ease of access and affordability of directly monitored and remotely sensed datasets improve over time. Concurrently, there is a need for inclusive participatory engagement with stakeholders to achieve solutions to current watershed management challenges. This paper explores the potential of these GIS and remote sensing datasets, tools, models, and immersive engagement technologies from other domains, for improving public participation and stakeholder engagement throughout the watershed planning process. To do so, an initial review is presented about the use of GIS and remote sensing in watershed management and its role in impairment identification, model development, and planning and implementation. Then, ways in which GIS and remote sensing can be integrated with stakeholder engagement through (1) leveraging GIS and remote sensing datasets, and (2) stakeholder engagement approaches including outreach and education, modeler-led development, and stakeholder-led involvement and feedback, are discussed. Finally, future perspectives on the potential for transforming public participation and stakeholder engagement in the watershed management process through applications of GIS and remote sensing are presented.

Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework.

BackgroundInvolving chronically ill patients in the management of their health is widely recognized as a vital component of high-quality health care. However, to assume the role of informed participants, patients need both access to their health information and assistance in interpreting such data. Smartphone technology with SMS text messaging functionality offers a convenient and minimally demanding mechanism for providing such dual capabilities to patients. To date, a number of similar digital tools have been developed for use in various chronic and progressive disease conditions, including rheumatoid arthritis.ObjectiveThis paper aims to describe the development of a research protocol that applies a human-centered design (HCD) approach to develop a mobile health (mHealth) intervention to support symptom management and treatment adherence for rheumatoid arthritis.MethodsTo guide the development of the mHealth intervention for use within a commercial biotechnology context, we selected and applied an HCD framework consisting of three phases: understanding, ideation, and implementation.ResultsLeveraging the framework, we mapped the key objectives and research questions to each phase and identified the HCD techniques and methods most suitable for addressing them. In addition, we identified the need to include a fourth phase, one that referred to postimplementation assessment, which would enable evaluation of patient engagement and intervention impact on symptom self-management.ConclusionsThis paper presents a research protocol that applied an HCD framework to guide the development of an mHealth intervention within a commercial biotechnology context. This type of guidance is salient because commercial entities are becoming one of the leading producers of this type of intervention. However, the methodologies used and challenges faced from a research and development perspective are not well-represented in the published research literature to date. Our application of the HCD framework yielded important findings. Each phase of the HCD framework provided important guidance for increasing the likelihood that the final product would be understandable, acceptable, feasible, and engaging to use. Consistent with other researchers in the field of mHealth interventions, we identified the need to add a fourth phase to the HCD framework, one that focused on a postimplementation assessment to guide further improvements to support adoption in real-world settings.International Registered Report Identifier (IRRID)RR1-10.2196/16430

The need for gender-based approach in the assessment of local energy projects

Local renewable energy initiatives, that involve the local population, can help empower the communities, economically, culturally, and socially. In many cases, the ambitions of energy projects go beyond mere electricity production and involve issues of energy justice, environmental awareness, and environmental citizenship. However, these aspirations are often forgotten during project assessments, or they fail to include local voices, especially those of women and other marginalized groups. Gender has been given little attention in the energy scholarship and especially during the post-implementation assessment of energy projects due to the belief that energy technologies are gender neutral and beneficial for the whole community. The present study, with a focus on two local energy projects with mixed ownership, challenges this notion. The two case studies are the islands of El Hierro in Spain and Tilos in Greece. A detailed survey based on a series of indicators drawn from the energy justice framework is used to evaluate women's perceptions. By following a feminist approach, this work draws attention on the difference experiences of women and how these are often not acknowledged during the assessment of renewable energy projects. Local renewable energy does not automatically imply energy justice and pluralism. More effort is needed from policy makers to include women in the decision making and to ensure a fair distribution of the benefits of the projects.

Multicenter Postimplementation Assessment of the Positive Predictive Value of SARS-CoV-2 Antigen-Based Point-of-Care Tests Used for Screening of Asymptomatic Continuing Care Staff.

ABSTRACTFrequent screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic populations using antigen-based point-of-care tests (APOCTs) is occurring globally with limited clinical performance data. The positive predictive value (PPV) of two APOCTs used in the asymptomatic screening of SARS-CoV-2 among health care workers (HCWs) at continuing care (CC) sites across AB, Canada, was evaluated. Between 22 February and 2 May 2021, CC sites implemented SARS-CoV-2 voluntary screening of their asymptomatic HCWs. On-site testing with Abbott Panbio or BD Veritor occurred on a weekly or twice-weekly basis. Positive APOCTs were confirmed with a real-time reverse transcriptase PCR (rRT-PCR) reference method. A total of 71,847 APOCTs (17,689 Veritor and 54,158 Panbio) were performed among 369 CC sites. Eighty-seven (0.12%) APOCTs were positive, of which 39 (0.05%) were confirmed as true positives using rRT-PCR. Use of the Veritor and Panbio resulted in 76.6% and 30.0% false-positive detection, respectively (P < 0.001). This corresponded to PPVs of 23.4 and 70.0% for the Veritor and Panbio, respectively. Frequent screening of SARS-CoV-2 among asymptomatic HCWs in CC, using APOCTs, resulted in a very low detection rate and a high rate of detection of false positives. Careful assessment of the risks versus benefits of APOCT programs and the prevalence of infection in this population needs to be thoroughly considered before implementation.

Stepwise Development and Yearlong Assessment of a Pharmacist-Driven Molecular Rapid Diagnostic Test Result Service for Bloodstream Infections.

Provide a stepwise approach to the design and implementation of a service that integrates all staff pharmacists into the communication and interpretation of molecular rapid diagnostic tests (mRDT) for bloodstream infections and summarize outcomes from a 12-month post-implementation assessment. Physician and pharmacist impressions of the service are also described. mRDT have proven clinical benefit in the treatment of bacteremia. Pharmacy leadership can collaborate with other health system leaders to develop policies and a workflow that route result calls to pharmacists to maximize the impact of this technology. Pharmacist education, development of clinical resources and documentation templates allow all pharmacists to perform this antimicrobial stewardship service consistently and confidently. Physicians overwhelmingly recognize the value of this service and often accept the pharmacist's recommendations. Antibiotic de-escalation was the most frequent outcome when changes to the antibiotic regimen were made. Pharmacists are well positioned to utilize results from mRDT to improve antibiotic selection. Through the use of competencies and internally-derived resources, all pharmacists, rather than just infectious diseases pharmacy specialists, can perform this important antibiotic stewardship activity and positively influence patient outcomes.

The feasibility and acceptability of mobile health monitoring for real-time assessment of traumatic injury outcomes.

Traumatic injuries are a health event that can begin a trajectory towards chronic health and social challenges. Mobile technology-based prevention and treatment interventions have been used to monitor and transform outcomes across a myriad of health conditions, but their potential in long-term injury recovery is unexplored. The goal of this pilot study was to assess the acceptability and feasibility of mobile health monitoring for long-term outcomes in a population of trauma patients with known barriers to health and social care after injury. We re-recruited 25 individuals, 12-36 months after acute hospitalization, from a recently concluded study of psychological outcomes in seriously injured Black men in Philadelphia, Pennsylvania. This mixed- methods pilot study was conducted in three phases: (I) qualitative interviews and development of a pilot monitoring platform; (II) a 3-month feasibility trial of mobile monitoring of patient-reported outcomes and biometric data using a wrist-worn commercial fitness monitor (n=18); (III) post-implementation qualitative interviews. Analysis of data from pre-implementation interviews indicated that the majority of participants used smartphones as a primary means of communicating with their social network and to access the internet. The 90-day pilot trial of mobile monitoring indicated participants' preference text-delivered communication and survey elicitation. Response rates for 12 automated surveys ranged from 84-92%. Twenty-four hours a day adherence to optional biometric monitoring was generally lower than 50% but ranged widely indicating both very low adherence and very high adherence. Four of 25 participants, 2 who had opted for Fitbit monitoring, were lost to follow-up at the end of the 90-day pilot trial. In post-implementation assessments, participants endorsed the acceptability of mobile monitoring highlighting the benefit of its convenience and flexibility over in-person outcome monitoring. Participants also perceived its potential benefit in long-term engagement with health and social services to assist with the challenges they faced when attempting to achieve physical, psychological, social, and financial recovery after hospitalization. These findings were reinforced through qualitative interviews which highlighted, in addition to acceptability, the perceived value of self-monitoring through the use of wearable devices to track health data like physical activity and sleep. This study indicates the feasibility and acceptability of mobile health monitoring used to examine long-term injury sequalae. Future research may leverage this novel strategy, refining its application to address current limitations in the reliability and accuracy of commercially available wearable technology, relative costs and benefits of different mobile data collection strategies, integration within current clinical paradigms and generalizability across injured populations and socio-ecological environments.

Improving care for residents in long term care facilities experiencing an acute change in health status

BackgroundLong term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community.Methods/designWe will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a standardized LTC-ED care and referral pathway, along with targeted INTERACT® tools. The implementation strategies will be adapted to the local context of each facility and to address potential implementation barriers identified through a staff completed barriers assessment tool. The evaluation will use a mixed-methods approach. The primary outcome will be any change in the rate of transfers to ED from LTC facilities adjusted by resident-days. Secondary outcomes will include a post-implementation qualitative assessment of the pathway. Comparative cost-analysis will be undertaken from the perspective of publicly funded health care.DiscussionThis study will integrate current resources in the LTC-ED pathway in a manner that will better coordinate and optimize the care for LTC residents experiencing an acute change in health status.

A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers

BackgroundEffective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability.MethodsWe conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis.ResultsFacilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains.ConclusionOur findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users.Trial registrationNCT02564653, registered September 2015

Use of composite index to critically assess the post rights recognition impact of Forest Rights Act, 2006: A case study from the tribal state of Tripura, India

The Scheduled Tribe and Other Traditional Forest Dwellers (Recognition of Forest Rights) Act, 2006 (FRA) was implemented in India in 2008, to recognize forest rights of forest-dwelling tribal communities as a historical reparation of injustices faced by them. In over a decade of implementation majority of the rights recognised are in the category of Individual forest rights (IFR), to improve the socio-economic condition and put tribal development in a sustainable pattern. But only a handful of studies assess the post rights recognition impacts of FRA. This study uses composite index to assess the impacts on the socio-economic condition of the scheduled tribes and the condition of the land vested as forest rights. The composite Indexes were constructed using the methodology given by Organization for Economic Co-operation and Development (OECD). The socio-economic composite index consisted of 8 parameters and 15 indicators and the Index for vegetation condition used four indicators. To validate the Index, evaluation was undertaken in the North Eastern state of Tripura. A total of 300 households and 108 vegetation plots from 12 villages were sampled to generate primary data. The evaluation successfully classified 25% of the villages as having ‘very good’ socio-economic and vegetation conditions. The status of each parameter including their inter-linkages and their impact on the overall socio-economic and vegetation conditions was also delineated. The major factor that impact the conditions were identified as size of land holding, assistance for development, household income, use of alternative sustainable practices, and lack of skill building. Analysis of the relationship between socio-economic and vegetation conditions pointed towards deterioration of vegetation condition as socio-economic conditions improved and indicated the existence of other possible factors that impact the post right conditions. This study successfully marks the advent into the sphere of post-recognition impacts of FRA. The use of Composite Index can enhance post implementation assessments and guide future policies and course of actions. Index can be adapted to uniformly assess FRA's performance in India, or any forest policy for devolution of rights around the world.

Senior Friendly Communities: Designing an approach for cross-border exchange of public health policy

Communities are generally responsible for creating health policies for people with dementia, people with late-life depression and informal caregivers. So far, the exchange of knowledge and best practices on older people’s public health between communities has remained limited, especially across borders. The cross-border Interreg Senior Friendly Communities (SFC) approach focuses on older people’s public health in the Euregion Meuse-Rhine, a border region of Belgium, Germany and the Netherlands. It aims at supporting communities to promote healthy ageing, especially for people with dementia, people with late-life depression and informal caregivers. It makes use of the WHO’s frameworks of Active and Healthy Ageing, with the pillars health, participation and security. The methodology of the SFC approach consists of a five-step approach: (1) creating an infrastructure for the SFC project (2); including communities (3); baseline assessments in the participating communities (4); creating an activity buffet of a variety of activities promoting older people’s wellbeing; and (5) implementing the activities, conducting post-implementation assessments to measure the impact of SFC and creating a sustainability plan for communities to continue on this path. This paper discusses this five-step SFC approach that aims to address the limited use of cross-border exchange of health policies and best practices. It can serve as a guideline for other regions that deem the cross-border exchange of health policy valuable.

Increasing Capacity for Farm to Early Care and Education in Maryland and Washington: Study Protocol

Abstract Objectives Farm to early care and education (farm to ECE) incorporates local food purchasing; on-site gardens; and food, nutrition, and agriculture education into ECE settings to advance child health and well-being, engage families and communities, and enhance ECE quality. This project aims to advance capacity for farm to ECE training and implementation in Maryland and Washington by (1) measuring uptake and sustainability of farm to ECE activities at two demonstration sites; and (2) testing the feasibility of a train-the-trainer model, which includes training professionals who offer technical assistance to ECE providers to incorporate farm to ECE into existing training models. Methods For this demonstration study, researchers will work in partnership with each site to determine interests, needs, and capacity and develop a plan for integrating farm to ECE activities. Evaluation will consist of process and outcome components, including: (1) Semi-structured interviews with site administrators and educators to determine site needs and priorities (pre), progress and on-going needs (mid) and feedback on process, challenges, successes, and program sustainability (post); and (2) pre and post implementation assessment of ECE program quality (e.g., child nutrition, family engagement, learning environment). For the train-the-trainer model, researchers will utilize pre, post, and follow up surveys to assess changes in knowledge, attitudes, and self-efficacy regarding delivery and implementation of farm to ECE activities and participant uptake and implementation of training content. Results N/A. Conclusions Farm to ECE has the potential to promote healthier ECE environments and healthier community food systems. This project aims to examine impacts of expanding farm to ECE through state training and individual site level activities, with the goal of identifying best practices to support expansion of sustained and comprehensive farm to ECE initiatives. Funding Sources Bloomberg American Health Initiative Collaboration Awards; Lerner Center for Public Health Promotion, Johns Hopkins Bloomberg School of Public Health.

Quality measures in electrodiagnosis: Carpal tunnel syndrome-An AANEM Quality Measure Set.

Carpal tunnel syndrome (CTS) is a common neuromuscular condition and a major cause of work-related disability. As healthcare in the United States transitions toward a value-based system from fee-for-service, quality measures assume importance in the evaluation of care provided. This report from the American Association of Neuromuscular & Electrodiagnostic Medicine Quality Improvement Committee provides an introduction to quality measures and outlines a quality measurement set for the electrodiagnosis of CTS. The measures attempt to standardize technical requirements for electrodiagnostic (EDX) studies of CTS, the criteria for diagnosing median neuropathy at the wrist and assessing its severity, and the role of operative EDX testing. The assumption is that implementation of these measures will improve the accuracy of CTS diagnosis when EDX is performed, help exclude mimics, and, therefore, improve care of patients with CTS with the ultimate goal of improving outcomes. Postimplementation assessment of outcomes will refine these measures.