Post-implementation Evaluation Research Articles

Postimplementation Evaluation in Assisted Living Facilities of an eHealth Medical Device Developed to Predict and Avoid Unplanned Hospitalizations: Pragmatic Trial.

The proportion of very old adults in the population is increasing, representing a significant challenge. Due to their vulnerability, there is a higher frequency of unplanned hospitalizations in this population, leading to adverse events. Digital tools based on artificial intelligence (AI) can help to identify early signs of vulnerability and unfavorable health events and can contribute to earlier and optimized management. This study aims to report the implementation in assisted living facilities of an innovative monitoring system (Presage Care) for predicting the short-term risk of emergency hospitalization. We describe its use and assess its performance. An uncontrolled multicenter intervention study was conducted between March and August 2022 in 7 assisted living facilities in France that house very old and vulnerable adults. The monitoring system was set up to provide alerts in cases of a high risk of emergency hospitalization. Nurse assistants (NAs) at the assisted living facilities used a smartphone app to complete a questionnaire on the functional status of the patients, comprising electronic patient-reported outcome measures (ePROMs); these were analyzed in real time by a previously designed machine learning algorithm. This remote monitoring of patients using ePROMs allowed notification of a coordinating nurse or a coordinating NA who subsequently informed the patient's nurses or physician. The primary outcomes were the acceptability and feasibility of the monitoring system in the context and confirmation of the effectiveness and efficiency of AI in risk prevention and detection in practical, real-life scenarios. The secondary outcome was the hospitalization rate after alert-triggered interventions. In this study, 118 of 194 (61%) eligible patients were included who had at least 1 follow-up visit. A total of 38 emergency hospitalizations were documented. The system generated 92 alerts for 47 of the 118 (40%) patients. Of these 92 alerts, 46 (50%) led to 46 health care interventions for 14 of the 118 (12%) patients and resulted in 4 hospitalizations. The other 46 of the 92 (50%) alerts did not trigger a health care intervention and resulted in 25 hospitalizations (P<.001). Almost all hospitalizations were associated with a lack of alert-triggered interventions (P<.001). System performance to predict hospitalization had a high specificity (96%) and negative predictive value (99.4%). The Presage Care system has been implemented with success in assisted living facilities. It was well accepted by coordinating nurses and performed well in predicting emergency hospitalizations. However, its use by NAs was less than expected. Overall, the system performed well in terms of performance and clinical impact in this setting. Nevertheless, further work is needed to improve the moderate use rate by NAs. ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697.

Artificial Intelligence for Breast Ultrasound: AJR Expert Panel Narrative Review.

Breast ultrasound is used in a wide variety of clinical scenarios, including both diagnostic and screening applications. Limitations of ultrasound, however, include its low specificity and, for automated breast ultrasound screening, the time necessary to review whole-breast ultrasound images. As of this writing, four AI tools that are approved or cleared by the FDA address these limitations. Current tools, which are intended to provide decision support for lesion classification and/or detection, have been shown to increase specificity among nonspecialists and to decrease interpretation times. Potential future applications include triage of patients with palpable masses in low-resource settings, preoperative prediction of axillary lymph node metastasis, and preoperative prediction of neoadjuvant chemotherapy response. Challenges in the development and clinical deployment of AI for ultrasound include the limited availability of curated training datasets compared with mammography, the high variability in ultrasound image acquisition due to equipment- and operator-related factors (which may limit algorithm generalizability), and the lack of postimplementation evaluation studies. Furthermore, current AI tools for lesion classification were developed based on 2D data, but diagnostic accuracy could potentially be improved if multimodal ultrasound data were used, such as color Doppler, elastography, cine clips, and 3D imaging.

Restoration and evaluation for severed streams in high-density urban areas based on a multi-objective framework: A case study of Heping Stream in Nanjing

Numerous severed streams that emerge during rapid urbanization has been negatively impacting regional water systems and urban environments. Traditional restoration efforts are prone to focus on water quality, overlooking the complex of urban severed stream as natural-social ecosystems. However, current literature indicates a lack of systematic restoration methods and post-implementation evaluations tailored to severed streams, which adversely affects water resource management and sustainable urban development. This study bases on research of the severed streams in Nanjing’s Hexi New District to develop methods for the restoration and evaluation of severed streams in high-density urban areas. Taking the Heping Stream as a case study, it took three years to complete a full-process study encompassing the design, implementation, and post-occupancy evaluation of the restoration of the severed stream. We developed a multi-objective framework, including five measures for the restoration of severed streams, along with performance evaluation indicators from environmental, social, and economic perspectives to compare the state of the severed-stream before and after the restoration. So as to assess the effectiveness of the restoration methods and to put forward suggestions for the improvement of the restoration measures. The results showed that the method had a positive effect on the quality of the water environment, public evaluation, capital investment and energy consumption. Some of the environmental performance indicators were significantly improved after the restoration, especially the dissolved oxygen content, water flow. Most of the social performance indicators were better after the restoration than before. In terms of economic performance indicators, the use of photovoltaic energy resulted in significant savings in electricity and pumping costs. Performance evaluation confirmed comprehensive benefits of the method, with Run off Control, Waterfalls Construction and Riverbank Ecological Restoration being most effective. To improve the benefits of restoration, diverse strategies should be combined together, including runoff control, artificial wetlands, vegetated buffers, and riverbank restoration. This research can support the optimization of future restoration measures and scientific decision-making in urban severed-stream restoration.

Pengembangan Aplikasi Pengenalan Budaya Kasepuhan Cirompang berbasis Virtual Reality untuk Pembelajaran IPAS di Sekolah Dasar

The Independent Curriculum is a curriculum with diverse intracurricular learning where the content will be more optimal so that students have enough time to explore concepts and strengthen competencies. The problem that occurred at SDN Jatimulya 1 was that teachers had difficulty choosing the right media in implementing the Independent Curriculum, so researchers analyzed the problems found to find the right solution. Through the initial research study, researchers also found problems in the learning of the "Indonesia Kaya Budaya" science subject, namely 80% of students did not know the culture in their own environment. The urgency of this study is the need for a learning model that is combined with media that is considered suitable, namely Virtual Reality based on local wisdom, VR is considered the most suitable media in the current learning period, this is expected to increase children's interest in learning. The purpose of this study is to develop virtual reality as a learning medium in the implementation of the independent curriculum. This study uses the method of developing a Virtual Reality Application for culture in Kasepuhan Cirompang, an area that is still thick with customs and arts that have existed since ancient times. Post-implementation evaluation showed that 85% of students were more interested and understood the Kasepuhan culture material better. The results of the study showed that the use of VR in learning was able to increase students' interest and understanding of local culture. This application not only acts as an innovative learning tool, but also as a means to preserve local culture. In the future, further research is needed to evaluate the long-term impact of using this application in learning.

The implementation of a "safety officer" program: an innovative approach to improve infection prevention and control practices in Ethiopia.

Effective infection prevention and control (IPC) was central to keeping healthcare workers (HCWs) safe during the COVID-19 pandemic. However, as the pandemic continued, the maintenance of high-quality IPC practices waned, placing HCWs at increased risk of infection. A COVID-19 Safety Officer (SO) program was piloted by the United States Agency for International Development (USAID)-funded Reaching Impact, Saturation and Epidemic Control (RISE) project across two health facilities in Ethiopia, which trained clinical and non-clinical HCWs on IPC protocols to promote safe practices in patient care areas. We sought to evaluate the implementation and effectiveness of the SO program in improving IPC practices within the clinical setting. This is a post-implementation evaluation of the SO program, implemented in two hospitals in Ethiopia between May 2022 and December 2022. Participants completed a 4-day course on COVID-19 epidemiology, IPC, safety communication, and learning theory as a part of the Training of Trainers component (n = 23), and were posted in clinical wards to provide staff training and support to maintain IPC protocols. The program was evaluated at 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using direct observation of IPC practices across intervention sites. Implementation outcomes were measured using surveys and qualitative interviews to capture training cascade, knowledge, comfort, acceptability, and maintenance. Participants were able to cascade training to an additional 167 clinical (67.6%) and 80 non-clinical (32.3%) staff across both sites. Direct observation of clinical staff at 6 months showed that 95% (59/62) wore at least a surgical mask with patients and were compliant with masking and/or distancing protocol. Clinical interviews revealed that SOs contributed to increased perceived comfort with screening and isolation procedures and environmental cleaning procedures. The SO training program was widely adopted, and effective in improving the implementation and comfort of maintaining IPC practices in clinical settings.

You Are Not Alone! Care Professionals‘ Acceptance of Telemedicine in Nursing Homes Comparing Pre- and Post-Implementation Evaluations

A lack of personnel in care institutions and high proportions of older people in need of care pose central challenges for today’s aging society, often resulting in the hospitalization of geriatric patients. In many cases, these hospitalizations are not medically necessary and cause deterioration of health. Applying telemedicine in nursing homes represents one approach aimed at a reduction of unnecessary hospitalizations of geriatric patients and supporting care personnel in medically uncertain situations. For a sustainable and successful implementation of technical innovations such as telemedical consultations, the care personnel’s perspectives and acceptance are especially essential. The Optimal@NRW project implemented telemedical consultations in 24 nursing homes in Germany, investigating medical and economic efficiency and in particular also the social acceptance of digital care in nursing homes. This paper presents quantitative results comparing the acceptance evaluations before (PRE: N = 130) and after (POST: N = 87) the implementation of the telemedical consultations in the nursing homes from the perspective of care professionals. The results showed positive evaluations of the telemedical consultations in both evaluation phases: POST evaluations especially showed a lower evaluation of perceived barriers of using telemedical consultations in nursing homes. This study’s insights enable one to derive guidelines and recommendations regarding the communication and information of telemedical applications considering the needs and wishes of care personnel as a central user group.

Post-implementation evaluation of enterprise resource planning (ERP) systems: an internal auditors’ perspective

PurposeEnterprise resource planning systems (ERPs) have provided new challenges in the management of organizations’ internal and external risks, and their adoption has triggered groundbreaking changes to internal audit practices. This study aims to shed light on the use of ERPs in internal auditing by identifying interrelations between postevaluations of the ERPs’ quality dimensions with internal auditors’ satisfaction, intentions to continue using such systems and perceived benefits.Design/methodology/approachDrawing on a unique data set of internal auditors’ responses on a structured questionnaire, and by using the DeLone and McLean’s (2003) Information Systems success model as the conceptual framework, this study tests the research propositions by using partial least square structural equation modeling (PLS-SEM).FindingsThe findings report statistically significant positive relationships among all three ERPs’ quality dimensions (system, information and service quality) with internal auditors’ satisfaction and intention to continue using these systems. Moreover, the study found that the benefits perceived by internal auditors were significantly influenced by their satisfaction with the system and their intention to continue using it.Originality/valueThe authors survey ERP postevaluation success factors in two unique contexts: internal auditors and Greece. Thus, the authors ground on previous research findings in diverse professional groups and national environments. In parallel, this study lends conceptual clarity and empirical evidence to a small but growing number of studies examining the implications of individuals’ perceptions, intentions and behavioral reactions in the context of ERP implementation.

Detection of DNA Contamination in Prenatal Samples from Whole Exome Sequencing Data.

Maternal cell contamination (MCC) in prenatal samples poses a risk for misdiagnosis, and therefore, testing for contamination is necessary during genetic analysis of prenatal specimens. MCC testing is currently performed as a method separate from the diagnostic method. With the increasing application of whole exome sequencing (WES) in prenatal diagnosis, we sought to develop a method to estimate the level of contamination from WES data, aiming to eliminate the need for a separate MCC test. To investigate the impact of MCC on the distribution of the variant allele fraction in WES data, contamination was both simulated in silico and artificially induced. Subsequently, a bioinformatic WES contamination method was developed and validated by comparing its performance to that of the gold standard (short tandem repeat [STR]) MCC test, validated for detecting ≥5% contamination. Finally, post-implementation performance was monitored for a 15-month period. During validation, 270 prenatal samples underwent analysis with both WES and the gold standard test. In 259 samples, the results were concordant (248 not contaminated, 11 contaminated with both tests). In 11 samples, contamination was only detected in WES data (2 of which contained ≥5% contamination with WES, which is above the detection limit of the gold standard test). The data of the post-implementation evaluation on 361 samples, of which 68 were contaminated, were in line with the validation data. Contamination can reliably be detected in WES data, rendering a separate contamination test unnecessary for the majority of samples.

How Green Are Romania’s Motorways? An Analysis of the Impact Avoidance and Mitigation Measures Proposed for Motorway Projects in Romania

Abstract The development of infrastructure, particularly motorway infrastructure has been one of the main goals of Romania after 1990. However, the sustainable development of this type of infrastructure has only become an issue in the last few years. In this paper are presented the results of a literature review and analysis of the environmental impact mitigation measures which were proposed for motorway and express road projects in Romania within their Environmental Impact Assessments. The paper analyses whether appropriate measures have been proposed in the Environmental Impact Assessment Reports and how consistently they were proposed in different EIAs done in Romania. It analyses how much the measures proposed address impacts such as habitat loss, habitat alteration, fragmentation, species disturbance, and mortality So far, there is no known analysis on this topic Romania, although these types of projects have been implemented for many years. The hypothesis for this analysis is that the measures proposed for motorway and express road projects are not completely adequate for addressing identified impacts and that they are not in accordance with best practices. The results of the analysis indicate important gaps in the implementation of measures, particularly in regards to maintenance of ecological connectivity, as a response to potential fragmentation, and light pollution mitigation. It also highlights the lack of available data on the effectiveness of implemented mitigation measures, indicating the need for rigorous post-implementation monitoring and assessment of effectiveness. The paper proposes a more comprehensive and consistent approach to environmental impact mitigation in infrastructure projects, and for the public availability of post-implementation evaluation results.

Navigating the challenges in the land intervention practices of peri-urban areas in Indian cities using CRITIC-TOPSIS approach

ABSTRACT Peri-urbanisation is a dynamic phenomenon that is perpetually altering the territories of the metropolises and land management regimes for peri-urban areas have left a void in combating the acceleration of metropolitan encroachment into the peripheral areas. Land-related decisions in the conflicted context of peri-urban are required to be strategized, considering the opportunities they present for urban development. The research aims to rank the significance of the challenges in land intervention practices by the planning professionals in the peri-urban context of India. A questionnaire-based survey is used to collect data for analysis from 84 experts from the planning field and academia. The CRITIC method is used to ascertain the weight of each participant’s response, while the TOPSIS method ranks the significance of the challenges (C1–C10). The lack of comprehensive planning standards and benchmarks (C5) is of the the most significance. Uncertain demarcation of peri-urban areas (C1) and the the absence of post-implementation and compliance evaluation studies (C9) are the next most challenging, as per the analysis. The result aids in the understanding of the policymakers to mitigate the challenges faced in peri-urban land management by prioritising actions.

Designing, piloting and evaluating (through a matched pre- and post-implementation survey) a targeted e-learning resource on antimicrobial resistance for public health professionals.

Antimicrobial resistance (AMR) is a significant global public health threat and key priority for the public health, especially health protection, workforce to lead by example. There is a paucity of learning resources on this for public health professionals (PHPs) in the UK. This project aimed to develop and disseminate a tailored interactive learning resource and evaluate impact on self-reported intention to change behaviour. Learning objectives were agreed, content developed by the multi-disciplinary team and piloted by PHPs in 2022 alongside a matched pre- and post-implementation evaluation survey. Questions were mapped to the capability-opportunity-motivation-behaviour change model. Before and after responses were calculated to compare change in self-reported knowledge, understanding and behaviour. Significance of change in binary responses was estimated. The resource was delivered using an interactive, user-friendly and cost-free internal platform. Thirty-one PHPs completed the pilot e-learning and survey. Perceived and actual knowledge increased in parallel. Actual knowledge on AMR burden increased from 6.45 to 35.48% (P = 0.004). Self-reported confidence to explain AMR to others improved by 0.71 (95% CI; 0.38-1.04: P = 0.0001) Likert points on a five-point scale. Motivation to advocate for antimicrobial stewardship (AMS) in day-to-day work, improved by 0.71 (95% CI; 0.34-1.08: P < 0.00001) Likert points. Case scenarios were well-received as an effective way to apply theory to practice. Ensuring a well-informed and confident public health workforce is vital for reducing the AMR threat and advocating for AMS with the public and partner organizations. This targeted e-learning module is an effective additional learning medium in contributing to PHPs knowledge, understanding and self-reported intention to change behaviours.

The Healthy Start scheme in England “is a lifeline for families but many are missing out”: a rapid qualitative analysis

BackgroundHealthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow’s milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme’s effectiveness and uptake.MethodsThe study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi‐structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non‐government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants.ResultsSix core themes cut across stakeholders’ perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child’s right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels.ConclusionsHS provides benefits for child development and family wellbeing. The study’s recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.

A Mixed-Method Approach to Post-Implementation Success of Technology Performance in UAE Universities: Assessing DeLone and McLean IS Success Model

Technology brings tremendous changes in education because it is a system that automates all educational institutions and academic performance. Therefore, the study examines the effect of technology’s system, information and service quality on faculty, operational and university performance. To explore the more contextual factors, this study empirically and theoretically tested a proposed model by the D&amp;M theory of IS among UAE universities. The study employed mixed-method research using a sequential explanatory research design. Using a designed survey questionnaire, the study targeted 512 faculty members and conducted 10 semi-structured face-to-face interviews with faculty members of 27 UAE universities. The results reported that system, information, and service quality significantly influenced faculty performance. In addition, system quality strongly affects faculty performance, which is the most necessary part of successful technology implementation. Faculty performance significantly influences operational and university performance; surprisingly, it has the strongest influence on operational performance. In turn, operating performance has a significant impact on university performance. The study further identified four contextual factors, that is, external, individual, organizational, and technical. The study put the novel ideas by contributing performance-level measures that support Delone and Mclean’s IS success model to successfully operationalize the university’s actual performance. The research uniquely extends the D&amp;M IS success model to assess technology implementation success at individual, operational, and organizational levels within UAE universities, touching previously unexplored areas of post-implementation evaluation. University management in the UAE should prioritize enhancing service, system, and information quality to bolster faculty performance, leading to improved operational and overall organizational outcomes.

International collaboration between low-middle-income and high-income institutions to improve radiation therapy care delivery.

The Philippines is a lower-middle-income island country with over 153 000 new cancer diagnosis each year. Despite many patients needing radiotherapy as part of disease management, there remains limitations to access. Currently, the Philippines has 50 linear accelerator facilities serving a population of 110 million. However, given the recommendation of 1 linear accelerator for every 250 thousand people, it is evident that the demand for accessible radiotherapy resources is significantly underserved in the country. This paper outlines the collaboration between GenesisCare Solutions (GCS) and Fairview Cancer Center (FCC) to address efficiency and access within the radiotherapy department at FCC. Through international collaboration between GCS and FCC, areas for improvement were identified and categorized into four domains: Dosimetry quality, Patient workflow, Data & Reporting, and Information Technology (IT) Infrastructure. Action plans were developed then implemented. A baseline measurement was obtained for each domain, and post-implementation evaluation undertaken at 3 months, 6 months, and 12 months. Data captured within the electronic medical record system was extrapolated, and average treatment times were established for pre- and post-engagement. A paired, 2-tailed t-test was used for statistical analysis of outcome parameters using IBM SPSS version 23 for all statistics. Twelve months post-initial engagement, all four domains saw positive outcomes. Improved plan quality linked to Intensity Modulated Radiotherapy (IMRT) utilization rates saw an increase from 20% to 54%. A significant reduction in patient average wait times was also observed, from 27 to 17 min (p≤0.001). Prior to engagement, tracking patient demographics and diagnosis was not prioritized, post engagement an average of 92% diagnosis entry compliance was achieved. Through the collaboration of GCS and FCC, objectives in all action plan domains were achieved, highlighting the benefits of collaboration between low-middle-income and high-income institutions.

A CRITICAL REVIEW OF ERP SYSTEMS IMPLEMENTATION IN MULTINATIONAL CORPORATIONS: TRENDS, CHALLENGES, AND FUTURE DIRECTIONS

Enterprise Resource Planning (ERP) systems have become indispensable tools for managing complex business processes in multinational corporations (MNCs). This paper presents a critical review of the trends, challenges, and future directions associated with ERP systems implementation in the context of MNCs. The study synthesizes existing literature to offer a comprehensive understanding of the evolving landscape of ERP adoption in a globalized business environment. The trends in ERP implementation within MNCs underscore the increasing reliance on integrated software solutions to enhance operational efficiency and facilitate seamless communication across diverse geographical locations. Notably, the integration of emerging technologies such as artificial intelligence, machine learning, and blockchain into ERP systems has gained traction, presenting new opportunities and complexities for MNCs. However, the implementation of ERP systems in MNCs is not without challenges. Cultural diversity, varying regulatory frameworks, and differences in business practices across regions pose significant obstacles to successful deployment. Additionally, the sheer scale and complexity of MNCs' operations demand careful consideration of customization needs, scalability, and alignment with organizational goals. The critical review highlights the need for a strategic approach to ERP implementation in MNCs. Successful cases often involve top management commitment, extensive user training, and a phased implementation strategy that accommodates regional variations. Furthermore, the study emphasizes the importance of post-implementation evaluation and continuous improvement to address evolving business requirements. Looking ahead, future directions in ERP systems implementation within MNCs are shaped by the rapid evolution of technology and the dynamic nature of global business. The integration of cloud-based solutions, the advancement of Industry 4.0 technologies, and the increasing emphasis on sustainability are anticipated to influence the next wave of ERP adoption in MNCs. This critical review contributes valuable insights into the current state of ERP systems implementation in multinational corporations, addressing trends, challenges, and future directions. It provides a roadmap for practitioners, researchers, and policymakers to navigate the complexities of ERP adoption in the ever-evolving landscape of global business.&#x0D; Keywords: ERP, MNCs, Industry 4.0, Multinational, Corporation, Review.

Interventional radiology education: Patient experience with an educational website

Rationale and objectivesThe aim of this study was to examine the impact of an educational website on patient understanding of Interventional Radiology (IR). Material and methodsAn informational website with descriptions and images of 12 common IR procedures was developed with the aim of educating patients. One hundred patients referred to a large, academic institution were randomly selected to participate. Anonymous 11-question, 5-point Likert-scale assessments were administered before and after engaging with the educational website. The survey evaluated patients' understanding of IR procedures and satisfaction with the website as an educational tool. ResultsOne hundred patients completed the pre−/post-implementation evaluations. Among matched questions, there was an increase in patient understanding of IR with mean score improvement from 2.10 to 4.57 (p < 0.001), their knowledge of common procedures from 1.74 to 4.66 (p < 0.001), and their consideration for their next procedure to be with IR from 2.24 to 4.62 (p < 0.001). Additionally, patients had an overall positive impression of the website (mean 4.80). Over 75% of patients found the descriptions and images “very helpful”. ConclusionThis study demonstrated that website use for patient education has the potential to be effective in increasing overall patient understanding of IR and familiarity with common interventional procedures.

Review and Bibliometric Analysis of Biogas Power Plants in Indonesia

The demand for energy is increasing due to population growth, technological advancements, and a growing need for sustainable energy sources. Indonesia, which faces an energy deficit, is exploring alternatives to fossil fuels. Biogas, produced through the anaerobic fermentation of organic matter, offers a clean and sustainable energy option while addressing waste disposal issues. Therefore, this literature review examines various aspects of a biogas power plant, including a feasibility study that encompasses technical and economic analyses, generator design, trials, implementation, and post-implementation evaluation. In this review, we gathered scientific papers from Google Scholar using the keywords "pembangkit listrik biogas" between 2019 and 2022, with a focus on recent content. Patents and citations were excluded from the Google Scholar searches to ensure article relevance. Out of a total of 40 articles, 30 were rejected because they did not originate from scientific journals. The collected articles are categorized based on the materials used for biogas generation in power plants. This systematic approach yielded 10 relevant articles. Consequently, the literature reveals that various raw materials, such as palm oil mill waste (POME), livestock manure, and organic waste, hold the potential for biogas production. The results emphasize the economic feasibility of specific biogas projects, the environmental challenges they pose, and the positive impact they have on community well-being

Post-implementation usability evaluation of a human factors-based clinical decision support for pulmonary embolism (PE) diagnosis (Dx): PE Dx Study Part 1

While there is promise for health IT, such as Clinical Decision Support (CDS), to improve patient safety and clinician efficiency, poor usability has hindered widespread use of these tools. Human Factors (HF) principles and methods remain the gold standard for health IT design; however, there is limited information on how HF methods and principles influence CDS usability “in the wild”. In this study, we explore the usability of an HF-based CDS used in the clinical environment; the CDS was designed according to a human-centered design process, which is described in Carayon et al. (2020). In this study, we interviewed 12 emergency medicine physicians, identifying 294 excerpts of barriers and facilitators of the CDS. Sixty-eight percent of excerpts related to the HF principles applied in the human-centered design of the CDS. The remaining 32% of excerpts related to 18 inductively-created categories, which highlight gaps in the CDS design process. Several barriers were related to the physical environment and organization work system elements as well as physicians’ broader workflow in the emergency department (e.g., teamwork). This study expands our understanding of the usability outcomes of HF-based CDS “in the wild”. We demonstrate the value of HF principles in the usability of CDS and identify areas for improvement to future human-centered design of CDS. The relationship between these usability outcomes and the HCD process is explored in an accompanying Part 2 manuscript.

The Quest for Excellence: A Quality Improvement Project on the Effects of a Standardized PACU/Phase II Bedside Report in a High Turnover Pediatric Ambulatory Surgery Center

PurposeTo evaluate the impact of an evidence-based standardized bedside report within a pediatric ambulatory surgery center on length of handoff time, registered nurse (RN) workflow, and patient and family satisfaction. DesignQuality improvement project using an evidence-based standardized bedside report intervention with pre- and postimplementation evaluation of process and outcome measures. MethodsIn January 2019, a unit-based task force evaluated ways to improve current report process and consistency of communication between staff and families. Time from admit into Phase II until nursing handoff was measured pre- and postimplementation. Nursing workflow was measured by time to first RN assessment after admit to Phase II and the postimplementation nursing survey. Patient and family satisfaction were measured pre- and postimplementation from National Research Council Health. FindingsPostimplementation, average handoff times decreased by 30%; average time from admit to the Phase II unit until the nursing handoff decreased by 28%. From the postimplementation RN survey, 100% RNs: (1) felt standardized bedside report had a positive impact on their workflow, (2) expressed confidence in giving and receiving reports, and (3) reported they had critical information to safely care for patients. Overall patient satisfaction was measured by How likely would you be to recommend this facility to your family and friends; 11.6% improvement over baseline scores was reported. Improved percentages of score improvement from baseline included: nurses explained things (4.42%), nurses listened carefully (4.3%), patient and family received consistent information (2.46%), care providers explained things (2.22%), and patient and family trusted nurses with care (1.74%). ConclusionsImplementation of standardized bedside report resulted in (1) more expeditious times to handoff and first RN assessment, (2) overall positive impact on nursing workflow, and (3) improvements in patient and family satisfaction.

Implementing a Machine Learning Screening Tool for Malnutrition: Insights From Qualitative Research Applicable to Other Machine Learning-Based Clinical Decision Support Systems.

Machine learning (ML)-based clinical decision support systems (CDSS) are popular in clinical practice settings but are often criticized for being limited in usability, interpretability, and effectiveness. Evaluating the implementation of ML-based CDSS is critical to ensure CDSS is acceptable and useful to clinicians and helps them deliver high-quality health care. Malnutrition is a common and underdiagnosed condition among hospital patients, which can have serious adverse impacts. Early identification and treatment of malnutrition are important. This study aims to evaluate the implementation of an ML tool, Malnutrition Universal Screening Tool (MUST)-Plus, that predicts hospital patients at high risk for malnutrition and identify best implementation practices applicable to this and other ML-based CDSS. We conducted a qualitative postimplementation evaluation using in-depth interviews with registered dietitians (RDs) who use MUST-Plus output in their everyday work. After coding the data, we mapped emergent themes onto select domains of the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. We interviewed 17 of the 24 RDs approached (71%), representing 37% of those who use MUST-Plus output. Several themes emerged: (1) enhancements to the tool were made to improve accuracy and usability; (2) MUST-Plus helped identify patients that would not otherwise be seen; perceived usefulness was highest in the original site; (3) perceived accuracy varied by respondent and site; (4) RDs valued autonomy in prioritizing patients; (5) depth of tool understanding varied by hospital and level; (6) MUST-Plus was integrated into workflows and electronic health records; and (7) RDs expressed a desire to eventually have 1 automated screener. Our findings suggest that continuous involvement of stakeholders at new sites given staff turnover is vital to ensure buy-in. Qualitative research can help identify the potential bias of ML tools and should be widely used to ensure health equity. Ongoing collaboration among CDSS developers, data scientists, and clinical providers may help refine CDSS for optimal use and improve the acceptability of CDSS in the clinical context.