Browsing by Subject "IMPLEMENTATION"

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  • Walsh, Jessica C.; Dicks, Lynn V.; Raymond, Christopher M.; Sutherland, William J. (2019)
    Over the last decade, there has been an increased focus (and pressure) in conservation practice globally towards evidence-based or evidence-informed decision making. Despite calls for increased use of scientific evidence, it often remains aspirational for many conservation organizations. Contributing to this is the lack of guidance on how to identify and classify the array of complex reasons limiting research use. In this study, we collated a comprehensive inventory of 230 factors that facilitate or limit the use of scientific evidence in conservation management decisions, through interviews with conservation practitioners in South Africa and UK and a review of the healthcare literature. We used the inventory, combined with concepts from knowledge exchange and research use theories, to construct a taxonomy that categorizes the barriers and enablers. We compared the similarities and differences between the taxonomies from the conservation and the healthcare fields, and highlighted the common barriers and enablers found within conservation organizations in the United Kingdom and South Africa. The most commonly mentioned barriers limiting the use of scientific evidence in our case studies were associated with the day-to-day decision-making processes of practitioners, and the organizational structures, management processes and resource constraints of conservation organizations. The key characteristics that facilitated the use of science in conservation decisions were associated with an organization's structure, decision-making processes and culture, along with practitioners' attitudes and the relationships between scientists and practitioners. This taxonomy and inventory of barriers and enablers can help researchers, practitioners and other conservation actors to identify aspects within their organizations and cross-institutional networks that limit research use – acting as a guide on how to strengthen the science-practice interface.
  • Kiiski, A.; Airaksinen, M.; Mäntylä, A.; Desselle, S.; Kumpusalo-Vauhkonen, A.; Järvensivu, T.; Pohjanoksa-Mäntylä, M. (2019)
    Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency's website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al's medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients' medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.
  • Kujala, Sari; Ammenwerth, Elske; Kolanen, Heta; Ervast, Minna (2020)
    Background: The number of public eHealth services that support patient self-management is rapidly increasing. However, the implementation of these eHealth services for self-management has encountered challenges. Objective: The purpose of this paper was to analyze the challenges and opportunities of implementing eHealth services for self-management by focusing on the fit between the technical solution and clinical use. Methods: We performed in-depth interviews with 10 clinical project coordinators and managers who were responsible for developing and implementing various eHealth services for self-management interventions in five university hospitals in Finland The results were analyzed using content analysis and open coding. The Fit between Individuals, Task, and Technology (FITT) framework was used to interpret the findings. Results: The implementation of self-management services involved many challenges related to technical problems, health professional acceptance, patient motivation, and health organization and management. The implementers identified practices to manage the identified challenges, including improving the design of the technology, supporting health professionals in the adoption of the eHealth services, changing the work processes and tasks, involving patients, and collectively planning the implementation inside an organization. The findings could be mostly attributed to the dimensions of the FITT framework. Conclusions: The FITT framework helped to analyze the challenges related to the implementation, and most of them were related to poor fit. The importance of patients as stakeholders in eHealth services for patient self-management needs to be highlighted. Thus, we propose that patients should be added as a different type of individual dimension to the FITT framework. In addition, the framework could be extended to include organization and management in a new context dimension.
  • van den Born, Riyan J.G.; Verbrugge, Laura; Ganzevoort, Wessel (2020)
    Adaptive management strategies are required to manage multi-actor and multifunctional river landscapes. Such strategies need to be inclusive of perspectives of different stakeholders. We present a case study of a pilot engineering project in the Dutch river Waal, which drastically changed the appearance of the river landscape. We study perceptions of four stakeholder groups (residents, recreational anglers, recreational boaters and shipping professionals) regarding the impacts of this intervention on landscape values, including aesthetics, naturalness, biodiversity, flood safety and accessibility. Results show that stakeholders differ in which functions of the river landscape they found important and how they perceive the longitudinal dams to influence the landscape. They also differ in levels of place attachment and trust in the responsible authority. Shipping professionals stood out for their more negative evaluations of the dams compared to the other stakeholders, while especially residents demonstrated high levels of place identity and connection with nature. Residents also feel that the dams are improving flood risk safety in the area, and they positively evaluate knowledge and skills of Dutch water managers. These results provide water managers with much needed insights into landscape functions valued by different stakeholder groups and those perceived as most endangered by landscape interventions.
  • Kujala, Paivi; Virkkala, Seija; Lahdesmaki, Merja (2021)
    This article focuses on rural business support as a policy regime of the second pillar of the Common Agricultural Policy (CAP). We examine the relationships present in the regime to find out how authorities become enablers in the entrepreneurship promotion process. A rural business support regime is considered as a government policy network, consisting of dynamic collaboration and interaction between the European Commission, policymakers, policy implementers and rural entrepreneurs. Based on 38 interviews of rural development actors in Finland, our case-study identifies four properties in the relationships, namely trust, learning, discretion and creativity that are crucial factors in enabling interactions in the rural business support regime. As a contribution, we develop a model for enabling rural authority. We conclude the article by presenting implications for the legitimacy, coherence and durability of the rural business support regime in Finland and in the EU, as we argue that enabling action affects these policy impacts.
  • Woolley, Skipton; Bax, Nicolas; Currie, Jock; Dunn, Daniel; Hansen, Cecilie; Hill, Nicole; O'Hara, Timothy; Ovaskainen, Otso; Sayre, Roger; Vanhatalo, Jarno; Dunstan, Piers (2020)
    Bioregions are important tools for understanding and managing natural resources. Bioregions should describe locations of relatively homogenous assemblages of species occur, enabling managers to better regulate activities that might affect these assemblages. Many existing bioregionalization approaches, which rely on expert-derived, Delphic comparisons or environmental surrogates, do not explicitly include observed biological data in such analyses. We highlight that, for bioregionalizations to be useful and reliable for systems scientists and managers, the bioregionalizations need to be based on biological data; to include an easily understood assessment of uncertainty, preferably in a spatial format matching the bioregions; and to be scientifically transparent and reproducible. Statistical models provide a scientifically robust, transparent, and interpretable approach for ensuring that bioregions are formed on the basis of observed biological and physical data. Using statistically derived bioregions provides a repeatable framework for the spatial representation of biodiversity at multiple spatial scales. This results in better-informed management decisions and biodiversity conservation outcomes.
  • Cadilhac, Dominique A.; Dewey, Helen M.; Denisenko, Sonia; Bladin, Christopher F.; Meretoja, Atte (2019)
    BackgroundHospital costs for stroke are increasing and variability in care quality creates inefficiencies. In 2007, the Victorian Government (Australia) employed clinical facilitators for three years in eight public hospitals to improve stroke care. Literature on the cost implications of such roles is rare. We report changes in the costs of acute stroke care following implementation of this program.MethodsObservational controlled before-and-after cohort design. Standardised hospital costing data were compared pre-program (financial year 2006-07) and post-program (2010-11) for all admitted episodes of stroke or transient ischaemic attack (TIA) using ICD-10 discharge codes. Costs in Australian dollars (AUD) were adjusted to a common year 2010. Generalised linear regression models were used for adjusted comparisons.ResultsA 20% increase in stroke and TIA episodes was observed: 2624 pre-program (age>75years: 53%) and 3142 post-program (age>75years: 51%); largely explained by more TIA admissions (up from 785 to 1072). Average length of stay reduced by 22% (pre-program 7.3days to post-program 5.7days, p
  • Selwood, Katherine E.; Wintle, Brendan A.; Kujala, Heini (2019)
    The importance of expert input to spatial conservation prioritization outcomes is poorly understood. We quantified the impacts of refinements made during consultation with experts on spatial conservation prioritization of Christmas Island. There was just 0.57 correlation between the spatial conservation priorities before and after consultation, bottom ranked areas being most sensitive to changes. The inclusion of a landscape condition layer was the most significant individual influence. Changes (addition, removal, modification) to biodiversity layers resulted in a combined 0.2 reduction in correlation between initial and final solutions. Representation of rare species in top ranked areas was much greater after expert consultation; representation of widely distributed species changed relatively little. Our results show how different inputs have notably different impacts on the final plan. Understanding these differences helps plan time and resources for expert consultation.
  • Heikkilä, Juha Markus; Parkkamäki, Stina; Salimäki, Johanna; Westermarck, Sari; Pohjanoksa-Mantyla, Marika (2018)
    Background and purpose: COPD is one of the leading causes of morbidity and mortality worldwide. Although medication counseling interventions by pharmacists have been found to support the management of COPD, little is known about pharmacists' knowledge concerning COPD and regular practices and perceptions concerning medication counseling of COPD patients. The purpose of this study was to research these topics among Finnish community pharmacists. Materials and methods: In January 2017, an electronic survey was e-mailed to Finnish community pharmacies (n=741) via the Association of the Finnish Pharmacies. One pharmacist from each pharmacy, preferably a specialist in asthma, was invited to answer the survey. Results: Completed responses were received from 263 pharmacists (response rate =35%), of whom 196 pharmacists were specialists in asthma. Response rate among asthma pharmacists was 42%. Pharmacists were positive about their role in medication counseling and in support of the self-management of COPD patients. COPD-related knowledge was self-assessed as being good and was on a good level in respect of basic facts. However, almost half (46%) of the pharmacists did not know that COPD is considered a national public health issue, and similar to 50% of the pharmacists were not familiar with the current care guideline on COPD. Medication counseling was found to be more medicinal product-driven and less advisory concerning lifestyle changes such as smoking cessation and physical exercise. Conclusion: Although the pharmacists' knowledge of COPD was good on general topics, there were some gaps in their knowledge on the current care guideline and status of the disease. Pharmacists should more systematically individually target medication counseling according to patients' needs. In addition, lifestyle treatments, including smoking cessation and physical exercise, should be part of the medication counseling.
  • Puumalainen, Emmi; Airaksinen, Marja; Jalava, Sanni E.; Chen, Timothy F.; Dimitrow, Maarit (2020)
    Purpose This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (>= 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. Methods The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool's content, development methods, and validation assessment. Results The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks; (2) pharmacotherapy-related risks; and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted (n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency (n = 3) and inter-rater reliability (n = 2). Conclusions The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.
  • Sullanmaa, Jenni; Pyhältö, Kirsi; Pietarinen, Janne; Soini, Tiina; Soini, Tiina (2019)
    Purpose Shared understandings of curriculum reform within and between the levels of the educational system are suggested to be crucial for the reform to take root. The purpose of this paper is to explore variation in perceived curriculum coherence and school impact among state- and district-level stakeholders. Design/methodology/approach The participants (n=666) included state- and district-level stakeholders involved in a national curriculum reform in Finland. Latent profile analysis was employed to identify profiles based on participants' perceptions of the core curriculum's coherence and the reform's impact on school development. Findings Two profiles were identified: high coherence and impact, and lower consistency of the intended direction and impact. State-level stakeholders had higher odds of belonging to the high coherence and impact profile than their district-level counterparts. Practical implications The results imply that more attention needs to be paid in developing a shared and coherent understanding particularly of the intended direction of the core curriculum as well as the reform's effects on school-level development among state- and district-level stakeholders. Originality/value The study contributes to the literature on curriculum reform by shedding light on the variation in perceived curriculum coherence and school impact of those responsible for a large-scale national curriculum reform process at different levels of the educational system.
  • Bousquet, Jean; Bedbrook, Anna; Czarlewski, Wienczyslawa; De Carlo, Giuseppe; Fonseca, Joao A.; Ballester, Miguel A. Gonzalez; Illario, Maddalena; Koskinen, Seppo; Laatikainen, Tiina; Onorato, Gabrielle L.; Palkonen, Susanna; Patella, Vincenzo; Nhan, Pham-Thi; Puggioni, Francesca; Ventura, Maria Teresa; Joos, Guy; Kuna, Piotr; Louis, Renaud; Makris, Michael; Zalud, Petra; Zuberbier, Torsten; Bachert, Claus; Brussino, Luisa; Carreiro-Martins, Pedro; Carrion y Ribas, Carme; Chalubinski, Maciej; Costa, Elisio M.; de Vries, Govert; Gemicioglu, Bilun; Gennimata, Dimitra; Micheli, Yann; Niedoszytko, Marek; Regateiro, Frederico S.; Romantowski, Jan; Taborda-Barata, Luis; Toppila-Salmi, Sanna; Tsiligianni, Ioanna; Viart, Frederic; Laune, Daniel (2021)
  • Yeung, J.; Matsuyama, T.; Bray, J.; Reynolds, J.; Skrifvars, M. B. (2019)
    Aim: To perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' Methods: The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) Results: We included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95% CI 0.68-12.48) and survival to 30 days (OR 2.14, 95% CI 0.73-6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95% CI 1.74-2.84) and survival to hospital discharge (OR 1.85, 95% CI 1.46-2.34). Conclusions: Very low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.
  • Isokuortti, Nanne; Aaltio, Elina; Laajasalo, Taina; Barlow, Jane (2020)
    Background: Attempts to improve child protection outcomes by implementing social work practice models embedded in a particular theory and practice approach, have increased internationally over the past decade. Objective: To assess the evidence of the effectiveness of child protection practice models in improving outcomes for children and families. Participants and setting: Children <18 years and their families involved in child protection services. Methods: A systematic review was conducted to synthesize evidence regarding the effectiveness of child protection practice models. Systematic searches across 10 electronic databases and grey literature were conducted to identify quasi-experimental studies minimally. Included studies were critically appraised and the findings summarized narratively. Results: Five papers, representing six studies, focusing on three practice models (Solution-Based Casework; Signs of Safety; and Reclaiming Social Work) met the inclusion criteria. All studies applied a quasi-experimental design. Overall, the quality of the evidence was rated as being poor, with studies suffering from a risk of selection bias, small sample sizes and short-term follow up. Conclusions: Despite the popularity of practice models, the evidence base for their effectiveness is still limited. The results suggest that high-quality studies are urgently needed to evaluate the impact of practice models in improving the outcomes of child-protection-involved families. The findings also illustrate the difficulties of conducting high-quality outcome evaluations in children's social care, and these challenges and future directions for research, are discussed.
  • Fan, Zheyong; Chen, Wei; Vierimaa, Ville; Harju, Ari (2017)
    Graphics processing units have been extensively used to accelerate classical molecular dynamics simulations. However, there is much less progress on the acceleration of force evaluations for many-body potentials compared to pairwise ones. In the conventional force evaluation algorithm for many-body potentials, the force, virial stress, and heat current for a given atom are accumulated within different loops, which could result in write conflict between different threads in a CUDA kernel. In this work, we provide a new force evaluation algorithm, which is based on an explicit pairwise force expression for many-body potentials derived recently (Fan et al., 2015). In our algorithm, the force, virial stress, and heat current for a given atom can be accumulated within a single thread and is free of write conflicts. We discuss the formulations and algorithms and evaluate their performance. A new open-source code, GPUMD, is developed based on the proposed formulations. For the Tersoff many-body potential, the double precision performance of GPUMD using a Tesla K40 card is equivalent to that of the LAMMPS (Large-scale Atomic/Molecular Massively Parallel Simulator) molecular dynamics code running with about 100 CPU cores (Intel Xeon CPU X5670 @ 2.93 GHz). (C) 2017 Elsevier B.V. All rights reserved.
  • Eronen, Lasse; Kokko, Sirpa; Sormunen, Kari (2019)
    In 2014, the Finnish National Board of Education launched a new core curriculum with the aim of meeting the skills and competence requirements of the 21st century. The purpose of this case study was to find out what transversal competencies Finnish eighth graders developed and how they experienced studying in a problem-based transdisciplinary course, which was arranged for the transitional stage between the former and the new curriculum. The qualitative data consisted of questionnaires and interviews. The analysis followed the methods of qualitative content analysis. When asked about their learning, the students commented on not having learnt much, referring to the discipline-based knowledge. Instead, they had learnt skills through teamwork, problem solving, and expression of their views and opinions, an aspect that they did not clearly connect with the things to be learnt at school. Many students felt that they acquired the competencies that they would need later in their lives. The students' teamwork had a crucial impact on their learning experience. The timeframe for the integrative approach needs careful consideration; the learning process in this course was perceived as being successful because it was long enough. Our study highlights that focusing on students' views is critical when reforming curriculum.
  • Hellings, Peter W.; Borrelli, David; Pietikainen, Sirpa; Agache, Ioana; Akdis, Cezmi; Bachert, Claus; Bewick, Michael; Botjes, Erna; Constantinidis, Jannis; Fokkens, Wytske; Haahtela, Tari; Hopkins, Claire; Illario, Maddalena; Joos, Guy; Lund, Valerie; Muraro, Antonella; Pugin, Benoit; Seys, Sven; Somekh, David; Stjärne, Pär; Valiulis, Arunas; Valovirta, Erkka; Bousquet, Jean (2017)
    On March 29, 2017, a European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases (CRD) was organized by the European Forum for Research and Education in Allergy and Airway Diseases. The event took place in the European Parliament of Brussels and was hosted by MEP David Borrelli and MEP Sirpa Pietikainen. The aim of the Summit was to correspond to the needs of the European Commission and of patients suffering from CRD to join forces in Europe for the prevention and self-management. Delegates of the European Rhinologic Society, European Respiratory Society, European Academy of Allergy and Clinical Immunology, European Academy of Paediatrics, and European Patients Organization EFA all lectured on their vision and action plan to join forces in achieving adequate prevention and self-management of CRD in the context of Precision Medicine. Recent data highlight the preventive capacity of education on optimal care pathways for CRD. Self-management and patient empowerment can be achieved by novel educational on-line materials and by novel mobile health tools enabling patients and doctors to monitor and optimally treat CRDs based on the level of control. This report summarizes the contributions of the representatives of different European academic stakeholders in the field of CRD.
  • Haapasaari, Arja; Engestrom, Yrjo; Kerosuo, Hannele (2018)
    Purpose - The purpose of this paper is to examine the generation of innovations by employees and the creation of initiative paths, and to discover which factors contribute to the implementation of an initiative. Design/methodology/approach - Based on longitudinal qualitative research, the study explores the profiles of initiative paths and the types of innovations and relationships among the generated innovations. Findings - It was found that, to become an innovation, an initiative followed different paths along which the processing and outcomes varied, as did the time needed for experimentation. The creation of initiative paths required the transformative agency of the actors involved. Power relations had an impact on the generation of initiatives and implementation of innovations. Originality/value - Innovations research has concentrated on the generation of ideas and the implementation of innovations. This study focuses on the process path along which ideas become innovations and on the role of power relations in the innovations process.
  • Jokelainen, Jarno; Udd, Marianne; Kylänpää, Leena; Mustonen, Harri; Halttunen, Jorma; Lindstrom, Outi; Pöyhiä, Reino (2017)
    Objective: Patient-controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large-scale studies are lacking. Material and methods: A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting. All 956 patients undergoing 1196 ERCPs in the endoscopy unit of Helsinki University Central Hospital 2012-2013, methods of sedation and adverse events associated with different sedations were recorded. Results: PCS was attempted a total of 685 times (57%), successful use of PCS was achieved with 526 patients (77% of attempts). PCS device was operated by the anesthesiologist or anesthesia nurse 268 times (22%). PCS was more likely chosen for younger (80.6% for <=60 years vs. 63.8% for >60 years, p <.001) patients and by trainee anesthetists. Anesthesiologist administered propofol sedation was used 240 times (20%). The risk of failure of PCS was increased, if systolic arterial pressure was <90mmHg, dosage of PCS > 17 ml, duration of procedure exceeded 23 min. The risk of failure was lower in patients with primary sclerosing cholangitis (PSC) and if sedation was deeper RASS<= -2. Uneventful PCS was associated with less respiratory and cardiovascular depression than other methods. There were no statistically significant differences in safety profiles with all the methods of sedation. Conclusions: PCS is readily implemented in clinical practice, is suitable for younger and low-risk patients and is associated with less cardiorespiratory adverse effects.