Search

Objective To evaluate the financial penalty effect of the Hospital Readmissions Reduction Program (HRRP) on 30-day inpatient readmissions for pneumonia (PN), acute myocardial infarction (AMI) and heart failure (HF) among hospitals identified as having excess readmissions. Setting Short-term, acute care hospitals in the USA. Design Secondary data analysis of publicly available HRRP Supplemental Data to examine the effect of HRRP on reducing excess hospital readmissions by utilizing repeated-measures analysis of variance models. Participants A total of 3395 nonfederal, short-term acute care hospitals under the Inpatient Prospective Payment System that are subject to the HRRP program and that reported discharges data for PN, AMI and HF for the calculation of readmission ratios for the fiscal years 2013, 2014 and 2015. Intervention Implementation of the HRRP in October 2012 by the Centers for Medicare and Medicaid Services (CMS) to reduce Medicare payments to hospitals with excess readmissions. Main Outcome Measures Thirty-day hospital readmission ratios for PN, AMI and HF. Results There was a significant decrease in excess readmissions for PN, AMI and HF between FY 2013 and FY 2015. The reduction in excess readmission ratios was 0.035 for PN ( P < 0.001), 0.082 for AMI ( P < 0.001) and 0.034 for HF ( P < 0.001). The effect of HRRP on excess readmissions was greater for small hospitals, public hospitals and hospitals located in rural areas. Conclusions HRRP to reduce payments to hospitals with excess readmissions had a significant effect on the inpatient readmissions for PN, AMI and HF in US Hospitals.

In this chapter, focus is on the intersection of problem solving, consultation, and response to intervention (RTI). After briefly defining each term,consultation and RTI are explored in depth, and a similarities/differences comparison is presented. Although there are some clear similarities that exist within the fields of school consultation and RTI (e.g., importance placed on the problem-solving process, prevention efforts, evidence-based practices, intervention implementation with high fidelity), the differences between the two fields outnumber these similarities (Erchul, J Educ Psychol Consult 21:191–208, 2011). The authors conclude that, although problem-solving consultation methods undergird many RTI practices, the established consultation literature could contribute much more to the science and practice of RTI. The chapter concludes with suggestions for further research and implications for enhancing practice.

Extensive evidence exists demonstrating the benefits of repeated readings (RR) interventions at increasing students’ fluency on intervention passages. Few studies however have examined the extent to which repeatedly reading one passage improves students’ reading fluency on similar passages. Using an alternating treatment design, we examined the extent to which two interventions resulted in improvements in students’ fluency on generalization passages. While both interventions incorporated RR, one intervention involved students reading one passage four times and the other involved students reading two similar passages each twice. Intervention effects were evaluated by having students read a generalization passage prior to and following intervention implementation. Results indicate that both interventions were effective in increasing students reading fluency on generalization passages. For 3 participants the RR intervention produced greater gains in fluency on the generalization passages, while data for the remaining 3 participants are inconclusive. Implications of these findings for practice and for better understanding application of the instructional hierarchy to the development of reading interventions are discussed.

This study examined teachers' implementation of treatment plans following consultation. Interventions were implemented for 45 elementary school students referred for consultation and intervention d...

Objective Older adults in the U.S. have high rates of obesity. Despite the demonstrated efficacy of lifestyle interventions among older adults, lifestyle interventions are not widely implemented in community settings. Program delivery by lay health educators (LHEs) might support greater dissemination because of lower delivery cost and greater accessibility. We examined the costs of a LHE-delivered translation of the Diabetes Prevention Program (DPP) evidence-based lifestyle intervention for older adults in Arkansas senior centers. Methods This examination of costs used data from a cluster randomized control trial (conducted 2008–2010) in which 7 senior centers (116 participants) were randomized to implement a LHE-delivered 12-session translation of the DPP lifestyle intervention. We compiled direct lifestyle intervention implementation costs, including training, recruitment, materials, and ongoing intervention implementation support. Weight loss data (at 4-month follow-up) were collected from participants. Results Participant weight loss averaged 3.7 kg at 4-months. The total estimated cost to implement the lifestyle intervention is $2731 per senior center, or $165 per participant. The implementation cost per kilogram lost is $45. Conclusions A LHE-delivered DPP translation in senior centers is effective in achieving weight loss at low cost and offers promise for the dissemination of this evidence-based intervention.

Objective:To examine whether implementation of safety-engineered devices in 2001 had an effect on rates of percutaneous injury (PI) reported by HCWs.Design:Before-and-after intervention trial comparing 3-year preintervention (1998–2001) and 2-year postintervention (2001–2002) periods. PI data from anonymous, self-administered surveys were prospectively entered into CDC NaSH software.Setting:A 427-bed, tertiary-care hospital in Manhattan.Participants:HCWs who attended state-mandated training sessions and completed the survey (1,132 preintervention; 821 postintervention).Intervention:Implementation of a “safer-needle system” composed of various safety-engineered devices for needle-safe TV delivery-insertion, blood collection, and intramuscular-subcutaneous injection.Results:Preintervention, the overall annual rate of PIs self-reported on the survey was 36.5 per 100 respondents, compared with 13.9 per 100 respondents postintervention (P < .01). The annual rate of formally reported PIs decreased from 8.3 to 3.1 per 100 respondents (P < .01). Report rates varied by occupational group (P ≤ .02). The overall rate did not change between study periods (22.7% to 22.3%), although reporting improved among nurses (23.6% to 44.4%, P = .03) and worsened among building services staff (90.5% to 50%, P = .03). HCWs with greater numbers of Pis self-reported on the survey were less likely to formally report injuries (P < .01). The two most common reasons for nonreport (ie, thought injury was low risk or believed patient was low risk for blood-borne disease) did not vary from preintervention to postintervention.Conclusions:Safety-engineered device implementation decreased rates of Pis formally reported and self-reported on the survey. However, this intervention, with concomitant intensive education, had varying effects on reporting behavior by occupation and a minimal effect on overall reporting rates.

68 Background: The Doris Howell Palliative Care (PC) Outpatient Consultation Service consists of a multidisciplinary team. Reasons for consultation include pain management, treatment of other physical symptoms, education about non-drug options for pain, and advanced care planning. To assess methods used for patient education, the PC team administered the ASCO pain survey to those prescribed opioid pain medications. Methods: The survey was a 26-item questionnaire evaluating patient education content communicated by a provider to a patient during a routine clinic visit. Twenty surveys were completed anonymously. After survey review, the outpatient PC team developed an intervention to address patient education concerns. The intervention consisted of written and verbal instructions on pain medication management reviewed by the PC nurse with the patient and/or caregiver at the end of the outpatient visit. Another twenty surveys were completed anonymously with patients after intervention implementation. Time required to complete the intervention was less than two minutes per patient. The Fisher’s exact test was used to analyze the differences between surveys completed with or without the intervention. Results: The majority of patients stated that his/her provider adequately explained the use (n = 40, 100%), side effects (n = 37, 93%), and storage (n = 32, 80%) of pain medications, regardless of the intervention. Both groups also indicated that the provider and/or nurse adequately explained the risks associated with medical history (n = 34, 85%) and other medications while taking pain medications (n = 33, 83%). The intervention did increase understanding to avoid sharing pain medications (75% vs. 85%, p < 0.05) and to use a lock box to secure pain medications (45% vs. 60%, p < 0.05). Additionally, asking patients if family members have a history of alcohol or substance abuse was also significant (p < 0.05). Conclusions: Written and verbal instructions as an intervention improved patient understanding to avoid sharing pain medications and to secure pain medications in a lock box.

Introduction: The study purpose was to evaluate the feasibility of a chronic disease self management/case management intervention for adults experiencing homelessness and diabetes and the ability to retain subjects. Methods: Participants with type 2 diabetes were recruited at a homeless clinic and a subset received the intervention. Analysis included calculating a retention rate and evaluating the intervention implementation process. Results: Of the nine participants, five were retained for 12 weeks and two of three participants completed the full intervention. Conclusions: Study retention is feasible for adults experiencing homelessness. Further intervention refinement is needed to address relevancy of content and time constraints.

Background The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. Methods This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. Results This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. Conclusions These findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers’ and organizational perspective.

Communication campaigns might be a viable means of improving contraceptive continuation; however, few such interventions aimed at reducing contraceptive discontinuation have been evaluated.Data were collected from independent samples of new injectable users in Nyando District, Kenya-site of a communication campaign to increase contraceptive continuation-and in a comparison district, nine months before and nine months after intervention implementation. Survival analysis was used to compare the intervention and comparison groups with respect to the distribution of time until first discontinuation of modern method use among women still in need of family planning.Exposure to family planning information was high in both the treatment and the comparison district before (97% and 85%, respectively) and after the intervention (99% and 78%). Postintervention, 5% of women in the comparison district discontinued by 98 days, 8% by 196 days and 23% by 294 days; the proportions in the treatment district were 4%, 6% and 16%, respectively. No significant difference between the districts was found in the ninemonth postintervention contraceptive continuation rates. Having method-related side effects or health concerns was the reason most consistently associated with discontinuation. Other factors associated with discontinuation differed between the districts.Addressing method-related side effects and health concerns will be critical in improving continuation of the injectable.

Social work has a long history of community practice, but community practice models have been understudied. An important first step in conducting such studies is the establishment of psychometrically sound measures that are relevant for evaluations of community practice. In this article, data are used from a community-randomized trial of Communities That Care, a coalition-based model of community practice shown to be effective at transforming communities and changing rates of problem behavior in youths. Coalition functioning is reported by coalition members in 12 communities across intervention implementation phases. A four-dimensional model of coalition functioning (goal-directedness, efficiency, opportunities for participation, and cohesion) was confirmed using factor analysis, and the dimensions were found to be invariant across time. One test of validity of these dimensions is conducted by correlating coalition members' ratings of coalition functioning with those of external observers. © 2013 National Association of Social Workers.

School psychologists commonly provide intervention services to children through consultation with teachers. Data suggest, however, that many teacher consultees struggle to implement these interventions. There are relatively few evidence-based strategies for promoting teacher consultees' intervention implementation. The purpose of this study was to evaluate Implementation Planning as a strategy for increasing the adherence and quality with which teacher consultees implemented behavior support plans. Implementation Planning involves adapting intervention steps to the implementation context, providing detailed logistical planning, as well as identifying implementation barriers and developing strategies to address them. Results indicated that teachers' implementation adherence levels increased and quality levels increased with corresponding decreases in variability, compared to standard behavioral consultation. Implications for future research on treatment integrity are discussed.

Although there is much research to support the effectiveness of classwide interventions aimed at improving student engagement, there is also a great deal of variability in terms of how response to group-level intervention has been measured. The unfortunate consequence of this procedural variability is that it is difficult to determine whether differences in obtained results across studies are attributable to the way in which behavior was measured or actual intervention effectiveness. The purpose of this study was to comparatively evaluate the most commonly used observational methods for monitoring the effects of classwide interventions in terms of the degree to which obtained data represented actual behavior. The 5 most common sampling methods were identified and evaluated against a criterion generated by averaging across observations conducted on 14 students in one seventh-grade classroom. Results suggested that the best approximation of mean student engagement was obtained by observing a different student during each consecutive 15-s interval whereas observing an entire group of students during each interval underestimated the mean level of behavior within a phase and the degree of behavior change across phases. In contrast, when observations were restricted to the 3 students with the lowest levels of engagement, data revealed greater variability in engagement across baseline sessions and suggested a more notable change in student behavior subsequent to intervention implementation.

Background and objectives In France, stroke is the third leading cause of mortality and the first leading cause of physical handicap with 130 000 cases annually. In ischaemic stroke thrombolytic treatment within 3 h from onset of symptoms decreases of 36% the risk of significant disability and mortality. Only 2% of patients receive thrombolysis. Out of the 1306 patients admitted in an emergency unit for a possible acute stroke in the Rhone area (AVC69 study) over seven consecutive months in 2007, 1098 (84%), 615 (56%) had an ischaemic stroke, 191 (31%) had no clinical or radiological exclusion criteria for thrombolysis, but less than 1% were thrombolysed within 3 hours. The primary objective of the AVC2 study is to assess the impact of a training programme aimed at ED staff on the rate of thrombolysis. The secondary objectives are to assess the feasibility of this programme on staff knowledge and on outcomes at 3 months follow-up. Method An interventional, multicenter, comparative, stepped-wedge, randomised cluster study will be carried out within 12 emergency departments in the Rhone valley. The intervention implementation order will be randomly assigned so that each department will belong successively to the control arm and the intervention arm of the trial, acting as its own control. The study will be performed in four clusters of three departments each, following a 5-step scheme. The intervention will consist in: A staff training programme (physicians and nurses) regarding the recognition and relevant emergency management of CIs, Setting up organisational environment-focused processes aimed at facilitating communication between the intervening departments (Centre 15 (ie, 911) radiology, neurology). Evaluation of the quality of management using indicators of HAS This programme will imply both the group training of emergency teams (situation simulation exercise following predefined scenarios) and the individual training of each professional (e-training on a dedicated web platform). Sample size calculation relies on the hypothesis of a 15% improvement of the primary endpoint; an inter-cluster coefficient of variation was applied to the calculation. Three hundred patients will be necessary to obtain a 99% power, that is, 15 patients per time and cluster. A comparative analysis of the endpoints of both intervention and control arms of the trial will be performed using a mixed-effect logistic regression model in order to take into account the 2-level data hierarchy The choice of the stepped wedge seems particularly suited to investigations of community level public health interventions and the modelling the effect of time on the effectiveness of an intervention (BMC). Expected outcomes We expect this programme to raise awareness among the health professionals of the French EMS and of emergency and radiology departments about the importance of the early recognition of strokes and the expected benefit of a fast, relevant management. The aim of this programme is to improve the emergency management of acute ischaemic strokes to increase the thrombolysis rate. If the programme proves significantly efficient, it could be brought into general use. Finally, this programme will also enable to prepare professionals to the implementation of telemedicine, including thrombolysis in remote areas under the supervision of expert vascular neurologists when patients cannot be hospitalised on time in a neurovascular unit. Conclusion This ambitious study was possible at the regional level thanks to the multidisciplinary AVC69 study network and the RESUVAL (Reseau des Urgences de la Vallee du Rhone – Network of the emergency departments of the Rhone valley) network. It features a multi-faceted training programme delivered by emergency physicians and neurologists with multiple, original methods. The study design is also innovative, ensuring training in all participating centres and allow the evaluation of clinical impact of quality improvement. Contexte et objectifs En France, l9accident vasculaire cerebral (AVC), troisieme cause de mortalite et premiere cause de handicap physique, a une incidence de 130 000 cas/an. La thrombolyse des infarctus cerebraux (IC) dans les 3 h apres le debut des symptomes reduit le risque de deces ou d9invalidite severe de 36%. Seulement 2% des IC sont thrombolyses. L’etude AVC 69, etude d9observation des patients admis dans un service d9urgence du Rhone pour une suspicion d9AVC pendant 7 mois consecutifs en 2007, incluant 1306 patients, montre que sur les 1098 (84%) patients admis aux urgences, 615 (56%) presentaient un IC, parmi lesquels 193 (31%) n9avaient aucune contre-indication clinique ni radiologique a la thrombolyse et seulement 7 (1% des IC) ont ete thrombolyses dans les 3 h. L9objectif principal de l’etude AVC2 est d9estimer l9impact d9un programme d9entrainement des professionnels des urgences sur le taux de thrombolyse. Les objectifs secondaires sont d’evaluer la faisabilite de ce programme et son impact sur la qualite et la securite des soins, et le devenir a 3 mois Methode Une etude d9intervention comparative multicentrique randomisee en cluster de type « stepped wedge » sera realisee dans 12 services d9urgence de la vallee du Rhone. L9ordre d9intervention dans les services sera tire au sort, de telle sorte que chaque service appartiendra successivement au bras controle puis au bras intervention de l9essai, agissant ainsi comme son propre temoin. L’etude se deroulera dans 4 clusters de 3 services en 5 temps successifs. L9intervention comprend: un programme de formation des personnels a la reconnaissance et la prise en charge des IC une mise en place de processus organisationnels adaptes au service, multidisciplinaire (centre 15, radiologie et neurologie), et privilegiant l9acces rapide au diagnostic et aux soins une evaluation des pratiques utilisant les indicateurs definis par l9HAS Ce programme combinera un entrainement collectif des equipes (mise en situation selon des scenarii preetablis) avec un entrainement individuel (e-training sur une plateforme Internet dediee). Le calcul de la taille de l’echantillon s9appuie sur l9hypothese d9une amelioration de 15% du critere de jugement principal. Un coefficient de variation inter-clusters a ete applique au calcul. Un effectif de 300 patients sera necessaire pour obtenir une puissance de 99% soit 15 patients par temps et par cluster. Une analyse comparative des criteres de jugement entre les bras intervention et controle sera realisee avec une regression logistique a effets mixtes pour tenir compte de la structure hierarchique a 2 niveaux de donnees. Le choix du stepped wedge convient particulierement aux interventions de sante publique. Il permet la formation de tous les centres participants afin d’eviter un biais de contamination et la modelisation de l9effet du temps sur l9efficacite d9une intervention. Retombees attendues Nous attendons de l’etude une amelioration des pratiques professionnelles des intervenants dans la prise en charge precoce des AVC par un programme qui pourra etre generalise s9il s9avere efficace. Ceci permettra egalement de preparer les professionnels a la telemedecine et notamment la thrombolyse a distance sous controle de neurologues vasculaires experts pour les lieux trop eloignes d9une Unite NeuroVasculaire. Conclusion Cette etude ambitieuse est rendue possible grâce a la dynamique pluridisciplinaire mise en place avec l’etude AVC69 et au reseau RESUVAL (Reseau des Urgences de la Vallee du Rhone). L9originalite tient au programme de formation multifacette, delivre par des urgentistes et des neurologues, avec des methodes originales. Le design de l’etude innovant.

For consultation to result in the delivery of services to students, it must lead to implementation of an intervention. For this reason, intervention implementation is the crucial challenge for the practice of consultation and, as a result, is the critical research need. The argument is advanced that too little is known about the extent to which teachers actually implement interventions following consultation, as opposed to what they say about implementation, because implementation has infrequently been directly measured. The consultation database also provides few analyses of the conditions under which consultees do and do not implement interventions. This article considers fundamental issues of definition, measurement, and design as they relate to the study of the relationship between consultation and intervention implementation.

Inconsistent implementation of the intervention in thefield setting presents a threat to the validity of the conclusions of an effectiveness study. Inconsistent implementation results in variability in the actual dosage of the intervention received by the participants, which leads to variability in outcomes achievement and, consequently, to Type II error. This article discusses the methodological implications of inconsistent intervention implementation and advances a strategy as a solution to this problem. The strategy proposes to quantify the dosage of the intervention as a continuous variable and to use this variable in the statistical analysis. The benefits of this strategy are illustrated with an empirical example from the Self-Help Intervention Project.

This fact sheet assesses the progress that partners in California's Prevention and Early Intervention (PEI) Program have made so far in developing capacities and reaching Californians in accordance with the statewide strategic PEI plan.

With growing numbers of developmental needs expressed in communities, the way services are delivered to families must change to assist children. A prevention model which provides multiple levels of support from prevention efforts to extensive, individualized interventions can assist practitioners in meeting the needs of children efficiently and effectively. In addition, prevention and intervention efforts are more effective when problems are clearly identified and tied to specific interventions which are evidence-based. The use of a problem-solving process gives practitioners a specific way to think about child concerns and develop and track progress of interventions matched to the child or children’s needs.

Health agencies have traditionally played a central role in the characterization of health problems and disease. Data-based planning is considered the cornerstone of effective public health action, enabling state health agencies to use limited resources most effectively to achieve maximum reductions in disease morbidity and mortality. Over the past decade, state health agencies have made important strides in enhancing their capacity for data-based planning for cancer control and in establishing models to facilitate similar planning efforts in other states. Federal programs have served an important catalyst role in establishing states' data-based planning capacity and in facilitating the resulting increase in the application of cancer control science across the United States. This article provides an overview of the infrastructure for data-based cancer control planning and highlights the critical role of federal programs in enhancing the capacity of states to effectively plan and implement cancer control initiatives as well as some of the gaps that remain in states' capacity for data-based planning.

Background Boxing headgear has previously been mandatory at the Olympic Games but was removed from men9s competition in 2016, citing evidence that it increases concussion risk. Objective To describe the dissemination of concussion information on social media in response to headgear removal during Olympic competition. Design Cross-sectional media analysis. Setting User-generated content posted on the social networking site Twitter during the 2016 Olympic Summer Games. Participants Twitter users posting relevant content between 5th-21st August, 2016. Assessment of Risk Factors Twitter data (“tweets”) were extracted and coded as either for (supporting) or against (opposed to) headgear removal, and to indicate the user9s belief that headgear prevents or increases the risk of concussion. Main Outcome Measurements The total number of tweets and the number of users reached were extracted. Pearson chi 2 was used to assess the effect of concussion risk beliefs on the type of disseminated message (e.g., personal opinion versus evidence-based). Results 646 tweets were captured, reaching ∼13.2 million Twitter users. Concussion was mentioned in 91 (14.1%) cases; increased laceration risk after headgear removal was referenced in 100 (15.5%). External links were included in 219 tweets (33.9%), comprising scientific publications/resources (n=27, 12.3%), news articles (n=141, 64.4%), and blog/opinion sites (n=51, 23.3%). Only 277 tweets were framed as either for (n=121, 43.7%) or against (n=156, 56.3%) headgear removal. Of these, 64 (45.4%) indicated that headgear increases concussion risk, whereas 77 (54.5%) suggested that it prevents concussions. Users who believed that headgear prevents concussions were more likely to base this on personal opinion (n=66, 85.7%) than those believing it increases risk (n=41, 64.1%) (x 2 =8.95, p=0.003). Conclusions Personal opinion and news articles were the most commonly disseminated concussion information sources, leading to conflicting positions on the counterintuitive removal of boxing headgear. These findings have implications for real-time knowledge translation strategies during intervention implementation across contexts.

OBJECTIVES To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends. DESIGN, SETTING AND PARTICIPANTS Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of the Blue BARRWUE handover system at Geelong Hospital. INTERVENTION Implementation of the Blue BARRWUE handover system and its components (updated working diagnosis, background, alerts, resuscitation status, requests, who to do what and when, updates and executable discharge plan). MAIN OUTCOME MEASURES Presence of any written handover notes or updated working diagnoses in the BOSSnet clinical information system, content of handover notes, frequency of weekend discharges and medical emergency team (MET) calls before and after implementation. RESULTS In the 12 months before implementation of the Blue BARRWUE handover system, 976 patients (47.98%) had a handover note in BOSSnet, versus 1646 patients (95.09%) in the 12 months after implementation (P< 0.001; rate ratio [RR], 20.75; 95% CI, 16.33-26.44). Before implementation, 289 patients (14.21%) were discharged over weekends, versus 353 patients (20.39%) after implementation, (P < 0.001; RR, 1.44; 95% CI, 1.25-1.65). MET calls were made for 152 general medical patients before implementation (7.47%), versus 95 general medical patients (5.49%) after implementation (P = 0.01; RR, 0.73; 95% CI, 0.57-0.94). CONCLUSIONS The Blue BARRWUE system has sustainably improved written handover in our organisation and was associated with improvement in both patient safety and hospital efficiency.

AB Purpose: It is a commonly held perception that most young children are naturally active and meet physical activity recommendations. However, there is no scientific evidence available on which to confirm or refute such perceptions. The purpose of this study was to describe the physical activity levels and patterns of Australian toddlers. Methods: Physical activity and demographic data of two hundred ninety-five 19-month-old children from the Melbourne InFANT Program were measured using accelerometers and parent surveys. Validated cut points of 192-1672 and >1672 counts per minute were used to determine time spent in light- (LPA) and moderate-to-vigorous- (MVPA) intensity physical activity, respectively. To be included in the analysis, children were required to have four valid days of accelerometer data to provide an acceptable (>0.70) reliability estimate of LPA and MVPA. Physical activity data for different periods of the day were examined. Results: On average, toddlers engaged in 184 min of LPA and 47 min of MVPA daily, and 90.5% met the current Australian physical activity recommendations for 0- to 5-yr-olds (180 min of LPA/MVPA per day). Physical activity levels during mid morning and mid afternoon were higher than those during other periods. Physical activity patterns for boys and girls were similar, although boys engaged in more physical activity during the morning hours than girls did. Conclusions: Most children meet the physical activity recommendations, although the majority of activity undertaken in the study was of light intensity. Boys were more active than girls were in the morning hours, but there were no differences between sexes over the entire day. Certain periods of the day may hold more promise for intervention implementation than others do. (C)2012The American College of Sports Medicine

Although treatment acceptability was originally proposed as a critical factor in determining the likelihood that a treatment will be used with integrity, more contemporary findings suggest that whether something is likely to be adopted into routine practice is dependent on the complex interplay among a number of different factors. The Usage Rating Profile-Intervention (URP-I; Chafouleas, Briesch, Riley-Tillman, & McCoach, 2009) was recently developed to assess these additional factors, conceptualized as potentially contributing to the quality of intervention use and maintenance over time. The purpose of the current study was to improve upon the URP-I by expanding and strengthening each of the original four subscales. Participants included 1005 elementary teachers who completed the instrument in response to a vignette depicting a common behavior intervention. Results of exploratory and confirmatory factor analyses, as well as reliability analyses, supported a measure containing 29 items and yielding 6 subscales: Acceptability, Understanding, Feasibility, Family-School Collaboration, System Climate, and System Support. Collectively, these items provide information about potential facilitators and barriers to usage that exist at the level of the individual, intervention, and environment. Information gleaned from the instrument is therefore likely to aid consultants in both the planning and evaluation of intervention efforts.

Background A 2005 report from the Centers for Medicare and Medicaid Services and the Centers for Disease Control Surgical Infection Prevention program indicated that only 41% of prophylactic antibacterials were correctly stopped within 24 h of the end of surgery. Electronic order sets have shown promise as a means of integrating guideline information with electronic order entry systems and facilitating safer, more effective care. Objective The aim was to study the effectiveness of a computer-based antibacterial order set on increasing the proportion of patients who have antibacterial wound prophylaxis discontinued in the appropriate time frame. Design The authors conducted a quasi-experimental interrupted time-series analysis over an 8-month study period with the implementation of a computer-based order system designed to prevent excessive duration of surgical prophylaxis antibacterials. Measurement The primary outcome was the proportion of surgeries with antibacterials discontinued in the appropriate time frame. Additionally, we evaluated the percent of surgeries after implementation of the electronic intervention with chart documentation of infection among surgeries where the prescriber indicated the reason for antibacterial therapy was treatment. Results The computer-based order intervention significantly improved the proportion of surgeries with timely discontinuation of antibacterials from 38.8% to 55.7% (p

The objective of this study was to define locations on the carcass with highest contamination of E. coli O157 throughout the harvest process and implement targeted interventions to reduce or eliminate contamination. To establish a pathogen baseline, samples were collected at the foreshank, hindshank, inside round, neck and midline area and evaluated for E. coli O157:H7 presence. Environmental samples were also collected in the harvest area and the fabrication area of the facility. E. coli O157:H7 prevalence was highest on the foreshank, hindshank and inside rounds in the baseline study and steam vacuums/cones were implemented as an intervention in these specific areas on the harvest floor. At pre-evisceration, foreshank prevalence of E. coli O157:H7 was significantly (P0.05) reduced from 21.7% to 3.1% after the application of steam interventions. At the final rail, foreshank prevalence in the baseline study was 4.2% while no E. coli O157:H7 was detected post-intervention implementation. E. coli O157:H7 on hindshanks and inside rounds was significantly reduced after intervention implementation from 24.2 to 11.5% and 37.5 to 16.7%, respectively at the final rail. Pathogen contamination of environmental samples collected in fabrication declined from 6.7% to 0.7% after slaughter interventions were implemented. Data indicate the identifying areas of contamination on the carcass and implementing interventions can significantly reduce E. coli O157 on the carcasses and in the fabrication environment.

Although the assessment of response to intervention (RTI) as a service delivery model has undergone considerable development over the last decade, all of the critical elements that must be in place for RTI to be successful have not received similar attention. One of the fundamental elements of RTI is the implementation of interventions. However, implementation of interventions appears to be commonly assumed within discussions of RTI rather than considered a major issue to be resolved. Emerging research suggests that assuring treatment or intervention implementation is, in fact, a substantial requirement for problem-solving services to students in schools (Noell, in press). This chapter describes some of the critical conceptual issues related to intervention implementation, and provides a selected review of the research regarding the assessment and assurance of intervention implementation.

AB Purpose: It is a commonly held perception that most young children are naturally active and meet physical activity recommendations. However, there is no scientific evidence available on which to confirm or refute such perceptions. The purpose of this study was to describe the physical activity levels and patterns of Australian toddlers. Methods: Physical activity and demographic data of two hundred ninety-five 19-month-old children from the Melbourne InFANT Program were measured using accelerometers and parent surveys. Validated cut points of 192-1672 and >1672 counts per minute were used to determine time spent in light- (LPA) and moderate-to-vigorous- (MVPA) intensity physical activity, respectively. To be included in the analysis, children were required to have four valid days of accelerometer data to provide an acceptable (>0.70) reliability estimate of LPA and MVPA. Physical activity data for different periods of the day were examined. Results: On average, toddlers engaged in 184 min of LPA and 47 min of MVPA daily, and 90.5% met the current Australian physical activity recommendations for 0- to 5-yr-olds (180 min of LPA/MVPA per day). Physical activity levels during mid morning and mid afternoon were higher than those during other periods. Physical activity patterns for boys and girls were similar, although boys engaged in more physical activity during the morning hours than girls did. Conclusions: Most children meet the physical activity recommendations, although the majority of activity undertaken in the study was of light intensity. Boys were more active than girls were in the morning hours, but there were no differences between sexes over the entire day. Certain periods of the day may hold more promise for intervention implementation than others do. (C)2012The American College of Sports Medicine