N-of-1 trial design offers a methodologically sound approach to determining optimum treatment for an individual patient and solves some limitations of randomized controlled trials. This design could offer an efficient method of reaching a personal treatment regime tailored to suit individual needs and preferences. The paper introduces practical application, objects and the implementation process of N-of-1 trial, to explore its design points and implementation.
The RE-AIM framework is the most commonly used framework for implementation research outcome evaluation, with the original paper cited 2 800 times. However, in the specific operationalization process of the framework, there are often situations of misuse or overuse of various dimensions and indicators. This article provides a detailed introduction to the main content, application scenarios, and characteristics of the RE-AIM framework. Taking the implementation research of Evidence-based Practice Guidelines for Integrated Traditional Chinese and Western Medicine Treatment of Stroke as an example, it introduces how to use the silent & anonymous feedback technology, which combines the improved Delphi method and nominal group technique, to construct an implementation outcome indicator evaluation system to achieve the operability of the RE-AIM framework. This will provide a reference for other researchers to use implementation science theories, models, and frameworks to develop implementation plans or evaluate implementation outcomes.
ObjectiveTo analyse the quality of implementation in clinical application guidelines of the Chinese patent medicines for the treatment of common diseases. MethodsWe retrieved clinical application guidelines of the Chinese patent medicines for the treatment of common diseases published from February, 2019 to August, 2022 in databases. The clinical practice guideline (CPG) implementation evaluation tool was used to evaluate the implementation of the included guidelines. ResultsA total of 29 guidelines were included. The implementation quality of included guidelines was moderate. Thirteen (44.8%) were high quality and 16 (55.2%) were moderate quality. ConclusionThe quality of implementation of clinical application guidelines of the Chinese patent medicines for the treatment of common diseases is higher than that of other traditional Chinese medicine CPG. The CPG implementation evaluation tool can be used in traditional Chinese medicine CPGs and particularity of TCM should also be considered.
ObjectiveTo analyze the problems in the construction of internal control in colleges and universities, and to explore the implementation path suitable for colleges and universities. MethodsThe relevant documents on the internal control construction of universities at home and abroad were retrieved, and the case study of the implementation path of the internal control system construction of C university was analyzed by using the methods of expert interviews, flow charts and walk-through tests. ResultsThe internal control system of colleges and universities takes digital intelligence as the technical support to explore the implementation path of "external standard rule riveting point, internal standard post entry process; data standardization, process progress visualization; speed of operation tracking, data backtracking to find deviation; business data is all smooth, performance evaluation to promote management", optimize the process and improve the system, real-time extraction of operation data for key projects to track, and shorten the business operation time by more than half. ConclusionThe case university carries out empirical research on the internal control system, based on the principle of effective implementation, makes full use of the digital intelligence technology to extract the whole process data of the business system across the system, and realizes the efficient collaboration, early warning and evaluation, and scientific decision-making of the "digital intelligence" platform.
To standardize and improve the reporting quality of implementation studies, BMJ published the standards for reporting implementation studies (StaRI). This paper introduces the background and process of StaRI development, and interprets the core content of StaRI. It is expected that StaRI will provide support for domestic researchers to carry out implementation studies and writing implementation research reports.
Objective
To evaluate the implementation effects and problems about quota payment of specific diseases for hyperplasia prostate and ureteral calculi in Chengdu.
Methods
Payments, man-time of operation, and the lengths of hospitalization of hyperplasia prostate and ureteral calculi as quota payment of specific diseases in Chengdu from 2013 to 2015 were analyzed by using SPSS 16.0 software.
Results
Based on the standards of medical expense limitation in Chengdu unchanged, tertiary and secondary hospitals remained surplus with quota standards of single diseases unchanged. The average lengths of hospitalization of hyperplasia prostate and ureteral calculi in tertiary and secondary hospitals were significantly decreased (P<0.05).
Conclusion
The application of quota payment policy for single disease in Chengdu city of Sichuan province has been proved to work on controlling the medical expense of treating hyperplasia prostate and ureteral calculi. Our results indicate the continuous implementation of quota payment policy. However, the exploration of proper payment standardization, enhance of hospital supervision and establishment of efficient system are still needed to define.
Implementation science is a new field that aims to scale up and sustain the application of evidence-based practice. It primarily studies the dissemination, adoption, evaluation, and improvement, etc. of the implementation process of evidence-based practice. In recent years, tens of implementation theories, frameworks and models have been developed. We systematically collected 41 of them and classified them into several categories. The first is the classical theories which are extended from the traditional social science and used as the predecessors of the implementation science. The second category is the implementation science frameworks/models that are derived from the first category, and can be divided into four groups: 1) the implementation models that explain the law of a certain aspect in the implementation; 2) the implementation determinants frameworks that summarize and classify the implementation determinants; 3) the process models that discuss how research translates into practice; 4) the evaluation models that evaluate the implementation and outcome. The implementation science theories can provide implementation researchers with valuable guidance for development of implementation strategies and evaluation of implementation outcomes.
This article elaborates the concept, meaning and role of clinical pathway, discusses development stages and implementation effects of clinical pathway at home and abroad, and proposes that clinical pathway has been developed very well abroad, but it still has many problems in domestic gtowth which needs to be put into effect with Single-DRGs system in combination.
ObjectiveTo summarize the evaluation tools for the implementation effect of clinical practice guidelines (CPGs), to inform and support the evidence-based development of a general tool for the evaluation of implementation effect of CPGs. MethodsSeven biomedical literature databases, including PubMed, Embase and CNKI, and two academic websites, were searched from establishment to June 2022. Theoretical and empirical research on the evaluation tools of the implementation effect of CPGs were included. Two researchers independently screened literature and extracted data according to the inclusion and exclusion criteria. Based on the Implementation Science RE-AIM theoretical framework, an evaluation framework and a list of alternative items of the implementation effect of the CPGs were initially drawn up by thematic synthesis methods. ResultsA total of 208 articles were included, and 8 mature evaluation tools related to the implementation effect of guidelines were selected. Current research on the evaluation of the implementation effect of CPGs mainly focused on single diseases, with concern of the cognition, attitude and compliance of users to CPGs, and the process of the implementation of CPGs and factors affecting the implementation effect of CPGs. There were limitations such as a lack of evaluation on the terminal effect of the implementation of CPGs, the rare use of mature theoretical frameworks, the use of single evaluation perspectives, and inclusion of limited evaluation dimensions. The initial proposed evaluation framework contains a list of alternative items with 6 primary indicators, 12 secondary indicators and 41 tertiary indicators. ConclusionCurrently, there is a lack of a comprehensive, multi-perspective, mature theory based, general tool for the evaluation of implementation effect of CPGs. The framework and the list of alternative items for the evaluation of implementation effect of CPGs based on the implementation science RE-AIM theory can inform and support the development of a tool for the evaluation of implementation effect of CPGs.
As evidence-based practice (EBP) continues to be valued, the guideline implementation has become an important field for research and practice in health care. In order to better guide the guideline implementation in the field of health care, this paper combines the EBP experience gained from several EBP programs carried out in our hospital those years, in aim of exploring and sharing the methodology of guideline implementation in domestic clinical settings.
