Explore the vast range of titles available.

Background In 2009, Damschroder et al. developed the Consolidated Framework for Implementation Research (CFIR), which provides a comprehensive listing of constructs thought to influence implementation. This systematic review assesses the extent to which the CFIR’s use in implementation research fulfills goals set forth by Damschroder et al. in terms of breadth of use, depth of application, and contribution to implementation research. Methods We searched Scopus and Web of Science for publications that cited the original CFIR publication by Damschroder et al. (Implement Sci 4:50, 2009) and downloaded each unique result for review. After applying exclusion criteria, the final articles were empirical studies published in peer-review journals that used the CFIR in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting). A framework analysis approach was used to guide abstraction and synthesis of the included articles. Results Twenty-six of 429 unique articles (6 %) met inclusion criteria. We found great breadth in CFIR application; the CFIR was applied across a wide variety of study objectives, settings, and units of analysis. There was also variation in the method of included studies (mixed methods ( n  = 13); qualitative ( n  = 10); quantitative ( n  = 3)). Depth of CFIR application revealed some areas for improvement. Few studies ( n  = 3) reported justification for selection of CFIR constructs used; the majority of studies ( n  = 14) used the CFIR to guide data analysis only; and few studies investigated any outcomes ( n  = 11). Finally, reflections on the contribution of the CFIR to implementation research were scarce. Conclusions Our results indicate that the CFIR has been used across a wide range of studies, though more in-depth use of the CFIR may help advance implementation science. To harness its potential, researchers should consider how to most meaningfully use the CFIR. Specific recommendations for applying the CFIR include explicitly justifying selection of CFIR constructs; integrating the CFIR throughout the research process (in study design, data collection, and analysis); and appropriately using the CFIR given the phase of implementation of the research (e.g., if the research is post-implementation, using the CFIR to link determinants of implementation to outcomes).

BackgroundIntegrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation.ObjectivesDevelop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA).DesignThis was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and self-rated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated.ParticipantsVHA facility-based MOVE! teams.InterventionsLEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform.Main MeasuresOrganizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction.Key ResultsSeventeen of 24 randomized teams participated in LEAP. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81–89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work.ConclusionsLEAP is scalable and does not require travel or time away from clinical responsibilities. While QI skills improved among participating teams and most completed the work, they struggled to do so amid competing clinical priorities.

Background Uropathogens are microorganisms that cause urinary tract infections (UTIs). Owing to higher blood glucose levels and compromised immune functions, treatment of uropathogens in diabetic patients is a challenge. Aim This study aims to assess the prevalence of uropathogens and their antibiotic susceptibility among diabetic patients at St. John of God Hospital at Duayaw Nkwanta (SJGHDN) in the Ahafo region of Ghana. Methods The cross‐sectional study recruited 175 diabetic patients at SJGHDN between August and September 2023. Questionnaires were used to collect patients’ background information. Fasting Blood Sugar (FBS) was assessed by using a glucometer. Urine samples were examined for the presence of uropathogens. A sterile inoculating loop with a calibrated volume of 2 µl was used for plating. Each colony equals 500 CFU/mL. Significant uropathogen was determined by multiplying the counted colonies by 500 to obtain CFU/mL. Positive uropathogen was defined as CFU ≥ 105/mL. Significant uropathogen was defined as ≥200 colonies per sample. The disc diffusion method was used to determine antibiotic susceptibility. Results Out of the 175 patients, 19.4% expressed various uropathogens with Escherichia coli being the predominant. Suboptimal glucose level was the most significant risk factor (p = 0.038). Glucosuria (p = 0.036), hazy urine (p = 0.028), positive leukocyte esterase (p = 0.001), and pus cells in urine sediment (p = 0.020) were significant indicators of uropathogen occurrence. Klebsiella pneumonia and Proteus mirabilis were resistant to ≥4 antibiotics. Amikacin, nitrofurantoin, levofloxacin, ciprofloxacin, and ceftriaxone demonstrated efficacy against the isolates. Conclusion This study underscores the notable prevalence of uropathogens in diabetic patients and the alarming levels of antibiotic resistance observed. The results highlight the critical need for vigilant monitoring and customized treatment approaches, particularly for diabetic patients exhibiting risk factors such as elevated urine glucose levels, cloudy urine, and presence of leukocyte esterase and pus cells in urine sediment. The significant resistance to frequently used antibiotics like co‐trimoxazole and tetracycline points to the necessity of routine susceptibility testing and the use of alternative antibiotics for effective treatment. These findings can assist healthcare providers in more effectively managing and preventing UTIs in diabetic populations.

BackgroundLow-value use of screening colonoscopy is wasteful and potentially harmful to patients. Decreasing low-value colonoscopy prevents procedural complications, saves patient time and reduces patient discomfort, and can improve access by reducing procedural demand. The objective of this study was to develop and validate an electronic measure of screening colonoscopy overuse using International Classification of Diseases, Tenth Edition codes and then apply this measure to estimate facility-level overuse to target quality improvement initiatives to reduce overuse in a large integrated healthcare system.MethodsRetrospective national observational study of US Veterans undergoing screening colonoscopy at 119 Veterans Health Administration (VHA) endoscopy facilities in 2017. A measure of screening colonoscopy overuse was specified by an expert workgroup, and electronic approximation of the measure numerator and denominator was performed (‘electronic measure’). The electronic measure was then validated via manual record review (n=511). Reliability statistics (n=100) were calculated along with diagnostic test characteristics of the electronic measure. The measure was then applied to estimate overall rates of overuse and facility-level variation in overuse among all eligible patients.ResultsThe electronic measure had high specificity (99%) and moderate sensitivity (46%). Adjusted positive predictive value and negative predictive value were 33% and 95%, respectively. Inter-rater reliability testing revealed near perfect agreement between raters (k=0.81). 269 572 colonoscopies were performed in VHA in 2017 (88 143 classified as screening procedures). Applying the measure to these 88 143 screening colonoscopies, 24.5% were identified as potential overuse. Median facility-level overuse was 22.5%, with substantial variability across facilities (IQR 19.1%–27.0%).ConclusionsAn International Classification of Diseases, Tenth Edition based electronic measure of screening colonoscopy overuse has high specificity and improved sensitivity compared with a previous International Classification of Diseases, Ninth Edition based measure. Despite increased focus on reducing low-value care and improving access, a quarter of VHA screening colonoscopies in 2017 were identified as potential low-value procedures, with substantial facility-level variability.

PurposeThis paper explores stakeholder perceptions on the nature and extent of sustainability reporting on the websites of technical universities (TUs) in Ghana.Design/methodology/approachThe authors collected data from the websites of the 10 TUs in Ghana and interviewed the stakeholders of the TUs. In analyzing the data, the authors used thematic analysis for the interview responses. The authors also adopted the global reporting initiative (GRI) guidelines and campus sustainability assessment tools for the presentation and analysis of the sustainability disclosures on the websites of the TUs.FindingsThe authors found that due to weak institutional coercions, there were limited disclosures on the websites of the TUs, which aimed at gaining stakeholders' legitimacy; the disclosures were more focused on organizational profile, governance and educational aspects of sustainability. To a large extent, while some external stakeholders such as parents, regulators and alumni appear to be less interested in the disclosures on the TU's websites, internal stakeholders such as employees (teaching and non-teaching staff) and students who frequently visited the TU's websites perceived limited reporting and were not impressed with the extent of sustainability disclosures on these websites.Practical implicationsThe findings of this study are intended to assist policy-makers in the educational sector to appreciate the importance of sustainability reporting on their websites. The results of this study will assist higher educational institutions (HEIs) in increasing the success rate of sustainability implementation by overcoming the lack of sustainability disclosures on their websites. Thus, the results of this study have implications for sustainability implementations, particularly those in emerging economies and policy-makers of universities worldwide.Originality/valueThis study could provide two significant values. First, to the best of the authors’ knowledge, no other study has explored stakeholder perceptions of sustainability reporting in implementing sustainability within the education sector. Second, the results were arrived at by combining stakeholder consultations with content analyses, which could be a good guideline for sustainability implementation in the educational sector of developing countries.

Purpose The purpose of this paper is to compare how the various sectors among the largest companies in Ghana have incorporated sustainability into their mission, vision and value statements. Design/methodology/approach The mission, vision and value statements of the 100 largest corporations in Ghana, known as Ghana Club 100 (GC100), were extracted from the firms’ official websites. These firms were grouped into nine sectors, and the sustainability components in the mission, vision and value statements were subjected to cross tabulation and thematic contents analysis to establish the sectoral variations. Findings In formulating their mission, vision and value statements, GC100 firms were more than six times likely to include economic sustainability themes than environmental sustainability themes. Even though three out of every five GC100 firms are financial institutions, the manufacturing and the extractive sectors and firms ranked 1st−20th are three times likely to incorporate all the sustainability dimensions (i.e. economic, social and environmental) into their mission, vision and value statements. Firms in the financial sector and those ranked 80th−100th were more likely not to publish either a mission, vision or value statements online. Practical implications This study reveals the magnitude of the strategic pronouncements such as mission, vision and value statements of large firms in emerging economies and how they are aligned with sustainability. This could serve as a basis for formulating guidelines to reinforce efforts that contribute to corporate sustainability. Originality/value Research on how large firms align sustainability into their mission, vision and value statements is not a new agenda, but fragmented in the context of the emerging economies. The novelty is that this study addresses this gap and contributes to this topic from a sectoral comparative perspective of largest organization in Ghana, an emerging economy.

In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing. We aimed to describe experiences and factors related to SM implementation. We administered a Web-based survey to chief nurse executives to obtain their implementation experiences. Structural, process, and outcome factors and barriers associated with self-reported implementation success were identified. Respondents representing 104 of 117 facilities participated. Almost all facilities (96%) had completed at least 1 cycle of SM, yet only half (52%) rated their implementation highly successful. Early implementation date, higher levels of leadership confidence in SM, and higher frequency in which nursing staff think in terms of hours per patient day were associated with higher SM implementation success. Time, staff training and educational needs, and engagement were common barriers. Understanding factors that influence successful implementation of staffing policies is important to ensuring safe staffing.

All Veterans Health Administration facilities have been mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel. A multi-step process was designed to lead to projection of full-time equivalent employees required for safe and effective care across all inpatient units. These projections were intended to develop appropriate budgets for each facility. While staffing levels can be increased, even in facilities subject to budget and personnel caps, doing so requires considerable commitment at all levels of the facility. This commitment must come from front-line nursing personnel to senior leadership, not only in nursing and patient care services, but throughout the hospital. Learning to interpret and rely on data requires a considerable shift in thinking for many facilities, which have relied on historical levels to budget for staffing, but which does not take into account the dynamic character of nursing units and patient need.