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The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption.

In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context.

Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients’ individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use.

Guideline adoption in clinical practice is partly within doctors’ control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver.

This survey among clinicians, despite limitations, gives helpful insights. While favourable attitudes may be helpful, clinical adoption could be improved more effectively by targeting barriers.

Cigarette smoking remains the primary preventable cause of mortality and morbidity globally. The overarching goal of the paper is to disseminate the Behavioral Activation Treatment for Smoking (BATS), which integrates behavioral activation principles with standard treatment guidelines to assist individuals in achieving short- and long-term smoking cessation. Through a series of sequential steps, BATS guides individuals who wish to quit smoking to increase their engagement in healthy, pleasurable, and value-consistent activities.

The document provides the BATS rationale and contains an abridged manual for use by clinicians and/or researchers in the context of clinical trials. Findings: BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms.

BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms.

A description of key components, forms, and strategies to address common treatment barriers are included.

BATS’s strong roots in learning theories and its idiographic nature allow for the intervention to be implemented flexibly across a wide range of settings and smoking populations. The treatment may also be combined seamlessly with pharmacotherapies. BATS targets both cigarette smoking and depressive symptoms, which constitute a significant barrier to cessation, through a common pathway: increasing rewarding activities. The treatment offers a parsimonious complement to standard smoking cessation treatments.

The purpose of this paper is to describe a jurisdiction-wide implementation and evaluation of intensity-modulated radiation therapy (IMRT) in Ontario, Canada, highlighting innovative strategies and lessons learned.

To obtain an accurate provincial representation, six cancer centres were chosen (based on their IMRT utilization, geography, population, academic affiliation and size) for an in-depth evaluation. At each cancer centre semi-structured, key informant interviews were conducted with senior administrators. An electronic survey, consisting of 40 questions, was also developed and distributed to all cancer centres in Ontario.

In total, 21 respondents participated in the interviews and a total of 266 electronic surveys were returned. Funding allocation, guidelines and utilization targets, expert coaching and educational activities were identified as effective implementation strategies. The implementation allowed for hands-on training, an exchange of knowledge and expertise and the sharing of responsibility. Future implementation initiatives could be improved by creating stronger avenues for clear, continuing and comprehensive communication at all stages to increase awareness, garner support and encourage participation and encouraging expert-based coaching. IMRT utilization for has increased without affecting wait times or safety (from fiscal year 2008/2009 to 2012/2013 absolute increased change: prostate 46, thyroid 36, head and neck 29, sarcoma 30, and CNS 32 per cent).

This multifaceted, jurisdiction-wide approach has been successful in implementing guideline recommended IMRT into standard practice. The expert based coaching initiative, in particular presents a novel training approach for those who are implementing complex techniques. This paper will be of interest to those exploring ways to fund, implement and sustain complex and evolving technologies.

The study aims to explore the utilisation of Clinical Decision Support (CDS) tools in Tanzanian healthcare facilities by identifying the tools used, the challenges encountered and the adaptive strategies employed by healthcare practitioners. It utilises an Activity Theory (AT) approach to understand the dynamic interactions between healthcare providers, CDS tools and the broader healthcare system.

The research adopts a qualitative approach in two prominent regions of Tanzania, Dar es Salaam and Dodoma. It involves semi-structured interviews with 26 healthcare professionals and key stakeholders across ten healthcare facilities, supplemented by document reviews. The study employs AT to analyse the interactions between healthcare professionals, CDS tools and the broader healthcare system, identifying best practices and providing recommendations for optimising the use of CDS tools.

The study reveals that Tanzanian healthcare practitioners predominantly rely on non-computerised CDS tools, such as clinical guidelines prepared by the Ministry of Health. Despite the availability of Health Information Systems (HIS), these systems often lack comprehensive decision-support functionalities, leading practitioners to depend on traditional methods and their professional judgement. Significant challenges include limited accessibility to updated clinical guidelines, unreliable infrastructure and inadequate training. Adaptive strategies identified include using non-standardised tools like Medscape, professional judgement and reliance on past experiences and colleagues’ opinions.

The investigation was constrained by access limitations because it was challenging to get some respondents to share information. However, a sufficient number of individuals participated in the interviews, and their knowledge was very beneficial in understanding the procedures and tools for clinical decision support.

This study contributes to AT by extending its application to a low-resource healthcare setting, uncovering new dimensions of the theory related to socio-cultural and technological constraints in healthcare facilities in Tanzania. It provides valuable insights into the practical barriers and facilitators of HIS and CDS tool implementation in developing countries, emphasising the need for context-specific adaptations, robust training programs and user-centred designs. The findings highlight the resilience and imagination of healthcare practitioners in adapting to systemic limitations, offering recommendations to enhance clinical decision-making and improve patient care outcomes in Tanzania.

Humanitarian crises increase vulnerability of children to pneumonia, so aid agencies store pharmaceuticals in advance of this demand. Decisions on how much to store are plagued by many diverse challenges as is common in humanitarian contexts, so this study considers storing more medications to improve the relatively poor (∼80) demand coverage at a representative aid agency.

The paper combines inventory theory with health economics to calculate the impact inventory increases would have on the final cost of pneumonia treatment. It can then assess to what extent inventory can be increased while pneumonia treatment remains cost effective.

The study finds that more drug investment has only a small effect on the final treatment cost. Substantial drug inventory increases remain well within established guidelines for highly cost-effective treatments, so the agency should consider large increases as an efficient use of funding.

The study focuses on pneumonia treatment only to allow sufficient depth of analysis. Further research could look at many other treatments using the same approach, although some problem scenarios will include complicating parameters like drug perishability.

The level of pharmaceutical inventory at humanitarian warehouses is a high-value decision for the aid sector. The method shows the potential for health economics to provide practical decision support for a wide range of humanitarian and ministry of health warehouse operations. While large increases in inventory investment are within guidelines, there is an asymptotically increasing cost as demand coverage approaches 100%. As a result, decision makers may want to set a target demand coverage (e.g. 99%) and allocate remaining aid funding to other projects.

Many humanitarian supply chain decisions lack analytical support due to issues with complexity, scale or a lack of reliable input data, and this study is the first to provide analytical insights which can greatly improve the current approach to inventory control policies for pneumonia medications and beyond.

Introduction: Lately, various tendencies to approach personalized medicine (PM) have developed. However, their result is a mutual application of technology without considering the essence of this field. The comprehensive approach to the concept of PM reveals some aspects that need to be dealt with for a successful implementation.

Aim: Identifying possible ways of implementing PM through person-centered care, with an overall positive economic impact, improved medical services, and customer satisfaction.

Methods: The research carried out represents a retrospective descriptive cross-sectional study. Qualitative and quantitative methods were used.

Findings: PM plays an increasingly important role in the political agenda of different countries, to approve an effective method of prevention, diagnosis, and treatment of various diseases. The postponement of its implementation by the authorities and the lack of public policies lead to the unjustified expenditure of public money and contribute to halting the development of the medical system through managerial inefficiency.

The originality of the study: Different approaches to PM and its implementations are analyzed in the context of the challenges of the contemporary economy.

Implications: The research is carried out in the Academy of Economic Studies of Moldova within the state research programs.

This article describes the fundamentals of the “model of integrated patient pathways” (“mipp”) and its mode of action as a tool for quality improvement and cost management in health care. The model is based on three pillars: construction, implementation and benchmarking. Transparency of processes and costs become available from interdisciplinary construction of care pathways via an Access database. The article provides details and lessons learned from applying the model to the pathway “Acute Myocardial Infarction”. A robust approach for delivering quality in a cost‐conscious world is uncovered, which lends itself to benchmarking and has limitless scope for quality improvements.

The purpose of this paper is to explore the applicability of the Australasian Therapeutic Communities Association (ATCA) Standard to Australian youth-specific modified therapeutic communities (MTCs). An Interpretive Guide for Youth MTCs and Residential Rehabilitation (RR) Services was developed and a pilot trial conducted with three Australian youth MTC services.

Using a mixed-methods design, this study included three components: a consultation process with residential youth MTCs (N=15), which informed the development of the ATCA Standard Interpretive Guide for Youth MTCs and RR Services; a pilot trial of the materials with three Australian youth MTCs (N=53); and an evaluation of the interpretive guide and assessment of applicability of the ATCA standard to youth MTCs through pre- (N=32) and post- (N=19) pilot trial administrations of the Survey of Essential Elements Questionnaires (SEEQ), and post-pilot trial focus groups (N=21).

Results indicate that the ATCA Standard is applicable to youth MTC settings when applied with the Interpretive Guide, although no significant differences were found between the pre- and post-pilot trial administrations of the SEEQ.

Future research is recommended to explore active mechanisms of youth-specific MTCs, differences between adults and youth MTCs, and the development of TC-specific training.

To date, no standard for youth residential substance use services in Australia has been developed, and this is the first study of its kind internationally to explore the efficacy of standards in a youth MTC.

This paper aims to examine lean thinking in medical commodities supply chains by considering its applications and success factors. It determines the drivers and wastes of medical commodity supply chain, and the existing lean tools and practices together with their application in the supply chain processes. The paper also examined the challenges and success factors for effective lean application in the medical commodities supply chains.

The study used qualitative approaches, in-depth interviews and focus group discussions with key informants to form the basis for data collection. Through thematic analysis, the collected data were analyzed by developing themes reflecting the objectives of the study.

The main drivers for waste associated with the supply chain were demand management, supplier development, institutional framework and governance. The wastes were observed at the level of inventory, operation costs, transaction costs, delays in terms of service, commodity delivery time and quality. Digitalization, information technology and standardization were the tools for medical supply chain. Poor infrastructure, unreliable internet supply, environmental uncertainty and poor management support were challenges to realizing an effective supply chain.

Although the qualitative approach used in the study provides detailed information, a quantitative study covers a larger sample for generalization.

Capacity building and professionalism should be given a priority because the philosophy of lean focuses on waste removal and continuous improvement, which highly depends on the quality of human resource (Brito et al., 2020). Limited human resource capabilities in supply chain management will, therefore, result into poor operational efficiency, which are wasted. Moreover, systems interoperability is key waste minimization and, therefore, demands interventions.

The government under the Ministry of Health and other key sector ministries such as local and regional governments should better understand the role of the waste drivers and adopt system-wide reforms to support improvements to remove waste in the medical supply chain. For example, the current institutional framework creates an administrative block and hence leads to wastes. This bureaucratic procedure should be removed to minimize wastes along the chain.

This study is among the first studies to determine applicability and implementation of lean in a resource-constrained context. The paper identifies contextual factors for lean implementation. This paper focused on a holistic view of the entire supply chains to enhance a well-functioning supply chain in delivering health commodities.

The purpose of this paper is to address a gap in current heritage practice within the USA, as defined by the US Secretary of Interior’s Standards, which offers no treatment for a building entering the end of its lifecycle.

Building on research conducted for “Deconstructing the Culture of Demolition,” Master of Design Studies thesis completed in 2018, this paper seeks to better understand how deconstruction industry practice could be changed by the inclusion of heritage values through a case study of the sustainability non-profit Emergent Structures of Savanah, Georgia.

The benefits of replacing demolition with deconstruction extend beyond the preservation of materials alone. Applying critical heritage theories to deconstruction practice addresses challenging issues in the discipline, such as mutability of heritage objects and equity in heritage practice. Deconstruction redefines the concept of death in the built environment, harnessing its energy to serve the heritage goals of memory, revival and sustainable community development.

The findings are based on real-world practice, linking heritage methodology to deconstruction practice. These examples will be useful to preservation professionals who deal with demolition in the course of their work, to rethink the idea of waste and value in heritage practice.

This paper explores best practices in promoting heritage value and community engagement through deconstruction. This insight will promote interdisciplinary communication around historic materials and their treatment, which remains unexplored in both deconstruction and heritage research.