The Science of Large-Scale Change in Global Health

McCannon, C. Joseph; Berwick, Donald M.; Massoud, M Rashad

doi:10.1001/jama.298.16.1937

Cited by 66 publications

(52 citation statements)

References 9 publications

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“…115,116 Much implementation research is from small-scale interventions, as opposed to large-scale programmes or interventions, for which the challenges to ensurance of quality, intensity, equity, and coverage are diff erent and need various factors to operate in concert. [117][118][119][120][121][122] Analyses of scaled-up programmes or of scale-up of small area or pilot interventions raise several challenges-eg, establishing of counterfactuals, assurance that real-time process documentation captures nuances of organisational changes that facilitated or hampered scale-up, and that research generated is of a publishable quality.…”

Section: Implementation Research: What Work Why and How?mentioning

confidence: 99%

The politics of reducing malnutrition: building commitment and accelerating progress

et al. 2013

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In the past 5 years, political discourse about the challenge of undernutrition has increased substantially at national and international levels and has led to stated commitments from many national governments, international organisations, and donors. The Scaling Up Nutrition movement has both driven, and been driven by, this developing momentum. Harmonisation has increased among stakeholders, with regard to their understanding of the main causes of malnutrition and to the various options for addressing it. The main challenges are to enhance and expand the quality and coverage of nutrition-specifi c interventions, and to maximise the nutrition sensitivity of more distal interventions, such as agriculture, social protection, and water and sanitation. But a crucial third level of action exists, which relates to the environments and processes that underpin and shape political and policy processes. We focus on this neglected level. We address several fundamental questions: how can enabling environments and processes be cultivated, sustained, and ultimately translated into results on the ground? How has high-level political momentum been generated? What needs to happen to turn this momentum into results? How can we ensure that high-quality, well-resourced interventions for nutrition are available to those who need them, and that agriculture, social protection, and water and sanitation systems and programmes are proactively reoriented to support nutrition goals? We use a six-cell framework to discuss the ways in which three domains (knowledge and evidence, politics and governance, and capacity and resources) are pivotal to create and sustain political momentum, and to translate momentum into results in high-burden countries.

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Section: Implementation Research: What Work Why and How?mentioning

confidence: 99%

The politics of reducing malnutrition: building commitment and accelerating progress

et al. 2013

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“…The dominant paradigm even now in the medical community is that good research and publication should be sufficient to ensure the translation of scientific findings into general practice [22]. Unfortunately, a landmark Institute of Medicine (IOM) report from 2001 clearly identified the failure of much scientific innovation to be translated into practice [23,24].…”

Section: Guideline Dissemination and Implementationmentioning

confidence: 99%

“…As we move forward to support the adoption, implementation, and maintenance of the new evidence-based principles embodied in the BHGI guidelines, it is critical that careful evaluation be incorporated in the efforts, to ensure that lessons about effectiveness and efficiency are captured. It is precisely because resources are more scarce in these countries, that it is even more imperative that LMCs adopt effective practices as quickly as possible, and that implementation approaches are designed with limited resources in mind [22].…”

Section: Guideline Dissemination and Implementationmentioning

confidence: 99%

Breast Cancer in Low and Middle Income Countries: How Can Guidelines Best Be Disseminated and Implemented?

Anderson

Tsu²

2008

Breast Care

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Background: Bilateral male breast cancer (MBC) is relatively rare. Case Reports: We report 2 bilateral nonsynchronous MBC cases. Second cancers developed during endocrine therapy with selective estrogen receptor modulators (SERM) after the initial surgeries. Since their second surgeries, both patients continued treatment with another SERM, because their second cancers were also hormone receptor-positive. We discuss the endocrine therapy in men based on a review of the literature. Conclusions: Adequate treatments for early MBC are still controversial. Aromatase inhibitors (AI) are not as effective in men as in women. We consider the higher androgen levels in men to be a major reason for AI not being as effective as expected, i.e. the hormonal environment is very different from that in women. Thus, different approaches are needed for MBC. With further investigation, it is hoped that methods of achieving maximal AI efficacy for MBC will be established.

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“…Additionally, we did not measure operational factors such as leadership, modification of current processes, measurement, reporting, and removal of barriers from practices, which probably influenced the effectiveness of all implemented strategies. [44][45][46] Another limitation is that the 2004-2005 influenza season was the initial season when influenza vaccine was universally recommended for all children aged 6-23 months. 7 The season was complicated by a limited supply of vaccine, 47 making it difficult for some parents to have their child vaccinated 48 and affecting 45% of pediatricians nationally with variation by region, practice type and size.…”

Section: Discussionmentioning

confidence: 99%

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

2010

PEDIATRICS

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Objective-To determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004-2005 influenza season, the first season for the universal influenza vaccination recommendation for all children aged 6-23 months.Methods-Clinical and demographic data from randomly selected children aged 6-23 months were obtained by chart review from a community-based cohort study in three U.S. counties. The proportion of children vaccinated by April 5, 2005 in each practice was obtained. To assess practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics predicting complete influenza vaccination were determined using multinomial logistic regression.Results-Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children aged 6-23 months who were studied, 27% were completely vaccinated. The proportion of children completely vaccinated varied widely among practices (0-71%). Most practices (87%) implemented ≥ 1 vaccination strategy (year-round discussion with parents about influenza vaccine, evening/weekend influenza vaccine clinics, standing orders, or saving a second dose for children who had received the first of two recommended doses). Complete influenza vaccination was associated with three practice characteristics--suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; and with child characteristics of younger age, existing high-risk conditions, ≥ 6 well visits to the practice by age 3 years, and any practice visit from October through January. [2004][2005]7 to children aged 6-59 months in [2006][2007]8 and to children aged 6 months-18 years in 2009-2010. 9 The administration of influenza vaccine presents unique challenges to healthcare providers since it requires yearly administration during a relatively short time period. Vaccine supply delays and shortages can occur, making it difficult for practices to predict when vaccination campaigns might begin and whether adequate supplies will be available. Because of poor immunogenicity of a single dose of vaccine in young children, two doses are required for children aged <9 years who previously have not been completely vaccinated. 9 Most studies evaluating methods to increase vaccination rates in young children were reported prior to the universal influenza vaccination recommendations for young children. [10][11][12][13][14] Since the majority of childhood vaccines are administered in primary care settings, 15 we sought to determine both practice and child characteristics and practice strategies that were associated with influenza vaccine coverage among children aged 6-23 months in 2004-2005, the first season that influenza vaccine was universally recommended. Methods Institutional Review BoardThis study was approved by the institutional review board of the Centers for Disease Control and Prevention (CDC) and of each ...

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The Science of Large-Scale Change in Global Health

Abstract: Contact me if this article is corrected. CitationsContact me when this article is cited. This article has been cited 6 times. Topic collectionsContact me when new articles are published in these topic areas.

Cited by 66 publications

References 9 publications

The politics of reducing malnutrition: building commitment and accelerating progress

The politics of reducing malnutrition: building commitment and accelerating progress

Breast Cancer in Low and Middle Income Countries: How Can Guidelines Best Be Disseminated and Implemented?

Practice and Child Characteristics Associated With Influenza Vaccine Uptake in Young Children

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