Open visitation in the NICU:nurses’perspectives on barriers and facilitators

Objective:This study aimed to investigate the nurses’perspectives on open family visitation and its barriers and facilitators in neonatal intensive care units(NICUs).Methods:This is a descriptive,cross-sectional study.A total of 113 nurses employed in 3 main NICUs of Tabriz participated in the study through the census sampling method.Nurses’perspectives on open visitation and its facilitators and barriers were assessed and analyzed using the Beliefs and Attitudes toward Visitation in NICU Questionnaire(BAVNIQ)and descriptive and analytical statistics,respectively.Results:Approximately 74%of the nurses who participating in the study had a moderate perspective on open visitation.From the nurses’viewpoint,“Parents’low awareness of sensitivity and hygienic principles of the NICU”was the first(90.3%)barrier,and the 2 factors,namely,“physical structure of the ward/lack of sufficient space”and“far distance between family’s residence and the hospital/having another child,”were the second(86.8%)barrier with an equal percentage.Among the facilitating factors,“Supporting employed parents during the neonate’s hospitalization”and“providing facilities for family accommodation in the hospital”were the first(82.3%)and the second(79.6%)facilitators,respectively,for open visitation.Conclusions:The majority of NICU nurses had a moderate perspective on the family open visitation.This reluctance seems to be originated mainly from the factors inhibiting open visitation,making its implementation challenging for nurses.The perspective of the frontline staff in caring for vulnerable infants on facilitators and barriers to open visitation may help policymakers,managers,and relevant officials in decision-making and implementing new visiting policies in the NICUs.

Challenges and facilitators for patient and public involvement in England;focus groups with senior nurses

The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations;three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.

An Investigation on the Barriers and Facilitators of the Implementation of Electronic Health Records (EHR)

The application of technology in health care, in the form of electronic health records (EHR), is the most important and necessary issue in order to improve the quality of health care, and studies have shown that, not only is it a way to integrate information and represent the condition of patients, and a dynamic source for health care, however it leads to gain access to clinical information and records, electronic communications, comprehensive training and management, and ultimately enhancing the public health;the aim of this study is to investigate the factors influencing the implementation of EHR, which are known as barriers and facilitators. The research is conducted in the form of a review research, and with the help of the Keywords of EHR;barriers and facilitators, articles, from 2008 to 2013, were searched and studied in the Internet-databases. The results of the studies show that the most effective factors include: efficiency, motivation, management, and the participation of end users. Factors such as technical aspects ease of use, available resources, and human resources, have limited effects. And security and privacy, the expected output, lack of time, and workload have relative effects, and also the relation between the patient and clinical staff, has no effects in the process of implementing EHR.

Facilitators to Immediate Post Partum Intra Uterine Contraceptive Device Uptake among Mothers Delivering in Meru Hospital

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is important to promote uptake of family planning services because it is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. It is also enshrined in health related Sustainable Development Goals. Post Partum Intra Uterine Contraceptive Device (PPIUCD) is the oldest methods of family planning. During the ancient times, foreign bodies like stones were introduced into the woman’s uterus for prevention of pregnancy. Post partum method of contraception is highly recommended because it is long acting, convenient, safe and highly effective with minimal side effects compared to the hormonal methods. Despite these advantages, the method is the lowest in use globally, regionally and locally. According to the Meru Hospital records for the year 2017, the immediate PPIUCD uptake was very low at 3.4%. The broad objective of this study was to assess the factors that facilitate uptake of PPIUCD at Meru Hospital. The study site was post natal ward maternity department of Meru Hospital for a period of two months that is September and October in the year 2018. A descriptive research design was used and the study population was the mothers who were admitted in the ward during the study period. A sample size of 74 respondents was used as the representative to the target population of 289 mothers. Simple random sampling was used to get the sample for the facilitators. Data were collected using structured questionnaires and interview schedules. The data collection instruments were pretested at Embu Level five Hospital and split half reliability test technique used. Validity was ensured through review of literature from similar studies and by consulting supervisors in the department. Permission to conduct the study was sought from National Commission for Science, Technology and Innovation through Chuka University Ethics and Research Committee. Descriptive analysis was done to get percentages using Statistical Package for Social Science (SPSS) for windows version 23.0. Qualitative data were analyzed by grouping data into themes according to the study objectives. The analyzed data were presented in tables, charts and narratives. The findings of the study revealed that;the main client related facilitators to PPIUCD uptake were older age above 30 years, employment, tertiary level of education and knowledge on the method as a result of the providers’ effort to share information. That is 70% of older aged mothers, 60% of the employed and 40% with tertiary education had the insertion. The main provider facilitator to PPIUCD uptake was timely counseling and insertion services. 20% of those who had the insertion said that timely counseling was done during antenatal period. The main method related facilitator to PPIUCD uptake was past experience and preference to alternative methods of contraception. 50% of those who accepted the insertion had previous bad experience and side effects of other alternative methods. Some 30% of users perceived that the method was effective and convenient because once inserted no need for frequent visits to the clinic. The study concluded that clients, providers and method factors facilitated uptake of immediate PPIUCD. The study recommends putting in place strategies to improve the uptake of the method by considering the client, provider and method related facilitators.

Barriers and Suggested Facilitators to the Implementation of Best Practice: An Integrative Review

It is well known that the incorporation of research findings into practice leads to less costs of health care, more personal productivity, longer and healthier lives for patients, and also will decrease pain and suffering of patients. Thus, the aim of this integrative review was to identify the barriers and facilitators of research utilization among the world and the best strategies used to overcome the barriers. A literature search was conducted by viewing relevant studies via computerized searching through EBSCO, Medline, Science Direct, Pub Med, Ovid, and Arabic Journals research databases. The number of reviewed studies was 192 and all of them in English, no studies in Arabic. Only 26 of them were selected based on inclusion criteria. Twenty six studies were included, with most using a cross-sectional survey design. The most identified barriers are lack of time, inadequate facilities and resources to implement new ideas, no enough authority to implement new ideas, lack of administrative support and others, while the most identified suggested that facilitators are improving the scientific knowledge of nurses and support from unit managers. The majority of these studies used Barriers scale which is not a standardized tool. However, there is a big gap between real situation and the identified evidences resulted from researches.

Facilitators and Barriers to Cervical Cancer Screening among Female Undergraduate Students of Makerere University

There is a higher Human Papilloma Virus peak prevalence in younger women (18 - 25 years) of university age. The undergraduate university students are more at a risk of acquiring cervical cancer because they are at the stage of exploring which predisposes them to risky behavior like early sexual intercourse and multiple sexual partners among others. This creates a need for cervical cancer screening in the population. The facilitators and barriers to cervical cancer screening have been studied in the Ugandan general population but little is known among University students which this study is taking interest. Objective: This study is aimed at determining the facilitators, barriers and background factors associated to cervical cancer screening among female undergraduate students in Makerere University. Methods: Four hundred twenty-two (422) female undergraduate students of Makerere University who fit the eligibility criteria were recruited in this descriptive cross-sectional quantitative study. A self-administered semi structured questionnaire was administered to these participants chosen by convenient sampling. Data collected was analyzed using SPSS version 23 software and logistic regression models was used. Results: Less than a half of (21.1%) of the participants had ever screened for cervical cancer. At multivariate analysis, only year of study and married status were associated to cervical cancer screening with a P-values were of (0.015) and (0.001) with a (1.173 - 4.261) and (1.594 - 6.130) 95% CI respectively. The facilitators agreed upon by participants included: Access to free cervical cancer screening services, adequate knowledge about cervical cancer screening and advice from a friend, family or physician among others. The reported barriers to screening were fear of bad result, low risk perception and fear of embarrassment among others. Conclusions and Recommendations: Among the female undergraduate students of Makerere University, only 21.1% had screened for cervical cancer. Therefore, there is a critical need for university based cancer education campaign on cervical cancer and the benefits of screening. Screening services should be integrated into the existing university medical services.

Barriers and facilitators to participating in cardiac rehabilitation and physical activity:A cross-sectional survey

BACKGROUND Cardiovascular diseases(CVD)have been shown to be the greatest cause of death worldwide and rates continue to increase.It is recommended that CVD patients attend cardiac rehabilitation(CR)following a cardiac event to reduce mortality,improve recovery and positively influence behaviour around CVD risk factors.Despite the recognised benefits and international recommendations for exercisebased CR,uptake and attendance remain suboptimal.A greater understanding of CR barriers and facilitators is required,not least to inform service development.Through understanding current cardiac patients’attitudes and opinions around CR and physical activity(PA)could inform patient-led improvements.Moreover,through understanding aspects of CR and PA that participants like/dislike could provide healthcare providers and policy makers with information around what elements to target in the future.AIM To investigate participants’attitudes and opinions around CR and PA.METHODS This study employed a cross-sectional survey design on 567 cardiac patients.Cardiac patients who were referred for standard CR classes at a hospital in the Scottish Highlands,from May 2016 to May 2017 were sampled.As part of a larger survey,the current study analysed the free-text responses to 5 open-ended questions included within the wider survey.Questions were related to the participants’experience of CR,reasons for non-attendance,ideas to increase attendance and their opinions on PA.Qualitative data were analysed using a 6-step,reflexive thematic analysis.RESULTS Two main topic areas were explored:“Cardiac rehabilitation experience”and“physical activity”.Self-efficacy was increased as a result of attending CR due to exercising with similar individuals and the safe environment offered.Barriers ranged from age and health to distance and starting times of the classes which increased travel time and costs.Moreover,responses demonstrated a lack of information and communication around the classes.Respondents highlighted that the provision of more classes and classes being held out with working hours,in addition to a greater variety would increase attendance.In terms of PA,respondents viewed this as different to the CR experience.Responses demonstrated increased freedom when conducting PA with regards to the location,time and type of exercise conducted.CONCLUSION Changes to the structure of CR may prove important in creating long term behaviour change after completing the rehabilitation programme.

Social Networks Design of Hospital Facilitators （HFs）＂ An Empirical Study of the Case of Italy

In this paper, the author provides a representation of Italian public hospital facilitators （HFs） （clinics, regional or local community hospitals, and medical centers） by means of different types of networks. Moving from the balance scorecards of HFs, the author has analyzed the representation of those data through the use of the minimum spanning tree （MST） and the planar maximally-filtered graph （PMFG）. This paper firstly examined the amount of information provided by the two networks and then run a sensitivity analysis of the networks by varying the elements of the balance scorecards to be considered. In this way, the author obtained a quite unusual representation of the overall economic situation of Italian HFs. Moreover, the author observed the emergence of patterns which in the author＇s opinion might help policy makers to realize a more efficient allocation of financial resources among the existing HFs.

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

Objective: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea.Methods: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records.Among 233 acute ischemic stroke patients enrolled in a large-scale study,160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis.Results: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs.625 min.,p =0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs.31.5%,p =0.013).For those who first contacted emergency medical service,the facilitators of emergency medical service use were the presence of hemiparesis (p =0.003),bilateral paralysis (p =0.040),and loss of balance (p =0.021).The predominant barrier was the failure to recognize the urgency of symptoms (p 0.006).Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h.Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier,public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

Creation of a Training Course Program for Cancer-Patient Group Facilitators and Its Effects

Background: The purpose of this study was to clarify the effects of a facilitator training course focused on teaching beginners facilitator intervention skills. Intervention Method: One-and-a-half-day program combining education, role plays and relaxation. Methods: Participants were 11 participants, and of these 8 gave valid responses to our questionnaire. The scores of the participants on a facilitator intervention skills scale and on a scale of facilitator skills to cope with difficult situations were compared before and after the course, using SPSS16 for windows. In addition, the participants’ impressions before and after the course were analyzed qualitatively and inductively. Results: Seven of the 16 items on the facilitator intervention skills scale and 7 of the 12 items on the facilitator skills to cope with difficult situations improved the participants after the facilitator training. All participants indicated that they could understand the lectures. Their impressions changed from anxiety and enthusiasm to pleasure of learning and discovery of specific problems. Conclusion: The results suggested that the educational method created in this study, with emphasis on role-playing, is useful.

Sex-specific facilitation and reproduction of the gynodioecious cushion plant Arenaria polytrichoides on the Himalaya-Hengduan mountains,SW China

When benefiting other beneficiaries,cushion plants may reciprocally receive feedback effects.The feedback effects on different sex morphs,however,remains unclear.In this study,taking the gynodioecious Arenaria polytrichiodes as a model species,we aimed to assess the sex-specific facilitation intensity of cushion plant by measuring the beneficiary cover ratio,and to assess the potential costs in cushion reproductive functions by measuring the flower and fruit cover ratios.The total beneficiary cover ratio was similar between females and hermaphrodites.Females produced much less flowers but more fruits than hermaphrodites.These results suggested that females and hermaphrodites possess similar facilitation intensity,and female cushion A.polytrichoides may allocate more resources saved from pollen production to seed production,while hermaphrodites possibly allocate more resources to pollen production hence reducing seed production.The surface areas covered by beneficiaries produced less flowers and fruits than areas without beneficiaries.In addition,strong negative correlations between beneficiary cover and flower cover were detected for both females and hermaphrodites,but the correlation strength were similar for these two sex morphs.However,the correlation between beneficiary cover and fruit cover was only significantly negative for females,suggesting that beneficiary plants negatively affect fruit reproduction of females while have neutral effects on hermaphrodites.All the results suggest that to facilitate other beneficiaries can induce reproductive costs on cushion A.polytrichoides,with females possibly suffering greater cost than hermaphrodites.Such differentiation in reproductive costs between sex morphs,in long-term perspective,may imply sex imbalance in population dynamics.

No effect of invasive tree species on aboveground biomass increments of oaks and pines in temperate forests

Prunus serotina and Robinia pseudoacacia are the most widespread invasive trees in Central Europe.In addition,according to climate models,decreased growth of many economically and ecologically important native trees will likely be observed in the future.We aimed to assess the impact of these two neophytes,which differ in the biomass range and nitrogen-fixing abilities observed in Central European conditions,on the relative aboveground biomass increments of native oaks Qucrcus robur and Q.petraea and Scots pine Pinus sylvestris.We aimed to increase our understanding of the relationship between facilitation and competition between woody alien species and overstory native trees.We established 72 circular plots(0.05 ha)in two different forest habitat types and stands varying in age in western Poland.We chose plots with different abundances of the studied neophytes to determine how effects scaled along the quantitative invasion gradient.Furthermore,we collected growth cores of the studied native species,and we calculated aboveground biomass increments at the tree and stand levels.Then,we used generalized linear mixed-effects models to assess the impact of invasive species abundances on relative aboveground biomass increments of native tree species.We did not find a biologically or statistically significant impact of invasive R.pseudoacacia or P.serotina on the relative aboveground,biomass increments of native oaks and pines along the quantitative gradient of invader biomass or on the proportion of total stand biomass accounted for by invaders.The neophytes did not act as native tree growth stimulators but also did not compete with them for resources,which would escalate the negative impact of climate change on pines and oaks.The neophytes should not significantly modify the carbon sequestration capacity of the native species.Our work combines elements of the per capita effect of invasion with research on mixed forest management.

Encroachment drives facilitation at alpine shrublines

Ongoing encroachment is driving recent alpine shrubline dynamics globally,but the role of shrub-shrub interactions in shaping shrublines and their relationships with stem density changes remain poorly understood.Here,the size and age of shrubs from 26 Salix shrubline populations along a 900-km latitudinal gradient(30°-38°N)were measured and mapped across the eastern Tibetan Plateau.Point pattern analyses were used to quantify the spatial distribution patterns of juveniles and adults,and to assess spatial associations between them.Mean intensity of univariate and bivariate spatial patterns was related to biotic and abiotic variables.Bivariate mark correlation functions with a quantitative mark(shrub height,basal stem diameter,crown width)were also employed to investigate the spatial relationships between shrub traits of juveniles and adults.Structural equation models were used to explore the relationships among conspecific interactions,patterns,shrub traits and recruitment dynamics under climate change.Most shrublines showed clustered patterns,suggesting the existence of conspecific facilitation.Clustered patterns of juveniles and conspecific interactions(potentially facilitation)tended to intensify with increasing soil moisture stress.Summer warming before 2010 triggered positive effects on population interactions and spatial patterns via increased shrub recruitment.However,summer warming after2010 triggered negative effects on interactions through reduced shrub recruitment.Therefore,shrub recruitment shifts under rapid climate change could impact spatial patterns,alter conspecific interactions and modify the direction and degree of shrublines responses to climate.These changes would have profound implications for the stability of alpine woody ecosystems.

Enhancing CO_(2) transport with plasma-functionalized ionic liquid membranes

The ionic liquid(IL) 1-butyl-3-methylimidazolium tetrafluoroborate treated with radiofrequency plasma is proposed for functionalization and immobilization on polyethersulfone supports to form supported ionic liquid membranes for CO_(2) separation.The effects of treatment time and transmembrane pressure difference on CO_(2) permeance were evaluated.The best gas permeation performance was obtained with a treatment time of 10 min and the transmembrane pressure difference was 0.25 MPa.Characterization of the materials by Fourier transform infrared spectroscopy,x-ray photoelectron spectroscopy and nuclear magnetic resonance spectroscopy demonstrates that the IL is grafted with carboxyl groups and deprotonated through plasma treatment.A preliminary mechanism for the plasma treatment and facilitated transport of CO_(2)has been proposed on this basis.

Functionalized lipid nanoparticles modulate the blood-brain barrier and eliminate α-synuclein to repair dopamine neurons

The challenge in the clinical treatment of Parkinson's disease lies in the lack of disease-modifying therapies that can halt or slow down the progression. Peptide drugs, such as exenatide (Exe), with potential disease-modifying efficacy, have difficulty in crossing the blood-brain barrier (BBB) due to their large molecular weight. Herein, we fabricate multi-functionalized lipid nanoparticles (LNP) Lpc-BoSA/CSO with BBB targeting, permeability-increasing and responsive release functions. Borneol is chemically bonded with stearic acid and, as one of the components of Lpc-BoSA/CSO, is used to increase BBB permeability. Immunofluorescence results of brain tissue of 15-month-old C57BL/6 mice show that Lpc-BoSA/CSO disperses across the BBB into brain parenchyma, and the amount is 4.21 times greater than that of conventional LNP. Motor symptoms of mice in Lpc-BoSA/CSO-Exe group are significantly improved, and the content of dopamine is 1.85 times (substantia nigra compacta) and 1.49 times (striatum) that of PD mice. α-Synuclein expression and Lewy bodies deposition are reduced to 51.85% and 44.72% of PD mice, respectively. Immunohistochemical mechanism studies show AKT expression in Lpc-BoSA/CSO-Exe is 4.23 times that of PD mice and GSK-3β expression is reduced to 18.41%. Lpc-BoSA/CSO-Exe could reduce the production of α-synuclein and Lewy bodies through AKT/GSK-3β pathway, and effectively prevent the progressive deterioration of Parkinson's disease. In summary, Lpc-BoSA/CSO-Exe increases the entry of exenatide into brain and promotes its clinical application for Parkinson's disease therapy.

Interaction of major facilitator superfamily domain containing 2A with the blood-brain barrier

The functional and structural integrity of the blood-brain barrier is crucial in maintaining homeostasis in the brain microenvironment;however,the molecular mechanisms underlying the formation and function of the blood-brain barrier remain poorly understood.The major facilitator superfamily domain containing 2A has been identified as a key regulator of blood-brain barrier function.It plays a critical role in promoting and maintaining the formation and functional stability of the blood-brain barrier,in addition to the transport of lipids,such as docosahexaenoic acid,across the blood-brain barrier.Furthermore,an increasing number of studies have suggested that major facilitator superfamily domain containing 2A is involved in the molecular mechanisms of blood-brain barrier dysfunction in a variety of neurological diseases;however,little is known regarding the mechanisms by which major facilitator superfamily domain containing 2A affects the blood-brain barrier.This paper provides a comprehensive and systematic review of the close relationship between major facilitator superfamily domain containing 2A proteins and the blood-brain barrier,including their basic structures and functions,cross-linking between major facilitator superfamily domain containing 2A and the blood-brain barrier,and the in-depth studies on lipid transport and the regulation of blood-brain barrier permeability.This comprehensive systematic review contributes to an in-depth understanding of the important role of major facilitator superfamily domain containing 2A proteins in maintaining the structure and function of the blood-brain barrier and the research progress to date.This will not only help to elucidate the pathogenesis of neurological diseases,improve the accuracy of laboratory diagnosis,and optimize clinical treatment strategies,but it may also play an important role in prognostic monitoring.In addition,the effects of major facilitator superfamily domain containing 2A on blood-brain barrier leakage in various diseases and the research progress on cross-blood-brain barrier drug delivery are summarized.This review may contribute to the development of new approaches for the treatment of neurological diseases.

Impact of BRICS Trade Facilitation on China's Exports Using Cross-Border E-Commerce

With the rapid growth of the global digital economy, cross-border e-commerce, as an emerging form of trade, has gradually become a powerful engine to promote the development of global trade. BRICS is an important force in the global economy, and the progress of the BRICS countries' trade facilitation level has an important impact on the global trade environment. This paper conducts an in-depth study of the dynamic changes in BRICS trade facilitation from 2013 to 2022, and uses an extended gravity model to analyze the specific impact of this change on China's exports using cross-border e-commerce. The results show that although the BRICS countries have made some progress in trade facilitation, the overall level still needs to be improved, and there are obvious differences among member countries. However, the improvement of trade facilitation among BRICS countries has undoubtedly brought significant positive effects to China's exports using cross-border e-commerce.

Fuel of the Future

Lawmakers call for stepping up hydrogen power production to facilitate China’s clean and low-carbon energy transformation and create a new engine of growth.

The Influence of the Implementation of Trade Facilitation Systems on the Time Required for Creating Delivery Orders: A Case Study of Tema Port

This study evaluated the impact of Ghana’s Integrated Customs Management System (ICUMS), implemented within the National Single Window initiative, on the efficiency of issuing Delivery Orders (DO) at Tema Port. Filling a gap in the existing literature, the research employed a quantitative approach to assess a specific time-related aspect of the cargo clearance process. Employing an Independent t-test on a dataset spanning 2026 Delivery Orders (924 pre-ICUMS and 1102 post-ICUMS) from July 2020 to July 2023, the study investigated ICUMS’s effectiveness in reducing DO issuance time. Results indicate a noteworthy decrease in average DO issuance time, from 11 days pre-implementation to approximately 9 days post-implementation, a reduction validated by statistical analysis through the independent t-test. In light of these findings, the study recommends ongoing refinement of the implementation, reinforcement of trade facilitation measures, and the adoption of best practices from successful global ports. Continuous stakeholder training and regular assessments of ICUMS performance are also endorsed. The study’s implications support the theoretical framework for Single Window systems and carry significant policy implications, emphasizing the need for collaborative efforts to streamline trade facilitation processes driven by Information Technology. Practically, the results serve as a management tool for stakeholders, highlighting areas for targeted interventions to reduce DO issuance times. Methodologically, this research contributes by applying robust statistical analysis to a specific component within the Time Release Study framework, offering a nuanced understanding of trade facilitation systems’ effectiveness in improving cargo clearance processes.

上海市实施整合式慢性病社区健康管理模式的促进和障碍因素

目的分析整合式慢性病社区健康管理模式实施的促进和障碍因素,区分模式服务量高覆盖率组和低覆盖率组在实施性研究的整合性理论框架(consolidated framework for implementation research,CFIR)上的结构差异,为政府部门提供政策建议。方法结合CFIR对22名专家进行半结构化访谈,采用定性结构评级法对13家社区卫生服务中心受访者评分,利用NVivo 12软件编码。结果高覆盖率组和低覆盖率组的相对优势、外部政策与激励、实施准备度、反思和评价、领导个人特质5个CFIR结构有差异。促进因素包括:测量数据更加精准,提高了高血压和糖尿病患者的异常检出率和控制率;模式实现了服务、技术、数据“三整合”,优化管理流程,提供管理抓手;基础性和个性化服务结合吸引患者到基层就诊;模式与我国政策背景,初级卫生保健工作和以患者为中心理念兼容;数字化工具的应用减轻医护人员工作负担;领导重视是基础,利益方间的通力合作是重要保障。障碍因素包括:宏观层面缺少卫生行政机构的支持性政策,组织架构和运行机制尚未建立,建设、投入主体以及具体工作规范和流程有待明确;缺乏监督管理机制和质量评估小组;模式推广目标模糊;缺乏规范化系统性的培训计划;为不同群体提供服务存在挑战,缺乏有效的社会面宣传;模式仍须提高需方获得感;社区布局限制了模式的服务提供。结论卫生行政部门应明确模式的建设、运行、投入主体,完善组织架构并明确各利益方的功能定位和职责分工,进一步制定工作规范和工作流程;建立信息反馈机制和质量控制小组并进行定期评估;制定清晰的目标;加大宣传教育,扩大宣传面;利用数字化工具形成良性医患互动机制。