Communication skill for pharmacists pdf free download

Massive hemoptysis C. Neurologic disorder 1. Intracranial hemorrhage 2. Meningitis with altered mental status or respiratory compromise 3. Central nervous system or neuromuscular disorders with deteriorating neurologic or pulmonary function 4.

Status epilepticus 5. Severe head injured patients 70Prof. Drug Ingestion and Drug Overdose 1. Hemodynamically unstable drug ingestion 2. Drug ingestion with significantly altered mental status with inadequate airway protection 3. Seizures following drug ingestion E.

Gastrointestinal Disorders 1. Life threatening gastrointestinal bleeding including hypotension, angina, continued bleeding, or with comorbid conditions 2. Hepatic failure 3. Severe pancreatitis 71Prof. Endocrine 1. Diabetic ketoacidosis complicated by hemodynamic instability, altered mental status, respiratory insufficiency, or severe acidosis 2.

Severe hypercalcemia with altered mental status, requiring hemodynamic monitoring 3. Hypo or hypernatremia with seizures, altered mental status 4. Hypo or hypermagnesemia with hemodynamic compromise or dysrhythmias 5. Hypo or hyperkalemia with dysrhythmias or muscular weakness 6. Hypophosphatemia with muscular weakness 72Prof. Surgical 1. Miscellaneous 1. Septic shock with hemodynamic instability 2.

Hemodynamic monitoring 3. Usually, these treatments include ventilator support, continuous vasoactive drug infusions. Examples include patients with chronic comorbid conditions who develop acute severe medical or surgical illness. Examples include patients with metastatic malignancy complicated by infection, cardiac tamponade, or airway obstruction. Priority 4: These are patients who are generally not appropriate for ICU admission.

Admission of these patients should be on an individual basis, under unusual circumstances and at the discretion of the ICU Director. These patients can be placed in the following categories: 77Prof. Diagnosis Model This model uses specific conditions or diseases to determine appropriateness of ICU admission. He or she communicates with other members of the team on a daily basis.

They not only help to provide, but also coordinate most aspects of care delivery. They have received specialized training in caring for critically ill patients. They set up, monitor and maintain the breathing machines mechanical ventilators , and they adjust these machines minute by minute and hour by hour to best meet the patient's needs.

Pharmacists also help to decrease medication side effects and provide valuable information to the team members. They can help to assess and determine what resources patients and families might be lacking, providing them with information on agencies to assist with various needs and generally assisting with other family difficulties.

Douglass, PharmD , Michael J. Supplements , October Immunization Guide for Pharmacists,. Accreditation Council for Pharmacy Education. February 2, Accessed July 27, American Pharmacists Association. Updated January Policy vaccine administration. September 4, Accessed August Accessed August 30, Also, team leaders need to be as honest as they can because people tend to be very sensitive from the reaction which they can see, hear, and feel.

In this way, proper remuneration which can make people motivated should be considered significantly to stimulate needs to change by promotion, recognition, bonuses, and benefit packages. Besides, regulations or further educations should be made for those who are opposed to standing in the way of change to increase the level of dedication. We all know that people have a different taste and perspective. So, leaders should maintain a strong leadership to control their team-members with warm-hearted mind-set, which can understand people's emotional part.

Analyzing potential outcomes through changes is most essential when pursing changes unless you want to face a high risk of changes. In addition, Change Management should be led by a leader. In this case, the value- focused leadership is very significant because the core of Change Management is based on change leaders, and the professionalization of Change Management is a leadership. Without these, the globalization would fail at the very starting point. Over 20 percent of parish residents live in poverty.

The hospital's need to develop a charity care policy became apparent in The letter explained that under certain circumstances, hospitals are able to classify uncollected service fees from Medicare recipients as "Medicare bad debt. After some political and financial analysis, it became clear that adopting and implementing a charity care policy would be advantageous to both the hospital and its patients.

Hospital revenue would increase because Medicare would be paying the deductibles and co-pays for indigent Medicare patients. Residents of the community who applied for charity care would not be turned over to collection agencies for failure to pay their hospital bills.

It seemed like a no-lose proposition. The development of the charity care policy moved quickly. The development of the policy was top-down in nature, as no consideration was given to or input taken from frontline staff. Because the CEO personally met with the frontline implementers and discussed the advantages of the policy, there seemed to be a clear understanding of what was needed for effective implementation.

Within weeks, a policy was developed that met the requirements of the CMS and the Hospital Board of Commissioners, as well as the needs of patients. Admissions personnel were assigned responsibility for informing patients about the charity policy and providing them with the assistance necessary to complete the application.

The business office manager and billing staff have personal contact with customers who are trying to use the policy to pay their bills. The CEO and CFO met with the directors of both the admissions and business offices to explain the intent of the policy.

The CEO expected that customers who knew they could not afford to pay their hospital bills would quickly discover the policy and take advantage of it — but that did not happen. Over the next four months, only one person applied for charity care. On the surface, it made little sense. The application form was simple.

Assistance in completing the form was readily available, but still, patients were not applying for free care. The CEO imagined that the new policy met the conditions described by these theorists and so would move forward quickly. The new policy required very little change in process for the staff. The policy was not ambiguous, and there seemed to be no conflict present; everyone agreed with the policy.

Given these factors, with little resistance and few hindrances to policy implementation, no ongoing mechanism was established to monitor the number of people applying for charity care.

With few applications being completed, the CEO began to question frontline implementers and customers about the application process. Initially, he had thought the staff were all in agreement with the new policy and that patients in need would apply in order to avoid being turned over to a collection agency; however, his interviews with the staff and patients uncovered new information.

The CEO had not considered the addition of the charity policy much of a change in the operations of the admissions office. However, employees in the admissions office considered it a major change. When employees were polled, some of the reasons offered for the low number of applications included the following: "I never think to tell people about the policy.

Most customers questioned had these comments: "I did not know about the charity care policy. The clerks in admissions thought the new policy significantly increased their workload.

Patients required more information about the existence of the charity care policy than the hospital was supplying. Customers needed financial counseling to understand the value of applying for charity care and assistance in completing the application.

The individual psychology of hospital employees influenced how they performed their roles in the implementation process. Conclusions The case study points to four lessons that can lead to successful implementation of a new policy, such as the charity care policy in a rural Louisiana hospital. The first lesson learned is that executives should take note of the need to plan the implementation process well in advance of the actual implementation.

In this case, no specific implementation plan was developed to educate and gain the support of frontline managers in implementing the new policy. The second lesson learned is the importance of accountability.

In this case, no process was put in place to monitor the outputs of frontline workers during policy implementation. The third lesson demonstrates the importance of appointing a leader and a sympathetic champion of the policy.

At West Feliciana Parish Hospital, no one had specific responsibility for ensuring that the policy was implemented successfully. The fourth lesson from the case study is the importance of not only working closely with the front line before implementation and during the early days of implementation but also continuing this close working relationship after the new policy has been implemented.

After further investigation, it became clear that the frontline workers neither fully understood nor agreed with the new policy. Their understanding and support had simply been taken for granted. This is a major lesson of the case. Based on their experience in implementing the charity care policy, the hospital CEO and his planning staff designed a new implementation plan that set new goals and described how they would be accomplished.

Outputs were clearly defined and measurable. Admissions clerks would now be held accountable for the actual education and assistance of consumers as measured by survey tools. Policy implementation is a process that occurs over time. Armed with knowledge about what is working and what is not working, implementers can move forward and modify the implementation process so that policies achieve their objectives.

This was a taxonomy project that we consider a failure. It was for a large organisation that specialises in designing and building new technology and equipment. They are highly innovation focused, they employ scientists and engineers in a wide range of very specialised fields and the work the entire knowledge value chain from basic research to the prototyping of equipment.

They had already purchased a large document management system and a very sophisticated enterprise search engine. Then they had discovered belatedly that these systems would not organise their contents for them and that they needed to do some taxonomy work. We were called in to help, with a very tight development timeline because the roll-out of the new system was already scheduled for some two months down the line.

Additionally, much of the work of this organisation is secret. We would not get clearance to work with their primary material to help derive the taxonomy. They wanted us to train and guide their KM champions in the evidence gathering and taxonomy construction techniques. We'd design the framework, make our recommendations, do the training and leave them to it. The taxonomy was, of course, doomed.

The belated realisation that significant taxonomy work needed to be done while in the middle of the system implementation, the scope, scale and complexity of the exercise, and a poor understanding of the purpose, all conspired to bring it down.

Meanwhile, the system implementation was delayed because of integration difficulties, the project sponsor was changed and there was a long period of simply coping in a vacuum. After we had left them, the decision was taken to roll out the system without a taxonomy; when this created difficulty in persuading staff to migrate work to the new system, the project team decided that they needed to address their taxonomy again.

Our failure here was not communicating clearly to our client, but partly this failure was a function of the organisation trying to move too quickly from what is essentially a mixed Level I and II technology environment to a primarily Level III environment. We took two key lessons from this failure: 1 don't take on impossible projects, because even valiant efforts do not absolve you of blame for failure; 2 don't encourage organisations to move too quickly, even when they are determined that they should.

Radical changes in their environments simply will not take hold. Conclusion This chapter does not aim to describe Management Innovation Programs, but to analyze how any modern enterprise develops their programs and strategies based on the arising issue, Change Management.

Change Management is critical that each organization member works collaboratively and maximizes their capacity under the control of Change leaders. Also, the effective leader who can lead people to the right phase of ongoing changes is indispensable. In future chapters, you will learn key elements of Change Management, methods of good implementation of Change Management, and further ideas to consider.

You will learn about the history of Change Management, which will discuss how the theory of Change Management was developed and where current theory is at. You will learn about the contemporary models in change management and how each of them varies from each other. The pros and cons of using one model over the other as well as various factors that should be considered while choosing a particular model are covered.

You will learn the factors that determine the readiness of an organization to incorporate change. Cultural changes can be subdivided into internal and external forces of organizational change. The perception of change within an organization emphasizes on the importance of belief in the change process and change management models.

You will explore the importance of mission and value statements to organizations and how it develops a clear vision and roadmap for an organization. The importance of communication in organizational change and the objectives of implementing a communication strategy are also discussed.

Risk management includes identification, analysis and assessment of risk, which includes measuring the impact and probability of risk. Practice runs involve going through the steps of implementation of the change. This results in finding the weak points in the process and helps in clarifying vague details. Contingency plans are backup plans that are implemented if the process does not go according to the initial plan and may result in crisis.

Support for process is an activity that can help the implementation team by supporting the employees, customers, and processes. Finally, it is important to realize how people are affected by any change policies that the company implements. Then we discuss, the role played by managers in helping employees cope with the stress. And, finally we discuss the different types of resistance to change a manager has to deal with.

References [1]. Jiju Antony. Pros and cons of Six Sigma: an academic perspective, onesixsigma. Jack Welch. Ernest Madara. Adel M. John P. Kirschner, P. Introduction 1. Chapter outline In this chapter, you will learn about the evolution of change management. Three significant areas of change management with case studies are first discussed. Then the chapter focuses on the history of change management. Relevant concepts are discussed with industry examples like military, government, and health care.

Towards the end of the chapter, the authors talk about the various lessons learned in this field. In order to understand change management, this chapter will provide an overview of its history by considering all predominant fields of thought in the discipline and how they converged into what is known today as change management.

Various fields of thought exist on change management but the consensus seems to be that change management refers to three significant areas — engineering a process in systems engineering , organization and people an organized approach to change in human beings, teams, groups, organizations and societies. Engineers focus on the former while psychologists focus on the human aspect of change. Keller, Piu Mitra, Prajakta S. Chapter outline a. History of change management b. Industry examples c.

Successes and failures B. Three significant areas in change management 1. Engineering 2. Organizational 3. People C. The early fields of thought in change management 1.

Frederick Winslow Taylor - 2. Kurt Lewin - 3. ADKAR 6. John Paul Kotter Present D. The convergence of said fields of thoughts E. Industry examples 1. Healthcare F. Lessons learned from change management implementation G. Introduction 2. Even countries that lag in technology fall further behind, as industrialized nations with financial resources and a trained scientific work force exploit new knowledge and technologies more quickly and intensively.

Implementing technologically advanced systems requires effective management. And for an organization to advance and prosper, updating those systems as new technologies are available becomes a norm. Why is it hard Managing technology change in an organization is hard.

This is because of a number of reasons. Firstly, organizations approach technology decision making in both rational and irrational ways. There may be a comprehensive and focused planning process to select new technologies to meet feasible and known business needs and goals.

Alternatively, a decision to adopt new equipment and technology may be driven solely by glamour of technology, external competition or internal political factors. Secondly, often decisions for technological change are made by top management excluding the key people who have valuable knowledge that can improve performance outcomes.

As a result, this change does not bring in the results as desired and at the same time incur additional cost for the organization. Thirdly, even if a change in technology has been successfully implemented, not enough resources are spent for training programs necessary to adapt the technology. Consequently, employees who interact with the new technology find it difficult to cope and this increases resentment.

Lastly, employees who are accustomed to doing their job using a particular technology often resist the change to a new technology. They fear whether their skills will be suitable for the changed circumstances and also whether their jobs will be secure. They chose the equipments based on their experience at a conference which both attended. Their plan was that the new laptops and mobile carts would meet the need for an additional computer laboratory and more than one class can have computer access at the same time.

Problem - This well-intentioned but top-down decision turned out to be quite disastrous and unproductive. The laptops were purchased without wireless cards and attaching wires to each of the machine generated tripping hazards. The machines lacked floppy disk drives and as a result students needed to save their work to the network rather than to disk.

This prevented them from doing additional work on class assignments and projects at home. The resolution of the laptop screens were poor and the Learning school authority received numerous complaints from students about frequent breakdowns of the newly purchased equipment.

This incident also had a long time effect — students were fast losing confidence in computers. Many teachers complained that a second computer laboratory would have been more beneficial and they quietly protested against the decision by staying away deliberately from the laptops. Later, the school authority decided to add wireless cards in the laptops and this increased the budget assigned for the purpose.

Breakdowns continued to occur and were costly to afford after the warranty period was over. Analysis - The decision to buy the laptops was made in haste. A decision supported by the committee would have been more fruitful and hassle-free.

Most importantly, teachers and students were not included in the decision and as a result the equipment did not meet their needs as desired. Training of using the new equipment was not taken into consideration, therefore, teacher and student would easily lose confidence and reluctant to use it when breakdown occurs.

As the machine breakdown occurs so frequently, contractors should be contacted as soon as possible to solve the problems or replace the laptops within the warranty period. How to efficiently implement and manage change of technology A prescriptive model for successful adoption of technological change is proposed by Haddad in the book Managing Technological Change - a strategic partnership approach.

The model comprises of various steps that are explained below. Identify business strategy and goals — The first step in the technology adoption process is to identify business strategy and goals of the organization. Data from the SWOT analysis are reviewed to find information about challenges and opportunities the organization has met, its strength and weaknesses, its market position and potential threats from rivals.

The strategic directions developed in this stage acts as a guiding reference to all future decisions. They also become the basis against which technology success will be measured in the evaluation stage. Assessment of need — A multidimensional assessment of whether a technology change is required to help the organization meet its business goals is dome in this step.

It starts with a complete analysis of the existing technology and its drawbacks. Technology planning — After deciding and coming to a consensus that a new technology is required, the committee decides in this stage whether to build or buy the new technology.

Suggestions are invited from the employees who would be using the new technology about design specifications. Implementation and training plans are also developed in this stage. System design — In this step, technological specifications are determined and the vendor is selected if technology is purchased instead of developing internally. One of the crucial aspects during this step is to negotiate with the vendor about items like software debugging, ongoing maintenance and providing training to the employees who will be using the system.

Implementation — In this stage, the new technology is implemented. This may occur in one or more pilot departments or across the entire organization all at once. The advantage for the former is that it gives the change for debugging before the full-scale implementation. Training sessions are held during this stage to employees before they start using the system fully. Evaluation —Evaluation is the final phase of the technology adoption process. The success of technology change is determined by measuring the performance against the goals and objectives that the new technology is expected to meet.

If the objectives are quantifiable, it is easy to find out whether the purpose has been met. However, not every objective can be quantified but comparing the outcomes to those of previous technology can give a sense of success or failure.

Case Study — Good Health Haddad, , pg. After receiving quite a number of complaints from employees about manual claims processing, Good Health executives planned to upgrade its dental claims processing system.

Action - First the list of complaints received from employees was reviewed. The employees most complained about two things - the amount of paper work they were responsible for and the lack of a claims tracking system.

They were also dissatisfied with the fact that the mainframe computer system used for processing claims lacked the capacity of allowing processors to access the provider database or printing labels for outgoing mails. The departmental manager and the quality supervisor decided to migrate to a personal computer PC system since they felt it would improve workflow, efficiency, speed and accuracy of the claim processing service.

The employees recommended three vital needs — an ability to track claims, include patient dental history in the system and general modernization of the claims processing system. Resolution - The dental claims department started working with the information system IS department to custom develop a PC-based claims processing system taking into account the recommendations of the employees.

If the IS team was unable to implement any of the proposals, they offered an explanation and offered an alternative solution. As a result of this whole initiative, the newly designed system offered various functionalities like scanning, batching, labeling, indexing capabilities and ability to track claims. Upper management was happy with this change and its successful implementation. The steering committee was also responsible for encouraging a bottom-up communication system so that the voices and ideas of the employees could easily reach the upper management.

Organizational Change What is organizational change The concept of organizational change typically means a change that affects the whole organization.

This does not represent small changes like adding a new manager or modifying a program but rather a massive transformation like change in the mission statement, restructuring the operations or adding a new technology that would affect majority of the employees of the organization. What provokes organizational change Change should not be done just for the sake of change.

It should be done to attain a desired goal. Usually organizational change is provoked by some major external driving force, e. But sometimes, organizational change can also be initiated due to some internal reasons, like change in the vision of the organization or the urge to change for accomplishing a good position in the market.

Why is organization-wide change difficult to accomplish Carrying out an organization-wide change is not easy. There are numerous reasons why such an initiate can fail. Ineffective change sponsorship from senior leaders — Effective and efficient leadership can mobilize and activate the change process creating enthusiasm and earning support from other comrades.

On the other hand, ineffective and poor sponsorship can delay progress and create confusion. Absence of an active and efficient sponsor for the change process is often misinterpreted by the employees. They feel that the change is not important. Resistance to the change from employees — It is a natural instinct of most human beings to resist change. Whenever the news about change is communicated, they think about how they fit into that change and whether their skills will be suitable to survive in that environment.

Poor support and alignment with middle management — In some cases middle level management can become the biggest hurdle in times of change. This resistance sometimes spreads over the entire organization like a virus affecting the good will and understanding among the blue collar and white collar staff. Lack of change management resources and planning — Without proper planning and availability of resources any process of a large scale, like organization-wide change, is doomed to fail.

Lack of resources and knowledge will affect in the planning and implementation of the change. Similarly, inadequate planning will not take into account all the aspects of change and the risks associated with it. As a result change management will not be holistic and unsuccessful to attain the desired state. How organizational changes can effectively be managed Most organizational change management models used today are in the form of a process or steps which have been developed based on experiences of experts in this field.

As a result, following the activities blindly without understanding why they are done would lead to failures in most cases. Based on the specific change and the particular organization that is being changed, one has to modify or tailor his approach.

As a change initiator, the guiding principles of organizational change are vital for understanding both why and how to use change management and they can give a guidance in attaining the desired state.

Often senders and receivers are not in the same line of communication at the onset of change. As a result confusion, resentment and resistance increase which disrupts and hurts the change process. Typically immediate supervisors and company executives are likely to be the key senders in such situations. Sometimes it so happen that the employees hear the whole message but take in only part of it that applies to their personal situation. This can also be dangerous for the success of the change process.

To avoid this, managers should not only convey what they have to say but also listen to employees to understand how the communicated message has been received at the other end.

Targeting can be accomplished by manipulating language, visuals, music, or choice of behavior topic that make the message more interesting, relevant, or appealing to specific subgroups. The characters and the situations in stories serve as a model for emulation and learning. Personal stories, case studies, anecdotes, testimonials, and experiential sharing e.

Messages that emphasize the positive consequences of compliance are referred to as a positive gain frame , whereas a version that stresses the negative consequence of noncompliance is called a negative loss frame.

Studies should explicitly state that the stimuli differed in terms of a gain or loss frame. Enhance your health! A multicomponent approach uses several communication techniques in concurrent combination or in sequence to increase the comprehension and understanding of evidence.

Dissemination KQ 2 : Active dissemination strategies involve active efforts to spread evidence-based information via specific strategies and channels. Table 6. Included dissemination strategies KQ 2 Dissemination Potential Approaches Improve reach of evidence: Distributing evidence widely to many audiences and across many settings increases the reach of information Any information delivered via a human carrier employed by a government-run postal service to a new destination or a for-profit mail delivery service like Fed Ex or United Parcel Service.

Any information delivered via TV, radio, print newspapers, print magazines, or billboards. Motivate recipients to use and apply evidence: Increasing interest in the evidence Champions aka a cheerleader , such as someone who takes ownership of the evidence and visibly promotes it within his or her own organization or across other settings. Champions help overcome social and political pressures imposed by an organization, role model personal commitment to the program, and involve others in its use.

They may or may not actually participate in the work and do not necessarily have any relationship with the organization to which evidence is to be disseminated.

They could endorse the intervention, have a role in its development, or advise on strategies. The idea here is that an opinion leader is endorsing the idea being disseminated.

For example, an opinion leader might be the chief executive officer of a company or the head of a department, or an external expert in a particular field applicable to the evidence, or a well-recognized figure like the Surgeon General of the United States Social networks, such as a network of individuals who are friends, colleagues, or know each other.

This might include tracking sheets to be given to patients and risk calculators to be used by clinicians. It might also include tailored toolkits that explain implementation of evidence in specific settings. Supporting materials do not include brochures, counseling resources, or resources that originate from the practice.

They must originate from the evidence developer and be given to the end-user. Skill training, capacity building, and problem solving including training in any skill that would allow appropriate use of evidence to overcome barriers ; might include training in recognizing the quality of evidence or the circumstances under which it can be reasonably used; and also includes training in various counseling techniques that would facilitate evidence implementation and interactive seminars.

Table 7. Included components of uncertainty in an entire body of evidence and study-specific uncertainty KQ 3 Component Description Sources: Owens et al. Overall strength of evidence The strength of the evidence represents the degree of confidence that the estimates of effects underlying evidence are correct and is used to provide a comprehensive evaluation of the evidence and an assessment of whether additional evidence might change conclusions.

Strength of evidence requires a value judgment based on the risk of bias, consistency, precision, and directness of evidence see definitions below.

Risk of bias The risk of bias is the degree to which individual studies are protected from systematic errors or bias. Biases may result from study design, study conduct, or confounding by other external variables. Consistency The consistency of a body of evidence reflects the degree to which studies present similar findings—in both direction and magnitude of effect. Evidence lacking consistency includes studies with greatly differing or conflicting effect estimates.

Lack of consistency is when studies suggest different effect sizes have a different sign or completely different i. Precision Precision reflects the degree of random error surrounding an effect estimate with respect to a given outcome; such studies express dispersion around a point estimate of risk, such as a confidence interval, which indicates the reproducibility of the estimate. Directness Directness is the degree to which the evidence links the interventions directly to the question of interest.

For instance, evidence on the benefits of screening is often not directly available i. Therefore, recommendations about screening are derived indirectly from evidence that a preclinical disease can be detected and that there is benefit in treating that same disease once symptomatic.

Net benefit Net benefit describes the balance or trade-offs in benefits and harms for prevention or treatment services. Net benefit is based on a judgment call by policymakers. Overall there may be net benefit, clinical equipoise benefit that is too close to call at the population level , or net harm. Applicability Applicability reflects whether an intervention is expected to have the same effect in the population in which it will be used as compared with the effect in the population in which it was studied.

Table 8. Data Abstraction and Data Management For studies that meet inclusion criteria, we will abstract relevant information into evidence tables. Table 9. Data Synthesis Data synthesis and analysis is a core step in developing a systematic review. Table Definitions of the grades of overall strength of evidence Grade Definition Source: Owens et al. Further research is very unlikely to change our confidence in the estimate of effect.

Moderate Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of the effect and may change the estimate. Low Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of the effect and is likely to change the estimate. Insufficient Evidence either is unavailable or does not permit estimation of an effect.

Assessing Applicability We will assess the applicability both of individual studies and of the body of evidence for specific KQs. Examples include the following: Population: narrow eligibility criteria, Outcomes: use of composite outcomes that mix outcomes of different significance to patients, Settings: restrictions to certain types of health care institutions when services might be rendered in many different locales or venues, and Timing: studies of different duration that may have various implications for applicability.

References Agency for Healthcare Research and Quality. Rockville, MD: U. Department of Health and Human Services; Accessed March 29, Institute of Medicine. Initial priorities for comparative effectiveness research. Available at www. Accessed April 5, Lomas J. Diffusion, dissemination, and implementation: who should do what? PMID: National Institutes of Health. NIH Conference.

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