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PubMed2000

Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: results of a randomized, controlled study.

OBJECTIVE: The National Cancer Institute (NCI) developed a manual to guide primary care practices in structuring their office environment and routine visits so as to enhance nutrition screening, advice/referral, and follow-up for cancer prevention. The adoption of the manual's recommendations by primary care practices was evaluated by examining two strategies: physician training on how to implement the manual's recommendations versus simple mailing of the manual. This article reports on the results of a randomized controlled trial to evaluate the effectiveness of these two strategies. DESIGN: A three-arm, randomized, controlled study. SETTING: Free-standing primary care physician practices in Pennsylvania and New Jersey. INTERVENTION: Each study practice was randomly assigned to one of three groups. The training group practices were invited to send one member from their practice of their choosing to a 3-hour "train-a-trainer" workshop, the manual-only-group practices were mailed the nutrition manual, and the control group practices received no intervention. For training group practices, training was provided in the four major components of the nutrition manual: how to organize the office environment to support cancer prevention nutrition-related activities; how to screen patient adherence to the NCI dietary guidelines; how to provide dietary advice/referral; and how to implement a patient follow-up system to support patients in making changes in their nutrition-related behaviors. MEASUREMENTS: The primary outcomes of the study were derived from two evaluation instruments. The observation instrument documented the tools and procedures recommended by the nutrition manual and adopted in patient charts and the office environment. The in-person structured interview evaluated the physician and staff's self-reported nutrition-related activities reflecting the nutrition manual's recommendations. Data from these two instruments were used to construct four adherence scores corresponding to the areas: office organization, nutrition screening, nutrition advice/referral, and patient follow-up. MAIN RESULTS: The adoption of the manual's recommendations was highest among the practices in the training group as reflected by their higher adherence scores. They organized their office ( P =.005) and screened their patients regarding their eating habits ( P =.046) significantly more closely to the recommendations of the nutrition manual than practices in the manual-only group. However, despite being the highest in compliance, the training group practices were only 54.9% adherent to the manual's recommendations regarding nutrition advice/referral, and 28.5% adherent to its recommendations on office organization, 23.5% adherent to its recommendations on nutrition screening, and 14.6% adherent to its patient follow-up recommendations. CONCLUSIONS: Primary care practices exposed to the nutrition manual in a training session adopted more of the manual's recommendations. Specifically, practices invited to training were more likely to perform nutrition screening and to structure their office environment to be conducive to providing nutrition-related services for cancer prevention. The impact of the training was moderate and not statistically significant for nutrition advice/referral or patient follow-up, which are important in achieving long-term dietary changes in patients. The overall low adherence scores to nutrition-related activities demonstrates that there is plenty of room for improvement among the practices in the training group.

Guideline Adherence↗
PubMed1983

Role of contrasuppression in the adoptive transfer of immunity.

The data presented in this paper show that the population of cells that adoptively transfer contact hypersensitivity are Lyt-1+ 2-, I-J- and nonadherent to V. villosa lectin. However, the adoptive transfer of immunity by this population of cells is successful only when the recipient has been treated in such a way as to impair the host immunosuppression mechanism. This population cannot, on its own, transfer immunity to adult, untreated naive recipients unless an additional population of immunoregulatory cells is present. This immunoregulatory population does not itself adoptively transfer immunity. This latter population is differentiated from the immune cells in that they are Lyt-1+ 2-, I-J+ and are adherent to V. villosa lectin. Both populations are required to adoptively transfer immunity to adult untreated naive recipients.

Animals↗
PubMed2003

Teledermatology: the case of adoption and diffusion of telemedicine health Waikato in New Zealand.

Telemedicine emerged as a possible solution to New Zealand health providers in reaching out to rural patients, by offering medical services and conducting administrative meetings and training. However, despite the rapid growth and high visibility of these projects in countries like the United States, relatively few patients are now being seen through telemedicine. Accordingly, this research attempts to investigate telemedicine's effectiveness in New Zealand by using a theoretical framework. Thus, the purpose of this paper is to explain factors influencing the adoption and diffusion of telemedicine utilising the video conferencing technology (TMVC) for dermatology within Health Waikato Ltd. (HW). Findings indicate weak presence of critical assessment into technological innovation prior to adoption. Factors like complexity, compatibility, and trialability were not assessed extensively by HW, and would have hindered its adoption. Teledermatology was mainly assessed according to its relative advantage and cost effectiveness. While essential this should be alongside other factors pertaining to as addressed within this research. On the other hand, the wide diffusion of teledermatology relied on its economical benefit to HW and on its effectiveness as a diagnostic tool. This research highlights the importance of the product champion for the successful adoption and diffusion of teledermatology.

Dermatology↗
PubMed2003

Assessing or predicting adoption of telehealth using the diffusion of innovations theory: a practical example from a rural program in New Mexico.

In New Mexico, a large rural state, it was anticipated that telehealth would bring significant value to health care delivery, improve local capacity for patient care, decrease the need for patient travel, diminish professional isolation, provide an avenue for enhanced professional education and information sharing, increase access to care, and ultimately improve health status. During the course of an evaluation of the University of New Mexico Center for Telehealth's rural telemedicine program, we used a grounded theory approach to assess barriers to the adoption of telemedicine and components of successful adoption. We then turned to the diffusion of innovations theory to better understand the dynamic interactions between the characteristics of telehealth and the social system in which it is applied. In doing so, we learned that the type of innovation decision involved in the adoption of telehealth appears to be particularly important in determining adoption. In this article we demonstrate that diffusion theory can be a useful framework for evaluating telehealth programs. We also suggest that the development of a predictive tool for prospective assessment would be useful, and could be applied when new telehealth programs are being planned.

Delivery of Health Care↗
PubMed1976

Host immune responses after administration of inactivated Venezuelan equine encephalomyelitis virus vaccines. I. Description and characterization of adoptive transfer by immune spleen cells.

Cellular immune responses after immunization with a number of inactivated Venezuelan equine encephalomyelitis (VEE) virus vaccines were evaluated in mice by means of an adoptive transfer system. Formalin-inactivated, TC-83 strain VEE virus vaccine was immunogenic and highly effective in protecting recipient mice against challenge with virulent VEE virus. In contrast to immunization with live TC-83 VEE virus vaccine, however, immunization with inactivated VEE vaccine did not provide donor mice with the capacity to transfer adoptive immunity readily. Only when mice were immunized with inactivated VEE vaccine combined with specific adjuvants (particularly complete Freund's adjuvant or Bordetella pertussis) were donors capable of consistently transferring adoptive immunity. The total dose of inactivated VEE vaccine did not appear to influence the capacity to transfer adoptive immunity. On the other hand, weekly boosters of VEE vaccine and/or administration of vaccine with specific adjuvants did markedly influence donor immune responses.

Animals↗
PubMed1976

Host immune responses after administration of inactivated Venezuelan equine encephalomyelitis virus vaccines. II. Kinetics of neutralizing antibody responses in donors and adoptively immunized recipients.

Lymphoid cell responses to immunization with various formalin-inactivated Venezuelan equine encephalomyelitis (VEE) virus vaccines were monitored in mice by assessment of the development of both the neutralizing antibody response in sera of spleen cell donors and the adoptive neutralizing antibody response induced by spleen cell transfer in recipients. Donors immunized intraperitoneally with formalin-inactivated VEE vaccine (a single dose or a dose on three consecutive days) developed early serum neutralizing antibody responses (larger than or equal to 1:88-1:100) by seven days after immunization. Recipients of spleen cells from such mice were, however, incapable of eliciting a neutralizing antibody response (less than or equal to 1:10). Only spleen cells from donors immunized with inactivated VEE vaccine plus adjuvants (particularly complete Freund's adjuvant and Bordetella pertussis) were consistently capable of producing early, high-titer serum neutralizing antibody responses in adoptively immunized recipients (larger than or equal to 1:50-1:120 on day 4). The magnitude of neutralizing antibody responses of donors to inactivated VEE vaccines did not serve as a useful indicator of whether spleen cells from such mice could adoptively induce antibody responses in recipients. Finally, treatment of immune spleen cells with rabbit antiserum to mouse thymocytes, but not with rabbit antiserum to mouse gamma-globulin or normal rabbit serum, abolished the capacity of such cells to transfer an antibody response adoptively.

Adjuvants, Immunologic↗
PubMed1993

Adoptive immunotherapy of gram-negative sepsis: use of monoclonal antibodies to lipopolysaccharide.

OBJECTIVE: To provide a succinct overview of the scientific rationale for adoptive immunotherapy of Gram-negative sepsis using antibodies directed at epitopes in the core region of the lipopolysaccharide molecule. DATA SOURCES: Relevant, English-language primary and secondary (i.e., review) articles dealing with the structure or toxicity of lipopolysaccharide or adoptive anti-endotoxin immunotherapy in animals or man. STUDY SELECTION AND DATA EXTRACTION: The review emphasizes the findings obtained in several recent multicenter, randomized, prospective trials of monoclonal antibodies to core determinants of lipopolysaccharide. DATA SYNTHESIS: Lipopolysaccharide, a component of the outer cell wall of Gram-negative bacteria, is a complex molecule consisting of three regions: lipid A, core polysaccharide, and O-antigenic side chains. Epitopes in the lipid A and core polysaccharide regions are highly conserved across species and strains of Gram-negative bacteria. Because of the availability of mutant strains of bacteria that synthesize lipopolysaccharides lacking O-specific side chains and, in some instances, portions of the core polysaccharide moiety, investigators have been able to develop polyclonal and monoclonal antibodies to core-region determinants. In experimental animals, many of these antibodies have been shown to protect against the deleterious effects of either purified heterologous lipopolysaccharides or viable heterologous Gram-negative bacteria. Recently, two different monoclonal "anti-core" antibodies (HA-1A and E5) were evaluated in prospective, placebo-controlled, double-blind, randomized trials. In the pivotal trial of HA-1A, a human monoclonal IgM, no treatment effect was discernible when data from all patients enrolled in the study were analyzed. However, in a subset of patients with positive blood cultures for Gram-negative organisms, there was a decrease in all-cause mortality over a 28-day observation period in patients treated with HA-1A, as compared with those patients treated with placebo (p = .014). Interpretation of this finding, however, is confounded because multiple other subsets and end-points also were analyzed, necessitating an adjustment in the p value necessary to reject the null hypothesis. A murine monoclonal IgM called E5 was evaluated in two separate trials. In the first trial, improved survival over a 30-day observation period was observed in a subset of patients with Gram-negative sepsis without refractory shock (p = .01). However, in a second trial of E5, which focused on this subset, a statistically significant improvement in survival was not observed in patients with documented Gram-negative sepsis without shock. CONCLUSIONS: Adoptive immunotherapy using monoclonal anticore antibodies seems to improve survival rate in selected patients with Gram-negative sepsis. Nevertheless, because of concerns about costs and the interpretation of the results from the completed clinical trials, these new agents have generated enormous controversy. The precise role of adoptive immunotherapy against lipopolysaccharide in the practice of critical care medicine in the United States remains unclear.

Animals↗
PubMedDate not supplied

The contingencies of organizational learning in long-term care: factors that affect innovation adoption.

We apply the theoretical frameworks of knowledge transfer and organizational learning, and findings from studies of clinical practice guideline (CPG) implementation in health care, to develop a contingency model of innovation adoption in long-term care (LTC) facilities. Our focus is on a particular type of innovation, CPGs designed to improve the quality of LTC. Our interest in this area is founded on the premise that the ability of LTC organizations to adopt and sustain the use of innovations like CPGs is contingent on the initial capacity these institutions have to learn about them, and on the presence of factors that contribute to capacity building at each stage of innovation adoption. Based on our review of relevant theory, we develop a set of fifteen testable propositions that relate factors operating at the guideline, individual, organizational, and environmental levels in LTC institutions to stages of guideline adoption/transfer. Our model offers insights into the complexities of adopting and sustaining innovations in LTC facilities particularly, in health care organizations specifically, and in service organizations generally.

Diffusion of Innovation↗
PubMed1990

Synergism in work site adoption of employee assistance programs and health promotion activities.

As workplaces increasingly adopt proactive programs directed toward employee health issues, the interrelation between different programs becomes an important issue. Of interest here is the "synergy" in patterns of program adoption between employee assistance programs (EAPs) and health promotion activities (HPAs). We utilize the 1985 National Survey of Worksite Health Promotion Activities (N = 1358) for analyses of the dual presence of EAPs and HPAs, and in multivariate analyses we consider factors affecting such dual presence. The data suggest that synergy occurs, with EAP adoption appearing to influence HPA adoption to a greater extent than the reverse. In multivariate analyses, synergy is confirmed by the finding that, among a variety of relevant organizational characteristics, EAP presence and HPA presence are the best predictors of each other's presence. The analyses also indicate that there is minimal commonality in program ingredients across organizations reporting the presence of HPAs. Implications of the data for the future development of these two programming strategies are discussed.

Cooperative Behavior↗
PubMed2006

Trends in the adoption of medications for alcohol dependence.

Increasing attention is being paid to the development and dissemination of effective pharmacotherapies for the treatment of alcohol and other drug dependence. However, numerous structural and philosophical barriers impede the widespread adoption of these treatment approaches in everyday clinical practice. Research is needed to understand and overcome this gap. Drawing upon data collected from 2 large samples of substance abuse treatment providers at multiple time points, this article examines the prevalence and correlates of the adoption of the currently available pharmacotherapies for alcohol dependence: disulfiram, oral naltrexone, and acamprosate. These data suggest that the proportion of treatment programs using pharmacotherapies for alcohol dependence has been declining over time. In addition, the proportion of patients to whom these medications are prescribed is notably low. The adoption of disulfiram and naltrexone is significantly more likely in programs that are accredited, employ at least 1 physician, offer integrated care for patients with co-occurring psychiatric conditions, derive proportionately more revenue from commercial insurance payers, and have fewer linkages with the criminal justice system. Preliminary data suggest that the early adoption of acamprosate is following a similar pattern. Recommendations for addressing challenges to the diffusion of pharmacotherapies for alcohol dependence are presented.

Acamprosate↗
PubMed2005

Telehealth adoption in hospitals: an organisational perspective.

PURPOSE: The purpose of this study is to explore the influence of hospitals' organisational characteristics on telehealth adoption by health-care centres involved in the extended telehealth network of Quebec (French acronym RQTE) DESIGN/METHODOLOGY/APPROACH: The article is based on a review of the literature and a questionnaire, which was administered via telephone interviews to the 32 hospitals involved in the Extended Telehealth Network of Quebec. Contingency analyses were performed to determine which organisational factors have influenced telehealth adoption. Subsequently, a multiple case study was conducted among nine hospitals representative of different categories of telehealth adopters. In-depth interviews with various actors involved in telehealth activities have permitted a deepening of one's understanding of the impact of clinical and administrative contexts on telehealth adoption. FINDINGS: The results from both the questionnaire and interviews support the observation made by Whitten and Adams in 2003 that telehealth programs are not isolated, but located within larger health organisations. Moreover, health-care organisations are also positioned in a larger geographical, economical and socio-political environment. Therefore, it is important to investigate the context in which telehealth projects are taking place prior to experimentation. ORIGINALITY/VALUE: This study has highlighted the relevance of considering the characteristics and the dynamics of health-care organisations at each stage of telehealth implementation in order to take their specific needs into account.

Attitude of Health Personnel↗
PubMed1992

The occupational hazard of human immunodeficiency virus and hepatitis B virus infection. II. Effect of grade, age, sex and region of employment on perceived risks and preventive measures adopted by anaesthetists.

The effect of grade, age, sex and region of employment on the attitude of anaesthetists to the possible risk of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) infection and the measures adopted to minimise the risk were assessed. As a group, anaesthetists in training were more concerned than consultants about the risk of HIV or HBV infection and, as a consequence, were more likely to adopt protective measures. A similar variation was seen with age, younger anaesthetists being more concerned about the risk of infection and adopting preventive measures in greater numbers than their older colleagues. The sex of the anaesthetist had minimal effect on their attitude. Despite the marked variation in the incidence of both HIV and HBV, the attitude of anaesthetists to the risk of infection and the numbers adopting simple preventive measures did not vary significantly on a regional basis throughout the country. However, there was a significant inter-regional variation in the availability and uptake of HBV immunisation (p < 0.01) and knowledge of the existence of local policy guidelines for the management of known HIV or HBV positive patients (p < 0.01).

Adult↗
PubMed2005

General practitioners' adoption of new drugs and previous prescribing of drugs belonging to the same therapeutic class: a pharmacoepidemiological study.

AIM: To test the hypothesis that general practitioners (GPs) with high prescribing levels of certain drugs will adopt new drugs belonging to the same therapeutic group faster than those with low prescribing levels. METHODS: The adoption of four new drugs: esomeprazol, selective cyclo-oxygenase-2 inhibitors, new triptans, and angiotensin-II receptor blockers were analysed using population-based prescription data. We used the preference proportion (prescriptions for new rather than older alternatives for the same indication) to measure GPs' adoption rate. Annual prescribing volume and prevalence were used to measure previous prescribing of older drug alternatives. We modelled the preference proportion using multiple linear regression analysis and the prescribing of older drugs as independent variables. We controlled for the GPs' general prescribing level and weighted for practice size. In the first three analyses, we dichotomized data using the median, lower and upper quartile as cut-off point. Next, we grouped data into quartiles and finally, we used continuous data. RESULTS: For esomeprazol and new triptans there was a higher preference for new drugs among "high prescribers", but only when this term was defined as the upper quarter and the upper half of previous prescribing levels, respectively (mean difference in preference proportion: 10.2% (99% confidence interval = 1.3%, 19.1%) and 8.2% (0.2%, 16.2%)). For the remaining two drug classes the associations were weak and almost all statistically nonsignificant. CONCLUSION: There is no consistent association between GPs' level of drug prescribing and their adoption of new drugs of the same therapeutic group.

Adult↗
PubMed2004

Outcomes of adoption: measuring evidence uptake by individuals and organizations.

BACKGROUND: The translation and diffusion of findings into health care validate the potential of evidence-based innovation to improve clinical practice and affirm the benefits of society's investment in advancing science. AIMS: This article briefly reviews key concepts in the knowledge use process, considers theoretical implications for measuring outcomes and uptake of innovation, discusses issues to consider in planning for measurement of adoption, and provides an example of confronting those challenges from a project now in progress. THEORETICAL PERSPECTIVES AND TRANSLATION OUTCOMES: Four principal conceptual frameworks related to translational science, Lewin, Rogers, Havelock, and Promoting Action on Research Implementation in Health Services (PARIHS), explicate a process that catalyzes new knowledge adoption and use by individuals and systems to solve problems. Each conceptual perspective suggests that translation is not complete until the extent and impact of use is examined and understood. Most perspectives support evaluation of impact of evidence-based practice using process measures that integrate clinician knowledge, actual performance of the practice, and patient/clinician outcomes. Based on the Agency for Healthcare Research and Quality (AHRQ) framework, additional measures might include changes in patterns of care and changes in policies, procedures, or protocols. CASE EXAMPLE: A description of process and outcome measures used in an in-progress quality improvement demonstration project, California Nursing Outcomes Coalition (CalNOC) Partners in Quality Translating Research into Practice to Reduce Patient Falls Project, is presented. IMPLICATION(S) FOR PRACTICE, RESEARCH, AND POLICY: Since the adoption of evidence-based innovation is a process that is often described along a continuum, investigators seeking to measure the impact of an evidence-based innovation must gather evidence that uptake of the innovation has occurred. The theoretical perspective and practical measurement issues of a given project will drive selection of process and outcome measures. CONCLUSIONS: Efforts to change practice in order to enhance evidence-based patient care must integrate monitoring and evaluation of specific target outcomes of adoption as the basis for validating the impact of the change.

Accidental Falls↗
PubMed2006

Adoption of a ventilator-associated pneumonia clinical practice guideline.

CONCEPTUAL FRAMEWORK: The Academic Center for Evidence-based Practice (ACE) Star Model was used to implement an evidence-based clinical practice guideline (CPG) in order to decrease ventilator-associated pneumonia (VAP) incidence rates and ventilator days. The goal was to interrupt person-to-person transmission of bacteria and bacterial colonization using low-cost, evidence-based strategies to prevent VAP. DISCOVERY: Two geographically proximate medical centers, inclusive of five intensive care units located in the southwestern region of the United States had significant variations in their VAP rates. EVIDENCE SUMMARY: Using the U.S. Preventive Services Task Force grading criteria, the results of 69 studies were used to establish a clinical practice guideline to prevent ventilator-associated pneumonia. TRANSLATION: A clinical practice guideline was developed for the prevention of VAP and included five nursing activities: (a) head-of-bed elevation; (b) oral care; (c) ventilator tubing condensate removal; (d) hand hygiene; and (e) glove use. The effect of the CPG, inclusive of an educational intervention, was measured using an observational, prospective, quasi-experimental design. INTEGRATION: A multidisciplinary education team developed a self-learning packet, educational materials, and storyboards for the staff as dissemination strategies. Strategies also included e-mail, one-on-one teaching with clinicians, and feedback on guideline adoption and VAP rate reports. EVALUATION: Observation data were collected to evaluate adoption of the CPG while caring for 106 ventilated patients. VAP rates changed at both hospitals although the change was not statistically significant. Additionally, the ICU length of stay declined at both facilities, causing cost savings. DISCUSSION: These results support the idea that adoption of evidence-based practices contributes to decreased VAP rates. For a successful program, ICU leaders should emphasize strategies that routinize adoption of evidence-based CPGs.

Adolescent↗
PubMed1983

A national study of fluoride mouthrinse adoption: implications for school health personnel.

The ongoing adoption of school-based fluoride mouthrinse programs in the U.S. has provided the opportunity to study the issues surrounding the adoption and implementation of a health technology by public schools. Findings from a National Study on the Diffusion of Preventive Health Measures to Schools have been selected for analysis with regard to the role of school health personnel in the adoption and delivery of the service. A more visible role for school health personnel as on-site health experts is discussed, as well as the potential ways for increasing their involvement through facilitating initial program adoption, relaying accurate and up-to-date implementation information to decision-makers, developing a constituency for long-term program support and ensuring program accuracy through monitoring and continuing education.

Diffusion of Innovation↗
PubMed1987

The adoption and implementation of the fluoride mouthrinse program: descriptive results from school districts.

Systematic research is needed about the dissemination and use of effective caries prevention measures to establish adoption trends and to examine factors related to desired practice. This paper examines the adoption and implementation of the fluoride mouthrinse program (FMRP) in public school districts. It extends a similar study by Silversin and Coombs in 1979 by reporting telephone interview data from the same sample of school districts. The results indicate that the extent of FMRP adoption has increased since 1979, but that the recent rate of new adopters has slowed considerably. About one-quarter of the districts that had ever offered the FMRP have since discontinued it, most frequently by gradual abandonment. The reported accuracy of school level implementation was assessed in terms of seven required components of the FMRP. Only 57 percent of the sample reported implementing six or seven components correctly, showing at best only moderate accuracy of delivery at the local level.

Attitude to Health↗
PubMed1975

Transfer of adoptive immunity to tuberculosis in mice.

A system is described for studying adoptive immunity to tuberculosis in syngeneic mice. Donor mice were immunized with 10(4) BCG intravenously, and lymphoid cells were harvested 28 days later. Adoptive immunity was measured in recipient mice in terms of the inhibition of growth of BCG in the liver and spleen following intravenous injection. Adoptive immunity was expressed optimally when recipients were sublethally irradiated (500 R), challenged with 10(4) to 10(5) viable organisms, and given sensitized lymphoid cells intravenously. Adoptive immunity was not manifest until 14 days after challenge and was effective against Mycobacterium tuberculosis H37Rv as well as BCG. Immunity could be conferred by spleen, lymph node, peritoneal exudate, and resident peritoneal (washout) cells. The lymphoid cells conferring immunity were shown to be thymus-dependent lymphocytes by virtue of their nonadherence to glass wool and sensitivity to anti-theta serum plus complement. The sensitized cells were relatively susceptible to both in vitro and in vivo X-irradiation.

Animals↗