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PubMed1982

Adoptive transfer of immunity to Nocardia asteroides in nude mice.

Nude mice on a BALB/c background were adoptively transferred with unprimed spleen cells, Nocardia-primed spleen cells, or Nocardia-primed splenic T lymphocytes from syngeneic, heterozygous (nu/+) littermates. Two days later, these recipient mice and unmanipulated (control) nude mice were infected intravenously with a 50% lethal dose of Nocardia asteroides GUH-2 from an early stationary-phase culture. Antibody titers, spleen weights, percent mortality, and organ clearance of the microorganisms were measured at 3 h to 28 days after infection. Adoptively transferred nude mice had larger spleens and greater titers of anti-nocardial antibody 7 to 28 days after infection as compared with control nude mice. Adoptive transfer with either primed spleen cells or primed splenic T lymphocytes enhanced both the survival of recipient nude mice and their ability to eliminate N. asteroides from the liver and spleen. These data indicate that adoptive immunity to infection with N. asteroides can be transferred with either specifically primed spleen cells or splenic T lymphocytes. Thus, it appears that cell-mediated immunity and T lymphocytes are of uppermost importance in host resistance to nocardial infection.

Animals↗
PubMed2006

Psychiatric decision making in the adoption of a new antipsychotic in Germany.

OBJECTIVE: Studies in somatic medicine have demonstrated delays in the implementation of new drugs, but data on psychiatric drugs are scarce. This study examined psychiatrists' adoption of a new antipsychotic. METHODS: A prospective survey of 50 hospital psychiatrists in Germany was conducted three months before and three months after the market introduction of aripiprazole. Psychiatrists' awareness and perceptions of the drug and psychiatrist-related data were obtained before the launching of aripiprazole; actual prescription patterns were recorded afterward. RESULTS: Predictors of major concerns about the credibility of statements related to efficacy or tolerability of the drug were older age and longer work experience of the psychiatrists. Three months after market introduction, 79 percent of the psychiatrists had already prescribed the new antipsychotic. Predictors for early adoption were older age, being responsible for patients with mild mental illness, and having a higher tolerance of uncertainty. CONCLUSIONS: Despite concerns as to the credibility of statements about aripiprazole's efficacy and tolerability, the psychiatrists were found to be early adopters of the new compound. The predictors identified for early adoption show the importance of physician-related factors for the quality of everyday care.

Antipsychotic Agents↗
PubMed1996

Nurses' adoption of a patient-controlled analgesia approach.

The value of a patient-controlled analgesia (PCA) approach has been demonstrated in the literature. A group of nurses responsible for implementing a PCA approach in their agencies reported varying levels of success. It was not known how nurses' values, goals, and experiences influenced their innovation adoption behavior, nor was it understood how an organization's contextual factors affected nurses' adoption of the PCA approach. The purpose of this study was to increase the understanding of the factors that influence nurses' adoption of PCA. A total of 13 coinvestigators responsible for the implementation of PCA in their agencies formed a participatory action research group. A phenomenological approach, using staff nurse focus groups, was chosen by the coinvestigators to gather data from their respective agencies. The concept of innovation adoption provided the framework for the study.

Adolescent↗
PubMed2004

Predictors of vigorous exercise adoption and maintenance over four years in a community sample.

BACKGROUND: Very little is known about the correlates of adoption and maintenance of vigorous exercise. The purpose of this study was to understand the sociodemographic correlates of exercise adoption and maintenance in a community sample. METHODS: 917 women and 229 men completed annual surveys as part of a community-based weight gain prevention trial over four years. Multivariate regressions evaluated predictive factors for maintenance of vigorous exercise over time in regular exercisers, and predictors of adoption of exercise in adults who were sedentary at baseline. RESULTS: Exercise maintenance at Years 2 and 3 was associated with ethnicity and exercise level at baseline, while exercise maintenance at Year 4 was associated with television watching, BMI and exercise at baseline. Exercise level at baseline was associated with exercise initiation at Year 2 and Year 3. Income level, marital status, and smoking status predicted exercise initiation at Year 4. CONCLUSIONS: Predictors of vigorous exercise maintenance were more consistent than predictors of vigorous exercise initiation. Results suggest that those who adopt vigorous exercise are a heterogeneous group and intervention messages could be more broadly focused. These data also suggest that exercise maintenance interventions should continue to target low-income populations with messages regarding smoking, weight and television. Clearly further research is needed to understand the factors that contribute to exercise initiation and maintenance, and to develop effective interventions to improve levels of physical activity levels.

Journal Article↗
PubMed2005

Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption.

Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. The biomedical literature does not yet adequately describe the potential capabilities and utility of PHR systems. In addition, the lack of a proven business case for widespread deployment hinders PHR adoption. In a 2005 working symposium, the American Medical Informatics Association's College of Medical Informatics discussed the issues surrounding personal health record systems and developed recommendations for PHR-promoting activities. Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care. When PHRs are integrated with electronic health record systems, they provide greater benefits than would stand-alone systems for consumers. This paper summarizes the College Symposium discussions on PHR systems and provides definitions, system characteristics, technical architectures, benefits, barriers to adoption, and strategies for increasing adoption.

Attitude to Computers↗
PubMed1989

Recombinant interleukin-2 by continuous infusion and adoptive transfer of recombinant interleukin-2-activated cells in patients with advanced cancer.

Twenty-five patients with disseminated cancer (nine with renal cell carcinoma, five with melanoma, three with Hodgkin's lymphoma and chronic myelocytic leukemia [CML], two with soft tissue sarcoma, one each with large-cell lymphoma, breast cancer, and colon cancer), 13 males and 12 females, aged 25 to 68, were treated with recombinant human interleukin-2 (rIL2) by continuous infusion and adoptive transfer of autologous lymphocytes activated in vitro with IL2. Patients underwent leukapheresis on days 1, 8, 15, and 22 of the treatment. Cells, bulk activated for 20 hours in serum-free culture medium with 1,000 U IL2/mL in transfusion transfer packs as culture vessels, were transfused the following day. The infusion of IL2 by continuous infusion for six days started immediately after each adoptive transfer for 4 weekly courses. The dose of IL2 was escalated weekly in each patient; starting doses of IL2 were also escalated in subsequent cohorts of patients until maximally tolerated doses were reached. Nine patients had objective tumor regressions (three with renal cell cancer, two with Hodgkin's lymphoma, and one each with melanoma, sarcoma, breast, and colon cancer). Six responses were partial, two were minor, and one was mixed. Responding patients were maintained with IL2 by continuous infusion for six days every 6 to 8 weeks, without adoptive cell transfer. The median duration of responses was 16 weeks (3 to 60 + weeks). Tumor regression was related to the dose of IL2 (greater than or equal to 3.4 x 10(6) U/m2/d for six days) and to the in vivo lymphoproliferative effects of the lymphokine, but not to the total number of cells adoptively transferred. Side effects of treatment were transient and quickly reversible. Renal, hepatic dysfunction, and dyspnea were directly related to the dose of IL2 and to lymphocytosis. Other toxicities were mild hypotension with mild fluid retention, oral mucositis, anemia, thrombocytopenia, fever, and fatigue.

Adult↗
PubMed2005

The who, what, and why of risk adjustment: a technology on the cusp of adoption.

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.

Diffusion of Innovation↗
PubMed1995

New drug adoption models: a review and assessment of future needs.

New drug products today are the key to survival in the pharmaceutical industry. However, the new product development process in the pharmaceutical industry also happens to be one of the riskiest and most expensive undertakings because of the huge research and development costs involved. Consequently market forecasting of new pharmaceutical products takes on added importance if the formidable investments are to be recovered. New drug adoption models provide the marketer with a means to assess new product potential. Although several adoption models are available in the marketing literature for assessing potential of common consumer goods, the unique characteristics of the prescription drug market makes it necessary to examine the current state of pharmaceutical innovations. The purpose of this study, therefore, is to: (1) review new drug adoption models in the pharmaceutical literature, (2) evaluate the existing models of new drug adoption using the ten criteria for a good model as prescribed by Zaltman and Wallendorf (1983), and (3) provide an overall assessment and a ¿prescription¿ for better forecasting of new drug products.

Decision Theory↗
PubMed2003

Hospital marketing and the Internet: the adoption of an innovation.

Given the manner in which the Internet permeates today's society, it is easy to forget that the Internet as we know it is only about a decade old. Due to its newness, the Internet has provided an opportunity to view the manner in which marketers move to adopt such an innovation. To that end, since 1995 a series of studies has tracked the adoption and use of the Internet by hospital marketers. In addition to simply investigating the number of hospitals that utilize the Internet in their marketing efforts, the studies have addressed such questions as: How are hospitals using the Internet to market themselves?, What roadblocks have held hospitals back from adopting the Internet as a marketing tool?, and How happy are hospitals with their Internet investment? This manuscript details the most recent in this series of research studies. In addition, the authors compare the results of this study, conducted in the fall of 2002, with the results from the previous studies. As a result, this study provides a unique opportunity to observe the actual adoption of an innovation, the Internet, by hospital marketing professionals.

Costs and Cost Analysis↗
PubMed1997

Adoption of innovative caries-control services in dental practice: a survey of Washington State dentists.

To assess the adoptability of the medical model for caries control, the authors surveyed general dentists about their use of four caries-control services among adult patients: salivary functioning tests, fluoride varnishes, chlorhexidine rinses, and pit-and-fissure sealants. Responses indicated that leaders in the dental community and those with a wider network of professional colleagues were likely to adopt new services more quickly than other dentists. Earlier adopters also had more correct information about these services than later or nonadopters. Overall, the knowledge base of the services studied in this survey was not uniform, making adoption of the medical model for caries control premature.

Adult↗
PubMed2001

Variation in clinician recommendations for multiple injections during adoption of inactivated polio vaccine.

OBJECTIVES: To describe variation in clinician recommendations for multiple injections during the adoption of inactivated poliovirus vaccine (IPV) in 2 large health maintenance organizations (HMOs), and to test the hypothesis that variation in recommendations would be associated with variation in immunization coverage rates. DESIGN: Cross-sectional study based on a survey of clinician practices 1 year after IPV was recommended and computerized immunization data from these clinicians' patients. STUDY SETTINGS: Two large West Coast HMOs: Kaiser Permanente in Northern California and Group Health Cooperative of Puget Sound. OUTCOME MEASURES: Immunization status of 8-month-olds and 24-month-olds cared for by the clinicians during the study. RESULTS: More clinicians at Group Health (82%), where a central guideline was issued, had adopted the IPV/oral poliovirus vaccine (OPV) sequential schedule than at Kaiser (65%), where no central guideline was issued. Clinicians at both HMOs said that if multiple injections fell due at a visit and they elected to defer some vaccines, they would be most likely to defer the hepatitis B vaccine (HBV) for infants (40%). At Kaiser, IPV users were more likely than OPV users to recommend the first HBV at birth (64% vs 28%) or if they did not, to defer the third HBV to 8 months or later (62% vs 39%). In multivariate analyses, patients whose clinicians used IPV were as likely to be fully immunized at 8 months old as those whose clinicians used all OPV. At Kaiser, where there was variability in the maximum number of injections clinicians recommended at infant visits, providers who routinely recommended 3 or 4 injections at a visit had similar immunization coverage rates as those who recommended 1 or 2. At both HMOs, clinicians who strongly recommended all possible injections at a visit had higher immunization coverage rates at 8 months than those who offered parents the choice of deferring some vaccines to a subsequent visit (at Kaiser, odds ratio [OR]: 1.2; 95% confidence interval [CI]: 1.0-1.5; at Group Health, OR: 1.8; 95% CI: 1.1-2.8). CONCLUSIONS: Neither IPV adoption nor the use of multiple injections at infant visits were associated with reductions in immunization coverage. However, at the HMO without centralized immunization guidelines, IPV adoption was associated with changes in the timing of the first and third HBV. Clinical policymakers should continue to monitor practice variation as future vaccines are added to the infant immunization schedule.

Child, Preschool↗
PubMed2003

Adoption of reminder and recall messages for immunizations by pediatricians and public health clinics.

OBJECTIVE: Strong scientific evidence and national recommendations support the use of reminder and recall messages to improve immunization coverage rates, yet reports have suggested that only a minority of pediatric practices use such messages. Our aims were to 1) determine the proportions of pediatric practices and public clinics that currently use practice-based reminder or recall messages and routinely undergo immunization assessment efforts, 2) evaluate barriers and supports to implementing these practices, and 3) identify predictors of either current use or plans for future adoption of these practices. METHODS: This study combined qualitative and quantitative methods in sequential phases. In the qualitative phase, we conducted semistructured, open-ended interviews with a convenience sample of 18 clinician-administrators representing adopters and nonadopters of these messages in both private practices and public health clinics. In the subsequent quantitative phase, we mailed a structured, closed-ended survey to national samples of randomly selected pediatricians (n = 600) and public clinics (n = 600). RESULTS: Response rates were 75% for pediatricians and 77% for public clinics. Among pediatricians, 38% were conducting regular assessments of immunization coverage but only 16% were currently using routine reminder or recall messages. Among public clinics, 85% were conducting regular assessments and 51% were using reminder or recall messages. Among pediatricians' practices, the most commonly reported barriers to the adoption of reminder or recall messages were lack of time and funding and the inability to identify children at specified ages. For pediatricians' practices, the strongest predictors of current use of reminder or recall messages were having a champion who led efforts to improve immunization delivery (odds ratio: 1.85; 95% confidence interval: 1.08-3.18) and current use of regular immunization assessments (odds ratio: 2.30; 95% confidence interval: 1.33-3.84). Likewise, for public health clinics, having a champion to lead immunization improvement efforts and believing that their current system needed improvement was associated with current use of reminder or recall messages. CONCLUSIONS: Reminder and recall messages remain underused by both pediatricians and public health clinics. Promising strategies to promote adoption of these approaches in both the private and the public sectors include identifying and training champions to promote immunization delivery improvement efforts and helping practices develop methods to identify children at specific ages.

Ambulatory Care Facilities↗
PubMed1998

The effects of acquisition cost and budget-based compensation on the attitudes of pharmacy directors toward the adoption of a cost-effective new drug.

To test the effect of differences in acquisition cost and budget-based monetary compensation systems on the intent to support the adoption of a cost-effective new drug, over 350 hospital pharmacy directors were asked to indicate their intentions as to the adoption of a cost-effective new thrombolytic agent, presented at 3 different prices. Although the economic savings for the hypothetical product were constant across all price points tested, respondents exposed to the highest price were more likely to resist the adoption of the new agent than those exposed to lower prices (p < 0.001). Respondents whose compensation was contingent on their control of the drug budget indicated a higher likelihood to resist the adoption of the new agent than did those whose salary was not so determined. These findings indicate that significant hurdles, psychological and organisational, still exist for the acceptance and use of pharmacoeconomic information in the hospital setting.

Decision Making↗
PubMed1984

Adoption and diffusion of a new imaging technology: a magnetic resonance imaging prospective.

Adoption of magnetic resonance imaging (MRI) by individual purchasers and by the health care system will be influenced by many factors. A framework for considering these influences is offered, incorporating them into four major considerations: (1) MRI and its attributes--the technology, its safety and efficacy, and the benefits of acquisition; (2) communication channels--commercial and professional; (3) time for consideration of adoption and experiential testing; and (4) the medical system--including potential acquirers, health planning, and reimbursement. Among these, positive, negative, and variable influences affecting adoption can be identified. Factors that should most strongly motivate early adoption are the potential of the technology for providing new and useful clinical information and the competitive and economic benefits that early acquirers might enjoy. Important discouragements include the possibility of early obsolescence and that MRI represents an economic risk under diagnostic-related-group reimbursement. The less risky approach for most practices is to delay acquisition of MRI pending further experience with the technology and the changing reimbursement climate. Institutions that are primarily interested in the research potential of MRI or that are large enough to sustain the economic risks should consider earlier acquisition.

Health Planning↗
PubMed1994

Effect of socioeconomic factors on bovine somatotropin adoption choices.

Adoption and use of bST by dairy farmers will likely be influenced by socioeconomic factors. This article examines the effects of dairy farmers' socioeconomic characteristics on the probability of adopting bST. Hypotheses that adoption is associated with herd size, specialization, financial status, management skills, educational level, and age of operator were tested. Potential adopters of bST are characterized as being young, having more formal education, having larger herds, and operating with relatively low net worth.

Age Factors↗
PubMedDate not supplied

Diffusion of innovations in schools: a study of adoption and implementation of school-based tobacco prevention curricula.

PURPOSE: The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process. DESIGN: The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions. SETTING: The study was conducted in North Carolina. SUBJECTS: All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample. INTERVENTION: An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted. MEASURES: Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%. RESULTS: Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation. CONCLUSIONS: While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.

Adolescent↗
PubMed1987

Environmental and organizational predictors of adoption of cost containment policies in hospitals.

This study examined predictors of the adoption of cost containment policies in a national sample of 303 not-for-profit hospitals. Analysis of the full sample indicated that adoption of such policies was positively related to response to external regulation, cooperative interorganizational involvement, external orientation, number of beds, occupancy rate, and the influence of chief administrators on governing boards; adoption was negatively related to length of patients' stays. Additional exploratory analysis of the data revealed different combinations of characteristics that were unique to subgroups of hospitals with the lowest and highest levels of policy adoption.

American Hospital Association↗
PubMed1989

Health care technology assessment and adoption: a case study.

Today's progressive hospital and health care system managers look to new ways to retain or augment their market share and to position themselves in their service areas. Since diffusion of new technologies into health care is market driven, informed decisions on the adoption of certain emerging patient care technologies can place a health care organization in a favorable financial position. There is a compelling need for hospital management and the governing board to collaborate with their medical staff on the development of an acceptable process to quickly identify and implement appropriate new technologies into the patient care environment. This joint effort is vital to ensure the integration of sound clinical values and objectives with planned institutional business strategies. Mount Carmel Health, a multifaceted health care corporation in central Ohio, has met the challenge of managing patient needs, physician interests, and limited hospital resources by forming a unique entity within the organization for the effective assessment and adoption of the latest medical technology. The division, which is called the Advanced Treatment and Bionics Institute (ATBI), is charged with assessing the latest clinical technologies and managing a hospital's adoption of the most appropriate ones. It serves to organize and streamline the identification, acquisition, adoption, and implementation of innovative treatment technologies at Mount Carmel hospitals.

Academies and Institutes↗