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PubMed1985

Cancer patients' personality characteristics, physician-patient communication and adoption of the Moerman diet.

Breast cancer patients and patients with Hodgkin's disease (N = 663) were contacted initially by medical specialists at 15 medical centers across The Netherlands and subsequently 498 of them were interviewed in their homes in order to examine interactions between their personality characteristics, their assessment of the adequacy of information feedback from their physicians about their illness, its treatment and prognosis, and their adoption of an unproven diet remedy. The data indicate that patients who believed they had received insufficient and unclear information were more likely to be adopters of the Moerman diet than patients who believed the information was adequate. Personality moderator analyses indicated further that the relationship between information adequacy and diet adoption held specifically for those patients with high trait anxiety, low self-esteem, angry-aggressive coping styles or impulsive attitudes. The discussion focused on rational and irrational elements in physician-patient communications, the strategies available to physicians to improve their communication skills, the desirability of constructing and distributing educational and informational materials for use by patients, and the need for physicians to offer their patients an opportunity for contact with companions in distress.

Adaptation, Psychological↗

PubMed1988

The role of commercial sources in the adoption of a new drug.

The goal of this study was to focus on the adoption process for a specific new drug upon its introduction to the marketplace. The reception of temazepam by doctors was investigated in interviews with 124 specialists and general practitioners. Their response to this new drug at different stages of the adoption process was related to contact with drug information sources and to characteristics of the doctor and practice. Within about 13 months after its release, 71% were familiar with temazepam, 48% had prescribed it, and 27% now preferred it to the alternatives. Contact with the detailman regarding this drug was the most consistent predictor of favourable reception. Results suggest that the adoption of the new drug was related to commercial forces rather than to a doctor's professional involvements.

Adult↗

PubMed1986

Inhibition and augmentation of lymphoma metastasis by adoptively transferred peritoneal macrophages in hamster.

The effect of adoptively transferred peritoneal exudate cells on the metastasis of hamster lymphoma was studied. Metastatic spread occurring after the surgical removal of a primary tumor was considerably inhibited by the adoptive transfer of the peritoneal exudate cells (PEC) stimulated by immunostimulants, using a streptococcal preparation (OK-432) or a purified beta (1-3) glucan (SPG). However, the inhibitory effect on metastasis was abrogated by the in vitro treatment of the peritoneal adherent cells with silica. PEC stimulated with lymphokines in vitro was also effective in inhibiting metastasis. However, the adoptive transfer of peritoneal adherent cells treated in vitro with 12-O-tetradecanoylphorbol acetate (TPA) in vitro, augmented metastatic spread in tumor-bearing hamsters which usually exhibit concomitant immunity. The relation of the state of the functional activity of macrophages to metastasis is discussed.

Animals↗

PubMed1991

rIL-1 alpha enhances adoptive transfer of resistance to Listeria monocytogenes infection.

We have previously demonstrated that administration of recombinant rIL-1 alpha enhances resistance against Listeria monocytogenes infection in mice. In this study we considered the possibility that this cytokine might also augment adoptive immunity conferred by the transfer of listeria-immune spleen cells. Concomitant administration of rIL-1 alpha with large numbers (2 x 10(7) or 10(8)) of listeria-immune spleen cells reduced the protection mediated by the transferred cells. Conversely, rIL-1 alpha co-administered with suboptimal numbers (1-5 x 10(6)) of immune splenocytes augmented anti-listeria resistance in an additive fashion. Although transfer of 10(6) listeria-immune spleen cells alone did not result in significant protection, when 10(6) immune cells were incubated with rIL-1 alpha prior to transfer they conferred significant protection to naive recipients. Time course experiments indicated that the greatest protection was achieved when listeria-immune spleen cells were pretreated with rIL-1 alpha for 2 h prior to adoptive transfer. The protection transferred by 10(6) rIL-1 alpha-pretreated immune spleen cells was not inhibited by TGF beta. This study is the first to use rIL-1 alpha to potentiate the adoptive transfer of resistance to an infectious agent by immune cells.

Animals↗

PubMed2006

Characteristics of U.S. substance abuse treatment facilities adopting buprenorphine in its initial stage of availability.

This study examined the adoption of buprenorphine for the treatment of opiate dependence among U.S. substance abuse treatment facilities and their characteristics at the time of the initial availability of the medication. Data come from a 2003 national survey of all substance abuse treatment facilities in the U.S. Out of our sample of 13,060 facilities, 5.5% of facilities reported they offered buprenorphine. Not unexpectedly, the prevalence was higher in certified opioid treatment programs (11.3%) compared to other facilities (4.6%). For opioid treatment programs, offering Naltrexone (OR=8.34, 95% CI=5.53, 12.58) and offering medically supervised withdrawal (OR=2.76, 95% CI=1.38, 5.52) were independent and robust predictors of offering buprenorphine. These same variables were independent predictors for the non-opioid treatment programs as well (Naltrexone, OR=14.32, 95% CI=7.85, 26.10; and medically supervised withdrawal services, OR=4.42, 95% CI=3.01, 6.49). Our results suggest that the adoption of buprenorphine soon after the Food and Drug Administration approved its use for treatment of opioid dependence and the shipping of the medication commenced was associated with facilities already offering pharmacotherapies such as Naltrexone and medically assisted withdrawal. These findings provide baseline data to track the adoption of buprenorphine by substance abuse treatment programs in future years.

Buprenorphine↗

PubMed2006

Knowledge barriers to PACS adoption and implementation in hospitals.

PURPOSE: Drawing on the classical theory of diffusion of innovations advanced by Rogers [E.M. Rogers, Diffusion of Innovations, 4th ed., Free Press, New York, NY, 1995] and on the theory of barriers to innovation [P. Attewell, Technology diffusion and organizational learning: the case of business computing. Organ. Sci. 3 (1992) 1-19; H. Tanriverdi, C.S. Iacono, Knowledge barriers to diffusion of telemedicine. Proceedings of the 20th International Conference on Information Systems, Charlotte, NC, 1999, pp. 39-50; S. Nambisan, Y.-M. Wang, Roadblocks to web technology adoption? Commun. ACM, 42 (1) (1999) 98-101], this study seeks a better understanding of challenges faced in PACS implementations in hospitals and of the strategies required to ensure their success. METHODS: To attain this objective, we describe and analyze the process used to adopt and implement PACS at two Canadian hospitals. RESULTS: Our findings clearly demonstrate the importance of treating any PACS deployment not simply as a rollout of new technology but as a project that will transform the organization. Proponents of these projects must not lose sight of the fact that, even if technological complexity represents a significant issue, it must not garner all the project team's attention. This situation is even more dangerous, inasmuch as the greatest risk to the implementation often lies elsewhere. It would also appear to be crucial to anticipate and address organizational and behavioral challenges from the very first phase of the innovation process, in order to ensure that all participants will be committed to the project. CONCLUSIONS: In order to maximize the likelihood of PACS success, it appears crucial to adopt a proactive implementation strategy, one that takes into consideration all the technical, economic, organizational, and human factors, and does so from the first phase of the innovation process.

Attitude of Health Personnel↗

PubMed2004

A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system.

Addiction research is challenged to disseminate evidence-based practices into routine clinical settings. The successful adoption of innovation must consider issues of fit, such as the characteristics, readiness, and attitudes of clinicians in the community. We constructed a survey to assess clinical practices and readiness to adopt certain evidence-based practices in addiction treatment programs. The instrument was administered to directors (n = 21) and clinicians (n = 89) from 24 public addiction treatment programs in New Hampshire (USA). Clinicians are more motivated to adopt some evidence-based practices (twelve-step facilitation, cognitive behavioral therapy, motivational interviewing, relapse prevention therapy) than others (contingency management, behavioral couples therapy, pharmacotherapies). Translational strategies for treatment development and research dissemination are discussed.

Adult↗

PubMed2006

A feasibility study on the adoption of e-learning for public health nurse continuing education in Taiwan.

The purpose of this study is to investigate the feasibility of developing e-learning and to examine reasons for adopting or rejecting e-learning as an alternative way to conduct continuing education (CE) for public health nurses (PHNs). A nationwide-based cross-sectional study was conducted with a randomly selected sample of 233 PHNs in Taiwan. A structured questionnaire was used to collect data by mailing methods. The majority of PHNs (88.84%, n=207) showed an affirmative intention towards adopting e-learning as their one way of CE. Reasons for adopting e-learning included achieving life learning, fulfilling personal interests, time-saving, based on job needs, information diversity, flexible in time and space, self-regulatory learning, cost-effectiveness, less impact on family duties and life. Twenty-six PHNs (11.16%) who rejected e-learning as their way of CE indicated main reasons including poor computer competence, lack of personal computer and without internet access, heavy work load, heavy family duties, conflict with personal preference, heavy economic burden, lack of motivation, and low self-control. This study reveals a high feasibility of developing e-learning that coexists with other CE models (e.g. traditional instruction). Reasons analyses provide directions for decreasing barriers for developing a learning model of this new medium for nurses' CE.

Adult↗

PubMed2005

Challenges in the adoption of new pharmacotherapeutics for addiction to alcohol and other drugs.

The adoption of pharmacotherapies for the treatment of alcohol and drug use disorders has progressed slowly despite the approval of new and effective medications. This paper begins with overviews of the prevalence of alcohol and drug abuse and dependence, the costs of addiction to the nation, and the value of treatment services. The role of pharmacotherapy in the treatment of addictive diseases is examined, and factors that affect the adoption and use of medications for alcohol and drug treatment are identified and discussed. Investigations that tested the effectiveness of buprenorphine for treatment of opioid dependence in new settings illustrate physician and counselor training and mentorship strategies that may promote the adoption of medications in the treatment of alcohol and drug use disorders. The paper concludes with a discussion of barriers and ways to surmount the barriers and to foster greater use of medications in alcohol and drug treatment.

Alcoholism↗

PubMed2003

Synergy between publication and promotion: comparing adoption of new evidence in Canada and the United States.

PURPOSE: Few studies have examined the effect of new evidence from clinical trials on physician practice. We took advantage of differences in promotional activity in Canada and the United States for the Heart Outcomes Prevention and Evaluation (HOPE) study and the Randomized Aldactone Evaluation Study (RALES) to determine if publication of new evidence changes practice, and the extent to which promotion influences adoption of new evidence. METHODS: We used longitudinal dispensing data, collected from 1998 to 2001, to examine changes in prescribing patterns for ramipril and other angiotensin-converting enzyme (ACE) inhibitors before and after the HOPE study. We also obtained estimates for promotional expenditures. We stratified analyses by country, to isolate the effect of promotion, and used interrupted time series methods to adjust for pre-existing prescribing trends. Similar analyses were conducted for spironolactone use before and after RALES. RESULTS: Publication of the HOPE study results was associated with rapid increases in the use of ramipril. After adjusting for pre-existing prescribing trends, ramipril prescribing increased by 12% per month (P = 0.001) in Canada versus 5% per month (P = 0.001) in the United States after the study results were presented and published. One year later, ramipril accounted for 30% of the ACE inhibitor market in Canada versus 6% in the United States. The year before publication of these results, expenditures for detailing increased by 20% in Canada (to 18 US dollars per physician) but decreased by 7% in the United States (to 13 US dollars per physician); the year after publication, spending increased to 27 US dollars per physician in Canada versus 23 US dollars per physician in the United States. In the absence of promotional activity for RALES in either country, publication of results was associated with more modest but similar increases of 2% per month (P = 0.001) in spironolactone use in both countries. CONCLUSION: Publication of new evidence is associated with modest changes in practice. Promotional activity appears to increase the adoption of evidence. Rather than relying on the publication of articles and creation of guidelines, those wishing to accelerate the adoption of new evidence may need to undertake more active promotion.

Advertising↗

PubMed2004

Adoptive transfer of natural antibodies to non-immunized chickens affects subsequent antigen-specific humoral and cellular immune responses.

To determine a regulatory function of natural antibodies in the immune response of chickens, pooled plasma obtained from non-immunized (naïve) 15 months old hens was subjected to keyhole limpet hemocyanin (KLH) antigen-affinity chromatography. Purified KLH-binding antibodies were adoptively transferred intravenously to 5 weeks-old cocks that were subsequently immunized subcutaneously 24 h later with KLH. Control groups consisted of birds that were either adoptively transferred with KLH-binding antibodies purified from plasma of KLH-immunized chickens, or PBS, or a salt precipitated total immunoglobulin fraction obtained from the corresponding pooled nai;ve chicken plasma, respectively.Total, IgM and IgY antibody titers to KLH in the plasma of recipients adoptively transferred with KLH-NAb, but not in the plasma of the groups transferred with salt precipitate or KLH-binding specific antibodies, were significantly enhanced as compared to the non-treated, KLH immunized group. Titers of IgA antibodies binding KLH were decreased in the plasma of the group that received specific KLH-binding antibodies, but not in the plasma of the other groups. Proliferation from peripheral blood leucocytes in whole blood from the KLH-NAb treated group, the group treated with KLH-binding specific antibodies and the group treated with salt precipitate, respectively, to both concanavalin A and KLH were significantly decreased as compared to the group receiving PBS. Our data show that antigen-specific antibodies can be isolated from plasma obtained from non-immunized chickens. Such antibodies that resemble natural antibodies as described in mammals may perform an important role in the enhancement of subsequent antigen-specific antibody responses or the maturation of the immune system, which may differ from the role of specific antibodies.

Animals↗

PubMed2001

Adoption of new health care services in Norway (1993-1997): specialists' self-assessment according to national criteria for priority setting.

OBJECTIVES: To identify health care services adopted in Norway in the period 1993-1997, and examine them according to proposed national guidelines for priority setting. These guidelines define core services. DESIGN: Two-stage self-administered questionnaire. SETTING: The Norwegian public healthcare system. SUBJECTS: Presidents of all relevant specialist and sub-specialist associations in the Norwegian Medical Association (n=56). OUTCOME MEASURES: Number of adopted services satisfying the priority criteria of core services, according to physician's self-assessment. Number and type of interventions suited for the priority-setting criteria. RESULTS: Thirty-two percent of new technologies satisfied the definition of core services according to specialists' own assessment. Of the 88 responses analysed for the second stage of our survey, fifteen answers (17%) indicated lack of applicability of the priority setting criteria. Loss of applicability was related to diagnostic and procedure-related technologies. CONCLUSIONS: Less than one-half of the assessed technologies adopted in Norway in the period 1993-1997 satisfy proposed national criteria for priority setting. The guidelines are applicable for most interventions, but fail in most evaluations of diagnostic and procedure-related improvements. Independent and systematic evaluations of new technologies are needed within the context of priority setting.

Attitude of Health Personnel↗

PubMed1986

Immune responsiveness in offspring of adoptively immunized mothers.

The rate of appearance of cells forming 19S hemolytic antibody (PFC) in the spleens of F1 newborn mice after adoptive anti-paternal immunization of fetuses, newborns and/or their mothers during pregnancy has been studied. An increase in the number of PFC was found at the age of 6 to 11 days in offspring of adoptively immunized mothers. These newborns, even when foster nursed by untreated mothers, still had a significantly higher number of PFC in comparison to the controls. In contrast, adoptive immunization of the newborns themselves resulted in a decrease of PFC during the second week after birth. Several possible explanations for the obtained results are discussed including the putative transplacental passage of immunocompetent cells.

Animals↗

PubMed2000

[Adoption of new medications by prescribing physicians. The innovator physician].

OBJECTIVES: To determine how new medicines are adopted by primary care doctors, identifying innovators or first adopters. Also, to define the variables determining the characteristics of innovative doctors. DESIGN: Retrospective, longitudinal, observational and descriptive study. SETTING: Primary care doctors from the Bahía-Vejer Area in Cádiz (78 general practitioners and 22 paediatricians). MEASUREMENTS AND MAIN RESULTS: All the prescriptions dispensed in pharmacy offices between 1/1/94 and 31/12/96 and prescribed by doctors with over three years experience (74 doctors) were analysed. The active principles sold for the first time between 1/10/93 and 31/12/96 and mainly used in primary care were chosen. Medicines coming on prescription were grouped by three-month periods (28 medicines) and studied for a year. The number of containers of each group prescribed by each doctor was calculated. The doctors were classified in decreasing order according to the number of containers used and given scores through weighting more the initial periods of the prescription of each medicine. The characteristics of the innovative doctor were found with the following variables: age, gender, training, type of care network, type of contract, drugs expenditure and prescription quality through logistic regression. The OR of prevalence for each variable analysed was calculated, and 90% confidence intervals were also determined. 33% of the total (25 doctors) were identified as innovative doctors or first adopters. The statistically significant variables correlating with this group of doctors were: doctors aged > 45, male, non-MIR training, temporary contract, not their sole job, with drug expenditure over the area's 50 percentile, from non-reformed centres. CONCLUSIONS: The identification of this group of doctors will enable specific programmes to be set up in an attempt to alter their attitude to the marketing of new medicines (objective information, evaluation comparing new medicines with existing ones, and increasing doctors' awareness of perceived risk of the use of medicines).

Drug Prescriptions↗

PubMed2002

Adoption of drug avoidance activities among patients in contingency management and cognitive-behavioral treatments.

This study of 97 cocaine-dependent subjects assessed differences in the effects of cognitive behavioral therapy (CBT) and non-CBT treatments, such as contingency management (CM) and methadone maintenance, on patients' adoption of drug avoidance activities (DAA) after treatment, and whether the adoption of these activities was associated with sustained reductions in cocaine use during the follow-up period. Subjects who had been exposed to CBT reported more frequent engagement in drug-use avoidance activities at treatment end and at the 1-year follow-up than did subjects assigned to either the CM or control conditions. The composite DAA scores were significantly related to cocaine abstinence at both follow-up contacts. This finding suggests the importance of adopting a range of avoidance activities and engaging in them frequently, rather than relying on any single activity. Further, a series of multivariate regression models revealed that a subject's total DAA score accounted for more variance than did treatment group assignment in predicting reduced cocaine use over the 1-year follow-up period.

Adaptation, Psychological↗

PubMed2001

Predicting stages of adoption of mammography screening in a general population.

This study assessed predictions of the Transtheoretical Model (TTM) of behaviour change applied to mammography screening in a random sample of 909 Swiss women aged 40-80 years. We examined stages of mammography adoption, positive and negative attitudes toward screening (pros, cons and decisional balance), and additional predisposing, enabling and reinforcing characteristics. The stage of mammography adoption was defined for 827 women, of whom 46.9% reported on-schedule screening (action 10.2%, maintenance 29.7%, relapse risk 7.0%) and 53% did not (precontemplation 23.1%, contemplation 13.5%, relapse 16.4%). Independent factors associated with more advanced stages (from precontemplation to maintenance) were high pros, low cons, belief that mammography screening is recommended every 2 years, high objective risk of breast cancer, being married and higher income. Independent correlates of stage regression (from action/maintenance to relapse) were high cons, belief that mammography screening is recommended every 4 years or not at all and not being married. Perceived utility of an organised screening programme and reluctance to pay for a mammogram were independently associated with only certain transitions between stages of adoption. Our results confirm the applicability of the TTM to mammography screening in a European context. They also suggest that constructs other than pros and cons may be useful in predicting mammography use.

Adult↗

PubMed2004

Senior executive adopt-a-work unit: a model for safety improvement.

BACKGROUND: At The Johns Hopkins Hospital (JHH), the patient safety committee created a safety program that focused on encouraging staff in selected units to identify and eliminate potential errors in the patient care environment. As part of this program, senior hospital executives each adopted an intensive care unit and worked with the unit staff to identify issues and to empower staff to address safety issues. JHH PATIENT SAFETY PROGRAM: The program consisted of eight steps, which together require six months for implementation: (1) conduct a culture survey; (2) educate staff on the science of safety; (3) identify staff safety concerns through a staff safety survey; (4) implement the senior executive adopt-a-work unit program; (5) implement improvements; (6-7) document results, share stories, and disseminate results; and (8) resurvey staff. RESULTS: The senior executive adopt-a-work unit program was successful in identifying and eliminating hazards to patient safety and in creating a culture of safety. DISCUSSION: The program can be broadly implemented. The keys to program success are the active role of an executive advocate and staff's willingness to openly discuss safety issues on the units. Regular meetings between the advocates and the units have provided a forum for enhancing executive awareness, increasing staff confidence and trust in executive involvement, and swiftly and effectively addressing areas of potential patient harm.

Baltimore↗

PubMed1987

Decision making on the adoption of advanced medical technology in Taiwan.

This paper discusses both the current interest in and approaches to the employment of advanced medical technology in Taiwan. It describes the formation of the national policy, including funding, reimbursement, and regulatory processes, on adopting innovative and expensive medical technologies. Using the case of extracorporeal shockwave lithotripsy (ESWL), the key players who affect organizational decision making on the adoption and diffusion of medical technology have also been analyzed. Finally, it examines some of the salient features of medical technology adoption and assessment in Taiwan, and in other countries which depend heavily upon imported advanced medical technology. It is hoped that an understanding of Taiwan's attempts to use innovative medical technology wisely while incorporating the practice of technology assessment and appropriate policies, will assist other countries with similar conditions to gain maximal benefit from technological advancement.

Decision Making, Organizational↗