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PubMed2004

Adoptive immunotherapy of cancer with polyclonal, 108-fold hyperexpanded, CD4+ and CD8+ T cells.

T cell-mediated cancer immunotherapy is dose dependent and optimally requires participation of antigen-specific CD4+ and CD8+ T cells. Here, we isolated tumor-sensitized T cells and activated them in vitro using conditions that led to greater than 108-fold numerical hyperexpansion of either the CD4+ or CD8+ subset while retaining their capacity for in vivo therapeutic efficacy. Murine tumor-draining lymph node (TDLN) cells were segregated to purify the CD62Llow subset, or the CD4+ subset thereof. Cells were then propagated through multiple cycles of anti-CD3 activation with IL-2 + IL-7 for the CD8+ subset, or IL-7 + IL-23 for the CD4+ subset. A broad repertoire of TCR Vbeta families was maintained throughout hyperexpansion, which was similar to the starting population. Adoptive transfer of hyper-expanded CD8+ T cells eliminated established pulmonary metastases, in an immunologically specific fashion without the requirement for adjunct IL-2. Hyper-expanded CD4+ T cells cured established tumors in intracranial or subcutaneous sites that were not susceptible to CD8+ T cells alone. Because accessibility and antigen presentation within metastases varies according to anatomic site, maintenance of a broad repertoire of both CD4+ and CD8+ T effector cells will augment the overall systemic efficacy of adoptive immunotherapy.

Journal Article↗
PubMed2004

Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion.

After the first session of the American College of Medical Informatics 2004 retreat, during which the history of electronic health records was reviewed, the second session served as a forum for discussion about the state of the art of EHR adoption. Adoption and diffusion rates for both inpatient and outpatient EHRs are low for a myriad of reasons ranging from personal physician concerns about workflow to broad environmental issues. Initial recommendations for addressing these issues include providing communication and education to both providers and consumers and alignment of incentives for clinicians.

Diffusion of Innovation↗
PubMed1989

A phase II clinical trial of adoptive immunotherapy for advanced renal cell carcinoma using mitogen-activated autologous leukocytes and continuous infusion interleukin-2.

Forty patients with metastatic, recurrent, or unresectable renal cell carcinoma were entered into a study of the therapeutic efficacy of adoptive immunotherapy using periodate (IO4-) and interleukin-2 (IL2)-activated autologous leukocytes and continuous infusion low-dose IL2. Patient survival was also examined. The first 15 consecutive patients were enrolled in protocol A without an IL2 priming phase and the following 25 patients were entered in protocol B where a 5-day priming phase was initiated before leukapheresis. A maintenance regimen consisted of either 3 x 10(6) units of recombinant interferon-alpha (rIFN-alpha), three times per week only or together with leukapheresis and infusion of IO4-/IL2-activated cells and 2 days of continuous infusion IL2 per month. Thirty-four patients completed the protocol treatment. Four patients were removed from the study owing to rapid tumor progression and two patients died while receiving treatment. The clinical response rate was 22%: two patients had a complete response and five patients had a partial response. Among the 25 patients who had no clinical response, 11 patients had either a mixed response or stabilization. Neither response, response duration, nor site response correlated with the total dose of IL2 administered or the number of activated killer cells infused. Patients who received maintenance therapy had longer survival times than patients who did not receive such therapy. All toxicity and side effects associated with IL2 treatment were transient and resolved after discontinuation of the drug. Patients on maintenance therapy tolerated both rIFN-alpha and monthly infusions of activated killer cells and IL2 well. This study confirms the concept of adoptive immunotherapy as a new treatment approach for advanced renal cell carcinoma and suggests that maintenance therapy may prolong survival time.

Adult↗
PubMed2003

Adoption of regulatory compliance programmes across United States healthcare organizations: a view of institutional disobedience.

The growing acceptance of evidence-based decision-support systems in healthcare organizations has resulted in recognition of information accuracy as a key area of organizational management. In the United States, rigid data mandates related to information management have met with some resistance from healthcare provider groups, who have traditionally found little relevance between personalized healthcare practice and accurate information. Variation in management practice poses quality problems in such an environment, since it precludes comparisons across larger markets or areas, a critical component of evidence-based quality assessments. In this study, a national census of health information managers was employed to provide a benchmark of the degree of such variation, examining how proper billing compliance practices vary across organization types as well as market area indicators. Findings here suggest that managers continue to ignore, to some extent, regulatory compliance standards, despite nationwide laws that mandate adoption of uniform compliance practices and programmes. The level of adoption of compliance management in this study varied significantly across practice characteristics and areas, suggesting the existence of barriers to cross-market comparative performance assessment.

Data Collection↗
PubMed2000

Perceived barriers to exercise and stage of exercise adoption in older women of different racial/ethnic groups.

The purpose of this study was to determine whether barriers to exercise differ among racial/ethnic groups at the same stage of exercise adoption and adjacent stages within racial/ethnic groups. Questions about stage of exercise adoption and perceived barriers to exercise were administered to a cross sectional sample of 745 African American, 660 Hispanic, 738 Native American/Native Alaskan, and 769 Caucasian U.S. women aged 40 years and older. Correlations between rankings of barriers among racial/ethnic groups within the same stage ranged from .43 to .89. For each racial/ethnic group, significant differences existed between adjacent stages in the percentage of women reporting barriers to interfere with exercise (p < .10). Barriers were not similar enough among racial/ethnic groups to recommend that the same barriers be addressed for all races/ethnicities.

Adult↗
PubMedDate not supplied

Provider adoption of pneumococcal conjugate vaccine and the impact of vaccine shortages.

OBJECTIVES: To 1) determine the factors associated with provider acceptance of pneumococcal conjugate vaccine and 2) describe how providers prioritize pneumococcal conjugate vaccine during shortages. DESIGN/METHODS: During April-November 2002, we conducted a mailed survey of rural and urban Colorado practitioners who provided routine pediatric immunizations. Three groups were surveyed: 1) all immunization providers (n = 51) in 2 geographically large rural areas, identified through a regional immunization registry; 2) all providers (n = 61) from private pediatric practices in metropolitan Denver that were actively participating in the same registry; and 3) all family physicians (n = 244) from the same urban areas as the pediatric practices. RESULTS: Response rate was 60%. Provider adoption of pneumococcal conjugate vaccine was strong: 66% of urban family physicians, 84% of rural providers, and 98% of urban pediatric providers always recommended pneumococcal conjugate vaccine to healthy children < or = 23 months old when vaccine supplies were adequate. In multivariate analysis, vaccine nonadopters were significantly more likely than adopters to report financial barriers to vaccination (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.58, 6.35) and concerns about vaccine safety (OR 3.37, 95% CI 1.37, 8.26). Eighty-nine percent of respondents had encountered pneumococcal conjugate vaccine shortages. During shortages, children <5 years old with a chronic medical condition were considered the highest priority for vaccination. CONCLUSIONS: While provider acceptance of pneumococcal conjugate vaccine appears high, concerns about vaccine safety, cost, and availability exist, and these concerns will need to be addressed to maximize prevention of invasive pneumococcal disease in children.

Attitude of Health Personnel↗
PubMedDate not supplied

Achieving U.S. Health information technology adoption: the need for a third hand.

The U.S. health care information technology (HIT) market is broken; broad-scale adoption of HIT is not occurring despite considerable evidence of its impact on the quality of care and patient safety. Although adoption of HIT will not cure all that ails health care, it is an important step toward transformation of the U.S. health care delivery system. In this commentary I describe several critical issues pertaining to the HIT market failure and several ways in which the federal government may act as a deft and gentle "Third Hand" to assist the Invisible Hand of Adam Smith.

Diffusion of Innovation↗
PubMedDate not supplied

The adoption gap: health information technology in small physician practices. Understanding office workflow can help realize the promise of technology.

Health information technology (HIT) can promote higher quality, lower costs, and increased patient and clinician satisfaction. Yet small practice settings (where the vast majority of patient care is provided) have been slow to adopt HIT products and services. Successful adoption requires close attention to office workflow, or how tasks are organized and resources used to achieve outcomes. HIT improvements in the small physician office setting are achieved through strong leadership, strategic planning, process reengineering, change management, and customizing IT systems to match and support desired office workflows and health care outcomes.

Diffusion of Innovation↗
PubMed2006

Examining the adoption of electronic health records and personal digital assistants by family physicians in Florida.

PURPOSE: The purpose of this paper is to comprehensively characterise the current use of electronic health records (EHRs) and personal digital assistants (PDAs) among family physicians in Florida; and to compare family physicians with other doctors with respect to the functions commonly used on their EHR and PDA systems. METHODS: A postal survey was sent to family physicians (n=2076) and other doctors with a clear and active licence in Florida (total n=14 921). To examine factors among family physicians related to EHR and PDA use, binary logistic regression modelling techniques were utilised. Chi-square analysis was used to compare EHR and PDA functions between family physicians and other doctors. RESULTS: A total of 4203 responses, of which 756 were from family physicians, were available for the current study (28.2% overall response rate). EHR use among family physicians was significantly related to large practice size, urban location and young physician age, after controlling for confounders. Likewise, PDA usage among family physicians was independently associated with male gender and younger physician age. Additionally, even though no differences in overall EHR adoption were found, family physicians, when compared with other physicians, were significantly more likely to be using a more robust set of EHR functions. This included allergy and medication lists, diagnosis, problem lists, patient scheduling and educational materials, preventive services reminders and access to reference material. CONCLUSIONS: Even though family physicians utilise many EHR and PDA functions more commonly than other physician groups, the overall level of EHR adoption among family physicians remains low. Until more barriers to the use of EHR are minimised, the goals of the Future of Family Medicine Report to broadly implement EHR and other health IT functions will not be fully realised.

Adult↗
PubMed2006

Enhancing adoption of evidence-based HIV interventions: promotion of a suite of HIV prevention interventions for African American women.

The Centers for Disease Control and Prevention (CDC) currently promotes an HIV prevention intervention for young adult African American women, known as SISTA, through the Diffusion of Effective Behavioral Interventions (DEBI) program. Nationally, more than 700 agencies have completed a 1-week CDC-funded training to implement SISTA. Agencies that have been trained in SISTA are also eligible to receive training in a newly published HIV prevention intervention for African American adolescent females, known as SiHLE (Sistering, Informing, Healing, Living, and Empowering), as well as to receive training in a newly published prevention intervention for women living with HIV, known as WiLLOW (Women Involved in Life Learning From Other Women). All three of these HIV prevention interventions, target African American females, are designed to reduce HIV sexual risk behaviors and share similar theoretical, core, and methodological elements. The diffusion of innovation paradigm suggests that if potential adopters perceive one innovation as being closely related to another innovation, it may be useful to promote a cluster of innovations, rather than to treat each new innovation separately. This article examines how promotion of a suite of HIV interventions for African American females may facilitate adoption of the three evidence-based HIV interventions for this population.

Adult↗
PubMedDate not supplied

Serological survey for canine cutaneous and visceral leishmaniasis in areas at risk for transmission in Rio de Janeiro where prophylactic measures had been adopted.

A serological survey for canine visceral (VL) and American cutaneous leishmaniasis (ACL) has been carried out during 1984-1989, to assess the effects of the prophylactic measures adopted in areas where there was a risk of transmission of the diseases in Rio de Janeiro. A previous serological survey (1982/83) had detected serum positive dogs as well as the human disease in these same areas. A total of 22,828 dogs have been examined in this last survey, 7,807 of which came from Campo Grande (VL and ACL area), 4,110 from Jacarepaguá (ACL area), 4,146 from Realengo, 3,879 from Bangu and 2,886 from Senador Camará, (three VL areas). The analysis of these results showed a notable reduction in the number of serum positive dogs, compared to those of the first survey of 1982/83 as follows: (a) in Campo Grande (VL and ACL) the infection rate of the first survey was 12.7%, against 0.62% of the second; (b) in Jacarepaguá (ACL) it decreased from 8.6% to 1.8% (c) in Bangu, Realengo and Senador Camará (VL) the rate decreased from 4.3% to 0.38%. The results indicate that this decrease was due to the prophylactic measures adopted in those areas.

Animals↗
PubMed2005

Swedish Advanced Home Care: organizational structure and implications of adopting this care model in Brazilian health care system.

The purpose of this paper was to describe the organization of the Advanced Home Care Program provided in a region of Sweden and to discuss some benefits and implications of this model adoption in Brazilian settings. Data triangulation as interview, observation and questionnaire was used. Thirty two professionals participated in this study. The organizational structure, working method, home visits, and related health resources were described. The investigated model presented both clear effectiveness and versatility; therefore feasible to be adopted in Brazilian settings improving their population health care. Doubtless, the improvement of life quality and security are the best benefits this model of care can provide.

Adult↗
PubMed2006

Prognostic factors in diffuse large B-cell lymphoma treated by risk-adopted therapy.

OBJECTIVE: The International Prognostic Index (IPI) was reported in 1993 and it is now widely used for predicting the outcome in patients with aggressive non-Hodgkin's lymphoma. It defines 5 risk factors and 4 distinct risk groups from retrospective data. In this study, we evaluated the outcome of risk-adopted therapy for diffuse large B-cell lymphoma (DLBCL), the most common aggressive lymphoma, and assessed the possible prognostic factors. METHODS AND PATIENTS: We treated 177 consecutive patients newly diagnosed with DLBCL using therapies determined by putative risk factors. Therapies included CHOP followed by involved field irradiation; ACOMPB with the consolidation regimen MLY9; high-dose chemotherapy supported by autologous peripheral blood stem cell transplantation; or performance status (PS) oriented CHOP. Statistical analysis was performed to determine the comprehensive risk factors in DLBCL. RESULTS: Overall, the complete response (CR), 3-year overall survival (OS), and 3-year relapse-free survival (RFS) rates for CR patients were 71%, 69%, and 75%, respectively. Male gender, high LDH, poor PS (> or = 2), more than one extranodal involvement site, and B symptoms were independent adverse prognostic factors for OS. High LDH and poor PS were independent, adverse prognostic factors for RFS. CONCLUSION: In the 5 risk factors indicated by IPI, high LDH and poor PS remained for OS and RFS even after risk-adopted therapy.

Aged↗
PubMed2002

A diabetes outcome progression trial (ADOPT): an international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes.

OBJECTIVE: Therapies with metformin, sulfonylureas, or insulin improve glycemic control in the short term but do not prevent progressive islet beta-cell failure or long-term deterioration in glycemia. Our goal was to evaluate, in patients recently diagnosed with type 2 diabetes (<3 years), the long-term efficacy of monotherapy with rosiglitazone on glycemic control and on the progression of pathophysiological abnormalities associated with type 2 diabetes as compared with metformin or glyburide monotherapy. RESEARCH DESIGN AND METHODS: A Diabetes Outcome Progression Trial (ADOPT) is a randomized, double-blind, parallel-group study consisting of a screening visit, a 4-week placebo run-in, a 4-year treatment period, and an observational follow-up of approximately 3,600 drug-naïve patients with type 2 diabetes diagnosed within the previous 3 years. After run-in, patients will be randomized to rosiglitazone, glyburide, or metformin titrated to the maximum effective daily doses (8 mg rosiglitazone, 15 mg glyburide, or 2 g metformin). The primary outcome is time to monotherapy failure, defined as the time following titration to the maximal effective or tolerated dose when fasting plasma glucose exceeds 180 mg/dl (10 mmol/l). Secondary outcomes include measures of islet beta-cell function, insulin sensitivity, dyslipidemia, changes in urinary albumin excretion, plasminogen activator inhibitor-1 antigen, fibrinogen, and C-reactive protein. Safety and tolerability will also be evaluated. Patient-reported outcomes and resource utilization data will be collected and analyzed. CONCLUSIONS: ADOPT will provide data on the effect of mechanistically differing treatment options on metabolic control, beta-cell function, and markers of macrovascular disease risk in type 2 diabetes.

Albuminuria↗
PubMed2006

Hand-held dynamometry: adoption 1900-2005.

The purpose of this brief report is to describe the adoption of hand-held dynamometry, a procedure for documenting muscle strength. Between the early 1900s and the end of 2005, 478 research articles were published that documented use of hand-held dynamometry. The adoption of the procedure for research is consistent with the S-shaped curve described by Rogers. The extent to which hand-held dynamometry is used in clinical practice remains to be delineated.

Equipment Design↗
PubMed2000

Psychosocial, behavioral, and biometric characteristics of stages of exercise adoption.

This study incorporates the Stages of Change model to examine the relationship between the stages of exercise adoption and indicators of health and fitness. Subjects were 198 United States Forest Service (USFS) workers recruited from 8 USFS ranger stations in the Pacific Northwest. Analysis indicated that those subjects in Action and Maintenance stages of exercise adoption differed significantly from those in Preparation and Precontemplation/Contemplation stages on a variety of indicators of both health and fitness. Also, interesting differences were noted among the physically inactive stages, e.g., Preparation stage subjects showed lower triglycerides, systolic blood pressure, and higher HDL cholesterol compared with subjects in the Precontemplation/Contemplation stage. Progressing to the Preparation stage, where the individual remains inactive but is aware of the problem and has begun to make small changes, is associated with a differing (more positive) health profile in this study compared to those in the Precontemplation/Contemplation stage. These results imply that simply advancing in stage can have a variety of health benefits.

Adult↗
PubMedDate not supplied

Adoptive immunotherapy for head and neck cancer with killer cells induced by stimulation with autologous or allogeneic tumour cells and recombinant interleukin-2.

Peripheral blood lymphocytes drawn by leukapheresis using Haemonetics V50 were mixed and cultured with autologous or allogeneic tumour cell line to activate killer cells by tumour antigenic stimulation, and further with recombinant interleukin-2 (rIL-2). Killer cells were intra-arterially infused, as a primary therapy, in 5 patients with maxillary and one with lingual cancer (squamous cell carcinoma). Effects on reduction of primary tumour size were significantly high without any severe side effects. The effects were interpreted mainly by direct day-by-day observation of the site, findings of CT and histology. Histological findings of the tissue obtained by surgical operation performed after adoptive immunotherapy were remarkable changes, such as infiltration of lymphoid cells around the cancer nets, degeneration of cancer cells, infiltration of scavenger macrophages (giant cells) and so on. The results suggested that adoptive immunotherapy by the killer cells can be a powerful treatment to bring the cancer under control, in with combination of other therapies.

Adult↗
PubMed1997

Calibration problems encountered while monitoring stump/socket interface pressures with force sensing resistors: techniques adopted to minimise inaccuracies.

Force sensing resistors (FSR) have been used to measure dynamic pressures at the interface between appliance and patient. Inaccuracies using FSRs have been reported. This paper summarises both the calibration problems encountered and the techniques adopted to minimise inaccuracies. It is considered that, by calibrating the transducers attached to the socket, and by adopting a strict test protocol, FSRs may provide a guide to the dynamic pressure distribution applied to the trans-tibial stump during gait.

Amputation Stumps↗