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PubMed1985

Adoption of the Uniform Alcoholism Act and the availability of alcoholism treatment programs: a state-by-state examination.

This research examines geographic differences in the availability of alcoholism treatment programs throughout the United States. Using a substantially complete national listing of alcoholism treatment programs, significant differences in treatment availability based upon state, division, and region were found. The variations in treatment availability were strongly related to the adoption of the Uniform Alcoholism Act, with the influence of the UAA being more pronounced in nonmetropolitan areas. Treatment availability was only weakly related to the extent of alcohol-related problems. It is suggested that the UAA may be adopted through the social mandates of metropolitan areas and that nonmetropolitan areas respond with increased treatment availability as a result of the legal mandate of the legislation. It is concluded that without the official redefinition of alcoholism as a condition requiring treatment, the establishment of an adequate treatment capability is severely impaired.

Alcoholism↗
PubMed2002

An interactive, student-centered approach, adopting the SOLO taxonomy, for learning to analyze laboratory data in veterinary clinical pathology.

INTRODUCTION: The purpose of this study was to describe and evaluate an interactive, student-centered teaching strategy for learning to analyze laboratory data in veterinary clinical pathology. The strategy was designed to operate in tutorials of approximately one hour duration and adopted the structure of the observed learning outcome (SOLO) taxonomy in order to align with outcomes and assessment components of unit of study design and to encourage a deep approach to learning. METHODOLOGY: The teaching strategy adopted group discussion and reflective observation as core activities. Students worked alone in identifying abnormal laboratory data, in pairs in discussing possible reasons for the abnormalities, and in two larger groups in deciding on conclusions for, and further investigation and management of, the case. The final debriefing brought the two groups together to reflect, question, and reach a consensus about the case. The teaching strategy was evaluated on the basis of its success in encouraging interaction through discussion, developing self confidence in analyzing laboratory data, and enhancing understanding as to how the disciplines of veterinary clinical pathology and veterinary medicine interrelate. Evaluation used self-reflection, peer feedback, and a student questionnaire. CONCLUSION: The teaching strategy provided the opportunity for students to develop and practice an approach to the analysis of laboratory data in a manner consistent with current educational thinking on student-centered learning. The use of group discussion and significant reflective practice not only enhanced interpersonal skills but also encouraged a deep approach to learning, leading to ownership of knowledge and increased awareness of the worth of veterinary clinical pathology in the investigative process.

Animals↗
PubMed1987

Adoptive immunotherapy of human meningeal gliomatosis and carcinomatosis with LAK cells and recombinant interleukin-2.

Previous in vitro studies have demonstrated that peripheral blood lymphocytes activated with recombinant interleukin-2 (rIL-2) generated cells that were lytic for fresh autologous tumor cells but not for normal lymphocytes or lymphoblasts. Adoptive transfer of autologous lymphokine-activated killer (LAK) cells induced in vitro with rIL-2 was used in two patients: one with meningeal gliomatosis and the other with meningeal carcinomatosis. The adoptive transfer of LAK cells was very effective in reducing the clinical symptoms and signs, and in eliminating the malignant cells from the cerebrospinal fluid. Thus, this therapy is an attractive approach for the treatment of malignant tumors that have poor immunogenicity and are insensitive to several anti-cancer agents, and for patients with severe immunosuppressive conditions induced by repeated radiation therapy or chemotherapy.

Adult↗
PubMed1990

Adoptive immunotherapy of intracerebral metastases in mice.

Lymphokine-activated killer (LAK) cells are a heterogeneous population of immune effector cells that nonspecifically destroy neoplastic cells but not normal cells. Although parenteral treatment with interleukin-2 (IL-2) alone or a combination of IL-2 and LAK cells reduces tumor load and prolongs survival in mice with pulmonary, peritoneal, or hepatic metastases, the effect of these treatments on brain metastases has not been studied. To determine in an animal model if intracerebral metastases would be protected by the immunologically privileged status of the brain, intracardiac and intravenous injections of 10(5) KHT sarcoma cells were performed in C3H mice to create brain and lung metastases, respectively. The mice were treated with adoptive immunotherapy to determine if efficacy seen in an extracerebral site could be reproduced in the brain, and if histological examination of these brains would reveal a significant degree of lymphocyte infiltration and cytolytic activity. Animals were treated with either parenteral IL-2 (7500 U three times daily on Days 3 to 7 after tumor injection), or IL-2 plus LAK cells (7500 U IL-2 times daily on Days 3 to 7, and 10(8) LAK cells intravenously on Days 3 and 6 after tumor injection), or IL-2 excipient (three times daily on Days 3 to 7 after tumor injection). As compared to control animals, pulmonary metastases on Day 14 after tumor injection were reduced or eliminated in animals treated with either IL-2 or IL-2 plus LAK cells (p less than 0.01). In these same animals, there was no reduction in the number of intracerebral metastases and no evidence of lymphocytic infiltration or cytolytic activity in the brain. This is the first study that reveals an organ-specific resistance to the treatment of metastases with adoptive immunotherapy, and affirms the concern that due to inadequate trafficking of endogenous or exogenous-activated lymphocytes or due to inadequate activation of in situ brain lymphoid precursors, there is no rejection of tumors in the brain. This information suggests that brain metastases in patients with systemic malignancies will not respond to intravenous treatment with LAK cells and IL-2, and that alternative forms of treatment are needed. Furthermore, this modification of a previously existing model of murine brain metastasis provides a method for concurrently evaluating the effectiveness of treatments for intra- and extracranial cancers.

Animals↗
PubMed1983

Adoptive transfer of delayed wattle reactivity in chickens with a dialyzable leukocyte extract containing transfer factor.

Delayed wattle reactions (DWR) to tuberculin, diphtheria toxoid (DT), and keyhole limpet hemocyanin (KLH) were transferred to chickens with dialyzable leukocyte extracts (DLE) prepared from splenic leukocytes of chickens sensitized and reactive by DWR to the tuberculin, DT, or KLH. A DLE prepared from chickens unsensitized and unreactive to tuberculin by DWR failed to transfer DWR to tuberculin in recipients. Only chickens injected with DLE from tuberculin sensitized and reactive chickens exhibited significant (P less than .01) DWR to tuberculin. Chickens that received DLE prepared from DT sensitized and reactive chickens exhibited significant (P less than .01) DWR to DT but not to KLH. Further, DWR to both DT and KLH was transferred with DLE prepared from chickens sensitized to both antigens. Adoptive transfer of DWR to KLH in comparison to DT was more successful. Finally, the serial transfer of DWR to KLH (P less than .05) but not to DT (P greater than .05) was accomplished using DLE prepared from chickens that previously were recipients of DLE prepared from chickens sensitized to KLH and DT. Results indicate that DLE prepared from chickens contain transfer factor (TF) responsible for adoptive transfer of DWR to tuberculin, DT, and KLH.

Animals↗
PubMed2006

The practice doctorate: perspectives of early adopters.

The emergence of the Doctor of Nursing Practice (DNP) degree is being described as a disruptive innovation that is altering the landscape of nursing and health care and creating a great deal of controversy within and beyond the profession of nursing. This article proposes that the DNP is actually the natural evolution of a larger disruptive innovation begun in the late 1960s with the advent of nurse practitioner programs. As expected with disruptive innovations, many challenges face those who are early adopters and who forge ahead during the early phase of innovation and later during the upmarketing phase. As faculty and administrators of one of the early, second-generation DNP programs, the authors are fully aware of ongoing discussion and issues related to the practice doctorate. This article shares the experiences of this group of early adopters and their insights into controversies surrounding the DNP movement.

Curriculum↗
PubMedDate not supplied

The relationship between the stages of exercise adoption and other health behaviors.

PURPOSE: To examine the relationship between stage of exercise adoption and the practice of other health behaviors. DESIGN: Demographic, socioeconomic, and health behavior data were collected using a cross-sectional mail survey. Data were collected as part of a larger employee benefits research study. SETTING: Montana State University-Bozeman, Bozeman, Montana. SUBJECTS: University employees (n = 1269) comprised of 46% men with a mean age of 44 years. MEASURES: Demographic and socioeconomic data included age, sex, marital status, level of income and education, dependent status, and job classification. Stage of exercise adoption classifications were based on self-reported responses to four exercise statements. The health behaviors included in this study were cigarette and smokeless tobacco use, seat belt use, alcohol use, and use of stress management practices. Logistic regression analysis was used to determine if stage of exercise predicted the presence of each of the health behaviors while controlling for demographic, socioeconomic, and other health behavior variables. RESULTS: The survey response rate was 68%. Respondents in action exercise stage (p = .0367) were less likely to smoke cigarettes than respondents in precontemplation stage of exercise. Respondents in contemplation (p = .0419), preparation (p = .0060), action (p = .0432), and maintenance (p = .0006) were more likely to use seat belts than respondents in precontemplation. Respondents in maintenance (p = .0059) were more likely to use regular stress reduction techniques than respondents in precontemplation. CONCLUSIONS: Although longitudinal research is needed to determine any causal relationships, this research suggests that encouraging individuals to become more involved in exercise could indirectly influence other health behaviors. Hence, exercise could be a possible "gateway" behavior toward healthier lifestyle practices.

Adult↗
PubMedDate not supplied

Using the stages of change model to increase the adoption of physical activity among community participants.

PURPOSE: This study examined the use of the stages of change model to design an exercise intervention for community volunteers. DESIGN: The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. SUBJECTS: Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). SETTING: The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. MEASURES: One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. INTERVENTION: The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." RESULTS: A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61% in Preparation became more active. CONCLUSIONS: Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions.

Adolescent↗
PubMed1990

[Study on adoptive immunotherapy with tumor-infiltrating lymphocytes (TIL) for renal cell carcinoma--amplification of IL-2-elicited TIL proliferation by OKT3-monoclonal antibody].

Human autologous peripheral blood lymphocytes (PBL) and lymphocytes infiltrating renal cell carcinoma (TIL) were cultured with medium containing 1000 IU/ml of human interleukin 2 (IL-2). A high cytotoxic activity against fresh autologous as well as cultured allogenic tumor cells was developed. By culturing these lymphocytes with OKT3 monoclonal antibody during the initial 2 days of long-term culture, in terms of T cell activation signal, IL-2-driven lymphocyte proliferation was remarkably accelerated with maintenance of appreciable level of cytotoxic activity. The same culture method also induced an increase in OKT3 and IL-2 receptor positive lymphocyte population in LAK cells and TIL. This method may enable us to gain more autologous TIL in vitro for adoptive immunotherapy of renal cell carcinoma than the usual culture method with IL-2 alone. Five patients with metastatic renal cell carcinoma were treated with adoptive immunotherapy with TIL, LAK and IL-2. One patient with pulmonary metastasis has had a minor response which has lasted for 3 months so far. We have not experienced any serious side effects during the treatment.

Antibodies, Monoclonal↗
PubMed1992

Forecasting the adoption of new medical technology using the Bass model.

A mathematical model, the Bass model, was used to forecast the adoption of new medical technology based on durable equipment. When the model was applied to five successful medical technologies, actual unit sales were predicted for three. The technologies investigated are computed tomography (CT scan), magnetic resonance imaging (MRI), ultrasound, hemodialysis, and lithotripsy. Because unit sales data for dialysis and ultrasound could not be obtained or estimated from secondary sources for the years immediately after market entry, application of the Bass model produced questionable results for those technologies. However, results for CT scan, MRI, and lithotripsy suggest that this model can be used to predict the adoption of new medical technology based on durable equipment when annual unit sales data can be estimated for the period immediately after market entry.

Data Collection↗
PubMed1993

Needlestick injuries among critical care nurses before and after adoption of universal precautions or body substance isolation.

A small, self-selected sample of Canadian acute-care hospitals participated in an analysis of their critical care nurses' needle disposal practices and needlestick injury experience before and after adopting new Universal Precautions or Body Substance Isolation infection control strategies. Covert observation of disposal practices, review of employee health injury reports and direct survey of the nurses indicated that employee health records documented fewer injured nurses during a thirty-day period (2.3% of 929 nurses in 33 hospitals) than was found by surveying nurses directly (3.5% of 312 nurses in 11 hospitals; only 36% of these injuries had been documented in employee health records). Injury rates in only one of eleven hospitals indicated appreciable needlestick risk reduction after adopting Universal Precautions or Body Substance Isolation, and an association between reduced needle recapping and reduced needlestick injury was not evident. Rates of injury found in this research remain commensurate with rates reported before the era of Universal Precautions and Body Substance Isolation. These findings suggest that new strategies have not had significant impact on healthcare workers' greatest source of exposure to bloodborne pathogens.

Canada↗
PubMed1993

The impact of Medicaid adoption of the Medicare fee schedule.

In this article, the authors simulate the effects on Federal and State Medicaid expenditures of increasing Medicaid fees to Medicare fee schedule (MFS) levels. Strict adoption of the MFS by the States would increase total Medicaid spending by approximately 4 percent, $2.5 to $2.9 billion. Because Medicaid fees vary across States, so does the impact of adopting the MFS. Medicaid spending would increase significantly in some wealthy States with large Medicaid populations and in a few small, relatively poor States. Some States currently pay more than the MFS for obstetrical services. If these fees continued at higher levels for obstetrical care, total Medicaid spending would increase by $3.5 to $4.0 billion.

Adult↗
PubMed1996

Factors affecting decisions to adopt medical technologies in acute care hospitals.

The results of this research have added an expanded perspective on the decision to adopt particular technologies. The perception had been that, given the current state of health care reimbursement, decisions to acquire radical and often expensive devices will center around economic or strategic considerations. However, it was discovered that technology acquisition appeared to be a physician centered activity with less consideration given to strategic or economic factors. While these data suggest that hospitals have not been listening to complaints about rising health care costs and continue to operate in a "business as usual" manner, it may because physicians continue to be the dominant players in what is for them an unrestrained free market. This trend, if continued, may ultimately lead to a reimposition of heavy handed government regulation in the adoption of even the most routine medical technology. As a result, it is vital that health care administrators begin to explore ways for moving from physician centered and tactical considerations to a more strategic focus which builds upon the needs and interests of the medical staff to serve the community in a more responsible fashion before that ability is taken away from them.

California↗
PubMed1997

Medical liability risk avoidance: a case for adopting the International Normalized Ratio (INR) system.

Since bleeding is a common adverse effect associated with the oral anticoagulant warfarin, maximizing the therapeutic potential of this drug requires close laboratory monitoring. The International Normalized Ratio (INR) is a system that has been developed to improve and standardize the assessment of the intensity of oral anticoagulation therapy. Clinical information and medicolegal arguments supporting the adoption of this system are reviewed. The potential for improvement in patient outcomes and minimization of medical liability favors the adoption of the INR system.

Anticoagulants↗
PubMed1998

Does competition by health maintenance organizations affect the adoption of cost-containment measures by fee-for-service plans?

How groups insured by fee-for-service health plans react to increased competition from health maintenance organizations (HMOs) is an unresolved question. We investigated whether groups insured by indemnity plans respond to HMO market competition by changing selected health insurance features, such as deductible amounts, stop loss levels, and coinsurance rates, or by adopting utilization management or preferred provider organization (PPO) benefit options. We collected benefit design data for the years 1985 through 1992 from 95 insured groups in 62 US metropolitan statistical areas. Multivariate hazard analysis showed that groups located in markets with higher rates of change in HMO enrollment were less likely to increase deductibles or stop loss levels. Groups located in markets with higher HMO enrollment were more likely to adopt utilization management or PPO benefit options. A group located in a market with an HMO penetration rate of 20% was 65% more likely to have included a PPO option as part of its insurance benefit plan than a group located in a market with an HMO penetration rate of 15% (p < 0.05). Concern about possible adverse selection effects may deter some fee-for-service groups from changing their health insurance coverage. Under some conditions, however, groups insured under fee-for-service plans do respond to managed care competition by changing their insurance benefits to achieve greater cost containment.

Cost Control↗
PubMed1999

The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.

OBJECTIVE: To examine the response of rural hospitals to various market and organizational signals by determining the factors that influence whether or not they establish a provider-based rural health clinic (RHC) (a joint Medicare/Medicaid program). DATA SOURCES/STUDY SETTING: Several secondary sources for 1989-1995: the AHA Annual Survey, the PPS Minimum Data Set and a list of RHCs from HCFA, the Area Resource File, and professional associations. The analysis includes all general medical/surgical rural hospitals operating in the United States during the study period. STUDY DESIGN: A longitudinal design and pooled cross-sectional data were used, with the rural hospital as the unit of analysis. Key variables were examined as sets and include measures of competitive pressures (e.g., hospital market share), physician resources, nurse practitioner/physician assistant (NP/PA) practice regulation, hospital performance pressures (e.g., operating margin), innovativeness, and institutional pressure (i.e., the cumulative force of adoption). PRINCIPAL FINDINGS: Adoption of provider-based RHCs by rural hospitals appears to be motivated less as an adaptive response to observable economic or internal organizational signals than as a reaction to bandwagon pressures. CONCLUSIONS: Rural hospitals with limited resources may resort to imitating others because of uncertainty or a limited ability to fully evaluate strategic activities. This can result in actions or behaviors that are not consistent with policy objectives and the perceived need for policy changes. Such activity in turn could have a negative effect on some providers and some rural residents.

Community Health Centers↗
PubMedDate not supplied

Preventing repeat adolescent pregnancies with early adoption of the contraceptive implant.

CONTEXT: Even in intensive, adolescent-oriented programs, in which access to highly effective contraceptives is guaranteed, repeat adolescent pregnancies commonly occur. METHODS: To assess whether adoption of the contraceptive implant would lower the rate of repeat pregnancy, contraceptive use and pregnancy outcomes were tracked among 309 adolescent mothers--171 "early" implant users who began use within six months of delivery and 138 who either adopted another method or had used no method. Participants were interviewed at delivery and at six-month intervals through the second year postpartum. Multivariate logistic regression analyses were conducted to ascertain the likelihood of a repeat pregnancy within the first and second year postpartum. RESULTS: During the first year postpartum, although 7% of the early implant users had their implants removed, pregnancy rates were significantly (p < .0001) lower among early implant users (less than 1%) than among the other adolescent mothers in the sample (20%). By the end of the second year postpartum, 37% of early implant users had discontinued use. Nevertheless, their two-year pregnancy rate (12%) remained significantly lower (p < .0001) than that of the other adolescent mothers (46%). The multivariate analysis showed that early implant use was the only independent predictor of a repeat pregnancy within the first year postpartum, while early use, parity and number of risk factors for repeat pregnancy were independently associated with the likelihood of another pregnancy in the second year postpartum. CONCLUSIONS: Although early implant insertion significantly decreased the rate of rapid, repeat adolescent pregnancies, the rates of removal and of pregnancy by the end of the second year postpartum were high. Thus, health care providers need to address the motivational components of adolescent pregnancy even among those who accept ostensibly long-term methods.

Adolescent↗