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PubMed1999

Barriers to the adoption of computerized technology in health care systems.

The increased emphasis on national health care plans, cost reduction, and additional recordkeeping has given impetus to the adoption of computerized information technologies in hospitals. A series of case studies performed in large, multihospital health care systems revealed ten important barriers to the adoption of information technologies grouped as follows: knowledge problems, approval problems, design problems, and implementation problems. These aspects were uncovered by using focus studies and interviews with chief information officers, physicians, consultants, and medical staff and by consulting numerous journals in the field. The article describes the barriers that arise because of the special conditions in hospitals and shows how some institutions are working to eliminate these barriers. The strategic issues that should be studied to overcome these barriers are also discussed.

Attitude to Computers↗
PubMed2000

Adoption of perinatal group B streptococcal disease prevention recommendations by prenatal-care providers--Connecticut and Minnesota, 1998.

Group B streptococcal (GBS) infections are the leading bacterial cause of serious neonatal disease in the United States (1). In 1996, in collaboration with the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, CDC issued consensus guidelines for preventing perinatal GBS disease (2-4). These guidelines recommend using either a screening-based or a risk-based strategy to identify women who should receive intrapartum antimicrobial prophylaxis. To assess adoption of the GBS disease prevention guidelines, the Connecticut and Minnesota state health departments surveyed prenatal-care providers during January-April 1998. This report presents the survey findings, which indicate that most prenatal-care providers in Connecticut and Minnesota have adopted perinatal GBS disease prevention policies and that strategy choice may vary by state and provider type.

Connecticut↗
PubMed2000

T cell adoptive immunotherapy of newly diagnosed gliomas.

Patients with newly diagnosed gliomas were treated with adoptive transfer of ex vivo activated T lymphocytes, derived from lymph nodes (LNs) draining autologous tumor vaccines, to determine the long-term toxicity of this treatment. Twelve consecutive patients were enrolled: 2 with grade II astrocytoma, 4 with anaplastic gliomas, and 6 with glioblastoma multiforme. Patients were injected intradermally with short-term cultured autologous irradiated tumor cells, admixed with granulocyte macrophage colony-stimulating factor, to stimulate draining LNs. The LN cells were activated with staphylococcal enterotoxin A for 48 h and then cultured in medium containing interleukin 2 for an additional 6-8 days and subsequently transferred i.v. to the patients. The number of cells obtained from the LNs ranged from 9 x 10(7) to 1.1 x 10(9), and the median cell proliferation was 41-fold. The dose of T cells infused ranged from 0.6 to 5.5 x 10(10) with a median of 1.1 x 10(10), the majority of which were CD 4+ (mean, 71%). The entire treatment was performed as outpatient therapy and was associated with a toxicity of grade 2 or less, consisting mainly of fever, nausea, and myalgias during the first 24 h. There were no indications of late adverse events from this treatment even among three patients with follow-up greater than 2 years post T cell transfer. Moreover, four patients demonstrated partial regression of residual tumor. This Phase I clinical trial of adoptive immunotherapy for patients with newly diagnosed malignant gliomas demonstrates feasibility, lack of long-term toxicity, and several objective clinical responses.

Adult↗
PubMed1994

Adoptive Immunotherapy and Interleukin-2 Following High-dose Therapy: A Potential Approach to Reduce Residual Tumor Cells.

Immune modulation and adoptive immunotherapy are being investigated as an additional cancer treatment modality. The influence of immunologic reactions, manifested as graft-vs-host disease (GVHD), has clearly been demonstrated in patients undergoing allogeneic bone marrow transplantation. More recently, adoptive immunotherapy by infusion of donor peripheral blood leukocyte products to recipients at relapse has shown benefit. As the immune system regenerates after high-dose therapy and stem cell transplantation, it is possible that we may be able to enhance an immune response against tumor cells. Trials are underway to evaluate the effect of interleukin-2 (IL-2) given early after transplantation to produce this effect.

Journal Article↗
PubMed2000

Does user satisfaction relate to adoption behavior?: an exploratory analysis using CPRS implementation.

User satisfaction is commonly assessed in evaluations of information systems as a proxy for user adoption. However few studies actually report directly assessing the relationship between the two constructs. In this study the relationship between four user satisfaction measures and five adoption behaviors were explored in the context of the implementation of the Veteran's Health Administration Computerized Patient Record System 1.0. Findings suggest that the relationship is modest and depends on the measurement system used. Specifically, direct reports of affect and judgements of specific task efficacy related to behavior more often than usability and a general user satisfaction instrument.

Attitude to Computers↗
PubMed2000

CD2-mediated IL-12-dependent signals render human gamma delta-T cells resistant to mitogen-induced apoptosis, permitting the large-scale ex vivo expansion of functionally distinct lymphocytes: implications for the development of adoptive immunotherapy strategies.

The ability of human gamma delta-T cells to mediate a number of in vitro functions, including innate antitumor and antiviral activity, suggests these cells can be exploited in selected examples of adoptive immunotherapy. To date, however, studies to examine such issues on a clinical scale have not been possible, owing in large measure to the difficulty of obtaining sufficient numbers of viable human gamma delta-T cells given their relative infrequency in readily available tissues. Standard methods used to expand human T cells often use a combination of mitogens, such as anti-T-cell receptor antibody OKT3 and interleukin (IL)-2. These stimuli, though promoting the expansion of alpha beta-T cells, usually do not promote the efficient expansion of gamma delta-T cells. CD2-mediated, IL-12-dependent signals that result in the selective expansion of human gamma delta-T cells from cultures of mitogen-stimulated human peripheral blood mononuclear cells are identified. It is first established that human gamma delta-T cells are exquisitely sensitive to apoptosis induced by T-cell mitogens OKT3 and IL-2. Next it is shown that the CD2-mediated IL-12-dependent signals, which lead to the expansion of gamma delta-T cells, do so by selectively protecting subsets of human gamma delta-T cells from mitogen-induced apoptosis. Finally, it is demonstrated that apoptosis-resistant gamma delta-T cells are capable of mediating significant antitumor cytotoxicity against a panel of human-derived tumor cell lines in vitro. Both the biologic and the practical implications of induced resistance to apoptosis in gamma delta-T cells are considered and discussed because these findings may play a role in the development of new forms of adoptive cellular immunotherapy. (Blood. 2000;96:3827-3837)

Adult↗
PubMed1975

Adoptive transfer of cell-mediated immunity to tuberculin using RNA from tuberculin-sensitive subjects.

Adoptive transfer of delayed hypersensitivity skin test response to tuberculin with 'immune' RNA extracted from the sensitized lymphocytes of a healthy subject or a patient with Hodgkin's disease was successfully demonstrated in previously non-sensitive patients with neoplastic diseases including Hodgkin's disease. 'Non-immune' RNA obtained from non-sensitive man, on the other hand, failed to transfer PPD skin reactivity in non-sensitive recipients. 'Immune' RNA-mediated PPD skin test response remained positive for a considerable period of time, indicating that the effect of 'immune' RNA is systemically active. 'Immune' RNA was found to be RNase-sensitive but DNase-resistant. In vitro adoptive transfer of delayed hypersensitivity with 'immune' RNA, as assayed by lymphocyte transformation test, was unsuccessful.

Deoxyribonucleases↗
PubMed1996

[Time frame and reasons of Kangxi Emperor adopted variolation].

This paper is concerned with the time frame and the reasons why the Kangxi Emperor adopted variolation in the Qing Imperial family. The Manchus, especially the Qing Imperial family, lived in the fear of contracting smallpox. They took various strategies to protect themselves from smallpox. One of the most conspicuous methods was adopting variolation in royal family in the Kangxi reign. The purpose of this important action was to maintain the superiority of the Manchu minority and to reduce the mortality rate of smallpox in the Imperial family. In this paper, I would like to point out the time when the Kangxi Emperor intended to use variolation was earlier than we had known through the previous studies. The Emperor's decision of variolation was mainly stimulated by his personal experiences and his practical character.

China↗
PubMed2002

Factors influencing the adoption of blood alternatives to minimize allogeneic transfusion: the perspective of eight Ontario hospitals.

OBJECTIVE: To identify and describe the factors influencing the use and nonuse of blood-sparing methods such as preoperative autologous donation, acute normovolemic hemodilution, and the use of cell salvage devices, hemostatic agents and erythropoietin. DESIGN: An interview survey. SETTING: Eight Ontario hospitals. METHOD: Interviews were conducted with chiefs of surgery, orthopedics, cardiac surgery and anesthesia, and with heads of transfusion medicine and pharmacy. Hospitals were selected using the qualitative sampling strategy of maximum variation based on their use of the methods (as reported in a previous mail survey). RESULTS: Use of blood-sparing methods was influenced by diverse factors often operating simultaneously. These included the following: characteristics of the method (e.g., evidence of its effectiveness, ease of use, cost); perceptions and experiences of the potential adopters (experience with the method, perception of the current safety of allogeneic blood, perceived convenience or inconvenience of using the method); aspects of the practice setting (inability to move resources between hospital departments, presence of a local clinical champion); and the external environment (patient and public expectations, funding of the blood system, blood shortages). INTERPRETATION: More rational and evidence-based use of blood-sparing methods could be promoted by the adoption of an interdisciplinary, comprehensive, coordinated approach tailored to each patient's needs.

Blood Transfusion↗
PubMed2002

Adopting integrated management of childhood illness module at local level in Bangladesh: implications for recurrent costs.

This study estimated the recurrent cost implications of adopting Integrated Management of Childhood Illness (IMCI) at the first-level healthcare facilities in Bangladesh. Data on illnesses of children who sought care either from community health workers (CHWs) or from paramedics over a four-month period were collected in a rural community. A total of 5,505 children sought care. About 75% of symptoms mentioned by mothers were directly related to illnesses that are targeted in the IMCI. Cough and fever represented 64% of all reported complaints. Referral of patients to higher facilities varied from 3% for the paramedics to 77% for the CHWs. Had the IMCI module been followed, proportion of children needing referral should have been around 8%. Significant differences were observed between IMCI-recommended drug treatment and current practice followed by the paramedics. Adoption of IMCI should save about US$ 7 million on drugs alone for the whole country. Proper implementation of IMCI will require employment of additional health workers that will cost about US$ 2.7 million. If the current level of healthcare use is assumed, introduction of IMCI in Bangladesh will save over US$ 4 million.

Bangladesh↗
PubMed1999

[Adoption of standard precautions: a report].

During 1993 and 1994, a recycling program on Standard Precautions was conducted for the nursing personnel at the Women's Health Centre (CAISM). In 1995, an evaluation was obtained through direct observation of these sectors regarding the adoption of these measures, the adequate use, access and availability of gloves and boxes for the disposal of perforating, sharp material. Sixty observations and 232 procedures were reported. One hundred sixty four procedures (71%) adopted these measures and 68 procedures (29%) did not. It was evident that the need to wash hands and not to use needles twice should be emphasized.

Guideline Adherence↗
PubMed2001

Construction of a Novel Engineering Strain E.coli G830,which is Adoptable to High-cell-density Fermentation.

A novel engineered strain G830 adoptable to high-cell-density fermentation by integrating bacterial hemoglobin vhb (Vitreoscilla hemoglobin gene) into thr operon in the chromosome of PA1 blocking Pta-Ack metabolic pathway through the homologous recombination between the homologous fragments of integrated plasmid and that of chromosome. The engineered strain G830 was characterized by phenotype observation, PCR, thr mutant, acetate acid detection, Western blotting and VHb activity assays. In high dentity fermentation, the cellular respiration, energy metabolism, highest bacterial density and dry bacteria weight of the G830 strain were markedly better than control strains PA1 and BL21. The expression of recombinant prolyl endopeptidase (PEP) in G830 and PA1 under the above condition was high and stable. Their growth situation and fermentation parameters were similar with their parental strains without plasmids, and resided plasmids maintained stably in those strains. It revealed that the integral VHb and acetate metabolism pathway (Pta-Ack) block improved the growth of host strain under low-dissolved-oxygen conditions, enhanced the recombinant proteins production and reduced the accumulation of acetate harmful to bacterial growth. In conclusion, the novel engineering strain G830 was adoptable to high cell density fermentation.

Journal Article↗
PubMed1981

Ningxia People's Congress adopts marriage law.

A supplement to the national marriage law was adopted by the 3rd session of the 4th People's Congress of the Ningxia Hui Autonomous Region which ended here today. The supplement includes a number of areas. With regard to marriage age it says no marriage shall be contracted before the man has reached 20 years of age and the woman 18. Both these figures are 2 years earlier than the national age specified by the national law. Legal marriage registration must not be replaced by religious ceremonies. With regard to Moslems, those who want religious wedding ceremonies can do so only after obtaining their marriage certificates. Freedom of marriage of widows is protected against any interference under any pretext. Marriage between Hui people and other nationalities, of their own free will, must not be interfered with. The nationality of any children shall be decided by the parents and children may reexamine the decision themselves when they grow up. The supplement has been adopted in accordance with the national marriage law's article 36 which says "The people's congresses and their standing committees in national autonomous areas may enact certain modifications or supplementary articles in keeping with the principles of this law and in conformity with the actual conditions prevailing among the minority nationalities of the locality in regard to marriage and family relations." The congress, held from June 9-June 14, reviewed the implementation of the Communist Party's policies on nationalities and development of economy, culture, education and public health.

Asia↗
PubMed2002

Understanding changes in primary care clinicians' satisfaction from depression care activities during adoption of selective serotonin reuptake inhibitors.

OBJECTIVES: To describe how primary care clinicians' perceptions about depression care as a clinical activity changed during the adoption of selective serotonin reuptake inhibitors (SSRIs) in their health maintenance organization (HMO). STUDY DESIGN: Prospective study of change in primary care clinicians' level of satisfaction from depression care activities from time 1 (mid-1993) to time 2 (early 1995). METHODS: Study subjects were internal medicine and family practice physicians, physician assistants, and nurse practitioners (n = 196) in a large, not-for-profit group-model HMO. We modeled level of satisfaction from depression care activities at time 2 as a function of changes in depression-care-related attitudes and perceptions over the study period, controlling for time 1 level of satisfaction and personal and professional characteristics. RESULTS: Overall satisfaction showed a small, statistically significant improvement over the study period. Time 2 satisfaction was a function of improved perceptions about the feasibility of primary care treatment of depression, which in turn were related to improved perceptions about the effectiveness of drug treatment. The relevance of clinicians' perceptions about their own depression care skills declined concomitantly. CONCLUSIONS: The adoption of SSRIs in the HMO was associated with improvement in primary care clinicians' perceptions about their ability to successfully treat depression (especially using pharmacology) and in their overall satisfaction from depression care activities. Future research should address whether reliance on SSRIs replaces the use of other depression treatment modalities, and if so, how this reliance affects patient outcomes and satisfaction and overall healthcare costs.

Attitude of Health Personnel↗
PubMed2002

Peptides corresponding to gelsolin derived amyloid of the finnish type (AGelFIN) adopt two distinct forms in solution of which only one can polymerize into amyloid fibrils and form complexes with apoE.

Familial amyloidosis of the Finnish type is caused by a point mutation at position 187 of gelsolin. The mutation generates a proteolytic fragment, which forms amyloid fibrils in vivo. In the present study we have elucidated the aggregation properties of synthetic peptides corresponding to the wild type and mutated gelsolin fragments. We show by high performance size exclusion chromatography and mass spectrometry that a part of these peptides polymerize with an increase in incubation time, while a portion of the same peptide can adopt a soluble, non-polymerizing structure. Peptides that remain soluble are in their monomeric stage, while the polymerizing peptides prefer a dimerized intermediate stage. We also show that the initialform of these peptides in the solution dramatically influence their capability to interact with amlyloid associated proteins, such as apolipoprotein E. Our results indicate that the amyloidogenic fragment of gelsolin can adopt two distinct forms, of which only one can form amyloid fibrils in vitro.

Amyloid↗
PubMed1992

Adopting the primary health care approach in malaria control in Malaysia: lessons in community participation.

The Primary Health Care approach in Malaysia was first tried out in Sarawak, East Malaysia in 1982. In 1984, the Vector Borne Disease Control Program, Kelantan decided to adopt the Primary Health Care approach as an additional strategy in its effort to control malaria in the state, which then experienced an increase in malaria cases. Much effort was directed at creating the awareness and stimulating the interest of health staff and communities to adopt the strategy. Kelantan was made the model state. The paper gives an outline of the process involved and some characteristics of PHC workers. A study was carried out among health workers, community members and health staff on their knowledge and involvement in PHC in three states, including Kelantan. In view of the overall success of this approach, and the weaknesses which have been identified possible solutions have been suggested and should be acted upon.

Communicable Disease Control↗
PubMedDate not supplied

Fertility and contraceptive adoption and discontinuation in rural Kenya.

After a long period of slow progress, the recent uptake of contraceptive use in Kenya has been dramatic. This report describes adoption of a method and method switching and discontinuation among a cohort of married women aged 25-34 in two contrasting rural areas. A retrospective "fertility diary" completed by each woman provided information on spousal separation, reproductive status, and contraceptive use over a period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both areas, with significant net adoption of injectables in both areas and of IUDs in one only. Method discontinuation was concentrated among users of pills, barrier methods, and "natural" methods, and only one-third of all discontinuations were voluntary. The wide differences between the two rural areas in contraceptive prevalence were not totally reflected in recent fertility levels, and the contribution of other proximate determinants of fertility, particularly postpartum amenorrhea and spousal separation, are discussed.

Adult↗
PubMed2003

Antecedents to the adoption of ASPS in healthcare.

The objective of this exploratory study was to identify drivers of adoption for a new form of information technology outsourcing--the ASP model--in the healthcare industry. Primary data were collected in January 2002 from a nationwide survey of senior-level healthcare information technology executives. Cost management (supplier presence, asset specificity, production costs, transaction costs, resource availability) and relative advantage (reliability, customizability, strategic alignment, and magnitude of potential loss) were found to have the largest influences on adoption behavior.

Administrative Personnel↗