Building a high-performance team.

Health care managers and supervisors face a particularly tough challenge. Today more than ever they must balance the increased demand for productivity with their own desires to provide excellent care. Many health care workers seem to feel that these objectives are antithetical. Given the methods for promoting productivity and increased performance that have been inflicted upon them in the past, such a view is not surprising, but it does not have to be this way. Most, perhaps all, health care workers have an intuitive awareness of what they need to do to meet their customers' highest expectations, because they have all been customers themselves. They know that productivity, quality, and courtesy are components of high performance. The wise manager taps into this knowledge and experience on the part of his or her employees to develop a vision of high performance that generates excitement and commitment within the work group.

Simultaneous administration of rhesus rotavirus vaccine and oral poliovirus vaccine: immunogenicity and reactogenicity.

Rotavirus vaccine could be administered most efficiently if it were incorporated into routine childhood immunizations and did not interfere with the immune response to the other vaccines, principally oral poliovirus vaccine (OPV). We conducted a placebo-controlled randomized trial giving oral rhesus rotavirus vaccine (RRV) (strain MMU 18006) alone and together with a child's first dose of OPV and diphtheria-tetanus toxoids-pertussis to examine the possible interaction of these vaccines. A total of 102 infants 2 to 3 months of age were randomized into 3 groups to receive (1) RRV with OPV, (2) placebo with OPV and (3) RRV 2 weeks after OPV. All infants were given diphtheria-tetanus toxoids-pertussis. Serum samples were collected at the time of OPV immunization and 3 to 5 weeks later. Three to 5 weeks after OPV immunization 60% of infants had a 4-fold rise in neutralization titer to at least one of the three poliovirus serotypes. The rate of antibody response to poliovirus did not differ by RRV groups but a lower rate was correlated with a shorter interval (3 vs. 5 weeks) between OPV vaccination and antibody measurement. Fifty-six percent of infants had a 4-fold rise of IgA and 62% had a 4-fold rise of neutralizing antibody to RRV; this rise did not differ according to time of OPV immunization. RRV was not associated with side effects and may be safely given with OPV to infants 2 to 3 months of age.