ABSTRACT
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Subject(s)
Humans , Telemedicine/organization & administration , Remote Consultation/trends , Information Technology , Primary Health Care/trendsABSTRACT
Fundamento. Ante las dificultades que encuentra la Telemedicinapara su incorporación definitiva a la práctica clínicay ante la falta de evidencia sobre las estrategias de implementaciónmás adecuadas, resulta necesario recoger y difundirel aprendizaje obtenido a partir de la experiencia ensu introducción en nuestro sistema de salud. El objetivo delestudio es identificar los elementos facilitadores percibidospor los profesionales que participan en el diseño y puestaen marcha de proyectos de Telemedicina.Métodos. Estudio cualitativo realizado a partir de los datosobtenidos a través de entrevistas semi-estructuradas a 17informantes clave de diferentes organizaciones del ámbitode la salud en Cataluña.Resultados. Los facilitadores identificados son que el serviciode Telemedicina responda a una necesidad claramentepercibida por los profesionales; que el núcleo del liderazgoincorpore a clínicos en un modelo abierto, participativo yflexible que tenga en cuenta las necesidades de los profesionales;que sea capaz de establecer relaciones de colaboracióncon los diferentes participantes más allá de la delcliente-proveedor; y que incorpore desde el diseño inicialuna estrategia para su sostenibilidad y normalización.Conclusiones. Conocer los facilitadores y las barrerasque aparecen en el proceso de implantación de TM en lasorganizaciones sanitarias se convierte en un elemento dealto valor para su introducción definitiva. Un enfoque quecombine evidencia sobre eficacia clínica y coste-beneficiocon lecciones aprendidas sobre las dinámicas de implementacióny normalización permitirá obtener una comprensiónglobal de la adopción de la TM y mejorar su gestión organizativa(AU)
Background. Given the difficulties encountered by Telemedicinefor final incorporation into clinical practice and giventhe lack of scientific evidence regarding the most appropriateimplementation strategies, it is necessary to collect anddisseminate lessons gained from experience in its introductionand diffusion in our health system. The aim of this studyis to identify the facilitators perceived by professionalswho actively participate in the design and implementationof telemedicine projects in the health care system.Methods. Qualitative study of data from semi-structuredinterviews with 17 key informants belonging to different Catalanhealth organizationsResults. The identified facilitators are grouped in fourbroad areas: a TM service that meets a need clearly perceivedby practitioners; a core leadership with a clinical profile,managing an open, participatory and flexible modelthat takes into account the needs of professionals; the abilityto establish partnerships with different stakeholdersbeyond the customer-supplier relationship; and the inclusionin the initial design of a strategy for sustainability andnormalization.Conclusions. Understanding the facilitators and barriersthat appear in the process of implementing TM experiencesin health care organizations becomes an item of highvalue for its final introduction. An approach combining theevidence on clinical effectiveness and cost-benefit with lessonslearned about the dynamics of implementation andnormalization will allow for a holistic understanding of theadoption of the TM and provide guidance for improving itsorganizational management(AU)
Subject(s)
Humans , Male , Female , Telemedicine/ethics , Telemedicine , Information Technology/history , Information Technology/policies , Telemedicine/economics , Telemedicine/methods , Telemedicine/statistics & numerical data , Telemedicine/standards , Telemedicine/trends , Telemedicine , Information Technology/ethics , Information Technology/ethnology , Information Technology/methods , Information Technology/statistics & numerical dataABSTRACT
The Serratia marcescens N28b wbbL gene has been shown to complement the rfb-50 mutation of Escherichia coli K-12 derivatives, and a wbbL mutant has been shown to be impaired in O4-antigen biosynthesis (X. Rubirés, F. Saigí, N. Piqué, N. Climent, S. Merino, S. Albertí, J. M. Tomás, and M. Regué, J. Bacteriol. 179:7581-7586, 1997). We analyzed a recombinant cosmid containing the wbbL gene by subcloning and determination of O-antigen production phenotype in E. coli DH5alpha by sodium dodecyl sulfate-polyacrylamide electrophoresis and Western blot experiments with S. marcescens O4 antiserum. The results obtained showed that a recombinant plasmid (pSUB6) containing about 10 kb of DNA insert was enough to induce O4-antigen biosynthesis. The same results were obtained when an E. coli K-12 strain with a deletion of the wb cluster was used, suggesting that the O4 wb cluster is located in pSUB6. No O4 antigen was produced when plasmid pSUB6 was introduced in a wecA mutant E. coli strain, suggesting that O4-antigen production is wecA dependent. Nucleotide sequence determination of the whole insert in plasmid pSUB6 showed seven open reading frames (ORFs). On the basis of protein similarity analysis of the ORF-encoded proteins and analysis of the S. marcescens N28b wbbA insertion mutant and wzm-wzt deletion mutant, we suggest that the O4 wb cluster codes for two dTDP-rhamnose biosynthetic enzymes (RmlDC), a rhamnosyltransferase (WbbL), a two-component ATP-binding-cassette-type export system (Wzm Wzt), and a putative glycosyltransferase (WbbA). A sequence showing DNA homology to insertion element IS4 was found downstream from the last gene in the cluster (wbbA), suggesting that an IS4-like element could have been involved in the acquisition of the O4 wb cluster.
Subject(s)
Genes, Bacterial , Multigene Family , O Antigens/biosynthesis , Serratia marcescens/genetics , Serratia marcescens/immunology , ATP-Binding Cassette Transporters/genetics , ATP-Binding Cassette Transporters/metabolism , Amino Acid Sequence , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Base Sequence , Chromosome Mapping , DNA Primers/genetics , DNA Transposable Elements/genetics , DNA, Bacterial/genetics , Escherichia coli/genetics , Escherichia coli/immunology , Genetic Complementation Test , Molecular Sequence Data , Mutation , Open Reading Frames , Phenotype , Polymerase Chain Reaction , Sequence Homology, Amino AcidABSTRACT
A cosmid-based genomic library of Serratia marcescens N28b was introduced into Escherichia coli DH5alpha, and clones were screened for serum resistance. One clone was found resistant to serum, to bacteriocin 28b, and to bacteriophages TuIa and TuIb. This clone also showed O antigen in its lipopolysaccharide. Subcloning and sequencing experiments showed that a 2,124-bp DNA fragment containing the rmlD and wbbL genes was responsible for the observed phenotypes. On the basis of amino acid similarity, we suggest that the 288-residue RmlD protein is a dTDP-L-rhamnose synthase. Plasmid pJT102, containing only the wbbL gene, was able to induce O16-antigen production and serum resistance in E. coli DH5alpha. These results suggest that the 282-residue WbbL protein is a rhamnosyltransferase able to complement the rJb-50 mutation in E. coli K-12 derivatives, despite the low level of amino acid identity between WbbL and the E. coli rhamnosyltransferase (24.80%). S. marcescens N28b rmlD and wbbL mutants were constructed by mobilization of suicide plasmids containing a portion of rmlD or wbbL. These insertion mutants were unable to produce O antigen; since strain N28b produces O4 antigen, these results suggest that both genes are involved in O4-antigen biosynthesis.
