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Objective: Effective healthcare innovations are often not adopted and implemented. An implementation strategy based on facilitators and barriers for use as perceived by healthcare professionals could increase adoption rates. This study therefore aimed to identify the most relevant facilitators and barriers for use of an innovative breast cancer aftercare decision aid (PtDA) in healthcare practice., Methods: Facilitators and barriers (related to the PtDA, adopter and healthcare organisation) were assessed among breast cancer aftercare health professionals (n = 81), using the MIDI questionnaire. For each category, a backward regression analysis was performed (dependent = intention to adopt). All significant factors were then added to a final regression analysis to identify to most relevant determinants of PtDA adoption., Results: Expecting higher compatibility with daily practice and clinical guidelines, more positive outcomes of use, higher perceived relevance for the patient and increased self-efficacy were significantly associated with a higher intention to adopt. Self-efficacy and perceived patient relevance remained significant in the final model., Conclusions: Low perceived self-efficacy and patient relevance are the most important barriers for health professions to adopt a breast cancer aftercare PtDA., Practice Implications: To target self-efficacy and perceived patient relevance, the implementation strategy could apply health professional peer champions., (Copyright © 2019. Published by Elsevier B.V.)

Objective: A patient decision aid (PtDA), was developed to support breast cancer patients making choices about their aftercare. The aim of this pilot was to test the effects of the PtDA on Shared Decision Making (SDM), Decision Evaluation (DES) in patients, consultation time, choice of aftercare and hospital costs., Methods: A prospective before-and-after study including a control (no PtDA-usage) and experimental group (PtDA-usage during consultation) was conducted in six hospitals. Patients were offered a choice between intensive (face-to-face consultations) and less intensive (telephonic or on demand consultations) aftercare. All patients filled out three validated questionnaires (baseline (T0), directly after the consultation (T1), three months later (T2)), assessing demographics (T0), SDM(T1) and DES (T1, T2). Hospital costs and choice of aftercare were assessed from the patients' files (T2). Effect sizes ( ɳ p 2 : 0.01 = small; 0.06 = medium; 0.14 = large; φ: 0.1 = small, 0.3 = medium, 0.5 = large) and p-values were calculated using both univariate and multivariate GLMs, a repeated measures GLM and chi-square-tests., Results: A small improvement in SDM ( ɳ p 2  = 0.02) and an effect ( ɳ p 2  = 0.10) on DES was found in the experimental group. Significantly more PtDA-users (51% vs. 29%, φ = 0.22) chose less intensive aftercare, leading to a small reduction of hospital costs (122 vs. 92 Euro, ɳ p 2  = 0.01), and a large increase in average consultation time (12.5 min; ɳ p 2  = 0.29)., Conclusion: This pilot study showed promising effects of the PtDA on SDM and hospital costs. The PtDA can be developed further to potentially reduce the increased consultation time., (Copyright © 2018. Published by Elsevier Ltd.)

The reactivity of the sulfhydryl groups of leucine aminopeptidase from bovine eye lens has been studied by carboxymethylation with iodoacetate of the native enzyme (Zn2+-Zn2+), of the enzyme activated with magnesium (Zn+-Mg2+) or manganese (Zn2+-Mn2+), the enzyme incubated with cobalt (CO2+-Co2+), and the metal-free apoenzyme. The reactivity of the sulfhydryl groups was also determined in the presence of denaturing agents with or without reducing agents. All seven half-cystines per leucine aminopeptidase subunit are in the sulfhydryl form. In the native and the Zn2+-Mn2+ enzyme, only one of the cysteines (residue 344) reacts readily with iodoacetate. In the Zn2+-Mg2+ enzyme, two cysteines react (residues 344 and 412) and in the Co2+-incubated enzyme only one (residue 412). The metal-free apoenzyme has at least three reactive cysteines (residues 344, 412, and 429). The data suggest that sulfhydryl groups are involved in the binding of metal ions.

The amino acid sequence of bovine eye lens leucine aminopeptidase has been determined. Cyanogen bromide fragments, the COOH-terminal hydroxylamine fragment, and a large fragment obtained by digestion with Staphylococcus aureus protease were isolated from reduced and S-alkylated leucine aminopeptidase. The amino acid sequences of these fragments were determined by automated sequence analysis, by manual direct Edman degradation, and by the dansyl-Edman technique. Overlapping peptides were obtained by tryptic digestion of the S-alkylated protein or the citraconylated S-alkylated protein. The polypeptide chain of leucine aminopeptidase comprises 478 residues, corresponding to a molecular weight of 51,691. No significant sequence homology with any other published protein primary structure could be detected. This is the first report of a complete amino acid sequence of an enzyme belonging to the class of two metal peptidases.