BackgroundDecisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making.ObjectivesThe purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making.MethodsIn-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software.ResultsA total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building.ConclusionsThis study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health.

BackgroundMobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place.MethodsThis qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software.ResultsLimited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM.ConclusionsThese results provide insights on the type of practical implementation imperatives involved in supporting EIDM.

We found in the environmental strain Nitrosomonas europaea a chromosomal integron-like structure with an integrase gene, intI Neu . We have tested the capacity of the IntINeu integrase to excise and integrate several resistance gene cassettes. The results allow us to consider IntINeu a new functional integron integrase.Integrons are a gene capture system in which gene cassettes are mobile elements. They consist of an integrase gene (intI) (18), a member of the tyrosine recombinase family, followed by a nonpalindromic attI site specific to each integrase, and one or more integrase-dependent mobile cassettes expressed from a common promoter upstream of this site (4, 13). Excised cassettes in their free circular form consist of a structural gene and a palindromic attC site and are unable to replicate (5). Cassettes are preferentially integrated at the attI site, containing the GTTRRRY core site.

Integrons are natural expression vectors in which gene cassettes are integrated downstream of a promoter region by a site-specific recombinase. Gene cassettes usually consist of a single gene followed by a recombination site designated attC. A major unanswered question is how a gene becomes associated with an attC site. Here, we investigate the potential role of a specific lineage of group IIC introns, named group IIC-attC, in cassette formation. Group IIC-attC introns preferentially target attC while retaining the ability to target transcriptional terminators. We show using a PCR-based mobility assay with Escherichia coli that the S.ma.I2 intron from the genome of a clinical isolate of Serratia marcescens can target both attC site and putative terminator motifs of resistance genes. Quantitative results showed that S.ma.I2 is more efficient in targeting various attC sequences than three group IIC-attC introns (54 to 64% sequence identity) from the genomes of environmental isolates. We also show that purified group IIC-attC intron-encoded reverse transcriptases have both RNA-dependent and DNA-dependent DNA polymerase activities in vitro. These data permit us to suggest a new model for gene cassette formation, in which a group IIC-attC intron targets separately a transcriptional terminator adjoining a gene and an isolated attC, joins the gene and the attC by homologous recombination, and then splices and reverse transcribes a gene-attC RNA template, leading to the formation of a cassette.Integrons and gene cassettes are considered important genetic elements in the evolution of multiresistance plasmids and transposons in gram-negative bacteria (39). Integrons can be categorized as mobile or chromosomal depending on their genomic location (i.e., on plasmids or on chromosomes). Mobile integrons and their cassettes are known to have a role in the dissemination of antibiotic resistance genes, whereas the majority of chromosomal integron cassettes include open reading frames (ORFs), most of whose products have no known function (21). Integrons are natural expression vectors composed of an integrase gene (intI) followed by a cassette promoter region and an integrase-specific recombination site (called an attI site) into which new cassettes are integrated (12). Gene cassettes usually consist of one promoterless gene associated with a distinct integrase-specific recombination site (called an attC site) that is located downstream of the gene. attC sites found in mobile integron cassettes exhibit little sequence similarity but contain a characteristic central palindromic sequence (11). attC sites can vary considerably in length (57 to 141 bp), and their sequence similarities are restricted primarily to the boundaries, which correspond to two pairs of conserved inverted repeats, 1L-2L and 2R-1R (40). Usually, a unique attC site is associated with one gene and is named by reference to the gene (e.g., the aminoglycoside resistance gene aadA1 and the attC aadA1 site). In contrast, attC sequences from chromosomal integrons with l...